Vascular Health and Risk Management最新文献

Background: While general anesthesia has been widely used in endovascular thrombectomy for acute ischemic stroke (AIS), the optimal anesthesia medication for hemodynamic management remains unclear.

Purpose: To compare the effects of remimazolam and propofol on endovascular thrombectomy for AIS.

Methods: This study is a single-center, double-blind and randomized controlled trial. Eligible patients will be randomly allocated into the remimazolam group and propofol group. Remimazolam and propofol will be administered to induce and maintain anesthesia respectively. The primary outcome is the incidence of intraoperative hypotension. The secondary outcomes include frequency of hypotension, the largest difference value of mean arterial pressure (MAP), dosage of vasopressors, extubation time, operation time, modified thrombolysis in cerebral infarction (mTICI) level, National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin scale (mRS) score.

Conclusion: This study evaluates the influences of remimazolam versus propofol on endovascular therapy for AIS patients. Results of this study are expected to provide more evidence of the choice of anesthetics in this kind of operation.

Trial registration: This study has been registered at the Chinese Clinical Trial Registry (ChiCTR2300076880).

Ischemic stroke is the second leading cause of mortality and morbidity worldwide. Due to the urgency of implementing immediate therapy, acute stroke necessitates prompt diagnosis. The current gold standards for vascular imaging in stroke include computed tomography angiography (CTA), digital subtraction angiography (DSA) and magnetic resonance angiography (MRA). However, the contrast agents used in these methods can be costly and pose risks for patients with renal impairment or allergies. The aim of this paper is to provide a comprehensive overview of current MRI techniques and sequences for evaluating ischemic stroke, emphasizing the importance of non-contrast options and their clinical implications for radiologists in the diagnosis and management of ischemic stroke. Standard MRI sequences-such as T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), DWI-FLAIR mismatch, and apparent diffusion coefficient (ADC)-are essential for determining infarct location, volume, and age. Additionally, incorporating susceptibility-weighted imaging (SWI) sequence aids in identifying signs of hemorrhagic transformation within the infarcted region. Advanced techniques like arterial spin labeling (ASL) can serve as a non-contrast alternative for mapping cerebral blood flow (CBF) and allowing for comparison between infarcted and healthy brain areas. Adding ASL to the routine sequence allows ASL-DWI mismatch analysis that is useful for quantifying salvageable tissue volume and facilitate timely recanalization, while time-of-flight (TOF) MRA and magnetic resonance venography (MRV) help assess venous thrombosis, stenosis, or arterial occlusions. Finally, MR spectroscopy can provide insights into critical brain metabolites, including N-acetylaspartate (NAA), and lactate (Lac) to determine patient prognosis. Current MRI technology provides a myriad of sequence options for the comprehensive evaluation of ischemic stroke without the need for contrast material. A thorough understanding of the advantages and limitations of each sequence is crucial for its optimal implementation in diagnosis and treatment.

Background: Anthropometric measures such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) are associated with elevated blood pressure and hypertension in adolescents. We aimed to assess these anthropometric measures (BMI, WC, and WHtR) and examine their association with hypertension in adolescents.

Methods: Adolescents' BMI, mid-upper arm circumference (MUAC), WC, body roundness index (BRI), waist-to-hip ratio (WHR), WHtR, and a body shape index(ABSI) values were measured and calculated. Receiver operating characteristic curves (ROCs) were created to determine the discriminatory capacities of these anthropometric parameters for hypertension. The cutoff points for these parameters were identified using Youden's index.

Results: A total of 401 adolescents [186(46.4%) were females and 215 (53.6%) were males] were included. The median (interquartile range, IQR) age was 14.0 (12.1‒16.2) years. Thirty-six adolescents were found to have hypertension. Among the anthropometric parameters, MUAC (area under the curve (AUC] = 0.76, at the cutoff 26.1 cm, sensitivity = 61.0, specificity = 83.0), WC (AUC= 0.74, at the cutoff 70.3 cm, sensitivity = 66.7, specificity = 77.0), BMI (AUC= 0.73, at the cutoff 17.4 kg/m², sensitivity = 83.3, specificity = 59.0), and hip circumference (HC) (AUC= 0.72, at the cutoff 91.0 cm, sensitivity = 55.6, specificity = 83.0) performed fairly in detecting hypertension in adolescents, whereas WHR, WHtR, ABSI, and BRI performed poorly. A univariate analysis showed that, except for WHR, all anthropometric parameters (BMI, MUAC, WC, HC, WHtR, BRI, and ABSI) were associated with hypertension. However, in a multivariate analysis, only increased MUAC (adjusted odds ratio [AOR]= 1.24, 95% CI= 1.03‒1.50) was associated with hypertension.

