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1. The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

Author

De Simone, Belinda, Abu-Zidan, Fikri M., Chouillard, Elie, Di Saverio, Salomone, Sartelli, Massimo, Podda, Mauro, Gomes, Carlos Augusto, Moore, Ernest E., Moug, Susan J., Ansaloni, Luca, Kluger, Yoram, Coccolini, Federico, Landaluce-Olavarria, Aitor, Estraviz-Mateos, Begoña, Uriguen-Etxeberria, Ana, Giordano, Alessio, Luna, Alfonso Palmieri, Amín, Luz Adriana Hernández, Hernández, Adriana María Palmieri, Shabana, Amanda, Dzulkarnaen, Zakaria Andee, Othman, Muhammad Asyraf, Sani, Mohamad Ikhwan, Balla, Andrea, Scaramuzzo, Rosa, Lepiane, Pasquale, Bottari, Andrea, Staderini, Fabio, Cianchi, Fabio, Cavallaro, Andrea, Zanghì, Antonio, Cappellani, Alessandro, Campagnacci, Roberto, Maurizi, Angela, Martinotti, Mario, Ruggieri, Annamaria, Jusoh, Asri Che, Rahman, Karim Abdul, Zulkifli, Anis Suraya M., Petronio, Barbara, Matías-García, Belén, Quiroga-Valcárcel, Ana, Mendoza-Moreno, Fernando, Atanasov, Boyko, Campanile, Fabio Cesare, Vecchioni, Ilaria, Cardinali, Luca, Travaglini, Grazia, Sebastiani, Elisa, Chooklin, Serge, Chuklin, Serhii, Cianci, Pasquale, Restini, Enrico, Capuzzolo, Sabino, Currò, Giuseppe, Filippo, Rosalinda, Rispoli, Michele, Aparicio-Sánchez, Daniel, Muñóz-Cruzado, Virginia Durán, Barbeito, Sandra Dios, Delibegovic, Samir, Kesetovic, Amar, Sasia, Diego, Borghi, Felice, Giraudo, Giorgio, Visconti, Diego, Doria, Emanuele, Santarelli, Mauro, Luppi, Davide, Bonilauri, Stefano, Grossi, Ugo, Zanus, Giacomo, Sartori, Alberto, Piatto, Giacomo, De Luca, Maurizio, Vita, Domenico, Conti, Luigi, Capelli, Patrizio, Cattaneo, Gaetano Maria, Marinis, Athanasios, Vederaki, Styliani-Aikaterini, Bayrak, Mehmet, Altıntas, Yasemin, Uzunoglu, Mustafa Yener, Demirbas, Iskender Eren, Altinel, Yuksel, Meric, Serhat, Aktimur, Yunus Emre, Uymaz, Derya Salim, Omarov, Nail, Azamat, Ibrahim, Lostoridis, Eftychios, Nagorni, Eleni-Aikaterini, Pujante, Antonio, Anania, Gabriele, Bombardini, Cristina, Bagolini, Francesco, Gonullu, Emre, Mantoglu, Baris, Capoglu, Recayi, Cappato, Stefano, Muzio, Elena, Colak, Elif, Polat, Suleyman, Koylu, Zehra Alan, Altintoprak, Fatih, Bayhan, Zülfü, Akin, Emrah, Andolfi, Enrico, Rezart, Sulce, Kim, Jae Il, Jung, Sung Won, Shin, Yong Chan, Enciu, Octavian, Toma, Elena Adelina, Medas, Fabio, Canu, Gian Luigi, Cappellacci, Federico, D’Acapito, Fabrizio, Ercolani, Giorgio, Solaini, Leonardo, Roscio, Francesco, Clerici, Federico, Gelmini, Roberta, Serra, Francesco, Rossi, Elena Giulia, Fleres, Francesco, Clarizia, Guglielmo, Spolini, Alessandro, Ferrara, Francesco, Nita, Gabriela, Sarnari, Jlenia, Gachabayov, Mahir, Abdullaev, Abakar, Poillucci, Gaetano, Palini, Gian Marco, Veneroni, Simone, Garulli, Gianluca, Piccoli, Micaela, Pattacini, Gianmaria Casoni, Pecchini, Francesca, Argenio, Giulio, Armellino, Mariano Fortunato, Brisinda, Giuseppe, Tedesco, Silvia, Fransvea, Pietro, Ietto, Giuseppe, Franchi, Caterina, Carcano, Giulio, Martines, Gennaro, Trigiante, Giuseppe, Negro, Giulia, Vega, Gustavo Machain, González, Agustín Rodríguez, Ojeda, Leonardo, Piccolo, Gaetano, Bondurri, Andrea, Maffioli, Anna, Guerci, Claudio, Sin, Boo Han, Zuhdi, Zamri, Azman, Azlanudin, Mousa, Hussam, al Bahri, Shadi, Augustin, Goran, Romic, Ivan, Moric, Trpimir, Nikolopoulos, Ioannis, Andreuccetti, Jacopo, Pignata, Giusto, D’Alessio, Rossella, Kenig, Jakub, Skorus, Urszula, Fraga, Gustavo Pereira, Hirano, Elcio Shiyoiti, de Lima Bertuol, Jackson Vinícius, Isik, Arda, Kurnaz, Eray, Asghar, Mohammad Sohail, Afzal, Ameer, Akbar, Ali, Nikolouzakis, Taxiarchis