BACKGROUND: renal artery stenosis (RAS) is a major cause of renovascular hypertension and renal function due to ischemic atrophy of kidney. There are several methods to treat the RAS, including are surgery, percutaneous transluminal renal angioplasty, and medical treatment. The purpose of this study is to evaluate the usefulness, safety, and efficacy of percutaneous transluminal stent deployment in RAS. METHOD: From January 1995 to July 1996, 17 patients underwent renal stent implantation due to renal artery stenosis (11 male, 6 female). the mean age was 49 years old, one patient had both renal artery stenosis and total lesions were 18. The causes of renal artery stenosis were atherosclerosis in 12, fibromuscular dysplasia in 2, Takayasu's disease in 2, and autoimmune disease (Bechet's) in one case. Renal artery stenting was performed via femoral artery in 12 lesions and brachial artery in 6 lesions. Follow up was performed by renogram, renal angiogram, and clinical examination. RESULT: the degree of renal artery stenosis was 83% (70-95%). the lesion sites were 12 ostial and 6 non-ostial lesions. The used renal stents were Palmaz-biliary stent in 17 lesions and Micro-2 stent in one lesions. All stents were implanted successfully and there was no residual stenosis in all patients except one case showed 20% residual stenosis due to huge renal artery size. The transstenotic pressure gradients after renal artery stenting was decreased markedly from 74mmHg to 2mmHg. There no serious complications such as a death, emergency surgery, or nephrectomy. There were two minor complications which were one case of pyelonephritis and one case of inguinal hematoma. After stenting, blood pressure was decreased partially in 13 patients and completely in 2 cases. CONCLUSION: Renal artery stenting appears to be safe and feasible and the alternative treatment modality to surgery for renal artery stenosis.
Angioplasty ; Atherosclerosis ; Atrophy ; Autoimmune Diseases ; Blood Pressure ; Brachial Artery ; Constriction, Pathologic ; Emergencies ; Femoral Artery ; Fibromuscular Dysplasia ; Follow-Up Studies ; Hematoma ; Humans ; Hypertension, Renovascular ; Kidney ; Male ; Middle Aged ; Nephrectomy ; Pyelonephritis ; Renal Artery Obstruction* ; Renal Artery* ; Stents*

BACKGROUND AND OBJECTIVES: For patients with bilateral carotid artery stenosis, simultaneous bilateral carotid endarterectomy is rarely performed due to a higher perioperative risk for death and strokes. We assessed the immediate and long-term outcomes of simultaneous bilateral carotid stenting (SBCS) for internal carotid stenosis in patients at high surgical risk. MATERIALS AND METHODS: We analyzed 10 patients who underwent SBCS for de novo stenoses of both internal carotid arteries (ICA). Included were those who had 60% to 99% stenosis of extracranial ICAs irrespective of neurologic symptoms and had more than 2 risk factors of Mayo grade III (medical risks) or IV (neurologic risks). RESULTS: The patients had a mean age of 67+/-7 years. Technical success was achieved in all lesions. The mean percent diameter stenosis was reduced from 79+/-13% to 8+/-8%. A total of 21 Wallstents were deployed at 20 lesions. One patient had a minor stroke just after the procedure which was completely resolved with local injection of urokinase. There were no deaths, major strokes or myocardial infarctions during the 30 day follow-up. Six months imaging studies were available on all 9 eligible patients with 18 lesions by duplex sonography and angiography. Late clinical follow-up at a mean of 15.1+/-8.1 months revealed no occurrence of neurologic event or death. CONCLUSION: SBCS is feasible, safe and effective to treat bilateral de novo ICA stenoses in patients at high surgical risk. The procedure, however, is investigational and more experience is required to define its role in the treatment of this patient population.
Angiography ; Carotid Artery, Internal* ; Carotid Stenosis* ; Constriction, Pathologic ; Endarterectomy, Carotid ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Neurologic Manifestations ; Risk Factors ; Stents* ; Stroke ; Urokinase-Type Plasminogen Activator

