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Cardiovascular - General

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Effectiveness and Safety of Drug-Eluting Stents in Ontario (NEJM 2007) "Conclusions Drug-eluting stents are effective in reducing the need for target-vessel revascularization in patients at highest risk for restenosis, without a significantly increased rate of death or myocardial infarction."

Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. (Lancet. 2007)

Long-Term Safety and Efficacy of Drug-Eluting Stents. Two-Year Results of the REAL (REgistro AngiopLastiche dell'Emilia Romagna) Multicenter Registry. (Circulation. 2007)

The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting. (J Vasc Surg. 2007) "CONCLUSIONS: Elderly patients, defined as those aged >80 years, have a higher incidence of anatomy that increases the technical difficulty of performing CAS. This increase in unfavorable anatomy may be associated with complications during CAS. Although the small number of perioperative events does not allow for determination of a direct relationship with specific anatomic characteristics, the presence of unfavorable anatomy does warrant serious consideration during evaluation for CAS in elderly patients."

[Are drug-eluting stents dangerous?] (Rev Med Suisse. 2007) "Based on the information available to us today, appropriate patient selection, meticulous implantation technique and uninterrupted dual antiplatelet therapy (aspirin and clopidogrel) for six to twelve months after angioplasty appear to be the main ingredients for a successful and uncomplicated procedure."

Surgery May Be Better Than Stenting for CAD

Low HDL cholesterol predicts cardiovascular events after carotid stenting: a long-term survey. (J Thromb Haemost. 2007) "Conclusions: Low HDL cholesterol is an independent predictor of the long-term outcome after CAS. The combination of low HDL cholesterol and elevated inflammatory markers identified high-risk patients."

Stent-vs-surgery debate heats up again "Three new studies, published in the March 24, 2007 issue of BMJ, have questioned the clinical and cost effectiveness of stenting and suggest that surgery may be the better option for many patients."

Predictors of carotid stent restenosis. (Catheter Cardiovasc Interv. 2007) "Conclusions: Restenosis after carotid stenting is uncommon; however, patients with previous CEA or XRT are at increased risk. Restenotic lesions may be safely treated with further percutaneous interventions."

Almost Two-Thirds of Pacemaker Users Have Sleep Apnea "Two out of three people given pacemakers for heart problems were found to have sleep apnea, which could worsen their cardiac disease, French researchers report."

Stent Thrombosis in Randomized Clinical Trials of Drug-Eluting Stents (NEJM 2007) "Conclusions The incidence of stent thrombosis did not differ significantly between patients with drug-eluting stents and those with bare-metal stents in randomized clinical trials, although the power to detect small differences in rates was limited."

Analysis of 14 Trials Comparing Sirolimus-Eluting Stents with Bare-Metal Stents (NEJM 2007) " Conclusions The use of sirolimus-eluting stents does not have a significant effect on overall long-term survival and survival free of myocardial infarction, as compared with bare-metal stents. There is a sustained reduction in the need for reintervention after the use of sirolimus-eluting stents. The risk of stent thrombosis is at least as great as that seen with bare-metal stents."

Long-Term Outcomes with Drug-Eluting Stents versus Bare-Metal Stents in Sweden (NEJM 2007) "Conclusions Drug-eluting stents were associated with an increased rate of death, as compared with bare-metal stents. This trend appeared after 6 months, when the risk of death was 0.5 percentage point higher and a composite of death or myocardial infarction was 0.5 to 1.0 percentage point higher per year. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials."

Stent Thrombosis Redux - The FDA Perspective

A Pooled Analysis of Data Comparing Sirolimus-Eluting Stents with Bare-Metal Stents (NEJM 2007) "Conclusions In a pooled analysis of data from four trials comparing sirolimus-eluting stents and bare-metal stents, no significant differences were found between the two treatments in rates of death, myocardial infarction, or stent thrombosis."

Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. (Lancet. 2007) "INTERPRETATION: Late stent thrombosis was encountered steadily with no evidence of diminution up to 3 years of follow-up. Early and late stent thrombosis were observed with SES and with PES. Acute coronary syndrome at presentation and diabetes were independent predictors of stent thrombosis."