Konstantinos, Lasithiotakis, Konstantinos, Chrysos, Emmanuel, Das, Koray, Özer, Nazmi, Seker, Ahmet, Ibrahim, Mohamed, Hamid, Hytham K. S., Babiker, Ahmed, Bouliaris, Konstantinos, Koukoulis, George, Kolla, Chrysoula-Christina, Lucchi, Andrea, Agostinelli, Laura, Taddei, Antonio, Fortuna, Laura, Agostini, Carlotta, Licari, Leo, Viola, Simona, Callari, Cosimo, Laface, Letizia, Abate, Emmanuele, Casati, Massimiliano, Anastasi, Alessandro, Canonico, Giuseppe, Gabellini, Linda, Tosi, Lorenzo, Guariniello, Anna, Zanzi, Federico, Bains, Lovenish, Sydorchuk, Larysa, Iftoda, Oksana, Sydorchuk, Andrii, Malerba, Michele, Costanzo, Federico, Galleano, Raffaele, Monteleone, Michela, Costanzi, Andrea, Riva, Carlo, Walędziak, Maciej, Kwiatkowski, Andrzej, Czyżykowski, Łukasz, Major, Piotr, Strzałka, Marcin, Matyja, Maciej, Natkaniec, Michal, Valenti, Maria Rosaria, Di Vita, Maria Domenica Pia, Sotiropoulou, Maria, Kapiris, Stylianos, Massalou, Damien, Veroux, Massimiliano, Volpicelli, Alessio, Gioco, Rossella, Uccelli, Matteo, Bonaldi, Marta, Olmi, Stefano, Nardi, Matteo, Livadoti, Giada, Mesina, Cristian, Dumitrescu, Theodor Viorel, Ciorbagiu, Mihai Calin, Ammendola, Michele, Ammerata, Giorgio, Romano, Roberto, Slavchev, Mihail, Misiakos, Evangelos P., Pikoulis, Emmanouil, Papaconstantinou, Dimitrios, Elbahnasawy, Mohamed, Abdel-elsalam, Sherief, Felsenreich, Daniel M., Jedamzik, Julia, Michalopoulos, Nikolaos V., Sidiropoulos, Theodoros A., Papadoliopoulou, Maria, Cillara, Nicola, Deserra, Antonello, Cannavera, Alessandro, Negoi, Ionuţ, Schizas, Dimitrios, Syllaios, Athanasios, Vagios, Ilias, Gourgiotis, Stavros, Dai, Nick, Gurung, Rekha, Norrey, Marcus, Pesce, Antonio, Feo, Carlo Vittorio, Fabbri, Nicolo’, Machairas, Nikolaos, Dorovinis, Panagiotis, Keramida, Myrto D., Mulita, Francesk, Verras, Georgios Ioannis, Vailas, Michail, Yalkin, Omer, Iflazoglu, Nidal, Yigit, Direnc, Baraket, Oussama, Ayed, Karim, Ghalloussi, Mohamed hedi, Patias, Parmenion, Ntokos, Georgios, Rahim, Razrim, Bala, Miklosh, Kedar, Asaf, Sawyer, Robert G., Trinh, Anna, Miller, Kelsey, Sydorchuk, Ruslan, Knut, Ruslan, Plehutsa, Oleksandr, Liman, Rumeysa Kevser, Ozkan, Zeynep, Kader, Saleh Abdel, Gupta, Sanjay, Gureh, Monika, Saeidi, Sara, Aliakbarian, Mohsen, Dalili, Amin, Shoko, Tomohisa, Kojima, Mitsuaki, Nakamoto, Raira, Atici, Semra Demirli, Tuncer, Gizem Kilinc, Kaya, Tayfun, Delis, Spiros G., Rossi, Stefano, Picardi, Biagio, del Monte, Simone Rossi, Triantafyllou, Tania, Theodorou, Dimitrios, Pintar, Tadeja, Salobir, Jure, Manatakis, Dimitrios K., Tasis, Nikolaos, Acheimastos, Vasileios, Ioannidis, Orestis, Loutzidou, Lydia, Symeonidis, Savvas, de Sá, Tiago Correia, Rocha, Mónica, Guagni, Tommaso, Pantalone, Desiré, Maltinti, Gherardo, Khokha, Vladimir, Abdel-elsalam, Wafaa, Ghoneim, Basma, López-Ruiz, José Antonio, Kara, Yasin, Zainudin, Syaza, Hayati, Firdaus, Azizan, Nornazirah, Khei, Victoria Tan Phooi, Yi, Rebecca Choy Xin, Sellappan, Harivinthan, Demetrashvili, Zaza, Lekiashvili, Nika, Tvaladze, Ana, Froiio, Caterina, Bernardi, Daniele, Bonavina, Luigi, Gil-Olarte, Angeles, Grassia, Sebastiano, Romero-Vargas, Estela, Bianco, Francesco, Gumbs, Andrew A., Dogjani, Agron, Agresta, Ferdinando, Litvin, Andrey, Balogh, Zsolt J., Gendrikson, George, Martino, Costanza, Damaskos, Dimitrios, Pararas, Nikolaos, Kirkpatrick, Andrew, Kurtenkov, Mikhail, Gomes, Felipe Couto, Pisanu, Adolfo, Nardello, Oreste, Gambarini, Fabrizio, Aref, Hager, Angelis, Nicola de’, Agnoletti, Vanni, Biondi, Antonio, Vacante, Marco, Griggio, Giulia, Tutino, Roberta, Massani, Marco, Bisetto, Giovanni, Occhionorelli, Savino, Andreotti, Dario, Lacavalla, Domenico, Biffl, Walter L., and Catena, Fausto

