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2. Choices of stent and cerebral protection in the ongoing ACST-2 trial: a descriptive study

Author

D.D. de Waard, A. Halliday, G.J. de Borst, R. Bulbulia, A. Huibers, R. Casana, L.H. Bonati, V. Tolva, G. Fraedrich, B. Rantner, E. Gizewski, I. Gruber, J. Hendriks, P. Cras, P. Lauwers, P. van Scheil, F. Vermassen, I. Van Herzeele, M. Geenens, D. Hemelsoet, P. Lerut, B. Lambrecht, G. Saad, A. Peeters, M. Bosiers, E. da Silva, N. de Luccia, J.C. Sitrangulo, A.E.V. Estenssoro, C. Presti, I. Casella, J.A.T. Monteiro, W. Campos, P. Puech-Leao, V. Petrov, C. Bachvarov, M. Hill, A. Mitha, J. Wong, C.-W. Liu, L. Bao, C. Yu, I. Cvjetko, V. Vidjak, J. Fiedler, S. Ostry, L. Sterba, P. Kostal, R. Staffa, R. Vlachovsky, M. Privara, Z. Kriz, B. Vojtisek, P. Krupa, M. Reif, V. Benes, P. Buchvald, L. Endrych, V. Prochazka, M. Kuliha, D. Otahal, T. Hrbac, D. Netuka, M. Mohapl, F. Kramier, M. Eldessoki, H. Heshmat, F. Abd-Allah, V. Palmiste, S. Margus, T. Toomsoo, J.-P. Becquemin, P. Bergeron, T. Abdulamit, J.-M. Cardon, S. Debus, G. Thomalla, J. Fiehler, C. Gerloss, U. Grzyska, M. Storck, E. LaMacchia, H.H. Eckstein, H. Söllner, H. Berger, M. Kallmayer, H. Popert, A. Zimmermann, A. Guenther, C. Klingner, T. Mayer, J. Schubert, J. Zanow, D. Scheinert, U. Banning-Eichenseer, Y. Bausback, D. Branzan, S. Braünilch, J. Lenzer, A. Schidt, H. Staab, M. Ulirch, J. Barlinn, K. Haase, A. Abramyuk, U. Bodechtel, J. Gerber, C. Reeps, T. Pfeiffer, G. Torello, A. Cöster, A. Giannoukas, K. Spanos, M. Matsagkas, S. Koutias, S. Vasdekis, J. Kakisis, K. Moulakakis, A. Lazaris, C. Liapas, E. Brountzos, M. Lazarides, N. Ioannou, A. Polydorou, B. Fulop, E. Fako, E. Voros, M. Bodosi, T. Nemeth, P. Barzo, S. Pazdernyik, L. Entz, Z. Szeberin, E. Dosa, B. Nemes, Z. Jaranyi, S. Pazdernyia, P. Madhaban, A. Hoffman, E. Nikolsky, R. Beyar, R. Silingardi, A. Lauricella, G. Coppi, E. Nicoloci, N. Tusini, F. Strozzi, E. Vecchiati, M. Ferri, E. Ferrero, D. Psacharopulo, A. Gaggiano, A. Viazzo, L. Farchioni, G. Parlani, V. Caso, P. De Rangoy, F. Verzini, P. Castelli, M.L. DeLodovici, G. Carrafiello, A.M. Ierardi, G. Piffaretti, G. Nano, M.T. Occhiuto, G. Malacrida, D. Tealdi, S. Steghter, A. Stella, R. Pini, G. Faggioli, S. Sacca, M.D. Negri, M. Palombo, M.C. Perfumo, G.F. Fadda, H. Kasemi, C. Cernetti, D. Tonello, A. Visonà, N. Mangialardi, S. Ronchey, M.C. Altavista, S. Michelagnoli, E. Chisci, F. Speziale, L. Capoccia, P. Veroux, A. Giaquinta, F. Patti, R. Pulli, P. Boggia, D. Angiletta, G. Amatucci, F. Spinetti, F. Mascoli, E. Tsolaki, E. Civilini, B. Reimers, C. Setacci, G. Pogany, A. Odero, F. Accrocca, G. Bajardi, I. Takashi, E. Masayuki, E. Hidenori, B. Aidashova, N. Kospanov, S. Bakke, M. Skjelland, A. Czlonkowska, A. Kobayashi, R. Proczka, A. Dowzenko, W. Czepel, J. Polanski, P. Bialek, G. Ozkinis, M. Snoch-Ziólkiewicz, M. Gabriel, M. Stanisic, W. Iwanowski, P. Andziak, F.B. Gonçalves, V. Starodubtsev, P. Ignatenko, A. Karpenko, D. Radak, N. Aleksic, D. Sagic, L. Davidovic, I. Koncar, I. Tomic, M. Colic, D. Bartkoy, F. Rusnak, M. Gaspirini, P. Praczek, Z. Milosevic, V. Flis, A. Bergauer, N. Kobilica, K. Miksic, J. Matela, E. Blanco, M. Guerra, V. Riambau, P. Gillgren, C. Skioldebrand, N. Nymen, B. Berg, M. Delle, J. Formgren, T.B. Kally, P. Qvarfordt, G. Plate, H. Pärson, H. Lindgren, K. Bjorses, A. Gottsäter, M. Warvsten, T. Kristmundsson, C. Forssell, M. Malina, J. Holst, T. Kuhme, B. Sonesson, B. Lindblad, T. Kolbel, S. Acosta, L. Bonati, C. Traenka, M. Mueller, T. Lattman, M. Wasner, E. Mujagic, A. Von Hessling, A. Isaak, P. Stierli, T. Eugster, L. Mariani, C. Stippich, T. Wolff, T. Kahles, R. Toorop, F. Moll, R. Lo, A. Meershoek, A.K. Jahrome, A.W.F. Vos, W. Schuiling, R. Keunen, M. Reijnen, S. Macsweeney, N. McConachie, A. Southam, G. Stansby, T. Lees, D. Lambert, M. Clarke, M. Wyatt, S. Kappadath, L. Wales, R. Jackson, A. Raudonaitis, S. MacDonald, P. Dunlop, A. Brown, S. Vetrivel, M. Bajoriene, R. Gopi, C. McCollum, L. Wolowczyk, J. Ghosh, D. Seriki, R. Ashleigh, J. Butterfield, M. Welch, J.V. Smyth, D. Briley, U. Schulz, J. Perkins, L. Hands, W. Kuker, C. Darby, A. Handa, L. Sekaran, K. Poskitt, J. Morrison, P. Guyler, I. Grunwald, J. Brown, M. Jakeways, S. Tysoe, D. Hargroves, G. Gunathilagan, R. Insall, J. Senaratne, J. Beard, T. Cleveland, S. Nawaz, R. Lonsdale, D. Turner, P. Gaines, R. Nair, I. Chetter, G. Robinson, B. Akomolafe, J. Hatfield, K. Saastamoinen, J. Crinnion, A.A. Egun, J. Thomas, S. Drinkwater, S. D'Souza, G. Thomson, B. Gregory, S. Babu, S. Ashley, T. Joseph, R. Gibbs, G. Tebit, A. Mehrzad, P. Enevoldson, D. Mendalow, A. Parry, G. Tervitt, A. Clifton, M. Nazzel, R. Peto, H. Pan, J. Potter, R. Bullbulia, B. Mihaylova, M. Flather, A. Mansfield, D. Simpson, D. Thomas, W. Gray, B. Farrell, C. Davies, K. Rahimi, M. Gough, P. Cao, P. Rothwell, A. Belli, M. Mafham, W. Herrington, P. Sandercock, R. Gray, C. Shearman, A. Molyneux, A. Gray, A. Clarke, M. Sneade, L. Tully, W. Brudlo, M. Lay, A. Munday, C. Berry, S. Tochlin, J. Cox, R. Kurien, and J. Chester