Unanswered Questions - Drug-Eluting Stents and the Risk of Late Thrombosis (NEJM 2007)

Majority of Drug-Coated Stent Use Not Approved by FDA "About 60 percent of the drug-coated stents that have become the center of intense controversy are being used in cases not approved by the U.S. Food and Drug Administration, new studies show. Although this was first reported in early February, the high incidence of so-called "off-label" use is published in a series of studies in the March 8 issue of the New England Journal of Medicine. The publication of the studies follows reports Monday of a U.S. House committee request for safety data from two key manufacturers of coated stents. "

Frequency, Etiology, Treatment, and Outcomes of Drug-Eluting Stent Thrombosis During One Year of Follow-Up (The American Journal of Cardiology 2007) "In conclusion, early clinical experience with DESs in routine clinical practice indicates a low risk of stent thrombosis, within the range previously reported for bare metal stent thrombosis. Further studies with longer follow-up will be required to definitively address long-term safety concerns."

Symptomatic failure after sirolimus-eluting stent implantation: A rare but challenging condition. (Can J Cardiol. 2007) "CONCLUSIONS: Restenosis after SES implantation occurs more commonly in a focal pattern in-body or at the proximal edge of the stent. Repeat SES implantation appears to be a safer and more effective therapeutic choice than balloon-only angioplasty."

The Rush to Stent: A Cause for Concern

Carotid Stenting for Asymptomatic Carotid Stenosis (Stroke. 2007)

Majority of Drug-Coated Stent Use Not Approved by FDA "About 60 percent of the drug-coated stents that have become the center of intense controversy are being used in cases not approved by the U.S. Food and Drug Administration, studies show. . The coated stents have FDA approval for use in patients with a single blocked artery who do not have any accompanying medical problems, such as diabetes. But the studies indicate that many patients are getting several stents, some under emergency conditions such as following a heart attack, even when there are other medical complications."

What's Up With Stents, Docs? " . almost everyone seems to agree that drug-eluting stents lead to a slightly greater risk of stent thrombosis seven or more months after implantation of the device. That's not surprising. Because the arterial lining doesn't grow back as quickly as with bare-metal stents, the metal mesh is exposed for longer, presenting a rough surface on which clots can form. Even Dr. Donald Baim, chief medical and scientific officer of Boston Scientific, which makes the Taxus stent, agreed with the point in an audio interview posted on the New England Journal's Web site. To compensate for the increased risk, the FDA panel recommended that patients stay on blood-thinning agents like aspirin and Plavix for at least 12 months afterward-an increase from the previous recommendation of 3-6 months. In addition, recipients should not undergo elective surgery during that time. Second, it's important to realize that stents are mainly effective for relief of angina. There's very little evidence that they prevent heart attacks or reduce deaths, except when implanted during a heart attack. That's because most heart attacks don't come from narrowed arteries, but from ruptured plaque, around which massive clots form."

Stent Thrombosis in Randomized Clinical Trials of Drug-Eluting Stents (NEJM 2007) " Conclusions The incidence of stent thrombosis did not differ significantly between patients with drug-eluting stents and those with bare-metal stents in randomized clinical trials, although the power to detect small differences in rates was limited."

Analysis of 14 Trials Comparing Sirolimus-Eluting Stents with Bare-Metal Stents (NEJM 2007) "Conclusions The use of sirolimus-eluting stents does not have a significant effect on overall long-term survival and survival free of myocardial infarction, as compared with bare-metal stents. There is a sustained reduction in the need for reintervention after the use of sirolimus-eluting stents. The risk of stent thrombosis is at least as great as that seen with bare-metal stents."

Long-Term Outcomes with Drug-Eluting Stents versus Bare-Metal Stents in Sweden (NEJM 2007) " Conclusions Drug-eluting stents were associated with an increased rate of death, as compared with bare-metal stents. This trend appeared after 6 months, when the risk of death was 0.5 percentage point higher and a composite of death or myocardial infarction was 0.5 to 1.0 percentage point higher per year. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials."

Safety and Efficacy of Sirolimus- and Paclitaxel-Eluting Coronary Stents (NEJM 2007) "Conclusions Stent thrombosis after 1 year was more common with both sirolimus-eluting stents and paclitaxel-eluting stents than with bare-metal stents. Both drug-eluting stents were associated with a marked reduction in target-lesion revascularization. There were no significant differences in the cumulative rates of death or myocardial infarction at 4 years."