Published
2022
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2. Sufentanil Sublingual Tablet System: from rationale of use to clinical practice.

Author

VERGARI, A., CORTEGIANI, A., RISPOLI, M., COLUZZI, F., DENI, F., LEYKIN, Y., LORIN, F. LUCA, MARTORANO, P. P., PAOLICCHI, A., POLATI, E., SCARDINO, M., CORCIONE, A., GIARRATANO, A., and ROSSI, M.

Abstract

The control of post-operative pain in Italy and other western countries is still suboptimal. In recent years, the Sufentanil Sublingual Tablet System (SSTS; Zalviso; Acel-Rx Pharmaceuticals, Redwood City, CA, USA), which is designed for patient-controlled analgesia (PCA), has entered clinical practice. SSTS enables patients to manage moderate-to-severe acute pain during the first 72 postoperative hours directly in the hospital setting. However, the role of SSTS within the current framework of options for the management of post-operative pain needs to be better established. This paper presents the position on the use of SSTS of a multidisciplinary group of Italian Experts and provides protocols for the use of this device. [ABSTRACT FROM AUTHOR]

Published
2020

3. Severity of Asymptomatic Carotid Stenosis and Risk of Ipsilateral Hemispheric Ischaemic Events: Results from the ACSRS Study

Author

Nicolaides, A, Kakkos, S, Griffin, M, Sabetai, M, Dhanjil, S, Tegos, T, Thomas, D, Giannoukas, A, Geroulakos, G, Georgiou, N, Francis, S, Ioannidou, E, Doré, C, Adovasio, R, Ziani, B, Aló, E, Cicilioni, C, Ambrosio, G, Andreev, A, Andreozzi, G, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, Barros D'Sa, A, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, G, Simoni, G, Bell, P, Bornstein, N, Bouchier Hayes, D, Fitzgerald, P, Cairols, M, Cao, P, DeRango, P, Carboni, G, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopolous, E, Andreadis, E, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Norgren, L, Ribbie, E, Novo, S, Tantillo, R, Olinic, D, Paaske, W, Pagnan, A, Pauletto, P, Pagliara, V, Pettina, G, Pratesi, C, Matticari, S, Polivka, J, Sevcik, P, Poredos, P, Blinc, A, Videcnik, V, Pujia, A, Raso, A, Rispoli, P, Conforti, M, Robinson, T, Dennis, M, Rosfors, S, Rudofsky, G, Schroeder, T, Gronholdt, M, Finocchi, C, Rodriguez, G, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardilleas, n, Aloi, T, Salerno, M, Fernandes, J., BIASI, GIORGIO MARIA, MINGAZZINI, PAOLO, Nicolaides, A, Kakkos, S, Griffin, M, Sabetai, M, Dhanjil, S, Tegos, T, Thomas, D, Giannoukas, A, Geroulakos, G, Georgiou, N, Francis, S, Ioannidou, E, Doré, C, Adovasio, R, Ziani, B, Aló, E, Cicilioni, C, Ambrosio, G, Andreev, A, Andreozzi, G, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, Barros D'Sa, A, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, G, Simoni, G, Bell, P, Biasi, G, Mingazzini, P, Bornstein, N, Bouchier Hayes, D, Fitzgerald, P, Cairols, M, Cao, P, Derango, P, Carboni, G, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopolous, E, Andreadis, E, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Norgren, L, Ribbie, E, Novo, S, Tantillo, R, Olinic, D, Paaske, W, Pagnan, A, Pauletto, P, Pagliara, V, Pettina, G, Pratesi, C, Matticari, S, Polivka, J, Sevcik, P, Poredos, P, Blinc, A, Videcnik, V, Pujia, A, Raso, A, Rispoli, P, Conforti, M, Robinson, T, Dennis, M, Rosfors, S, Rudofsky, G, Schroeder, T, Gronholdt, M, Finocchi, C, Rodriguez, G, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardilleas, N, Aloi, T, Salerno, M, Fernandes, J, NICOLAIDES A N, KAKKOS S K, GRIFFIN M, SABETAI M, DHANJIL S, TEGOS T, THOMAS D J, GIANNOUKAS A, GEROULAKOS G, GEORGIOU N, FRANCIS S, IOANNIDOU E, and NOVO S

Subjects
Risk, medicine.medical_specialty, medicine.medical_treatment, Carotid Stenosi, Predictive Value of Test, Carotid endarterectomy, Severity of Illness Index, Asymptomatic, Brain Ischemia, chemistry.chemical_compound, Cerebrovascular Accident, medicine.artery, Internal medicine, Severity of illness, NASCET, MED/22 - CHIRURGIA VASCOLARE, medicine, Carotid, Stenosis, Medicine(all), Ultrasonography, Doppler, Duplex, Creatinine, business.industry, Risk Factor, Incidence (epidemiology), medicine.disease, major clinical study, Ultrasonography, Duplex, Doppler, chemistry, Predictive value of tests, Cardiology, Surgery, ECST, Radiology, Internal carotid artery, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Objectives. This study determines the risk of ipsilateral ischaemic neurological events in relation to the degree of asymptomatic carotid stenosis and other risk factors. Methods. Patients (n = 1115) with asymptomatic internal carotid artery (ICA) stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6-84 (mean 37.1) months. Stenosis was graded using duplex, and clinical and biochemical risk factors were recorded. Results. The relationship between ICA stenosis and event rate is linear when stenosis is expressed by the ECST method, but S-shaped if expressed by the NASCET method. In addition to the ECST grade of stenosis (RR 1.6; 95% CI 1.21-2.15), history of contralateral TIAs (RR 3.0; 95% CI 1.90-4.73) and creatinine in excess of 85 μmol/L (RR 2.1; 95% CI 1.23-3.65) were independent risk predictors. The combination of these three risk factors can identify a high-risk group (7.3% annual event rate and 4.3% annual stroke rate) and a low risk group (2.3% annual event rate and 0.7% annual stroke rate). Conclusions. Linearity between ECST percent stenosis and risk makes this method for grading stenosis more amenable to risk prediction without any transformation not only in clinical practice but also when multivariable analysis is to be used. Identification of additional risk factors provides a new approach to risk stratification and should help refine the indications for carotid endarterectomy. © 2005 Elsevier Ltd. All rights reserved.

Published
2005
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4. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

