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Changes in vascular mechanics due to aging include elevated vascular impedance, diminished aorta distensibility, and an accelerated return of pulse wave reflection, which may increase the systolic workload on the heart. Classically, the accurate measurement of vascular mechanics requires the simultaneous recording of aortic pressure and flow signals. In practice, it is feasible to estimate arterial wave properties in terms of wave transit time (τw) and wave reflection index (RI) by using aortic pressure signal alone. In this study, we determined the τw and magnitudes of the forward (|Pf |) and backward (|Pb|) pressure waves in Long-Evans male rats aged 4 (n = 14), 6 (n = 17), 12 (n = 17), and 18 (n = 24) months, based on the measured aortic pressure and an assumed triangular flow (Qtri). The pulsatile pressure wave was the only signal recorded in the ascending aorta by using a high-fidelity pressure sensor. The base of the unknown Qtri was constructed using a duration, which equals to the ejection time. The timing at the peak of the triangle was derived using the fourth-order derivative of the aortic pressure waveform. In the 18-month-old rats, the ratio of τw to left ventricular ejection time (LVET) decreased, indicating a decline in the distensibility of the aorta. The increased |Pb| associated with unaltered |Pf | enhanced the RI in the older rats. The augmentation index (AI) also increased significantly with age. A significant negative correlation between the AI and τw/LVET was observed: AI = -0.7424 - 0.9026 × (τw/LVET) (r = 0.4901; P < 0.0001). By contrast, RI was positively linearly correlated with the AI as follows: AI = -0.4844 + 2.3634 × RI (r = 0.8423; P < 0.0001). Both the decreased τw/LVET and increased RI suggested that the aging process may increase the AI, thereby increasing the systolic hydraulic load on the heart. The novelty of the study is that Qtri is constructed using the measured aortic pressure wave to approximate its corresponding flow signal, and that calibration of Qtri is not essential in the analysis. [ABSTRACT FROM AUTHOR]

Background: Vascular closure devices such as angioseal are used as alternatives to traditional compression haemostasis. Although the safety and efficacy of angioseal are confirmed, their use remains controversial because of the potential complications of these devices compared with those of traditional compression haemostasis. The aim of this study was to compare the access site complication rate, the predictive factors for these complications, and patient comfort levels after coronary procedures with traditional compression or angioseal haemostasis. Methods: Data were collected from a cardiac unit in a medical center in northern Taiwan. A total of 130 adult patients were recruited and equally divided into two groups according to the method of haemostasis used after the coronary procedure: a traditional compression group and an angioseal group. We observed the incidence of access site complications, including bleeding, oozing, haematoma formation, and arteriovenous fistula formation. In addition, we used a 0-10 numeric rating scale to assess soreness, numbness, and back and groin access site pain after 1 h of catheter removal and immediately before getting out of bed. Results: The overall incidence of complications was 3.8 % (n = 5), which was not significantly different between the two groups (p = .06). The propensity score-adjusted multivariate analyses revealed that the only independent predictor for access site complications was an age of >70 years (OR, 10.44; 95 % CI, 1.81-60.06; p = .009). Comfort levels were higher in the angioseal group than in the traditional compression group. Conclusions: Angioseal used after coronary procedures did not increase the incidence of complications relative to that associated with traditional compression haemostasis; however, it increased patient comfort levels. Health personnel should pay special attention to the predictive factor for access site complications after coronary procedures, such as age >70 years. [ABSTRACT FROM AUTHOR]

Background: Studies have demonstrated that improvement in cardiovascular risk factors may contribute to reduced coronary artery disease (CAD) morbidity and mortality, improved patient outcomes, and lower medical costs associated with treating heart disease. Purpose: The purpose of this study was to understand the coronary risk factor profile, to have the knowledge of risk factors, to understand the modifying behaviors, and to understand the factors associated with modifying behaviors of cardiovascular risk factors among patients with CAD in northern Taiwan. Methods: A cross-sectional design was used in this study. Using nonprobability sampling, 156 patients diagnosed with CAD were interviewed and asked to complete a structural questionnaire in cardiovascular clinics at three medical centers in northern Taiwan. Data were analyzed by descriptive analysis, Pearson's correlation, chi-square tests, and stepwise multiple regression. Results: A total of 38% of variance of modifying behaviors was explained by self-efficacy, actual risk factors, work status, and health beliefs. Self-efficacy was the strongest predictor of behavior to modify cardiovascular risk factors. Age and type "A" personality were the two leading cardiovascular risk factors for the participants. Most participants could perform modifying behaviors such as taking medications, eating an appropriate diet, and following specific lifestyle recommendations. However, participants had relatively lower adherence to monitoring blood pressure, exercising regularly, and controlling weight. Conclusions/Implications for Practice: Nurses should assess patient cardiovascular risk factors, health beliefs, and self-efficacy and then provide comprehensive and adequate instruction to each based on his or her specific risk factors. [ABSTRACT FROM AUTHOR]

