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Clinical Applications and Protocols of Single Photon Emission Computed Tomography
Published in Bhagwat D. Ahluwalia, Tomographic Methods in Nuclear Medicine: Physical Principles, Instruments, and Clinical Applications, 2020
Hill et al.50 have summarized the properties of radiolabeled amines, their possible mechanism of localization in the brain, and their metabolism, once they have crossed the BBB. These investigators employed the Harvard multidetector brain system in their studies, using a dual-channel mode to eliminate the effects of 124I contamination (2.1 to 4.6%). From these studies, the following clinical indications are recommended for the use of IMP:Acute cerebral infarction where a CT scan may be normal over a week or more until anatomic abnormalities are detectable.Before and after endarterectomy to assess the success of surgical intervention.Epilepsy in cases where the extent and localization of hypermetabolic foci are important for treatment and follow-up.When an ambiguous clinical pattern is observed with no evidence of structural lesions by CT scan examination.
Brachiocephalic interventions
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
A hybrid procedure that combines simultaneous inflow stenting of the common carotid artery and carotid bifurcation endarterectomy is shown in Figure 21.10. Some additional maneuvers include the following steps. The carotid bifurcation is exposed and prepared as usual for endarterectomy. After anticoagulation, the internal and external carotid arteries are clamped. The micropuncture needle is placed in the common carotid artery at the location where the proximal end of the carotid arteriotomy is intended. The common carotid stent is placed as described in the section above. After completion arteriography, the guidewire is removed. The sheath is removed and the common carotid artery immediately clamped proximal to the arteriotomy site. The access site is used to begin the longitudinal carotid arteriotomy. After the artery has been opened in the usual manner, a shunt may be inserted as needed. The endarterectomy is performed in the usual manner.
Wound healing and ulcers
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
Sympathectomy removes sympathetic vasoconstrictor tone and causes some vasodilatation, but rarely results in much clinical benefit. Of greater help is endarterectomy, either by open surgical technique or percutaneously, or arterial grafting.
The role of carotid ultrasound in patients with non-lateralizing neurological complaints
Published in Hospital Practice, 2023
Shweta Varade, Abinayaa Ravichandran, Erafat Rehim, Hussam Yacoub, Rose Duncan, Hope Kincaid, Megan C. Leary, John Castaldo
A change in clinical management as a result of the CUS findings was seen in six patients, two of whom had carotid endarterectomy. A change in the type or dose of prescribed medication was made in all six patients. There was a statistically significant association between changes in clinical management and severity of stenosis (p = 0.0002), with a greater percentage of patients with 50–99% stenosis (21.05%) having a change made than in those with 0–49% stenosis (0.77%) (Table 4). The indication for the study in two patients with severe stenosis was syncope, and both were felt to have asymptomatic disease. In one patient, despite the symptoms being attributed to vertebrobasilar stenosis, ICA revascularization was performed with the stated objective of preventing more events by enriching the cerebral circulation. The patient denied recurrent symptoms for 12 months after surgery. The second patient with asymptomatic severe stenosis underwent endarterectomy given multiple underlying co-morbid risk factors including peripheral vascular disease, coronary vascular disease, hyperlipidemia, essential hypertension, diabetes mellitus, tobacco use, and obesity, with no changes in symptoms for a year following surgery.
Chronic thromboembolic pulmonary hypertension: a review of risk factors, management and current challenges
Published in Expert Review of Cardiovascular Therapy, 2022
John E Cannon, David P Jenkins, Stephen P Hoole
The operative procedure was refined and popularized by the University of California at San Diego, and the principles remain unchanged [30]. It is performed under general anesthesia with a median sternotomy incision as for conventional cardiac surgery. Cardiopulmonary bypass is required to divert blood away from the heart and allow systemic cooling to 20C. The pulmonary arteries are opened with separate right and left arteriotomies within the pericardium and a true endarterectomy plane is developed with the vessel wall. Periods of deep hypothermic circulatory arrest, of up to 20 minutes are required to give a bloodless field for the most distal endarterectomy dissection so that all visible thrombotic material is removed up to subsegmental level. Our own research demonstrated that the circulatory arrest is well tolerated without cognitive dysfunction [31]. Any concomitant procedures can be performed during rewarming although tricuspid regurgitation is usually self-limiting and repair usually unnecessary. After systemic rewarming on bypass, patients are initially managed in intensive care for the initial 2 days after surgery.
Nanotechnological approach to delivering nutraceuticals as promising drug candidates for the treatment of atherosclerosis
Published in Drug Delivery, 2021
Sindhu C. Pillai, Ankita Borah, Eden Mariam Jacob, D. Sakthi Kumar
Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is performed by opening narrowed coronary arteries to place a stent thus improving the blood flow to the heart and mitigating chest pain. Coronary artery bypass grafting (CABG) involves the grafting of a new artery to bypass the narrowed coronary arteries while boosting blood flow and preventing heart attacks. In the list of surgical methods, carotid endarterectomy is a common surgical process that involves the correction of the internal carotid artery by removing plaque build-up eventually restoring the blood flow to the brain. Surgical procedures of the blood vessel-blockade have achieved clinical success for many years, yet are also associated with numerous complications such as restenosis, in-stent restenosis, and late-stage clotting to name a few (Giannini et al., 2018).