A Pooled Analysis of Data Comparing Sirolimus-Eluting Stents with Bare-Metal Stents (NEJM 2007) "Conclusions In a pooled analysis of data from four trials comparing sirolimus-eluting stents and bare-metal stents, no significant differences were found between the two treatments in rates of death, myocardial infarction, or stent thrombosis."

Stenting gives uneven aid to patients at risk of stroke "Only patients with severe intracranial arterial stenosis may benefit from prophylactic stenting, according to a study from China in the February issue of Neurology. Evidence has been lacking to demonstrate that patients with symptomatic severe intracranial arterial stenosis faced a higher stroke risk after angioplasty and stenting than patients with moderate blockage disease. The latest study proved that patients in the former group actually benefit from preventive stenting, said Dr. Wei-Jian Jiang, an interventional neuroradiologist at the Capital University of Medical Sciences' Tiantan Hospital in Beijing. "

Enhanced inflammatory response to coronary stenting marks the development of clinically relevant restenosis. (Catheter Cardiovasc Interv. 2007) " Conclusions: Proinflammatory cytokines and inflammatory markers are released into the peripheral circulation early after coronary stenting, and increased levels of some are associated with clinically relevant restenosis."

Safety and efficacy of combined antiplatelet-warfarin therapy after coronary stenting. (Eur Heart J. 2007) "Conclusion Our study shows that the prognosis is unsatisfactory in warfarin-treated patients irrespective of the drug combination used. Aspirin plus warfarin combination seems to be inadequate to prevent stent thrombosis."

Drug-Eluting Stents Best After Artery Re-Closure "Using drug-coated stents to replace bare metal stents that have become blocked may be the best solution to reopening cardiac arteries and keeping them open, European researchers report. In fact, replacing bare metal stents with drug-coated stents cuts the risk of this re-closure, called restenosis, by 65 percent, compared with either balloon angioplasty or radiation treatment, the scientists added. Drug-eluting stents are coated with medications aimed at keeping restenosis at bay. The devices are considerably more expensive than bare-metal stents, however."

Late angiographic stent thrombosis after sirolimus-eluting stent implantation. (irc J. 2007)

Patients with drug stents need year of aspirin "Heart patients who had drug-coated stents inserted to prop open blocked coronary arteries should stay on anti-clotting drugs for at least a year, several doctor groups said in an advisory issued Tuesday. The advisory recommends that doctors tell their patients to take an anti-clotting drug like Plavix and aspirin for a year to reduce the risk of clotting, which could lead to a heart attack or death. The long-term safety of Plavix in stent patients has not been established."

Drug Side-Effects and Interactions

Thiazide Diuretics Exacerbate Fructose-Induced Metabolic Syndrome. (J Am Soc Nephrol. 2007)

Change Ordered to Warfarin Drug Label

Combined antiplatelet and anticoagulant therapy: clinical benefits and risks. (J Thromb Haemost. 2007)

An analysis of mortality rates with dual-antiplatelet therapy in the primary prevention population of the CHARISMA trial. (Eur Heart J. 2007) "Conclusion These findings do not support the use of dual-antiplatelet therapy with clopidogrel and aspirin in a primary prevention population. In this subgroup analysis, CV death occurred more frequently than anticipated."

Warfarin Linked to Higher Risk of Intracranial Hemorrhage in Nonwhite Patients "When warfarin is used to treat patients with atrial fibrillation (AF), the risk of intracranial hemorrhage (ICH) is significantly greater among blacks, Hispanics, and Asians than among whites, according to a paper in the Journal of the American College of Cardiology for July 24."

The Effect of Acetaminophen on the International Normalized Ratio in Patients Stabilized on Warfarin Therapy "Acetaminophen is often the preferred analgesic and antipyretic in patients receiving warfarin because of its perceived safety relative to aspirin and other nonsteroidal antiinflammatory drugs.[1] However, conflicting data have emerged over the years regarding a potential interaction between acetaminophen and oral anticoagulants. Early studies of this interaction are difficult to interpret in accordance with current monitoring standards because they were performed before the international normalization ratio (INR) became standard, they involved multiple oral anticoagulants,[2–6] or they had case-control designs.[7] … Conclusion: These findings support the existence of a clinically significant interaction between warfarin and daily use of acetaminophen 2–4 g, necessitating close monitoring of patients who receive this drug combination. Whether this interaction occurs when acetaminophen is taken in lower doses or is used sporadically requires further study."