BACKGROUND AND OBJECTIVES: Combination of ticlopidine and aspirin has been accepted as a standard antiplatelet regimen after coronary stenting because it reduced the rate of cardiac events and hemorrhagic-vascular compli-cations compared with intensive anticoagulation. Ticlopidine use, however, may accompany serious side effects such as neutropenia or liver dysfunction. Cilostazol, a c-AMP phosphodiesterase inhibitor, is a novel antiplatelet agent which is known to have less side effects. MATERIALS AND METHODS: We compared the efficacy and safety of ci lostazol plus aspirin (CA) with ticlopidine plus asprin (TA) after elective coronary stenting. Patients were randomly assigned to receive either CA or TA two days before stenting. The primary end point was a composite of angiographic stent thrombosis, death, myocardial infarction (Q or Non-Q), repeat intervention or bypass su rgery at 30 days. The secondary end points were hemorrhagic-vascular complications, or drug side effects such as neutropenia, thrombocytopenia, or any side effects requiring cessation of drugs at 30 days. RESULTS: After randomization of 300 patients equally to each group, 4 patients were excluded from the analysis: 1 failure of stenting, 3 follow-up loss. The primary end point was reached in 2 patients (1.4% ) in CA group and 3 patients (2.0% ) in TA group (p=1.0). The rate of hemorrhagic-vascular complications was not different between the gr oups (1.4% vs 2.0%, p=1.0). The incidence of significant drug-related side effects was not statistically different between CA group and TA group (0.7% vs 2.7%, p=0.37). However, serious side effect such as neutropenia was seen only in TA group. CONCLUSION: Compared with TA, CA has comparable effect for the prevention of stent thrombosis and major cardiac events with similar rate of hemorrhagic-complications and drug-related side effects after elective coronary-artery stenting. Thus CA regimen can be a safe alternative to TA in elective implantation of coronary artery stent.
Aspirin ; Coronary Vessels ; Follow-Up Studies ; Humans ; Incidence ; Liver Diseases ; Myocardial Infarction ; Neutropenia ; Random Allocation ; Stents ; Thrombocytopenia ; Thrombosis ; Ticlopidine*

Takayasu's arteritis is a chronic inflammatory disease of unknown etiology involving the aorta, major branches of aorta, and pulmonary arteries and leads either stenosis and occlusion of the involved artery or aneurysm formation or both. The clinical course and prognosis are variable according to two major prognostic factors, ie, complications and the pattern of the past clinical course, as well as by ESR. Though the aggressive medical and surgical treatment are required for patients with a major complication and a progressive course, surgical reconstruction entails a high incidence of suture line complications including stenosis or dilatation. Moreover all the vascular lesions are amenable for vascular surgery. Initial reports revealed excellent results of percutaneous transluminal angioplasty (PTA) in patients with Takayasu's arteritis. However the suboptimal results and restenosis have been the main limitations of the PTA. Stenting has some benefits for early elastic recoil of the fibrotic vessels and restenosis as in other large vessels in Takayasu's arteritis or atherosclerosis. We report early and long-term results of two cases of carotid stenting in patients with symptomatic carotid stenosis and Takayasu's arteritis, which revealed variable angiographic results according to clinical courses and recommend that stenting in Takayasu's arteritis may be another treatment modality in inactive Takayasu's arteritis.
Aneurysm ; Angioplasty ; Aorta ; Arteries ; Atherosclerosis ; Carotid Arteries* ; Carotid Stenosis ; Constriction, Pathologic ; Dilatation ; Follow-Up Studies* ; Humans ; Incidence ; Prognosis ; Pulmonary Artery ; Stents* ; Sutures ; Takayasu Arteritis

Surgical revascularization is very effective for the relief of chest pain, improvement of exercise tolerance and ventricular performance in certain ischemic heart diseases. Bypass graft angiography and native coronary angiography after coronary artery bypass graft(CABG) were required for the evaluation of graft patency, progression of the native coronary artery disease and to predict the prognosis of the patients after CABG. The cases included in this study involved 15 patients who underwent selective bypass graft angiography among 102 CABG cases. Thirty eight sites were bypassed by saphenous vein and two sites by internal mammary artery. The results were as follows: 1) The overall patency rate of the saphenous vein bypass graft was 76.3% and the two sites of the internal mammary artery bypass graft were both patent. 2) The patency rate of direct anastomosis was 86.2% and of sequential anastomosis, 44.4%. 3) In eight patients who underwent native coronary angiography, five patients showed progression of grafted coronary artery disease. Among them, two patients had accompanying progression of coronary artery disease in non-grafted vessels. 4) Follow up treadmill test performed in six patients showed improvement of exercise tolerance in all patients. 5) There was some increase in the ejection fraction of the left ventricle after CABG in six patients who received follow up left ventriculography.
Angiography* ; Chest Pain ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Exercise Test ; Exercise Tolerance ; Follow-Up Studies ; Heart Ventricles ; Humans ; Mammary Arteries ; Myocardial Ischemia ; Prognosis ; Saphenous Vein ; Transplants*