Conclusion: This study showed that MUAC, WC, BMI, and HC could be used to detect hypertension in adolescents. Other parameters,namelyWHR, WHtR, ABSI, and BRI, perform poorly in this regard. Larger studies are needed in the future.

Objective: We conducted a study titled for Investigation on the characteristics of 24-hour blood pressure (BP) dipping patterns in hypertensive stroke patients.

Methods: Descriptive research, analysis, and comparison, the research was conducted from July 2019 to September 2020 at the Vietnam Heart Institute - Bach Mai Hospital. There are 100 patients diagnosed with idiopathic hypertension who were divided into two groups (without stroke complications and another group with chronic stroke complications > 6 weeks), both groups were similar in age (45-64 years old).

Results: The daytime systolic BP (SBP) indices, 24-hour BP including SBP, diastolic BP (DBP), and mean arterial pressure (MAP), and particularly night-time BP indices were elevated in the stroke group compared with those without stroke complications (p < 0.05); there were no significant differences observed in daytime DBP and MAP between the two groups. SBP indices were higher in those with hemorrhage stroke compared with those with ischemic stroke, albeit without statistical significance. The prevalence of non-dipper was significantly higher in the stroke group compared with the non-stroke group (p < 0.001).

Conclusion: The daytime SBP indices, 24-hour BP (SBP, DBP, MAP), and particularly night-time BP indices were elevated in the stroke group compared with those without stroke complications. The prevalence of non-dipper was significantly higher in the stroke group compared with the non-stroke group.

Non-valvular atrial fibrillation (NVAF) is the most common sustained arrhythmia worldwide, and is associated with significant morbidity and mortality. Increasing life expectancy, coupled with a surge in comorbidity burden, has resulted in a sharp increase in NVAF prevalence over the last three decades. Coronary artery disease (CAD) is an important and clinically relevant risk factor of AF. Concomitant CAD has significant implications for AF management and is a major determinant of the overall outcomes. Shared risk factors, a common pathophysiological basis, and heightened thrombogenesis culminating in cardiovascular adverse events, highlight the close association between the two. The clinical course of AF is worse when associated with CAD, resulting in poor heart rate control, increased propensity to develop stroke and myocardial infarction, increased likelihood of acute presentation with hemodynamic collapse and pulmonary edema, increased bleeding tendencies, and poor response to ablation therapies. Emerging research highlighting the significant role of underlying CAD as an independent predictor of thromboembolic risk has paved the way for the adoption of CAD beyond prior myocardial infarction into the symbol "V" of the CHA2DS2-VASc score. In our opinion, elderly patients aged >65 years with AF, with a history of one or more cardiovascular comorbidities, or evidence of atherosclerosis in other vascular beds should warrant a closer look and a dedicated effort to look for associated CAD. This would allow for a more holistic and comprehensive approach to patients with AF and ultimately help reduce the disease burden and improve the overall outcomes.

The coexistence of heart failure (HF) and type 2 diabetes mellitus (T2DM) is common and poses a serious threat to human health because these diseases have a high degree of commonality at the vascular level. However, the diagnosis of HF in primary care can be challenging, leading to the risk of inadequate management of both conditions. Using two case reports as examples, we attempt to shed light on the issues involved in this challenge. In the first case presentation, a 62-year-old male patient with T2DM and dyspnea was initially diagnosed with HF during primary care. However, further workup revealed that the actual cause of the patient's breathlessness was the exacerbation of chronic obstructive pulmonary disease. In the second case, a 59-year-old woman with T2DM and obesity complained of leg swelling that was attributed to chronic venous insufficiency by a primary care physician. A correct diagnosis of HF with preserved ejection fraction (HFpEF) was made using N-terminal pro-B-type natriuretic peptide and echocardiography. Due to diabetic vasculopathy HF is more likely to progress with a preserved ejection fraction. In addition, symptoms of COPD or obesity may overlap with or mask symptoms of HFpEF. The issues of over- and misdiagnosis of HFpEF in primary care are discussed in our review, which emphasizes the nonspecific nature of symptoms, such as breathlessness and leg edema in patients with type 2 diabetes mellitus. It is of utmost importance for healthcare providers to be aware of unusual manifestations of heart failure and, vice versa, of diseases that masquerade as heart failure. This will enable them to manage risks in these patients with greater consistency.