Subjects
Plaque echolucency, Time Factors, medicine.medical_treatment, Practice Patterns, 030204 cardiovascular system & hematology, Severity of Illness Index, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Risk Factors, Occlusion, Carotid artery stenosis, Carotid Stenosis, Practice Patterns, Physicians', Stroke, Endarterectomy, Plaque, Atherosclerotic, Endarterectomy, Carotid, Endovascular Procedures, Plaque, Atherosclerotic, Treatment Outcome, Cerebrovascular Circulation, Stents, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, Carotid artery stenting, medicine.medical_specialty, Clinical Decision-Making, education, Cerebral protection devices, Stent design, Surgery, Prosthesis Design, Asymptomatic, Embolic Protection Devices, 03 medical and health sciences, Severity of illness, medicine, Humans, Carotid, Chi-Square Distribution, Physicians', business.industry, Patient Selection, Stent, METANÁLISE, medicine.disease, Asymptomatic Diseases, Cerebrovascular Disorders, Stenosis, business, 030217 neurology & neurosurgery
Abstract

Objectives Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics. Materials and methods Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90–99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed. Results In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90–99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics. Conclusions In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.

Published
2017

3. Erratum to 'Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study' [Eur J Vasc Endovasc Surg 53 (2017) 617–625]

Author

D.D. de Waard, A. Halliday, G.J. de Borst, R. Bulbulia, A. Huibers, R. Casana, L.H. Bonati, V. Tolva, G. Fraedrich, B. Rantner, E. Gizewski, I. Gruber, J. Hendriks, P. Cras, P. Lauwers, P. van Scheil, F. Vermassen, I. Van Herzeele, M. Geenens, D. Hemelsoet, P. Lerut, B. Lambrecht, G. Saad, A. Peeters, M. Bosiers, E. da Silva, N. de Luccia, J.C. Sitrangulo, A.E.V. Estenssoro, C. Presti, I. Casella, J.A.T. Monteiro, W. Campos, P. Puech-Leao, V. Petrov, C. Bachvarov, M. Hill, A. Mitha, J. Wong, C.-W. Liu, L. Bao, C. Yu, I. Cvjetko, V. Vidjak, J. Fiedler, S. Ostry, L. Sterba, P. Kostal, R. Staffa, R. Vlachovsky, M. Privara, Z. Kriz, B. Vojtisek, P. Krupa, M. Reif, V. Benes, P. Buchvald, L. Endrych, V. Prochazka, M. Kuliha, D. Otahal, T. Hrbac, D. Netuka, M. Mohapl, F. Kramier, M. Eldessoki, H. Heshmat, F. Abd-Allah, V. Palmiste, S. Margus, T. Toomsoo, J.-P. Becquemin, P. Bergeron, T. Abdulamit, J.-M. Cardon, S. Debus, G. Thomalla, J. Fiehler, C. Gerloss, U. Grzyska, M. Storck, E. LaMacchia, H.H. Eckstein, H. Söllner, H. Berger, M. Kallmayer, H. Popert, A. Zimmermann, A. Guenther, C. Klingner, T. Mayer, J. Schubert, J. Zanow, D. Scheinert, U. Banning-Eichenseer, Y. Bausback, D. Branzan, S. Braünilch, J. Lenzer, A. Schidt, H. Staab, M. Ulirch, J. Barlinn, K. Haase, A. Abramyuk, U. Bodechtel, J. Gerber, C. Reeps, T. Pfeiffer, G. Torello, A. Cöster, A. Giannoukas, K. Spanos, M. Matsagkas, S. Koutias, S. Vasdekis, J. Kakisis, K. Moulakakis, A. Lazaris, C. Liapas, E. Brountzos, M. Lazarides, N. Ioannou, A. Polydorou, B. Fulop, E. Fako, E. Voros, M. Bodosi, T. Nemeth, P. Barzo, S. Pazdernyik, L. Entz, Z. Szeberin, E. Dosa, B. Nemes, Z. Jaranyi, S. Pazdernyia, P. Madhaban, A. Hoffman, E. Nikolsky, R. Beyar, R. Silingardi, A. Lauricella, G. Coppi, E. Nicoloci, N. Tusini, F. Strozzi, E. Vecchiati, M. Ferri, E. Ferrero, D. Psacharopulo, A. Gaggiano, A. Viazzo, L. Farchioni, G. Parlani, V. Caso, P. De