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ΠΕΡΙΦΕΡΙΚΗ ΑΡΤΗΡΙΟΠΑΘΕΙΑ εξελίξεις στη διάγνωση και αντιμετώπιση PowerPoint PPT Presentation


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ΠΕΡΙΦΕΡΙΚΗ ΑΡΤΗΡΙΟΠΑΘΕΙΑ εξελίξεις στη διάγνωση και αντιμετώπιση. Ανδρουλάκης Αριστείδης , F.E.S.C. Δ/ντής, Καρδιολογικό Τμήμα Ιπποκράτειο Νοσοκομείο Αθηνών. ~ 1/4 of Patients with CAD Have Polyvascular Disease 1.

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ΠΕΡΙΦΕΡΙΚΗ ΑΡΤΗΡΙΟΠΑΘΕΙΑ εξελίξεις στη διάγνωση και αντιμετώπιση

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, F.E.S.C.

/,


1 4 of patients with cad have polyvascular disease 1

~ 1/4 of Patients with CADHave Polyvascular Disease1

~ 1/4 of the 40,258 patients with CAD also have atherothrombotic disease in other arterial territories

(%s are of totalpopulation)1

RISK FACTORS

ONLY

Patients with CAD = 59.3% of the REACH Registry population

Coronary Artery Dis

44.6%

4.7% = 2508 pts

. 2508/40258=

6.2%

Risk Factors only: 12389

Symptomatic pts: 55499

CAD: 40258

CVD: 18843

PAD: 8273

8.4%

Cerebro-vascular

1.6%

4.7%

Periph Art Disease

8273

1. Bhatt DL et al, on behalf of the REACH Registry Investigators.JAMA 2006; 295(2): 180-189.


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Age- and sex-adjusted one-year outcomes for patients with established vascular disease at one or more sites

REACH RegistrySteg, et al. JAMA March 2007


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  • :

  • 20-30%/

  • 2-3%/

  • (2012: < 1.5%)

x 10


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?


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  • CAS CEA

  • :

    • CEA

    • (.. ICA CCA)

ESC Guidelines on the diagnosis and treatmentofperipheral artery diseases. EHJ 2011; doi:10.1093/eurheartj/ehr211


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Diffusion-weighted MRI

(DWI)

()

> 0.5 cm3

9% CEA

43% CAS


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-

. > 5

-

  • Class III

  • Stenosis < 50%

  • Total ICA occlusion

  • Severe cerebral dysfunction

Plusoptimal MEDICAL THERAPY

s/d = Stroke/Death


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Carotid artery stenting in acute stroke

  • Stroke caused by acute occlusion of the ICA: death rate >50%

  • IV thrombolysis alone: good clinical outcome in only 17% of the cases

  • OBJECTIVES:

  • To demonstrate the technical success of CAS in acute extracranial (ICA) occlusion

  • What the benefit in clinical outcome

22 ptswith acute extracranial ICA occlusion within 6 hof stroke symptom onset

Successful revascularization was achieved in 21 patients (95%)

There was no acute stent thrombosis.

TIMI flow grade 2/3 was achieved in 11 of the 18 patients (61%)

The overall recanalization rate (extra- and intracranial) was 63%(14/22 pts)

14/22 pts (41%) had a modified Rankin Scale score of 2 at 90 days

The mortality rate was 13.6% at 90 days.

Carotid artery stenting in acute stroke

Papanagiotou P, Roth C, Walter S, Behnche S, Grunwald IQ, Viera J, Politi M, Krner H, Kostopoulos P, Haass A, Fassbender K, Reith W.

Clinic for Diagnostic and Interventional Neuroradiology, Saarland University Hospital,

Homburg, Germany.

JACC 2011 Nov 29;58(23):2363-9


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Unique microRNA Signature Present in Unstable Carotid Plaque

MicroRNAs (miRNAs) are small endogenous RNAs and represent a new important class of gene regulators

carotid atherosclerotic plaque from stroke patients expressed higher levels of 5 miRNAs

than carotid atherosclerotic plaque from asymptomatic patients: miRNA-100, miRNA-127,

miRNA-145, miRNA-133a, and miRNA-133b.

  • miRNAs /

  • 4-miRNA 73.5% , 5-miRNA 82.4%

  • miRNA

  • .

  • ,

miRNA

A unique microRNA signature associated with plaque instability in humans

Cipollone F, Felicioni L, Sarzani R, et al.

Stroke. 2011 Sep;42(9):2556-63


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Steven Hawking: Women are the only mystery on Earth...

  • ,

  • Carotid-COURAGE

  • TACIT study


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.

.


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R VERT ART

L VERT ART

42 , , , ..


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  • (M. Fisher 1970)

  • 3-4/100.000 (1994-2003), /=55/45, 35-45

  • / 2%

  • < 50 10-25%

  • o 75% . 2%

  • (Wallenbergs syndrome) (

  • , ,

  • , , , , , , ,

  • . Horner, )


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RAS

  • M (>3 )

  • -

  • Y ( )

  • .

  • ( >1.5-2 cm)

  • ,

  • PVD

  • (flash)


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CTA / MRA

  • CTA RAS stents

  • : 100-150 cc (CIN)

  • ( )

  • MRA ( )

  • ,


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STENTING

PTA (50% ,

)

> 70%

  • (. )

  • /


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> 0.8-1 cm /

> 5.5 cm

:

,

Marfan,

COPD


Abi nkle rachial ndex

- ABI (nkle rachial ndex)

0,91-1,30

0,41-0,90

.

0,00-0,40 .

=


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(CTA)

I

IIa

IIb

III

  • CTA ,

    • 96% 98%

    • 97% 94%

    • 95% 91%


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  • : .

    :

    • 3

    • :

      • Cilostazol ( 3)

      • Naftidrofuryl ( 2 5 )

      • Pentoxifylline

      • Carnitine, propionyl-L-carnitine

      • Buflomedil

      • AMEA

  • :

  • -

    -

    -


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( , , 3-6 )

?

  • :


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,

, ,


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    • (Dacron)

  • ,


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,

2030 23,6

WHO Fact sheet N317. September 2012


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2.000.000 plastic beverage bottles, the number used in the US every 5 min!

;

!

Running the NumbersAn American Self-Portrait

Cris jordan


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