Abstract Backgrounds  Atherosclerotic stenosis of extracranial carotid arteries is an important cause of ischemic stroke in Taiwan, an ethnic Chinese population. Concurrent atherosclerotic arterial disease is an important issue in the management of patients with carotid stenosis, but its prevalence and extent are unknown. Methods  One hundred and sixty-three consecutive patients with angiographically proven significant cervical carotid artery stenosis (≥50% stenosis) were enrolled in this study. Angiography was done to document concurrent coronary, renal, and limb artery stenosis. Clinical symptoms and signs were also correlated with the angiographic findings. Results  One or more significant concurrent arterial stenotic disease was found in 73% of the patients. The most frequent were coronary artery disease, found in 68% of the patients, while renal artery stenosis and limb artery stenosis were found in 20% and 21% of the patients, respectively. Age, diabetes, history of angina pectoris, intermittent claudication, and asymmetric arm blood pressures were significantly associated with the presence of concurrent arterial stenosis. However, 41% of the patients with concurrent coronary artery disease did not have any clinical symptoms or history of myocardial infarction. Conclusions  Our data indicated that concurrent advanced and extensive arterial disease is common in patients with significant cervical carotid stenosis, and also suggest the importance of global evaluation of systemic atherosclerosis in these patients to achieve optimal management. [ABSTRACT FROM AUTHOR]

Background: The amino-terminal propeptides of type I and III procollagens (PINP and PIIINP) are markers reflecting the status of collagen turnover. We hypothesized that measurement of these serum procollagen propeptides could be used to non-invasively assess acute rejection in heart transplant recipients. Methods: In heart transplant recipients, endomyocardial biopsy specimens taken at 6 and 12 months after surgery were used for study. PINP and PIIINP were measured postoperatively at 3, 6, and 12 months. Results: A total of 20 male heart transplant patients and seven male control subjects were enrolled. Five patients showed rejection 6 months after transplantation (group 1), while 15 patients showed no rejection (group 2). In group 2 patients, serum PINP and PIIINP levels decreased significantly 6 months after transplantation. In contrast, elevation of serum PINP and PIIINP levels persisted in group 1 patients 6 months after transplantation. At 6 months after transplantation, group 1 patients had significantly higher PIIINP levels than group 2 patients (p=0.025) and controls (p=0.003). After immunosuppressive therapy, all group 1 patients were free of rejection 12 months after transplantation and serial serum PIIINP levels decreased significantly in these patients. Conclusions: Serum PIIINP levels represent a non-invasive method to reflect the occurrence and resolution of acute rejection. Clin Chem Lab Med 2007;45:1004–8. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility and safety of stent implantation to treat ostial vertebral artery stenosis. Method: Fifty-eight symptomatic patients (44 men; mean age 72 years, range 54 to 88) with 67 ostial vertebral artery lesions received 67 balloon-expandable coronary stents. Follow-up angiography was performed if restenosis was suspected or during later catheterization for other indications. Restenosis was defined as >50% diameter narrowing. Result Technical success was 100%. Periprocedural neurological complications included 2 (3.4%) posterior and 1 (1.7%) anterior strokes. Other complications included 1 (1.7%) massive gastrointestinal hemorrhage requiring blood transfusion and endoscopic therapy, 1 (1.7%) femoral pseudoaneurysm requiring surgical repair, and 1 (1.7%) large shoulder hematoma secondary to a ruptured small branch of the thoracoacromial artery. Antiplatelet medication was discontinued in the ulcer patient, and the vertebral stent occluded at 8 months. At a mean follow-up of 31.3±17.1 months, 1 (1.7%) patient died after coronary bypass 2 months after stenting. One (1.7%) patient reported recurrent dizziness at 14 months and had angiographic evidence of in-stent restenosis. Angiographic evaluation of 32 (48%) lesions at a mean 11.0±9.6 months uncovered restenosis in 8 (25%) vessels, including the 2 cases noted above. Aside from these 2 patients, none of the other patients with restenosis were symptomatic. Multivariant Cox regression analysis showed reference vessel diameter as the only independent predictor of restenosis. Conclusion: Symptomatic ostial vertebral artery stenosis can be treated with relative safety using coronary techniques and equipment. Reference vessel diameter was the only predictor of restenosis in vertebral artery ostial stents. [ABSTRACT FROM AUTHOR]