Twenty-one patients undergoing aortic valve replacement for pure aoritic regurgitation were studied retrospectively to evaluate the left ventricular function and internal dimension change before, 1-6 weeks(early postoperative) and 2-36 months after(late postoperative) aortic valve replacement by serial echocardiography. Postoperatively, NYHA function class improved remarkably (from 3.3+/-0.6 to 1.4+/-0.7). Early postoperatively, left ventricular end-diastolic dimension (EDD), left ventricular end-systolic dimension(ESD), left ventricular fractional shortenting(FS) significantly decreased in all patients(7.6+/-1.2cm vs 5.8+/-1.5cm P<0.001, 5.5+/-1.3cm vs 4.7+/-1.3cm P<0.001, 39+/-12% vs20+/-8% P<0.001 respectively). Interventricular septum thickness(IVS) and posterior wall thickness (PW) were slightly thickened before(1.4+/-0.3cm, 1.3+/-0.3cm respectively) and in the early postoperative period (1.3+/-0.4cm, 1.3+/-0.3cm respectively) without significant interval change. Late postoperatively, EDD and ESD decreased significantly (7.8+/-1.2cm vs 5.1+/-0.8cm P<0.01, 5.1+/-1.1cm vs 3.4+/-0.8cm P<0.001. respectively), and FS increased significantly (25+/-9% vs 34+/-9%, P<0.05). Among 3 patients of so called high risk group mentioned by Henry(22,33), ESD and FS improved to normal range in 2 patients, and ESD decreased to 4.4cm and FS increased to 33% in the other one. EDD and ESD decreased significantly in both group I(preoperative ESD<5.5cm) and group II(preoperative ESD<5.5cm), without no decrement difference between two groups, and there was a significant difference of FS decrement between group I and group II at early postoperative period. Preoperative ESD correlated highly with the early postoperative EDD(r=0.89) and ESD(r=0.87) with statistical significance, and moderately high with late postoperative EDD(r=0.45), ESD(r=0.50) and FS(r=0.42) without statistical signiticance. We concluded that there was significant improvement in left ventricular function in pure aortic regurgitation patients postoperatively. Preoperative left ventricular and systolic dimension above 5.5cm and fractional shortenting below 25% are not so reliabel index of poor postoperative prognosis.
Aortic Valve Insufficiency* ; Aortic Valve* ; Echocardiography* ; Humans ; Postoperative Period ; Prognosis ; Reference Values ; Retrospective Studies ; Ventricular Function, Left

Radiographic axial spondyloarthritis (r-axSpA), a chronic inflammatory disease, can cause significant radiographic damage to the axial skeleton. Regarding the pathogenic mechanism, association of r-axSpA with tumor necrosis factor (TNF) and the interleukin-23/17 (IL­23/IL­17) pathway has been reported. Development of extraarticular manifestations, including uveitis, inflammatory bowel disease, and psoriasis, has been reported in some patients. The pivotal role of human leukocyte antigenB27 in the pathogenesis of r-axSpA remains to be clarified. Symptoms usually start in late adolescence or early adulthood, and disease progression can vary in each patient, with clinical manifestations ranging from mild joint stiffness without radiographic changes to advanced manifestations including complete fusion of the spine, and severe arthritis of the hip, and could include peripheral arthritis and extraarticular manifestations. The modified New York criteria was used previously in diagnosis of r-axSpA. However, early diagnosis of the disease prior to development of bone deformity was required due to development of biological agents. As a result of Assessment of SpondyloArthritis international Society (ASAS), the classification was improved in part for diagnosis of spondyloarthritis prior to development of bone deformity. The diagnosis is based on comprehensive laboratory findings, physical examinations, and radiologic findings. Medical treatment for r-axSpA involves the use of a stepwise strategy, starting with administration of nonsteroidal anti-inflammatory drugs and physiotherapy, and progressing to sulfasalazine or methotrexate and biologics including TNF-α inhibitors or IL-17 inhibitors as needed. Use of Janus kinase inhibitors has been recently reported.