Bleeding Complications With Warfarin Use (Arch Intern Med. 2007) "Conclusions Use of warfarin has increased, and bleeding from warfarin use is a prevalent reaction and an important cause of mortality. Consequently, a "black box" warning about warfarin's bleeding risk was added to the US product labeling in 2006. Physicians and nurses should tell patients to immediately report signs and symptoms of bleeding. A Medication Guide, which is required to be provided with each prescription, reinforces this message."

Evidence-Based Medicine and the Cochrane Collaboration on Trial "While evidence-based medicine is absolutely essential to comprehensive healthcare reform, it has been profoundly corrupted by money. . From this single well-designed study of anticoagulants came a startling result: The anticoagulants did not prevent deaths. . Based on the complication rate of anticoagulation for DVT or PE in much larger observational studies, anticoagulants kill 1000-4000 Americans with VTE each year due to internal bleeding, mostly in the brain. . The Cochrane peer reviewers (at least 4 out of 7 of which had undisclosed financial ties to the drug companies that make anticoagulants) delayed four years over releasing this review for publication. . Since anticoagulation researchers and FDA scientists chose not to rebut any of the data or conclusions of either review, the media was not interested, few physicians read the reviews, and no debate ensued. Researchers continue receiving lucrative contracts from drug companies for more anticoagulant trials. The medical establishment (drug companies, doctors, hospitals) keeps making money from the diagnosis and treatment of DVT and PE with anticoagulants (estimated total cost in 2007 will be $13 billion-$48 billion in the United States[15]), and medical journals keep publishing more anticoagulation trials without proper controls, which are dutifully covered by a compliant media, while thousands of DVT and PE patients keep bleeding to death."

Amiodaronoma: an unusual form of amiodarone-induced pulmonary toxicity (CMAJ 2007) "When initiating amiodarone therapy, a chest radiograph and the results of pulmonary function tests, including lung volumes and diffusion capacity, should be obtained as baseline mea-surements. Longitudinal serial pulmonary function tests for all patients taking amiodarone therapy are currently not recommended. Patient education about the signs and symptoms of amiodarone-induced pulmonary toxicity and regular clinical follow-up are essential."

High-Risk Patients Taking Aspirin at Greater Risk for CV Events With Ibuprofen "A new analysis of the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET) shows that ibuprofen, relative to the cyclooxygenase (COX)-2 inhibitor lumiracoxib (Prexige; Novartis Pharmaceuticals), increases the risk for thrombotic and congestive heart failure events among high cardiovascular-risk patients with osteoarthritis currently taking aspirin."

Hemorrhagic upper extremity complications from tissue plasminogen activator. (J Surg Orthop Adv. 2007) "Caution should be used particularly for IV sites, central lines, arterial catheterization, and pneumatic tourniquets, to avoid upper extremity hemorrhage."

Interaction Between Warfarin and Cranberry Juice (Pharmacotherapy. 2006)

Treatment of warfarin-associated intracerebral hemorrhage: literature review and expert opinion. (Mayo Clin Proc. 2007) "For warfarin-associated ICH, discontinuing warfarin therapy with administration of vitamin K does not reverse the hemostatic defect for many hours and is inadequate. Reasonable management based on expert opinion includes a wide range of additional measures to reverse anticoagulation in the absence of solid evidence."

Combined Aspirin-Oral Anticoagulant Therapy Compared With Oral Anticoagulant Therapy Alone Among Patients at Risk for Cardiovascular Disease (Arch Intern Med. 2007) "Conclusion Our findings question the current practice of using combined aspirin-OAC therapy except in patients with a mechanical heart valve, given the questionable benefits in reducing thromboembolic events and the increased risk of major bleeding."

The increasing incidence of anticoagulant-associated intracerebral hemorrhage (NEUROLOGY 2007) "Conclusions: The incidence of anticoagulant-associated intracerebral hemorrhage quintupled in our population during the 1990s. The majority of this change can be explained by increasing warfarin use. Anticoagulant-associated intracerebral hemorrhage now occurs at a frequency comparable to subarachnoid hemorrhage."