Rangoy, F. Verzini, P. Castelli, M.L. DeLodovici, G. Carrafiello, A.M. Ierardi, G. Piffaretti, G. Nano, M.T. Occhiuto, G. Malacrida, D. Tealdi, S. Steghter, A. Stella, R. Pini, G. Faggioli, S. Sacca, M.D. Negri, M. Palombo, M.C. Perfumo, G.F. Fadda, H. Kasemi, C. Cernetti, D. Tonello, A. Visonà, N. Mangialardi, S. Ronchey, M.C. Altavista, S. Michelagnoli, E. Chisci, F. Speziale, L. Capoccia, P. Veroux, A. Giaquinta, F. Patti, R. Pulli, P. Boggia, D. Angiletta, G. Amatucci, F. Spinetti, F. Mascoli, E. Tsolaki, E. Civilini, B. Reimers, C. Setacci, G. Pogany, A. Odero, F. Accrocca, G. Bajardi, I. Takashi, E. Masayuki, E. Hidenori, B. Aidashova, N. Kospanov, S. Bakke, M. Skjelland, A. Czlonkowska, A. Kobayashi, R. Proczka, A. Dowzenko, W. Czepel, J. Polanski, P. Bialek, G. Ozkinis, M. Snoch-Ziólkiewicz, M. Gabriel, M. Stanisic, W. Iwanowski, P. Andziak, F.B. Gonçalves, V. Starodubtsev, P. Ignatenko, A. Karpenko, D. Radak, N. Aleksic, D. Sagic, L. Davidovic, I. Koncar, I. Tomic, M. Colic, D. Bartkoy, F. Rusnak, M. Gaspirini, P. Praczek, Z. Milosevic, V. Flis, A. Bergauer, N. Kobilica, K. Miksic, J. Matela, E. Blanco, M. Guerra, V. Riambau, P. Gillgren, C. Skioldebrand, N. Nymen, B. Berg, M. Delle, J. Formgren, T.B. Kally, P. Qvarfordt, G. Plate, H. Pärson, H. Lindgren, K. Bjorses, A. Gottsäter, M. Warvsten, T. Kristmundsson, C. Forssell, M. Malina, J. Holst, T. Kuhme, B. Sonesson, B. Lindblad, T. Kolbel, S. Acosta, L. Bonati, C. Traenka, M. Mueller, T. Lattman, M. Wasner, E. Mujagic, A. Von Hessling, A. Isaak, P. Stierli, T. Eugster, L. Mariani, C. Stippich, T. Wolff, T. Kahles, R. Toorop, F. Moll, R. Lo, A. Meershoek, A.K. Jahrome, A.W.F. Vos, W. Schuiling, R. Keunen, M. Reijnen, S. Macsweeney, N. McConachie, A. Southam, G. Stansby, T. Lees, D. Lambert, M. Clarke, M. Wyatt, S. Kappadath, L. Wales, R. Jackson, A. Raudonaitis, S. MacDonald, P. Dunlop, A. Brown, S. Vetrivel, M. Bajoriene, R. Gopi, C. McCollum, L. Wolowczyk, J. Ghosh, D. Seriki, R. Ashleigh, J. Butterfield, M. Welch, J.V. Smyth, D. Briley, U. Schulz, J. Perkins, L. Hands, W. Kuker, C. Darby, A. Handa, L. Sekaran, K. Poskitt, J. Morrison, P. Guyler, I. Grunwald, J. Brown, M. Jakeways, S. Tysoe, D. Hargroves, G. Gunathilagan, R. Insall, J. Senaratne, J. Beard, T. Cleveland, S. Nawaz, R. Lonsdale, D. Turner, P. Gaines, R. Nair, I. Chetter, G. Robinson, B. Akomolafe, J. Hatfield, K. Saastamoinen, J. Crinnion, A.A. Egun, J. Thomas, S. Drinkwater, S. D'Souza, G. Thomson, B. Gregory, S. Babu, S. Ashley, T. Joseph, R. Gibbs, G. Tebit, A. Mehrzad, P. Enevoldson, D. Mendalow, A. Parry, G. Tervitt, A. Clifton, M. Nazzel, R. Peto, H. Pan, J. Potter, R. Bullbulia, B. Mihaylova, M. Flather, A. Mansfield, D. Simpson, D. Thomas, W. Gray, B. Farrell, C. Davies, K. Rahimi, M. Gough, P. Cao, P. Rothwell, A. Belli, M. Mafham, W. Herrington, P. Sandercock, R. Gray, C. Shearman, A. Molyneux, A. Gray, A. Clarke, M. Sneade, L. Tully, W. Brudlo, M. Lay, A. Munday, C. Berry, S. Tochlin, J. Cox, R. Kurien, and J. Chester

Subjects
medicine.medical_specialty, Surgery, Cardiology and Cardiovascular Medicine, business.industry, Published Erratum, medicine.medical_treatment, Physical therapy, medicine, MEDLINE, Stent, Descriptive research, business
Published
2017
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6. Quality of life before surgery is a predictive factor for satisfaction among patients undergoing sympathectomy to treat hyperhidrosis.