Author

Nicolaides, Andrew N, Kakkos, Stavros K., Kyriacou, Efthyvoulos, Griffin, Maura, Sabetai, Michael, Thomas, Dafydd J., Tegos, Thomas, Geroulakos, George, Labropoulos, Nicos, Dor, Caroline J., Morris, Tim P., Naylor, Ross, Abbott, Anne L., Adovasio, Roberto, Ziani, B., Alò, F. P., Cicilioni, C. G., Ambrosio, G., Andreev, A., Andreozzi, G. M., Verlato, F., Camporese, G., Arosio, E., Barkauskas, E., Barros D'Sa, A. A. B., Brannigan, P., Batchvarova, V., Dramov, A., Belardi, P., Novelli, Gp, Simoni, G., Bell, P., Biasi, G. M., Mingazzini, P., Bornstein, N. M., Bouchier Hayes, D., Fitzgerald, P., Cairols, M. A., Cao, P. G., Derango, P., Carboni, G. P., Geoffredo, C., Catalano, M., Chambers, B., Goetzmann, M., Dickinson, A., Clement, D., Bobelyn, M., Coccheri, S., Conti, E., Diamantopoulos, E., Andreadis, E. A., Dimakakos, P. B., Kotsis, T., Eikelboom, B., Entz, L., Ferrari Bardile, Null, Aloi, T., Salerno, M., Fernandes e. Fernandes, J., Pedro, L., Fitzgerald, D. E., O'Shaunnersy, Anne, Fletcher, J., Forconi, S., Cappeli, R., Bicchi, M., Arrigucci, S., Gallai, V., Cardaiolli, G., Geroulakos, G., Kakkos, S., Gomez Isaza, L. F., Gorgoyannis, G., Liasis, N., Graf, M., Guarini, P., Hardy, S., Harris, P., Aston, S., Iosa, G., Katsamouris, A., Giannoukas, A., Krzanowski, M., Ladurner, G., Leal Monedero, J., Lee, B. B., Liapis, C., Galanis, P., Liboni, W., Pavanelli, E., Mannarino, E., Vaudo, G., Mccollum, P., Levison, R., Micieli, G., Bosone, D., Middleton, L., Pantziaris, M., Tyllis, T., Minar, E., Willfort, A., Moggi, L., Nenci, G., Radicchia, S., Nicolaides, A., Thomas, D, Norgren, L., Ribbe, E., Novo, S., Tantillo, R., Olinic, D., Paaske, W., Pagnan, A., Pauletto, P., Pagliara, V., Pettina, G., Pratesi, C., Matticari, S., Polivka, J., Sevcik, P., Poredos, P., Blinc, A., Videcnik, V., Pujia, A., Raso, A., Rispoli, P., Conforti, M., Robinson, T., Dennis, M. S. J., Rosfors, S., Rudofsky, G., Schroeder, T., Gronholdt, M. L., Finocchi, C., Rodriguez, G., Spartera, C., Ventura, M., Scarpelli, P., Sprynger, M., Sadzot, B., Hottermans, C., Moonen, Null, Taylor, P. R., Tovar Pardo, A., Negreira, J., Vayssairat, M., Faintuch, J. M., Valaikiené, J., Walker, M. G., Wilkinson, A. R., Nicolaides, A, Kakkos, S, Kyriacou, E, Griffin, M, Sabetai, M, Thomas, D, Tegos, T, Geroulakos, G, Labropoulos, N, Dor, C, Morris, T, Naylor, R, Abbott, A, Adovasio, R, Ziani, B, Alò, F, Cicilioni, C, Ambrosio, G, Andreev, A, Andreozzi, G, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, Barros D'Sa, A, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, G, Simoni, G, Bell, P, Biasi, G, Mingazzini, P, Bornstein, N, Bouchier Hayes, D, Fitzgerald, P, Cairols, M, Cao, P, Derango, P, Carboni, G, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopoulos, E, Andreadis, E, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardileah, N, Aloi, T, Salerno, M, Fernandes, J, Pedro, L, Fitzgerald, D, O'Shaunnersy, A, Fletcher, J, Forconi, S, Cappeli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Gomez Isaza, L, Gorgoyannis, G, Liasis, N, Graf, M, Guarini, P, Hardy, S, Harris, P, Aston, S, Iosa, G, Katsamouris, A, Giannoukas, A, Krzanowski, M, Ladurner, G, Leal Monedero, J, Lee, B, Liapis, C, Galanis, P, Liboni, W, Pavanelli, E, Mannarino, E, Vaudo, G, Mccollum, P, Levison, R, Micieli, G, Bosone, D, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Norgren, L, Ribbe, E, Novo, S, Tantillo, R, Olinic, D, Paaske, W, Pagnan, A, Pauletto, P, Pagliara, V, Pettina, G, Pratesi, C, Matticari, S, Polivka, J, Sevcik, P, Poredos, P, Blinc, A, Videcnik, V, Pujia, A, Raso, A, Rispoli, P, Conforti, M, Robinson, T, Dennis, M, Rosfors, S, Rudofsky, G, Schroeder, T, Gronholdt, M, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonenbp, N, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, J, Valaikiené, J, Walker, M, Wilkinson, A, Nicolaides, Andrew N, Kakkos, Stavros K., Kyriacou, Efthyvoulo, Griffin, Maura, Sabetai, Michael, Thomas, Dafydd J., Tegos, Thoma, Geroulakos, George, Labropoulos, Nico, Dor, Caroline J., Morris, Tim P., Naylor, Ro, Abbott, Anne L., Adovasio, Roberto, Ziani, B., Alò, F. P., Cicilioni, C. G., Ambrosio, G., Andreev, A., Andreozzi, G. M., Verlato, F., Camporese, G., Arosio, E., Barkauskas, E., Barros D'Sa, A. A. B., Brannigan, P., Batchvarova, V., Dramov, A., Belardi, P., Novelli, Gp, Simoni, G., Bell, P., Biasi, G. M., Mingazzini, P., Bornstein, N. M., Bouchier Hayes, D., Fitzgerald, P., Cairols, M. A., Cao, P. G., Derango, P., Carboni, G. P., Geoffredo, C., Catalano, M., Chambers, B., Goetzmann, M., Dickinson, A., Clement, D., Bobelyn, M., Coccheri, S., Conti, E., Diamantopoulos, E., Andreadis, E. A., Dimakakos, P. B., Kotsis, T., Eikelboom, B., Entz, L., Ferrari Bardile, Null, Aloi, T., Salerno, M., Fernandes e. Fernandes, J., Pedro, L., Fitzgerald, D. E., O'Shaunnersy, Anne, Fletcher, J., Forconi, S., Cappeli, R., Bicchi, M., Arrigucci, S., Gallai, V., Cardaiolli, G., Geroulakos, G., Kakkos, S., Gomez Isaza, L. F., Gorgoyannis, G., Liasis, N., Graf, M., Guarini, P., Hardy, S., Harris, P., Aston, S., Iosa, G., Katsamouris, A., Giannoukas, A., Krzanowski, M., Ladurner, G., Leal Monedero, J., Lee, B. B., Liapis, C., Galanis, P., Liboni, W., Pavanelli, E., Mannarino, E., Vaudo, G., Mccollum, P., Levison, R., Micieli, G., Bosone, D., Middleton, L., Pantziaris, M., Tyllis, T., Minar, E., Willfort, A., Moggi, L., Nenci, G., Radicchia, S., Nicolaides, A., Norgren, L., Ribbe, E., Novo, S., Tantillo, R., Olinic, D., Paaske, W., Pagnan, A., Pauletto, P., Pagliara, V., Pettina, G., Pratesi, C., Matticari, S., Polivka, J., Sevcik, P., Poredos, P., Blinc, A., Videcnik, V., Pujia, A., Raso, A., Rispoli, P., Conforti, M., Robinson, T., Dennis, M. S. J., Rosfors, S., Rudofsky, G., Schroeder, T., Gronholdt, M. L., Finocchi, C., Rodriguez, G., Spartera, C., Ventura, M., Scarpelli, P., Sprynger, M., Sadzot, B., Hottermans, C., Moonen, Null, Taylor, P. R., Tovar Pardo, A., Negreira, J., Vayssairat, M., Faintuch, J. M., Valaikiené, J., Walker, M. G., and Wilkinson, A. R.