Objective: Validation of blood pressure (BP) monitors in pregnant women are needed to ensure the accurate measurement of BP in pregnancy. Therefore the study aimed to evaluate the measurement accuracy of the G.LAB MD41A0 oscillometric automatic upper-arm blood pressure monitor in pregnancy and pre-eclampsia women according to the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018).

Methods: A total of 45 pregnant women were included in the cross-sectional validation study. The same left-arm sequential method was used for blood pressure measurement, and the blood pressure differences between the test device and the mercury standard reference were assessed according to the AAMI/ESH/ISO Universal Standard.

Results: The participants included 15 normotensives, 15 gestational hypertension and 15 pre-eclampsia. The average (mean ± SD) differences between the device and mercury standard was -0.84±3.88 mmHg and -0.58±3.35 mmHg for systolic and diastolic blood pressure, respectively, for the validation Criterion 1. The SD of the averaged differences between the device and reference readings per participant was 2.92 mmHg and 2.28 mmHg for systolic and diastolic blood pressure, respectively, for the Criterion 2 of the universal standard.

Conclusion: The G.LAB MD41A0 automatic upper-arm blood pressure monitor fulfills the criteria of the AAMI/ESH/ISO Universal Standard and can be recommended for clinical use and self-measurement in pregnancy and pre-eclampsia.

Introduction: We present a case of late endograft infection that progressed to the left iliac and femoral arteries, leading to left lower extremity gangrene, and the patient's death.

Case: A 65-year-old male with a history of endovascular abdominal aortic aneurysm repair (EVAR) developed left acute limb ischemia (Rutherford category III) and abdominal pain. A CT scan showed significant gas formation around the endograft and complete occlusion of the left distal iliac artery to the femoral arteries. Despite undergoing hip disarticulation and wound care, aortic endograft removal was not possible due to a lack of replacement grafts. Microbiological cultures from arterial pus and urine identified multiple antibiotic-resistant extended-spectrum beta-lactamases (ESBL) producing Escherichia coli. Histopathological analysis of the common femoral artery specimen indicated chronic medium-sized arteritis characterized by endothelial erosion, fibrotic myocytes in the tunica media, and fibrosis of the adventitial layer with inflammatory cell infiltration. The patient succumbed in the ICU 6 days later due to uncontrolled sepsis.

Discussion: Although the incidence of endograft infection after EVAR is low (20-75% morbidity and mortality), it poses significant risks. Sources are often hematogenous, stemming from urinary or respiratory tract infections, and infections extending to subsequent arteries are very rare; they could cause chronic arterial inflammation and, in the long term, may lead to thrombosis and limb ischemia. This case highlights a low-grade infection that emerged 3 months post-procedure. Diagnosis typically involves CT angiography to detect periaortic gas or fluid. Management of high-grade infections necessitates complete endograft removal and graft replacement with infection-resistant options.

Conclusion: Endograft infections after EVAR, while rare, can have severe outcomes. Early diagnosis based on symptoms and CT-Scan. In high-grade infections, endograft removal is the gold-standard therapy, with ongoing follow-up post-EVAR being essential for prevention.

Primary central nervous system vasculitis (PCNSV) is a rare and complex disease that poses formidable diagnostic and therapeutic challenges. Since its initial recognition as a distinct clinical entity in the 1950s, there has been considerable advancement in our understanding of PCNSV histopathology, specific clinical subsets, and their response to treatment. However, PCNSV is one of the rarest vasculitides, and still remains a challenging diagnosis with many unanswered questions regarding optimal management. In this review, we intend to provide a detailed outline of approaches that are currently being employed for the treatment of PCNSV. We exhaustively review available cohort series of PCNSV and critically appraise the data for study definitions, treatment approaches, and predictors of treatment outcomes. Finally, we also propose a treatment approach for PCNSV.