Author

Wolosker, Nelson, Yazbek, Guilherme, de Campos, José Ribas Milanez, Munia, Marco Antonio, Kauffman, Paulo, Jatene, Fábio Biscegli, and Puech-Leao, Pedro

Subjects
HYPERHIDROSIS treatment, POSTOPERATIVE period, QUALITY of life, SYMPATHECTOMY, CHEST endoscopic surgery, PREOPERATIVE period, COMPARATIVE studies, PATIENT satisfaction
Abstract

Purpose: The objective of this study was to evaluate the postoperative quality of life (QOL) experienced among a group of 1167 patients who underwent video-assisted thoracoscopic sympathectomy (VATS) to treat primary hyperhidrosis, as compared with the presurgical QOL. Methods: Between February 2002 and June 2007, 1167 patients who had undergone VATS were surveyed. The majority had presented with palmar hyperhidrosis (794 patients; 68%), while 340 (29%) had presented with axillary hyperhidrosis. Based on data obtained from the QOL protocol applied to all of the patients preoperatively, the patients were divided into two groups according to the level of their QOL: group 1 consisted of 312 patients (27%) with poor QOL and group 2 of 855 patients (73%) with very poor QOL. The same protocol was applied postoperatively, and five different levels of satisfaction were obtained. The same parameters were evaluated for both the palmar and the axillary hyperhidrosis subgroups. Results: The patients with very poor QOL had much better results in terms of improvement in QOL than did those with poor QOL (P < .05). The same result was observed for both the palmar and axillary hyperhidrosis subgroups (P < .05). Conclusion: The worse the preoperative QOL among patients undergoing sympathectomy to treat primary hyperhidrosis is, the better the postoperative improvement in QOL will be. [Copyright &y& Elsevier]

Published
2010
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7. Comparison of pain severity following video-assisted thoracoscopic sympathectomy: electric versus harmonic scalpels.

Author

de Campos, José Ribas Milanez, Wolosker, Nelson, Yazbek, Guilherme, Munia, Marco Antonio, Kauffman, Paulo, Puech-Leao, Pedro, and Jatene, Fábio Biscegli

Abstract

The aim of this study was to compare the severity of pain over a 30-day period in a group of 1515 patients who underwent video-assisted thoracoscopic sympathectomy (VATS) to treat primary hyperhidrosis, among whom 929 were treated using electric scalpels and 586 using harmonic scalpels. From February 2000 to June 2008, 1515 patients scheduled for VATS were prospectively surveyed. They were divided into two groups according to whether electric or harmonic scalpels would be used. The patients filled out a protocol at every visit according to their subjective perception of pain, evaluating it on a scale from 0 to 10, such that 0 represented no pain and 10, maximum pain. The severity was recorded as null when the score was 0; slight, 1-4; moderate, 5-7; or severe, 8-10. The results from the evaluations were compared between the two groups. Only 152 patients did not present postoperative pain. No significant association was found between the type of scalpel used and the severity of the pain. There was no difference between harmonic and electric scalpel use in the levels of thoracic pain during the first 30 days after VATS.

Published
2010
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8. Predictive factors for rupture of thoracoabdominal aortic aneurysm

Author

Lobato, A.C. and Puech-Leao, P.