Subjects
Male, Carotid Stenosi, carotid artery stenosis, Brain Ischemia, 80 and over, MED/22 - CHIRURGIA VASCOLARE, Carotid Stenosis, Cerebrovascular disease, cerebrovascular risk, Stroke, Ultrasonography, Aged, 80 and over, Middle Aged, cardiovascular system, Female, Radiology, Internal carotid artery, medicine.symptom, Cardiology and Cardiovascular Medicine, Carotid Artery, Internal, Adult, Aged, Amaurosis Fugax, Humans, ROC Curve, Risk Assessment, Surgery, Human, medicine.medical_specialty, Asymptomatic, Central nervous system disease, medicine.artery, medicine, Asymtomatic carotid stenosis, cardiovascular diseases, Risk factor, carotid surgery, Vascular disease, business.industry, Amaurosis fugax, medicine.disease, Internal, Stenosis, atherosclerosis, Carotid Artery, business
Abstract

Background: The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis. Methods: This was a prospective, multicenter, cohort study of patients undergoing medical intervention for vascular disease. Hazard ratios for ICA stenosis, clinical features, and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models. Results: A total of 1121 patients with 50% to 99% asymptomatic ICA stenosis in relation to the bulb (European Carotid Surgery Trial [ECST] method) were followed-up for 6 to 96 months (mean, 48). A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral transient ischemic attacks (TIAs) or stroke, low grayscale median (GSM), increased plaque area, plaque types 1, 2, and 3, and the presence of discrete white areas (DWAs) without acoustic shadowing were associated with increased risk. Receiver operating characteristic (ROC) curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with clinical features and a model of stenosis combined with clinical, and plaque features were 0.59 (95% confidence interval [CI] 0.54-0.64), 0.66 (0.62-0.72), and 0.82 (0.78-0.86), respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area, and DWAs were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close to observed risk. Of the 923 patients with

Published
2010
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5. Silent embolic infarcts on computed tomography brain scans and risk of ipsilateral hemispheric events in patients with asymptomatic internal carotid artery stenosis

Author

Kakkos, S, Sabetai, M, Tegos, T, Stevens, J, Thomas, D, Griffin, M, Geroulakos, G, Nicolaides, A, Adovasio, R, Ziani, B, Alò, F, Cicilioni, C, Ambrosio, G, Andreev, A, Andreozzi, G, Verlato, F, Camporese, G, Arosio, E, Barkaukas, E, Barros D'Sa, A, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, G, Simoni, G, Bell, P, BIASI, GIORGIO MARIA, MINGAZZINI, PAOLO, Bornstein, N, Bouchier Hayes, D, Fitzgerald, P, Cairols, M, Cao, P, DeRango, P, Carboni, G, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopoulos, E, Andreadis, A, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardile, T, Salerno, M, Fernandes, J, Pedro, L, Fitzgerald, D, O'Shaunnersy, A, Fletcher, J, Forconi, S, Capelli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Gomez Isaza, L, Gorgoyannis, G, Liasis, N, Graf, M, Guarini, P, Hardy, S, Harris, P, Aston, S, Iosa, G, Katsamouris, A, Giannoukas, A, Krzanowski, M, Ladurner, G, Leal Monedero, J, Lee, B, Liapis, C, Galanis, P, Liboni, W, Pavanelli, E, Mannarino, E, Vaudo, G, McCollum, P, Levison, R, Micieli, G, Bosone, D, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Norgren, L, Ribbe, E, Novo, S, Tantillo, R, Olinic, D, Paaske, W, Pagnan, A, Pauletto, P, Pagliara, V, Pettina, G, Pratesi, C, Matticari, S, Polivka, J, Sevcik, P, Poredos, P, Blinc, A, Videcnik, V, Pujia, A, Raso, A, Rispoli, P, Conforti, M, Robinson, T, Dennis, M, Rosfors, S, Rudofsky, G, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonenbj, n, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, J, Valaikiene, J, Walker, M, Wilkinson, A., Kakkos, S, Sabetai, M, Tegos, T, Stevens, J, Thomas, D, Griffin, M, Geroulakos, G, Nicolaides, A, Adovasio, R, Ziani, B, Alò, F, Cicilioni, C, Ambrosio, G, Andreev, A, Andreozzi, G, Verlato, F, Camporese, G, Arosio, E, Barkaukas, E, Barros D'Sa, A, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, G, Simoni, G, Bell, P, Biasi, G, Mingazzini, P, Bornstein, N, Bouchier Hayes, D, Fitzgerald, P, Cairols, M, Cao, P, Derango, P, Carboni, G, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopoulos, E, Andreadis, A, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardile, T, Salerno, M, Fernandes, J, Pedro, L, Fitzgerald, D, O'Shaunnersy, A, Fletcher, J, Forconi, S, Capelli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Gomez Isaza, L, Gorgoyannis, G, Liasis, N, Graf, M, Guarini, P, Hardy, S, Harris, P, Aston, S, Iosa, G, Katsamouris, A, Giannoukas, A, Krzanowski, M, Ladurner, G, Leal Monedero, J, Lee, B, Liapis, C, Galanis, P, Liboni, W, Pavanelli, E, Mannarino, E, Vaudo, G, Mccollum, P, Levison, R, Micieli, G, Bosone, D, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Norgren, L, Ribbe, E, Novo, S, Tantillo, R, Olinic, D, Paaske, W, Pagnan, A, Pauletto, P, Pagliara, V, Pettina, G, Pratesi, C, Matticari, S, Polivka, J, Sevcik, P, Poredos, P, Blinc, A, Videcnik, V, Pujia, A, Raso, A, Rispoli, P, Conforti, M, Robinson, T, Dennis, M, Rosfors, S, Rudofsky, G, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonenbj, N, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, J, Valaikiene, J, Walker, M, and Wilkinson, A

