Abstract Background: Carotid artery stenting (CAS) is considered an important tool in carotid revascularization. Carotid artery stenting is usually performed by using self-expandable stent with different designs. The stent design influences many physical characteristics. Also, it may affect the complication rate with special relevance to perioperative stroke, hemodynamic instability, and late restenosis.

Methods: This study comprised all consecutive patients who underwent carotid artery stenting for atherosclerotic carotid stenosis from March 2014 to May 2021. Both symptomatic patient and asymptomatic patients were included. Patients with a symptomatic carotid stenosis of ≥50% or asymptomatic carotid stenosis of ≥60% were selected for carotid artery stenting . Patients with fibromuscular dysplasia and acute or unstable plaque were not included. Variables of clinical relevance were tested in multivariable analysis using binary logistic regression model.

Results: A total of 728 patients were enrolled. The majority of this cohort was asymptomatic (578/728, 79.4%), while 150/ 728 (20.6%) were symptomatic. The mean degree of carotid stenosis was 77.82 ± 4.73%, with a mean plaque length of 1.76 ± 0.55 cm. A total of 277 (38%) patients were treated with Xact® Carotid Stent System. Successful carotid artery stenting was achieved in 698 (96%) of patients. Of these patients, stroke rate in symptomatic patients was nine (5.8%), while in asymptomatic patients was 20 (3.4%). In a multivariable analysis, the open-cell carotid stent was not associated with a differential risk for combined acute and sub-acute neurologic complications as compared with closed-cell stents. Patients treated with open cell stents had a significantly lower rate of procedural hypotension (P 0.0188) at bivariate analysis.

Conclusion: Carotid artery stenting is considered a safe alternative to CEA that can be used in selected average surgical risk patient. Different stent designs can affect the rate of major adverse events in carotid artery stenting patients, but further studies are necessary with avoiding different bias to study the effect of different stent designs.

Abstract: Background:

Patients undergoing carotid endarterectomy (CEA) may experiment intraoperative neurologic deficits (IND) during carotid cross-clamping. This work aimed to assess the impact of the Gupta Perioperative Myocardial Infarct or Cardiac Arrest (MICA) risk calculator in the IND.

Methods: From January 2012 to April 2021, patients undergoing CEA with regional anaesthesia for carotid stenosis with IND and consecutively control operated patients without IND were selected. A regressive predictive model was created, and a receiver operating characteristic (ROC) curve was applied for comparison. A multivariable dependence analysis was conducted using a classification and regression tree (CRT) algorithm. Results: A total of 97 out of 194 included patients developed IND. Obesity showed aOR = 4.01 (95% CI: 1.66–9.67) and MICA score aOR = 1.21 (1.03–1.43). Higher contralateral stenosis showed aOR = 1.29 (1.08–1.53). The AUROC curve was 0.656. The CRT algorithm differentiated obese patients with a MICA score ≥ 8. Regarding non-obese patients, the model identified the presence of contralateral stenosis ≥ 55% with a MICA ≥ 10.

Conclusion: MICA score might play an additional role in stratifying patients for IND in CEA. Obesity was determined as the best discrimination factor, followed by a score ≥ 8. A higher ipsilateral stenosis degree is suggested to have a part in avoiding procedure-related IND. Larger studies might validate the benefit of MICA score regarding the risk of IND.

Keywords: carotid endarterectomy; carotid stenosis; major adverse cardiovascular events; survival analysis; MICA score; atherosclerosis; perioperative stroke

Objectives Vascular access (VA) dysfunction, typically associated with progressive stenosis with subsequent failure, is a major problem associated with significant morbidity in hemodialysis (HD) patients and increased health care expenditure. The study aim was to report VA patency outcomes after intervention for flow dysfunction detected by duplex ultrasonography (DUS) surveillance associated with the presence of clinical indicator(s).

Patients and methods This prospective observational study was conducted in a tertiary university hospital (October 2018–October 2020). Patients with end-stage renal disease with newly created VAs underwent routine DUS surveillance every 3 months. Identified cases fulfilling at least one clinical indicator were included and underwent preemptive interventions. Thrombosed VA and asymptomatic lesions were excluded. Surveillance was subsequently performed using clinical, DUS and HD criteria to detect a failing/failed access. Patient follow-up and access-related events were analyzed.

Results The median age of the study group was 51 years, and 59.4% were male. Native VA was the predominant one. The mean access age was 13.9 months. Arm swelling was the major clinical presentation (32.9%). Most lesions were stenotic (86.5%), and juxta-anastomotic (42.9%) was the most common site. Balloon angioplasty +/− venous stent was used in all included patients. Multivariate analysis revealed that decreased access age, occlusive, multiple lesions, and lesion length more than5cm were significant predictors of primary patency loss.

Conclusion This study highlights the role of regular surveillance to stay ahead of the anticipated access dysfunction and to intervene in a timely manner. Integrated and efficient team work between HD providers and the vascular surgeons is crucial.

Keywords: surveillance, vascular access, vascular access dysfunction.

Background:  Obesity has become a prevalent issue worldwide, leading to various complications such as hyperlipidemia, diabetes, and cardiovascular problems. Statins, as FDA approved anti-hyperlipidemic drugs still pose some concerns upon their administration. Recently, researchers have looked for natural products as an alternative to manage hyperlipidemia and obesity. Aim: This work aimed to study the hypolipidemic effect of Lepidium sativum garden cress (GC) from differen preparations; orally administered seeds, and hydrogel, in comparison to atorvastatin. Methods:  GC hydrogel was prepared from the GC aqueous extract and pharmaceutically evaluated for it pH, spreadability, seeds content, homogeneity, rheology, and in vitro release. The rat’s body weight, bloo glucose levels, total lipid profile, and liver biomarkers were evaluated on obese rats for one month. In addition, the histopathology study was also performed. Results: GC hydrogel had acceptable pharmaceutical properties and showed a sustained release performance over 24h. Oral and topical GC significantly reduced the lipid profiles, blood sugar and AT, AST level than the negative control group and comparable to atorvastatin. It was found that oral GC showed significant effect on the percentage decrease in the rat’s body weight than the applied hydrogel. Histopathology study revealed a better outcome in the histological structure of pancreas and liver compared with rats feed on high fat diet post-treatment for one month. Conclusion:  GC orally administered, or topically applied hydrogel could be a promising, safe alternative formulation to atorvastatin in managing hyperlipidemia and normalizing body weight of obese rats