Anaphylactoid reaction to recombinant tissue plasminogen activator. (Eur J Emerg Med. 2007)

Subdural hematoma after a fall in an elderly patient taking high-dose omega-3 Fatty acids with warfarin and aspirin: case report and review of the literature. (Pharmacotherapy. 2007) " Omega-3 fatty acids, also known as fish oil, have been used for hyperlipidemia, coronary heart disease, hypertension, and other conditions. Some studies have demonstrated that consumption of fish oil concentrate, n-3 polyunsaturated fatty acid (n-3 PUFA), results in cardiovascular benefits that include reductions in mortality, sudden death, nonfatal myocardial infarction, and thrombotic stoke, as well as improvement in graft patency. The mechanism of action of n-3 PUFA is not completely understood, but a dual antiplatelet and anticoagulant effect has been proposed. Few data exist on whether or not fish oil can be used safely with other antiplatelet or anticoagulant drugs. We report the case of a patient who after a minor fall developed a subdural hematoma requiring craniotomy that likely was precipitated by concomitant use of high-dose omega-3 fatty acids 6 g/day with both aspirin and warfarin."

Drugs

Outpatient Management of Anticoagulation Therapy (Am Fam Physician 2007) "The ACCP guidelines recommend short-term warfarin therapy, with the goal of maintaining an International Normalized Ratio (INR) of 2.5 ± 0.5, after major orthopedic surgery. Therapy for venous thromboembolism includes an INR of 2.5 ± 0.5, with the length of therapy determined by associated conditions. For patients with atrial fibrillation, the INR is maintained at 2.5 ± 0.5 indefinitely; for most patients with mechanical valves, the recommended INR is 3.0 ± 0.5 indefinitely. Use of outpatient low-molecular-weight heparin (LMWH) is as safe and effective as inpatient unfractionated heparin for treatment of venous thromboembolism. The ACCP recommends starting warfarin with unfractionated heparin or LMWH for at least five days and continuing until a therapeutic INR is achieved. Because patients with venous thromboembolism and cancer who have been treated with LMWH have a survival advantage that extends beyond their venous thromboembolism treatment, the ACCP recommends beginning their therapy with three to six months of LMWH."

The Influence of Patient Adherence on Anticoagulation Control With Warfarin: Results From the International Normalized Ratio Adherence and Genetics (IN-RANGE) Study (Arch Intern Med 2007) "Conclusion Patients have substantial difficulties maintaining adequate adherence with warfarin regimens, and this poor adherence has a significant effect on anticoagulation control."

Comparison of Outcomes Among Patients Randomized to Warfarin Therapy According to Anticoagulant Control: Results From SPORTIF III and V (Arch Intern Med 2007) "Conclusions In patients with atrial fibrillation taking warfarin, the risks of death, MI, major bleeding, and stroke or SEE are related to INR control. Good INR control is important to improve patient outcomes."

Exercise

Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. (Circulation. 2007) "Habitual physical activity reduces coronary heart disease events, but vigorous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. This scientific statement discusses the potential cardiovascular complications of exercise, their pathological substrate, and their incidence and suggests strategies to reduce these complications. Exercise-associated acute cardiac events generally occur in individuals with structural cardiac disease."

Risks and Benefits of Exercise Reviewed in AHA Statement "A key point, said Dr. Thompson, is that doctors and allied healthcare professionals, while advocating regular physical activity, must keep in mind that some patients may not benefit from exercise. 'We always talk about the fact that exercise and physical activity has benefits, and that in adults, even if they have mild underlying heart disease or coronary atherosclerosis, the benefits of exercise outweigh the risks, and that's where most of the evidence lies,' he explained. 'But as we mention in this statement, some situations aren't improved by vigorous exercise, things like hypertrophic cardiomyopathy and anomalous coronary arteries. That's pretty obvious when you think about it, but it's an addition that hasn't been made before. The simple point that some doctors and cardiologists should take from this is that there are some groups who simply don't benefit from being engaged in vigorous exercise.' "

Effect of Impact Exercise on Physical Performance and Cardiovascular Risk Factors. (Med Sci Sports Exerc. 2007) "CONCLUSION:: The moderate-intensity exercise regimen, initially targeted at weight-bearing bones, improved cardiorespiratory fitness, speed-strength, and lipid profiles. In addition to bone health, impact exercise may be recommended for prevention of cardiovascular diseases."