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, internal carotid artery, Carotid endarterectomy, Kaplan-Meier Estimate, brain embolism, Asymptomatic, Risk Assessment, Central nervous system disease, Duplex scanning, Predictive Value of Tests, MED/22 - CHIRURGIA VASCOLARE, medicine, Humans, Carotid Stenosis, brain infarction, cardiovascular diseases, Prospective Studies, Stroke, Aged, Proportional Hazards Models, Ultrasonography, Doppler, Duplex, Cerebral infarction, business.industry, Amaurosis fugax, Cerebral Infarction, medicine.disease, major clinical study, neurologic disease, Stenosis, multicenter study, Intracranial Embolism, Ischemic Attack, Transient, transient ischemic attack, Disease Progression, carotid artery obstruction, Surgery, Female, Radiology, medicine.symptom, business, Cardiology and Cardiovascular Medicine, Tomography, X-Ray Computed, Carotid Artery, Internal, prospective study
Abstract

Udgivelsesdato: 2009-Apr OBJECTIVES: This study tested the hypothesis that silent embolic infarcts on computed tomography (CT) brain scans can predict ipsilateral neurologic hemispheric events and stroke in patients with asymptomatic internal carotid artery stenosis. METHODS: In a prospective multicenter natural history study, 821 patients with asymptomatic carotid stenosis graded with duplex scanning who had CT brain scans were monitored every 6 months for a maximum of 8 years. Duplex scans were reported centrally, and stenosis was expressed as a percentage in relation to the normal distal internal carotid criteria used by the North American Symptomatic Carotid Endarterectomy Trialists. CT brain scans were reported centrally by a neuroradiologist. In 146 patients (17.8%), 8 large cortical, 15 small cortical, 72 discrete subcortical, and 51 basal ganglia ipsilateral infarcts were present; these were considered likely to be embolic and were classified as such. Other infarct types, lacunes (n = 15), watershed (n = 9), and the presence of diffuse white matter changes (n = 95) were not considered to be embolic. RESULTS: During a mean follow-up of 44.6 months (range, 6 months-8 years), 102 ipsilateral hemispheric neurologic events (amaurosis fugax in 16, 38 transient ischemic attacks [TIAs], and 47 strokes) occurred, 138 patients died, and 24 were lost to follow-up. In 462 patients with 60% to 99% stenosis, the cumulative event-free rate at 8 years was 0.81 (2.4% annual event rate) when embolic infarcts were absent and 0.63 (4.6% annual event rate) when present (log-rank P = .032). In 359 patients with

Published
2008
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6. Day surgery versus Outpatient setting for endovenous laser ablation treatment. A prospective cohort study.

Author

Varetto, Gianfranco, Gibello, Lorenzo, Frola, Edoardo, Trevisan, Alessandra, Trucco, Andrea, Contessa, Luigi, and Rispoli, Pietro

Subjects
SAPHENOUS vein, AMBULATORY surgery, COMPARATIVE studies, MEDICAL lasers, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, QUALITY of life, RESEARCH, EVALUATION research, VENOUS insufficiency, PSYCHOLOGY, SURGERY
Abstract

Objectives: The traditional surgical approach to the treatment of the superficial venous insufficiency requires at least 12 h of post-operative monitoring and this often means the necessity of an overnight hospitalization. The introduction of new, less invasive techniques (i.e endovenous laser ablation) reduces the hospitalization stay in a Day Surgery setting. However, the increasing skills of the operators and the patient's selection, allows to propose endovenous laser ablation in an Outpatient setting. The aim of this study is to evaluate the activity of a single high-volume center.Method: We enrolled 112 consecutive patients with great sapehous vein insufficiency and indication to endothermal laser ablation, 57 operations (51%) were performed in Day Surgery setting and 55 (49%) in Outpatient setting according to endovascular laser ablation's criteria. Past medical history, CEAP classification, VCSS score, type of symptoms and intervention's data were collected. Post-operative results (success and complications rates, patient's functional and aesthetic satisfaction) were evaluated at 7 and 30 days after intervention. A QoL questionnaire (CIVIQ) was submitted to the patients 30 days after surgery.Results: We did not observe a statistically significant difference between the two groups concerning treatment results and complications onset. The QoL assessment did not differed significantly, except for over 65-year old patients undergoing outpatient treatment that showed a better QoL compared to those undergoing the same treatment in Day Surgery (p 0.05).Conclusions: The endothermal laser ablation technique allows a safe, comfortable and faster management of the venous disease in Outpatient setting. This would further reduce the costs of the treatment while preserving the functional and aesthetic results and the low complication rate of the Day Surgery setting. [ABSTRACT FROM AUTHOR]

Published
2018
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7. A one-stage approach to the treatment of intravenous leiomyomatosis extending to the right heart.

Author

Rispoli, Pietro, Santovito, Davide, Tallia, Caterina, Varetto, Gianfranco, Conforti, Massimo, and Rinaldi, Mauro

Subjects
INTRAVENOUS therapy, SMOOTH muscle tumors, HYSTERECTOMY complications, MUSCLES, MUSCLE tumors, PELVIS, RIGHT heart ventricle, SURGERY
Abstract

This report describes the case of a 60-year-old woman with a history of hysterectomy for myomas, totally asymptomatic, with incidental evidence of a pelvic intracaval mass extending to the right atrium. She underwent a staged procedure (sternothomic and abdominal) through a thoracolaparotomic approach in circulatory arrest and deep hypothermia. Using a one-stage surgical approach, we were able to withdraw one portion of the mass from the right atrium and another from the abdominal inferior vena cava, thus minimizing the risk of unexpected venous or atrial wall injury during surgical manipulation. [Copyright &y& Elsevier]

Published
2010
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8. Intraoperative Flow Evaluation During Reconstructive Arterial Surgery by C.W. Doppler Flowmeter and Angioscope.

Author

Raso, A. M., Rispoli, P., and Carliti, R.

Subjects
DOPPLER ultrasonography, SURGERY, FLOW meters, ANGIOGRAPHY, PLASTIC surgery
Abstract

In order to avoid errors of evaluation during reconstructive arterial surgery, some surgical teams, in addition to their personal skill and experience, have so far mainly employed intraoperative angiography. This method, still good and precise, but slightly unsafe and requiring very expensive equipment, is not exempt from some limits, which have been clearly described. [ABSTRACT FROM AUTHOR]

Published
1986
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9. Paraganglioma of the hypoglossal nerve.