Radiographic axial spondyloarthritis (r-axSpA), a chronic inflammatory disease, can cause significant radiographic damage to the axial skeleton. Regarding the pathogenic mechanism, association of r-axSpA with tumor necrosis factor (TNF) and the interleukin-23/17 (IL­23/IL­17) pathway has been reported. Development of extraarticular manifestations, including uveitis, inflammatory bowel disease, and psoriasis, has been reported in some patients. The pivotal role of human leukocyte antigenB27 in the pathogenesis of r-axSpA remains to be clarified. Symptoms usually start in late adolescence or early adulthood, and disease progression can vary in each patient, with clinical manifestations ranging from mild joint stiffness without radiographic changes to advanced manifestations including complete fusion of the spine, and severe arthritis of the hip, and could include peripheral arthritis and extraarticular manifestations. The modified New York criteria was used previously in diagnosis of r-axSpA. However, early diagnosis of the disease prior to development of bone deformity was required due to development of biological agents. As a result of Assessment of SpondyloArthritis international Society (ASAS), the classification was improved in part for diagnosis of spondyloarthritis prior to development of bone deformity. The diagnosis is based on comprehensive laboratory findings, physical examinations, and radiologic findings. Medical treatment for r-axSpA involves the use of a stepwise strategy, starting with administration of nonsteroidal anti-inflammatory drugs and physiotherapy, and progressing to sulfasalazine or methotrexate and biologics including TNF-α inhibitors or IL-17 inhibitors as needed. Use of Janus kinase inhibitors has been recently reported.

Radiographic axial spondyloarthritis (r-axSpA), a chronic inflammatory disease, can cause significant radiographic damage to the axial skeleton. Regarding the pathogenic mechanism, association of r-axSpA with tumor necrosis factor (TNF) and the interleukin-23/17 (IL­23/IL­17) pathway has been reported. Development of extraarticular manifestations, including uveitis, inflammatory bowel disease, and psoriasis, has been reported in some patients. The pivotal role of human leukocyte antigenB27 in the pathogenesis of r-axSpA remains to be clarified. Symptoms usually start in late adolescence or early adulthood, and disease progression can vary in each patient, with clinical manifestations ranging from mild joint stiffness without radiographic changes to advanced manifestations including complete fusion of the spine, and severe arthritis of the hip, and could include peripheral arthritis and extraarticular manifestations. The modified New York criteria was used previously in diagnosis of r-axSpA. However, early diagnosis of the disease prior to development of bone deformity was required due to development of biological agents. As a result of Assessment of SpondyloArthritis international Society (ASAS), the classification was improved in part for diagnosis of spondyloarthritis prior to development of bone deformity. The diagnosis is based on comprehensive laboratory findings, physical examinations, and radiologic findings. Medical treatment for r-axSpA involves the use of a stepwise strategy, starting with administration of nonsteroidal anti-inflammatory drugs and physiotherapy, and progressing to sulfasalazine or methotrexate and biologics including TNF-α inhibitors or IL-17 inhibitors as needed. Use of Janus kinase inhibitors has been recently reported.

Hemorrhagic cystitis is potentially life-threatening sequellae of chemotherapy using oxazaphosphorine alkylating agents (cyclophosphamide and ifosfamide). Mesna contains a sulfhydryl group that is believed to bind acrolein within the urinary collecting system and reduce the hemorrhagic cystitis without affecting the chemotherapeutic potential. To date, about thirty cases of hypersensitivity or allergic reactions of the delayed and urticarial type associated with mesna have been reported. We reported two patients with systemic lupus erythematosus who developed facial rash and flushing associated with mesna which imitate malar rash.
Acrolein ; Alkylating Agents ; Cyclophosphamide ; Cystitis ; Drug Therapy ; Exanthema* ; Flushing ; Humans ; Hypersensitivity* ; Lupus Erythematosus, Systemic ; Mesna*