Abstract

Purpose: To identify the predictive risk factors for rupture of thoracoabdominal aortic aneurysms (TAA). Methods: Thirty-one patients with TAA who did not have the indications for surgical repair of the aneurysm were selected. Inclusion criteria were maximum diameter less than 60 mm, refusal of surgical treatment, and high surgical risk. The selected patients participated in a prospective follow-up study for a median period of 47 months and underwent at least two thoracoabdominal computed tomographic scans a year to measure transverse and anteroposterior diameters. Identification of the predictive factors associated with rupture was undertaken with multivariate analysis by means of Cox regression model. Results: During the study period five patients underwent elective repair, six died of unrelated causes, nine had aneurysms that ruptured (all with diameters greater than 50 mm), and 11 reached the end of the study without rupture or surgical management. Initial anteroposterior diameter and annual growth rate of the anteroposterior diameter were the variables associated with rupture of the TAA according to the multivariate statistical analysis by means of Cox regression model. Conclusions: We recommend elective repair for a fit patient with asymptomatic TAA with an initial anteroposterior diameter of 50 mm only when there is an annual growth rate of at least 10 mm. Patients with similar diameters but with smaller annual growth rates should be treated conservatively and undergo thoracoabdominal computed tomography every 6 months. Patients with an initial anteroposterior diameter of 60 mm and an annual growth rate of 6 mm should undergo surgical treatment. These guidelines for elective repair of TAA are based on the results of a relatively small series and have to be carefully individualized for each patient. (J Vasc Surg 1998;27:446-53.)

Published
1998
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9. Symptoms of anxiety and depression and their relationship with barriers to physical activity in patients with intermittent claudication

Author

Ragazzo, Luciana, Puech-Leao, Pedro, Wolosker, Nelson, de Luccia, Nelson, Saes, Glauco, Ritti-Dias, Raphael M., Cucato, Gabriel Grizzo, Ferreira Kamikava, Debora Yumi, and Zerati, Antonio Eduardo

Abstract

Although the practice of physical exercise in patients with intermittent claudication (IC) is often encouraged, adherence is low. The difficulty in performing physical training may be related to the psychological characteristics of patients with claudication. To verify the association between anxiety and depression symptoms and barriers to physical exercise and walking capacity in patients with IC.

Published
2021
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10. Relationship between gait speed and physical function in patients with symptomatic peripheral artery disease

Author

Correia, Marilia de Almeida, Cucato, Gabriel Grizzo, Lanza, Fernanda Cordoba, Peixoto, Roger André Oliveira, Zerati, Antonio Eduardo, Puech-Leao, Pedro, Wolosker, Nelson, and Ritti-Dias, Raphael Mendes

Abstract

The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD).

Published
2019
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12. Effects of Isometric Handgrip Training in Patients With Peripheral Artery Disease: A Randomized Controlled Trial.

Author

A Correia M, Oliveira PL, Farah BQ, Vianna LC, Wolosker N, Puech-Leao P, Green DJ, Cucato GG, and Ritti-Dias RM

Subjects
Aged, Brazil, Female, Humans, Intermittent Claudication diagnosis, Intermittent Claudication physiopathology, Male, Middle Aged, Peripheral Arterial Disease diagnosis, Peripheral Arterial Disease physiopathology, Recovery of Function, Time Factors, Treatment Outcome, Brachial Artery physiopathology, Exercise Therapy, Hand Strength, Hemodynamics, Intermittent Claudication therapy, Isometric Contraction, Peripheral Arterial Disease therapy, Vascular Stiffness
Abstract

Background Meta-analyses have shown that isometric handgrip training (IHT) can reduce brachial systolic and diastolic blood pressure (BP) by >6/4 mm Hg, respectively. However, whether IHT promotes these effects among patients with peripheral artery disease, who exhibit severe impairment in cardiovascular function, is currently unknown. This study aimed to evaluate the effects of IHT on the cardiovascular function of patients with peripheral artery disease. Methods and Results A randomized controlled trial with peripheral artery disease patients assigned to either the IHT or control group was conducted. The IHT group performed 3 sessions per week, for 8 weeks, of unilateral handgrip exercises, consisting of 4 sets of isometric contractions for 2 minutes at 30% of maximum voluntary contraction and a 4-minute interval between sets. The control group received a compression ball in order to minimize the placebo effects, representing sham training. The primary outcome was brachial BP. The secondary outcomes were central BP, arterial stiffness parameters, cardiac autonomic modulation, and vascular function. The IHT program reduced diastolic BP (75 [10] mm Hg preintervention versus 72 [11] mm Hg postintervention), with no change in the control group (74 [11] mm Hg preintervention versus 74 [11] mm Hg postintervention), with this between-group difference being significant ( P =0.04). Flow-mediated dilation improved in the IHT group (6.0% [5.7] preintervention versus 9.7% [5.5] postintervention), with no change in the control group (7.6% [5.5] preintervention versus 7.4% [5.1] postintervention), with this between-group difference being significant ( P =0.04). There was no change in other measured variables over the intervention period. Conclusions IHT reduced brachial diastolic BP and improved local vascular function in patients with peripheral artery disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02742220.