Author

Santovito, Davide, Conforti, Massimo, Varetto, Gianfranco, and Rispoli, Pietro

Subjects
HYPOGLOSSAL nerve, CRANIAL nerves, PERIPHERAL nerve tumors, MEDICAL literature, DIAGNOSTIC imaging, DATABASE searching, SURGERY
Abstract

After the incidental intraoperative discovery of a paraganglioma of cranial nerve XII, we searched our hospital database and literature for similar cases to determine whether evidence exists to support the existence of paraganglioma of the hypoglossal nerve. We describe a case of cranial nerve XII paraganglioma, recognized only during surgery, without any indicative preoperative sign or symptom nor diagnostic imaging studies. In light of published findings, only four cases described since 1966, and our experience, the report discusses diagnostic criteria that could aid in establishing a diagnosis of hypoglossal nerve paraganglioma based on a reasonable degree of medical certainty. [Copyright &y& Elsevier]

Published
2009
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10. Predictors and clinical significance of progression or regression of asymptomatic carotid stenosis

Author

Kakkos, Sk, Nicolaides, An, Charalambous, I, Thomas, D, Giannopoulos, A, Naylor, Ar, Geroulakos, G, Abbott, Al, Asymptomatic Carotid Stenosis, Risk of Stroke Study Group Adovasio, R, Ziani, B, Alò, F, Cicilioni, C, Ambrosio, G, Andreev, A, Andreozzi, G, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, D'Sa, A, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, G, Simoni, G, Bell, P, Biasi, G, Mingazzini, P, Bornstein, N, Bouchier Hayes, D, Fitzgerald, P, Cairols, M, Cao, P, Derango, P, Carboni, G, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopoulos, E, Andreadis, E, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardile, A, Aloi, T, Salerno, M, Fernandes J, Fernandes e., Pedro, L, Fitzgerald, D, O'Shaughnessy, A, Fletcher, J, Forconi, S, Cappeli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Kakkos, S, Gomez Isaza, L, Gorgoyannis, G, Liasis, N, Graf, M, Guarini, P, Hardy, S, Harris, P, Aston, S, Iosa, G, Katsamouris, A, Giannoukas, A, Krzanowski, M, Ladurner, G, Leal Monedero, J, Lee, B, Liapis, C, Galanis, P, Liboni, W, Pavanelli, E, Mannarino, E, Vaudo, G, Mccollum, P, Levison, R, Micieli, G, Bosone, D, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Nicolaides, A, Norgren, L, Ribbe, E, Novo, S, Tantillo, R, Olinic, D, Paaske, W, Pagnan, A, Pauletto, P, Pagliara, V, Pettina, G, Pratesi, C, Matticari, S, Polivka, J, Sevcik, P, Poredos, P, Blinc, A, Videcnik, V, Pujia, A, Raso, A, Rispoli, Pietro, Conforti, M, Robinson, T, Dennis, M, Rosfors, S, Rudofsky, G, Schroeder, T, Gronholdt, M, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonen, M, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, J, Valaikiené, J, Walker, M, Wilkinson, A. R., Kakkos, Stavros K., Nicolaides, Andrew N., Charalambous, Ioanna, Thomas, Dafydd, Giannopoulos, Argyrio, Naylor, A. Ro, Geroulakos, George, Abbott, Anne L., Adovasio, Roberto, Ziani, B., Alò, F. P., Cicilioni, C. G., Ambrosio, G., Andreev, A., Andreozzi, G. M., Verlato, F., Camporese, G., Arosio, E., Barkauskas, E., Barros D'Sa, A. A. B., Brannigan, P., Batchvarova, V., Dramov, A., Belardi, P., Novelli, G. P., Simoni, G., Bell, P., Biasi, G. M., Mingazzini, P., Bornstein, N. M., Bouchier Hayes, D., Fitzgerald, P., Cairols, M. A., Cao, P. G., Derango, P., Carboni, G. P., Geoffredo, C., Catalano, M., Chambers, B., Goetzmann, M., Dickinson, A., Clement, D., Bobelyn, M., Coccheri, S., Conti, E., Diamantopoulos, E., Andreadis, E. A., Dimakakos, P. B., Kotsis, T., Eikelboom, B., Entz, L., Ferrari Bardile, A., Aloi, T., Salerno, M., Fernandes E. Fernandes, J., Pedro, L., Fitzgerald, D. E., O'Shaughnessy, A. M., Fletcher, J., Forconi, S., Cappeli, R., Bicchi, M., Arrigucci, S., Gallai, V., Cardaiolli, G., Gomez Isaza, L. F., Gorgoyannis, G., Liasis, N., Graf, M., Guarini, P., Hardy, S., Harris, P., Aston, S., Iosa, G., Katsamouris, A., Giannoukas, A., Krzanowski, M., Ladurner, G., Leal Monedero, J., Lee, B. B., Liapis, C., Galanis, P., Liboni, W., Pavanelli, E., Mannarino, E., Vaudo, G., Mccollum, P., Levison, R., Micieli, G., Bosone, D., Middleton, L., Pantziaris, M., Tyllis, T., Minar, E., Willfort, A., Moggi, L., Nenci, G., Radicchia, S., Norgren, L., Ribbe, E., Novo, S., Tantillo, R., Olinic, D., Paaske, W., Pagnan, A., Pauletto, P., Pagliara, V., Pettina, G., Pratesi, C., Matticari, S., Polivka, J., Sevcik, P., Poredos, P., Blinc, A., Videcnik, V., Pujia, A., Raso, A., Rispoli, P., Conforti, M., Robinson, T., Dennis, M. S. J., Rosfors, S., Rudofsky, G., Schroeder, T., Gronholdt, M. L., Finocchi, C., Rodriguez, G., Spartera, C., Ventura, M., Scarpelli, P., Sprynger, M., Sadzot, B., Hottermans, C., Moonen, M., Taylor, P. R., Tovar Pardo, A., Negreira, J., Vayssairat, M., Faintuch, J. M., Valaikiené, J., Walker, M. G., and Wilkinson, A. R.

