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Background Long-term outcome after endarterectomy of the femoral bifurcation has not been widely investigated, and the aim of this study was to assess its late results from a community-wide perspective. Patients and Methods Between 1983 and 2006 111 isolated endarterectomies of the common femoral artery and/or the proximal part of the superficial femoral artery or profunda femoris were performed in 90 patients at the Oulu University Hospital, Oulu, Finland. A total of 77 limbs were treated surgically for claudication and 34 others for critical limb ischemia. Angiographic findings of 100 extremities were evaluated. Results The in-hospital mortality rate was 1.8%. The mean follow-up period was 5.9 years. At 5-, 10-, and 15-year follow-up the overall survival was 60.5%, 32.7%, and 17.6%, respectively (S.E < 0.05). A C-reactive protein value ≥ 10 mg/l was predictive of poor late survival ( p = 0.008). Limb salvage rates after isolated femoral endarterectomy at 5-, 10-, and 15-year follow-up were 93.7%, 93.7%, and 85.2%, respectively (S.E. < 0.08). Critical limb ischemia ( p = 0.006) and current smoking ( p = 0.027) were independent predictors of major lower limb amputation. A total of 41 limbs were subjected to ipsilateral vascular procedures after femoral endarterectomy, only one of which was re-endarterectomy. Freedom from any ipsilateral revascularization procedure at 5-, 10-, and 15-year follow-up was calculated at 68.0%, 50.6%, and 42.5%, respectively (S.E. < 0.08). The overall linearized rate of reintervention on the ipsilateral limb was 0.16 ± 0.44/year. The linearized rate among patients who had any ipsilateral vascular reintervention was 0.43 ± 0.66/year. Conclusions Isolated femoral endarterectomy is a rather low-risk and durable procedure. However, a significant number of reinterventions distal or proximal to the endarterectomized site can be expected in one third of patients.

SUMMARY Objectives: The revascularization procedures become more and more popular to treat coronary artery disease, in many countries. Some patients are free of angina after revascularization, without any documented re-stenosis present with recurrent angina symptoms after a period of time. The aim of this work was to assess the efficacy of trimetazidine in the subpopulation of patients with a history of PTCA or CABG, who were included in the TRIMPOL II study. Methodology: A subgroup of 94 patients was retrospectively analysed from the Trimpol II study, a multicentre, double-blind randomised placebo-controlled trial in 426 patients with stable effort angina. These patients have a history of revascularization for coronary artery disease, and they are still symptomatic after 6 months despite a treatment with metoprolol (50 mg twice daily). They were randomly allocated to receive either trimetazidine (20 mg 3 times daily) or placebo for 12 weeks, on top of the β-blocker. Exercise test parameters, clinical efficacy and safety were assessed. Results were analysed using the Student test, the Mann-Whitney test or the Shapiro-Wilk test. Results: Compared to placebo, the 12-week treatment with trimetazidine significantly improved: time to 1 mm ST segment depression (385.1 s ± 144.6 s versus 465.0 s ± 143.8 s [p < 0.01]); exercise test duration (466.9 s ± 144.8 s versus 524.4 s ± 131.5 s [p = 0.048]), total workload (9.0 m.e. ± 2.4 m.e versus 10.1 m.e. ± 2.4 m.e [p = 0.035]) as well as time to onset of angina (433.6 s ± 164 s versus 508.1 s ± 132.4 s [p = 0.031]). Weekly number of angina attacks and nitrate consumption were significantly reduced in the trimetazidine group when compared to placebo. Three mild gastro-intestinal side-effects were reported in the trimetazidine group. Conclusion: These results show that trimetazidine provides anti-anginal efficacy in post-revascularized patients with recurrent angina despite a monotherapy with metoprolol. The treatment was well accepted.

Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy).

This chapter contains sections titled: Toe and foot amputations, debridements, and conservative treatment History of aggressive approach to limb salvage in patients with critical ischemia due to arteriosclerosis and evolution of the relationship between open bypass surgery and angiographic techniques and endovascular treatments Early use of endovascular techniques (angioplasty and stenting) with bypass surgery Current and future relationship between endovascular treatments and open bypass surgery Specific open surgical revascularization procedures Newer techniques for redo procedures after failed bypasses: thrombectomy and total or partial rescue of a failed ptfe bypass or at otally new bypass Conclusions References

This chapter contains sections titled: Introduction The problem of restenosis Pathobiologic events in restenosis: from growth regulatory factors to cell cycle genes Conclusions: is the end of restenosis possible?

This chapter contains sections titled: CABG surgery versus medical therapy PTCA versus medical therapy Theoretic considerations for comparison of CABG, PTCA, and medical therap Trials of PTCA versus CABG Relative effect of PTCA and CABG in patients with diabetes Effect of stents on outcome after revascularization Miscellaneous interventional device trials Limitations of current data Summary: overview of the evidence for myocardial revascularization in patients with chronic stable angina

BackgroundRevascularization after endovascular therapy for acute ischemic stroke is measured by the Thrombolysis In Cerebral Infarction (TICI) scale, yet variability exists in scale definitions. We examined the degree of reperfusion with the expanded TICI (eTICI) scale and association with outcomes in the HERMES collaboration of recent endovascular trials.MethodsThe HERMES Imaging Core, blind to all other data, evaluated angiography after endovascular therapy in HERMES. A battery of TICI scores (mTICI, TICI, TICI2C) was used to define reperfusion of the initial target occlusion defined by non-invasive imaging and conventional angiography.ResultsAngiography of 801 subjects was available, including 797 defined by non-invasive imaging (154 internal carotid artery (ICA), 583 M1, 60 M2) and 748 by conventional angiography (195 ICA, 459 M1, 94 M2). Among 729 subjects in whom the reperfusion grade could be established, using eTICI (3=100%, 2C=90–99%, 2b67=67–89%, 2b50=50–66%) of the conventional angiography target occlusion, there were 63 eTICI 3 (9%), 166 eTICI 2c (23%), 218 eTICI 2b67 (30%), 103 eTICI 2b50 (14%), 100 eTICI 2a (14%), 19 eTICI 1 (3%), and 60 eTICI 0 (8%). Modified Rankin Scale shift analyses from baseline to 90 days showed that increasing TICI grades were linked with better outcomes, with significant distinctions between TICI 0/1 versus 2a (p=0.028), 2a versus 2b50 (p=0.017), and 2b50 versus 2b67 (p=0.014).ConclusionsThe benefit of endovascular therapy in HERMES was strongly associated with increasing degrees of reperfusion defined by eTICI. The eTICI metric identified meaningful distinctions in clinical outcomes and may be used in future studies and routine practice.

Acute ischemic stroke affects men and women differently. In particular, women are often reported to experience higher acute stroke severity than men. We derived a low-dimensional representation of anatomical stroke lesions and designed a Bayesian hierarchical modeling framework tailored to estimate possible sex differences in lesion patterns linked to acute stroke severity (National Institute of Health Stroke Scale). This framework was developed in 555 patients (38% female). Findings were validated in an independent cohort (n = 503, 41% female). Here, we show brain lesions in regions subserving motor and language functions help explain stroke severity in both men and women, however more widespread lesion patterns are relevant in female patients. Higher stroke severity in women, but not men, is associated with left hemisphere lesions in the vicinity of the posterior circulation. Our results suggest there are sex-specific functional cerebral asymmetries that may be important for future investigations of sex-stratified approaches to management of acute ischemic stroke. Acute ischemic stroke impacts men and women differently. Here, the authors show how different lesion patterns in men and women are linked to the extent of stroke severity.