Published
2020
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13. Phage display identification of CD100 in human atherosclerotic plaque macrophages and foam cells.

Author

Luque MC, Gutierrez PS, Debbas V, Martins WK, Puech-Leao P, Porto G, Coelho V, Boumsell L, Kalil J, and Stolf B

Subjects
Analysis of Variance, Blotting, Western, CD36 Antigens metabolism, Cell Surface Display Techniques, Cells, Cultured, DNA Primers genetics, Fluorescent Antibody Technique, Humans, Immunohistochemistry, Nerve Tissue Proteins metabolism, Plaque, Atherosclerotic metabolism, RNA, Messenger metabolism, Receptors, Cell Surface metabolism, Reverse Transcriptase Polymerase Chain Reaction, Antigens, CD metabolism, Biomarkers metabolism, Foam Cells metabolism, Macrophages metabolism, Plaque, Atherosclerotic chemistry, Semaphorins metabolism
Abstract

Atherosclerosis is a complex disease in which vessels develop plaques comprising dysfunctional endothelium, monocyte derived lipid laden foam cells and activated lymphocytes. Considering that humans and animal models of the disease develop quite distinct plaques, we used human plaques to search for proteins that could be used as markers of human atheromas. Phage display peptide libraries were probed to fresh human carotid plaques, and a bound phage homologous to plexin B1, a high affinity receptor for CD100, was identified. CD100 is a member of the semaphorin family expressed by most hematopoietic cells and particularly by activated T cells. CD100 expression was analyzed in human plaques and normal samples. CD100 mRNA and protein were analyzed in cultured monocytes, macrophages and foam cells. The effects of CD100 in oxLDL-induced foam cell formation and in CD36 mRNA abundance were evaluated. Human atherosclerotic plaques showed strong labeling of CD100/SEMA4D. CD100 expression was further demonstrated in peripheral blood monocytes and in in vitro differentiated macrophages and foam cells, with diminished CD100 transcript along the differentiation of these cells. Incubation of macrophages with CD100 led to a reduction in oxLDL-induced foam cell formation probably through a decrease of CD36 expression, suggesting for the first time an atheroprotective role for CD100 in the human disease. Given its differential expression in the numerous foam cells and macrophages of the plaques and its capacity to decrease oxLDL engulfment by macrophages we propose that CD100 may have a role in atherosclerotic plaque development, and may possibly be employed in targeted treatments of these atheromas.

Published
2013
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14. Test-retest reliability of isokinetic strength and endurance tests in patients with intermittent claudication.

Author

Ritti-Dias RM, Basyches M, Câmara L, Puech-Leao P, Battistella L, and Wolosker N

Subjects
Aged, Ankle Brachial Index, Humans, Intermittent Claudication diagnosis, Middle Aged, Peripheral Arterial Disease diagnosis, Reproducibility of Results, Torque, Exercise Test methods, Exercise Test standards, Intermittent Claudication physiopathology, Muscle Strength physiology, Peripheral Arterial Disease physiopathology, Physical Endurance physiology
Abstract

The objective was to determine the reliability of isokinetic strength and endurance testing in the ankle joints of patients with intermittent claudication. Twenty-three patients with peripheral artery disease (PAD) and symptoms of intermittent claudication participated in the study. Isokinetic strength and endurance testing of the ankle joint were performed in symptomatic and asymptomatic legs on 3 separate days. Intraclass coefficient correlation of peak torque (PT) and total work (TW) ranged from 0.77 to 0.92 and 0.89 to 0.96, respectively. PT and TW increased significantly and similarly in both legs from day 1 to day 2 (PT: +42 +/- 84% in the symptomatic leg and +33 +/- 51% in the asymptomatic leg, p < 0.05;TW: +38 +/- 26% in the symptomatic leg and +26 +/- 50% in the asymptomatic leg, p < 0.05). In conclusion, isokinetic strength and endurance testing in the ankle joints of patients with PAD presents reliability coefficients ranging from 0.77 to 0.96. However, strength and endurance increased between the first and the other test sessions performed on separate days, suggesting that two test sessions are necessary for the accurate evaluation of strength and endurance in patients with PAD.

Published
2010
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