We report a new strategy—celiac artery stenting—to relieve stenosis of the celiac arterial root. This was performed in two patients with pancreaticoduodenal artery (PDA) aneurysm associated with a stenotic celiac arterial root. The first patient was a 66-year-old man complaining of abrupt onset of upper abdominal pain. Abdominal computed tomography revealed a huge retroperitoneal hematoma behind the duodenum, and superior mesenteric artery (SMA) angiography demonstrated an aneurysm arising from inferior pancreaticoduodenal artery and celiac arteriography showed a stenotic celiac arterial root. Transcatheter embolization of the aneurysm was tried, but failed. Because of his unstable hemodynamics, emergent laparotomy with resection of the aneurysm was performed. Fourteen days after the operation, percutaneous transluminal angioplasty with celiac arterial stenting was done. The patient was discharged 2 days later, and has had no further bleeding episode for 3 years. The second patient was a 46-year-old woman, who also complained of acute upper abdominal pain. Abdominal computed tomography disclosed a huge retroperitoneal hematoma, and selective SMA angiography demonstrated an aneurysm arising from the inferior pancreaticoduodenal artery, and celiac arteriography showed a stenotic celiac arterial root. Because angiography showed no active bleeding from the aneurysm, percutaneous transluminal angioplastic stenting of the stenotic celiac artery was performed. She was discharged 5 days later and has had no further bleeding episode for 2 years. Celiac arterial stenting, as shown in our two patients, could be easily and safely employed in patients with PDA aneurysm associated with a stenotic celiac arterial root to release the stenosis of the celiac arterial root and to prevent further possible bleeding. [ABSTRACT FROM AUTHOR]

Background: Stenting has been used as an alternative treatment for patients with internal carotid artery (ICA) stenosis. Color-coded duplex sonography (CDS) is able to measure not only the prestenting stenosis but also the poststenting hemodynamic changes. The purpose of this study was to quantify, using CDS, the hemodynamic changes after ICA stenting. Methods: Both symptomatic and asymptomatic patients were included in this study. The degree of ICA stenosis before stenting was required to be more than 50%. Thirty-two treated ICAs were included to compare the prestenting and poststenting CDS findings, including the diameter and cross-sectional area of the lumen, the flow peak systolic and end-diastolic velocities, the resistivity index and the amount of flow in bilateral extracranial carotid and vertebral arteries. Results: After stenting, the turbulent flow pattern in the stenotic ICA recovered to laminar flow, and the reversed ophthalmic flow direction normalized. Of the CDS parameters applied to evaluate the effect of stenting on ICA stenosis, the diameter, residual area, peak systolic velocity, diastolic velocity and the ration of systolic flow velocity ratio in the ICA to that in the common carotid artery (CCA) were altered significantly. The mean area and residual area of these stenotic ICAs showed increases of 24% (p = 0.005) and 84% (p = 0.001) after ICA stenting, respectively. The mean peak systolic flow velocity significantly decreased by 71%. The mean diastolic flow velocity also significantly decreased (by 77%). Both the systolic and diastolic velocities of the ipsilateral CCA significantly increased after stenting. The amount of flow in the contralateral ICA decreased significantly after stenting. The change in the amount of flow in the vertebral arteries after ICA stenting was insignificant. Conclusions: The results of this CDS study clearly demonstrated the hemodynamic changes after ICA stenting. The carotid stenting significantly changed the ICA flow pattern, diameter, residual area, peak systolic velocity and ICA to CCA velocity ratio. [ABSTRACT FROM AUTHOR]

Stenting for severe carotid stenosis has been proposed as an alternative for patients with high surgical risk for endarterectomy, but its effectiveness and safety has never been evaluated in large case series in a pure Asian population. One hundred and eighteen ethnic Chinese patients (mean age 72.8 years) with 129 severely narrowed carotid arteries were stented electively using self-expanding stents. The mean pre-treatment diameter stenosis was 85% and final residual diameter stenosis 14%. The peri-procedural stroke and death rate was 4.2%. One (0.8%) late ischemic stroke and 2 (1.7%) deaths occurred during a mean follow-up of 16.3 months, and the restenosis rate was 3.1%. Carotid stenting, therefore, can be done safely and effectively in Chinese patients.Copyright © 2002 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Discusses postprocedural complications after angioplasty with stenting of the internal carotid artery. Conclusion of the main results of the Carotid and Vertebral Artery Transluminal Angioplasty Study; Description of the patients; Background on hemodynamic compromise.

A fragment of fractured retention wire of an atrial I lead (Accufix) was found in the pulmonary artery in an asymptomatic patient by routine chest X ray, fluoroscopy, and pulmonary angiography. The lead itself looked normal in these imaging studies. Results after successful surgical removal was reported. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on the stent deployment for symptomatic ostial vertebral artery stenosis.