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      Renal Function and Survival – Lessons from Atheroembolic Disease

      Nephron Clinical Practice

      S. Karger AG

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          Atheroemboli to the brain: size threshold for causing acute neuronal cell death.

          The objective of this study was to investigate the dilemma posed by the observations that carotid angioplasty dislodges significant numbers of plaque fragments but is reported to have a low rate of neurologic consequences. We examined the fragments released by ex vivo carotid angioplasty. The smaller and most numerous were separated by size and injected into rats to determine the tolerance of the brain to microemboli. Ex vivo angioplasty was performed on a total of 20 human carotid plaques removed en bloc. Plaques were placed within polytetrafluoroethylene grafts, and three manipulations were performed: guide wire insertion, 3.5- or 4.0-mm balloon angioplasty, and 5-mm angioplasty with or without a Palmaz stent. After each manipulation, the lumen was flushed, effluent was collected, and fragments were counted under 100x magnification. Using 200-microm and 500-microm micropore mesh, we separated fragments by size into two groups: (1) less than 200 microm and (2) 200 to 500 microm. We then injected rats with saline alone (Group A), with 100 fragments less than 200 microm (Group B), or with 100 fragments 200 to 500 microm (Group C). Animals were euthanized at 1, 3, and 7 days, and brain sections were examined for cell viability and expression of HSP- 72. The total number of fragments dislodged from the plaques varied from 30 to 553. The mean number of fragments released with each manipulation was as follows: guide wire passage, 24; initial balloon angioplasty, 97; second balloon angioplasty, 68; and second angioplasty plus stent, 172. Sixteen of the 20 plaques dislodged fragments that were 1 mm or more in greatest dimension. There was no evidence of brain ischemia in Group A at any time. Group B also showed no injury at 1 or 3 days. However, injection of 200- to 500-microm fragments (Group C) caused a scattered pattern of neuronal cell death. At 7 days, brain sections from both Group B and Group C animals had a scattered pattern of ischemic neurons. There were no classic wedge-shaped infarctions. The brain appears to have a surprising tolerance for microembolization in the acute setting. Thus, carotid angioplasty may dislodge plaque fragments, but there may still be a low incidence of stroke. However, even small plaque fragments, less than 200 microm, may cause neuronal ischemia at later time points. Periprocedural microemboli could cause subtle neurologic dysfunction in late follow-up.
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            Author and article information

            Journal
            NEC
            Nephron Clin Pract
            10.1159/issn.1660-2110
            Nephron Clinical Practice
            S. Karger AG
            1660-2110
            2003
            May 2003
            17 November 2004
            : 94
            : 1
            : c1-c2
            Affiliations
            Nephrology, Transplantation and Urology, Guy’s and St. Thomas’ NHS Trust, London, UK
            Article
            70817 Nephron Clin Pract 2003;94:c1–c2
            10.1159/000070817
            © 2003 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            References: 9, Pages: 1
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/70817
            Categories
            Comment & Analysis

            Cardiovascular Medicine, Nephrology

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