Treatment of asymptomatic carotid disease with stenting: pro.

The assumptions upon which the decisions to treat asymptomatic patients are founded on landmark studies, such as the Asymptomatic Carotid Atherosclerotic Study (ACAS), the Veterans Affairs Cooperative Study (VA), and the Asymptomatic Carotid Surgical Trial (ACST). In total, these trials randomized more than 5,000 patients to surgical vs. medical therapy.

What is the clinical utility of a 6-month computed tomography in the follow-up of endovascular aneurysm repair patients?

Objective: A drawback of endovascular aneurysm repair (EVAR) is the need for ongoing surveillance. Follow-up schedules including 1-, 6-, and 12-month computed tomography (CT) established by regulatory trials have been carried into clinical practice without critical assessment. The utility of a 6-month CT, with its associated radiation exposure and contrast toxicity, obtained after a normal result at 1-month CT has not been established.

Isolated iliac artery aneurysms: a contemporary comparison of endovascular and open repair.

Objective: Iliac artery aneurysms are rare but associated with significant morbidity and mortality when ruptured. This study compares recent open and endovascular repairs of iliac aneurysms at a single institution.

Methods: Patients were identified and charts reviewed using ICD-9 and CPT codes for iliac artery aneurysm and open or endovascular repair performed between January 2000 and January 2006.

A randomized trial of carotid artery stenting with and without cerebral protection.

Background: The use of a distal filter cerebral protection device with carotid artery stenting is commonplace. There is little evidence, however, that filters are effective in preventing embolic lesions. This study examined the incidence of embolic phenomenon during carotid artery stenting with and without filter use.

Use of AngioJet mechanical thrombectomy for acute peripheral ischemia associated with stent fracture.

Stent fracture has been an uncommonly described etiology in the development of acute peripheral ischemia. We describe the utilization of a rheolytic thrombectomy catheter with thrombolytics for the rapid treatment of superficial femoral artery thrombosis after recanalization and subsequent stent fracture. The implications of stent fracture and the therapeutic maneuvers associated with their treatment in peripheral applications are discussed.

Thoracic endovascular aortic repair for traumatic aortic transection.

Background: Traumatic transection of the thoracic aorta is a highly morbid injury. Treatment may be delayed while attention focuses on concomitant injuries. Thoracic endovascular aortic repair (TEVAR) is effective but remains controversial in these often-young patients.

Contemporary results of open repair of ruptured descending thoracic and thoracoabdominal aortic aneurysms.

Objective: The purpose of this study was to evaluate the results of open repair for ruptured descending thoracic and thoracoabdominal aortic aneurysm (RDTAA).

Methods: A retrospective review identified 41 consecutive cases of open surgical repair in 40 patients presenting with nontraumatic, atherosclerotic RDTAA from 1996 to 2006. Patients with traumatic injuries or complicated dissections were excluded.

Nitric oxide-induced inhibition of smooth muscle cell proliferation involves S-nitrosation and inactivation of RhoA.

Nitric oxide (NO) acts as a vasoregulatory molecule that inhibits vascular smooth muscle cell (SMC) proliferation. Studies have illustrated that NO inhibits SMC proliferation via the extracellular signal-regulated kinase (ERK) pathway, leading to increased protein levels of the cyclin-dependent kinase inhibitor p21(Waf1/Cip1). The ERK pathway can be pro- or antiproliferative, and it has been demonstrated that the activation status of the small GTPase RhoA determines the proliferative fate of ERK signaling, whereby inactivation of RhoA influences ERK signaling to increase p21(Waf1/Cip1) and inhibit proliferation.

Inhaled carbon monoxide inhibits intimal hyperplasia and provides added benefit with nitric oxide.

Objective: Carbon monoxide (CO) and nitric oxide (NO) have both been shown to possess vasoprotective properties. NO has successfully inhibited intimal hyperplasia in both small-animal and large-animal experimental models, whereas CO has only been studied in rodents. Evidence suggests that these two molecules may exert their vascular effects through common as well as unique signaling pathways.

Biliverdin protects against polymicrobial sepsis by modulating inflammatory mediators.

Highly inducible heme oxygenase (HO)-1 is protective against acute and chronic inflammation. HO-1 generates carbon monoxide (CO), ferrous iron, and biliverdin. The aim of this study was to investigate the protective effects of biliverdin against sepsis-induced inflammation and intestinal dysmotility.

Inhibition of geranylgeranyltransferase I decreases generation of vascular reactive oxygen species and increases vascular nitric oxide production.

Background: Vascular injury with endothelial dysfunction results in an imbalance between the production of vasoprotective molecules such as nitric oxide (NO) and deleterious reactive oxygen species (ROS). The purpose of this work was to test the hypothesis that inhibition of geranylgeranyltransferase I (GG Tase I) reduces vascular injury by increasing vascular NO production while decreasing ROS generation.

Methods And Results: GGTI-298 decreased the formation of intimal hyperplasia at 14 days following balloon injury.

Nitric oxide modulates vascular inflammation and intimal hyperplasia in insulin resistance and the metabolic syndrome.

Type 2 diabetes mellitus (DM) and the metabolic syndrome, both characterized by insulin resistance, are associated with an accelerated form of atherosclerotic vascular disease and poor outcomes following vascular interventions. These vascular effects are thought to stem from a heightened inflammatory environment and reduced bioavailability of nitric oxide (NO). To better understand this process, we characterized the vascular injury response in the obese Zucker rat by examining the expression of adhesion molecules, the recruitment of inflammatory cells, and the development of intimal hyperplasia.

iNOS gene transfer for graft disease.

Vascular bypass surgery involves the use of a vascular conduit to circumvent a site of vascular compromise. Vascular graft failure continues to plague both the patients receiving and the surgeons performing these interventions. Demand for the development of a therapy to reduce intimal hyperplasia--the most common cause of bypass graft failure--is significant and has been the goal of many biotechnology groups.

Nitric oxide and arterial disease.

Nitric oxide (NO) is a molecule that has gained recognition as a crucial modulator of vascular disease. NO has a number of intracellular effects that lead to vasorelaxation, endothelial regeneration, inhibition of leukocyte chemotaxis, and platelet adhesion. Its role in vascular disease has been intensively investigated and further elucidated over the past two decades.

The emerging role of gene therapy in the treatment of cardiovascular diseases.

Cardiovascular disease is the number one source of morbidity and mortality in the United States. Therapies directed at a variety of cardiovascular diseases have blossomed over the last several decades. The advent of gene therapy, first as an intriguing tool, and subsequently with the early successes of gene trials involving the treatment of SCID, led to the development of gene therapy as a potentially exciting and viable therapy in cardiovascular diseases.

Safety of inhaled nitric oxide after lung transplantation.

Background: The present study tests the hypothesis that therapy with inhaled nitric oxide (iNO) at the time of lung transplantation in patients undergoing bilateral angle lung transplantation: (i) is safe; and (ii) does not increase either the duration of mechanical ventilation or the incidence of acute graft dysfunction.

Methods: We conducted a prospective, non-randomized trial of iNO at 20 parts per million. The treatment group was comprised of 14 patients (10 females, 4 males) undergoing lung transplantation to address severe end-stage lung disease and pulmonary hypertension (mean pulmonary artery pressure > 30 mmHg).