Subjects
Male, Time Factors, Cost effectiveness, medicine.medical_treatment, Carotid Stenosi, Predictive Value of Test, Kaplan-Meier Estimate, Carotid endarterectomy, Retinal Disease, Risk Factors, 80 and over, Carotid Stenosis, Plaque, Atherosclerotic, Ultrasonography, Aged, 80 and over, Ultrasonography, Doppler, Duplex, Incidence, Remission Induction, Doppler, Middle Aged, Prognosis, Plaque, Atherosclerotic, Duplex, Europe, Stroke, Predictive value of tests, Disease Progression, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Carotid Artery, Internal, Human, Adult, medicine.medical_specialty, Time Factor, Victoria, Prognosi, Asymptomatic, Retinal Diseases, Predictive Value of Tests, Internal medicine, medicine, Humans, Clinical significance, Aged, Asymptomatic Disease, business.industry, Risk Factor, medicine.disease, Internal, Confidence interval, Surgery, Stenosis, Asymptomatic Diseases, Relative risk, asymptomatic carotid artery stenosis, Carotid Artery, business
Abstract

OBJECTIVE: To determine baseline clinical and ultrasonographic plaque factors predictive of progression or regression of asymptomatic carotid stenosis and the predictive value of changes in stenosis severity on risk of first ipsilateral cerebral or retinal ischemic events (including stroke).METHODS: A total of 1121 patients with asymptomatic carotid stenosis of 50% to 99% in relation to the bulb diameter (European Carotid Surgery Trial [ECST] method) underwent six monthly clinical assessments and carotid duplexes for up to 8 years (mean follow-up, 4 years). Progression or regression was considered present if there was a change of at least one grade higher or lower, respectively, persisting for at least two consecutive examinations.RESULTS: Regression occurred in 43 (3.8%), no change in 856 (76.4%), and progression in 222 (19.8%) patients. Younger age, high grades of stenosis, absence of discrete white areas in the plaque, and taking lipid lowering therapy were independent baseline predictors of increased incidence of regression. High serum creatinine, male gender, not taking lipid lowering therapy, low grades of stenosis, and increased plaque area were independent baseline predictors of progression. One hundred and thirty first ipsilateral cerebral or retinal ischemic events, including 59 strokes, occurred. Forty (67.8%) of the strokes occurred in patients whose stenosis was unchanged, 19 (32.2%) in those with progression, and zero in those with regression. For the entire cohort, the 8-year cumulative ipsilateral cerebral ischemic stroke rate was zero in patients with regression, 9% if the stenosis was unchanged, and 16% if there was progression (average annual stroke rates of 0%, 1.1%, and 2.0%, respectively; log-rank, P = .05; relative risk in patients with progression, 1.92; 95% confidence interval, 1.14-3.25). For patients with baseline stenosis 70% to 99% in relation to the distal internal carotid (North American Symptomatic Carotid Endarterectomy Trial [NASCET] method), in the absence of progression (n = 349), the 8-year cumulative ipsilateral cerebral ischemic stroke rate was 12%. In the presence of progression (n = 77), it was 21% (average annual stroke rates of 1.5% and 2.6%, respectively; log-rank, P = .34). Only nine (30%) of the 30 strokes occurred in the progression group.CONCLUSIONS: Progressive asymptomatic carotid stenosis identified a subgroup with about twice the risk of ipsilateral stroke compared with those without progression. However, the clinical value of screening for progression simply for selecting patients for carotid procedures is limited because of the low frequency of progression and its relatively low associated stroke rate. The cost effectiveness of screening for change in stenosis severity to better direct current optimal medical treatment needs testing.

Published
2014
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11. Endoscopic Saphenous harvesting with an Open CO2 System (ESOS) trial for coronary artery bypass grafting surgery: study protocol for a randomized controlled trial

Author

Antonio Campanella, Mauro Rinaldi, Sofia Asioli, Serenella Scipioni, Laura Bergamasco, Luigia Macrì, Silvana Barbaro, Roger Devotini, Pietro Rispoli, Campanella A, Bergamasco L, Macri L, Asioli S, Devotini R, Scipioni S, Barbaro S, Rispoli P, and Rinaldi M

Subjects
medicine.medical_specialty, coronary disease, minimally invasive surgery, saphenous vein harvest, Bypass grafting, Cost-Benefit Analysis, Greater saphenous vein, Medicine (miscellaneous), law.invention, Vein harvesting, Study Protocol, Patient satisfaction, Randomized controlled trial, Clinical Protocols, law, medicine, Humans, Pharmacology (medical), Saphenous Vein, Prospective Studies, Coronary Artery Bypass, Prospective cohort study, lcsh:R5-920, medicine.diagnostic_test, business.industry, Endoscopy, Surgery, medicine.anatomical_structure, Research Design, cardiovascular system, Quality of Life, Tissue and Organ Harvesting, business, lcsh:Medicine (General), Artery
Abstract

Background In coronary artery bypass grafting surgery, arterial conduits are preferred because of more favourable long-term patency and outcome. Anyway the greater saphenous vein continues to be the most commonly used bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is increasingly being investigated in order to reduce the morbidity associated with conventional open vein harvesting, includes postoperative leg wound complications, pain and patient satisfaction. However, to date the short and the long-term benefits of the endoscopic technique remain controversial. This study provides an interesting opportunity to address this gap in the literature. Methods/Design Endoscopic Saphenous harvesting with an Open CO2 System trial includes two parallel vein harvesting arms in coronary artery bypass grafting surgery. It is an interventional, single centre, prospective, randomized, safety/efficacy, cost/effectiveness study, in adult patients with elective planned and first isolated coronary artery disease. A simple size of 100 patients for each arm will be required to achieve 80% statistical power, with a significant level of 0.05, for detecting most of the formulated hypotheses. A six-weeks leg wound complications rate was assumed to be 20% in the conventional arm and less of 4% in the endoscopic arm. Previously quoted studies suggest a first-year vein-graft failure rate of about 20% with an annual occlusion rate of 1% to 2% in the first six years, with practically no difference between the endoscopic and conventional approaches. Similarly, the results on event-free survival rates for the two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5% cross-over rate, the goal is to enrol 230 patients from a single Italian cardiac surgery centre. Discussion The goal of this prospective randomized trial is to compare and to test improvement in wound healing, quality of life, safety/efficacy, cost-effectiveness, short and long-term outcomes and vein-graft patency after endoscopic open CO2 harvesting system versus conventional vein harvesting. The expected results are of high clinical relevance and will show the safety/efficacy or non-inferiority of one treatment approach in terms of vein harvesting for coronary artery bypass grafting surgery. Trial registration www.clinicalTrials.gov NCT01121341.

Published
2011

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