Exercise training for patients with cardiovascular disease (Annales de Réadaptation et de Médecine Physique 2007)

[Exercise training in cardiovascular diseases] (Tidsskr Nor Laegeforen. 2007) "In patients with coronary heart disease, high intensity exercise seems to be more effective in improving maximal oxygen consumption than moderate exercise, but it is not known if such exercise is also more effective in improving survival. Further studies are also required to establish the safety of such exercise. Exercise has few contraindications, but patients should be screened in advance with an exercise-ECG. Future studies should to a larger extent include female, elderly and high-risk patients, and be precise in prescribing and reporting exercise intensity, duration and frequency. Maximum oxygen consumption is an accurate measure of cardiovascular fitness and a strong and independent prognostic marker for survival, both in patients and healthy subjects."

General Information

Use of warfarin and risk of urogenital cancer: a population-based, nested case-control study. (Lancet Oncol. 2007)

Recanalization after intravenous thrombolysis: does a recanalization time window exist? (eurology. 2007)

Does statin therapy decrease the risk for bleeding in patients who are receiving warfarin? (Am J Med. 2007) "CONCLUSION: Long-term statin use may be associated with a decreased risk for bleeding in warfarin users with atrial fibrillation. Additional research is needed to further explore this putative association."

Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation (JAMA. 2007)

Guidelines

Cardiologists Issue Guidelines for Stent Use

Immunotherapy

Internet Sites

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Anticoagulation Resource

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

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FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

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NIH - Herbal Supplements: Consider Safety, Too

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NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

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Other Treatments

Experimental

Radiotherapy

Supplements-Vitamins-CAM

Effects of Random Allocation to Vitamin E Supplementation on the Occurrence of Venous Thromboembolism. Report From the Women's Health Study (Circulation 2007) "Conclusions—These data suggest that supplementation with vitamin E may reduce the risk of VTE in women, and those with a prior history or genetic predisposition may particularly benefit."

Surgery

Nosocomial Infections after Peripheral Arterial Bypass Surgery. (World J Surg. 2007) "RESULTS: A total of 67 infections were diagnosed in association with 607 procedures, yielding an infection ratio of 10.0%. Surgical site infection was the most common (55.2%), followed by urinary tract infection (16.4%), pneumonia (14.9%) and bacteremia (10.4%). Staphylococcus aureus was the most commonly found isolate in surgical site infections (48.6%) and in bacteremia (42.9%). Age, the use of corticosteroids (p = 0.02), and critical ischemia with tissue loss (p = 0.009) could be identified as risk factors for the development of a nosocomial infection. Blood transfusion was a postoperative risk factor for nosocomial infection (p < .0001)."

Most angioplasties are unnecessary, study finds "More than half a million people a year with chest pain are getting an unnecessary or premature procedure to unclog their arteries because drugs are just as effective, suggests a landmark study that challenges one of the most common practices in heart care. The stunning results found that angioplasty did not save lives or prevent heart attacks in non-emergency heart patients. An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done. "

Angioplasty can save legs and feet, study shows "Non-surgical treatment to unblock clogged arteries in legs and feet can save them from being amputated, even though those blood vessels are small and tricky to work in, researchers reported on Monday. Dr. Nael Saad and colleagues at the University of Rochester Medical Center in New York reported a 91 percent success rate in preventing amputations after 18 months. The procedure is called angioplasty, in which the clogged artery is stretched open using a tube inserted via a very small incision and a metal mesh tube called a stent to hold the blood vessel open. "

Has evidence changed practice?: appropriateness of carotid endarterectomy after the clinical trials. (Neurology. 2007) " CONCLUSIONS: Since publication of the randomized controlled trials, there has been a reduction in the proportion of patients undergoing carotid endarterectomy (CEA) for inappropriate reasons. The shift toward many asymptomatic patients undergoing CEA is concerning because the net benefit from surgery for these patients is low and is reduced further for patients with high comorbidity."

Combining Heart and Stroke-Prevention Surgeries Raises Death Risk "Combining heart-bypass surgery with surgery to prevent stroke increases the risk that a patient will die or suffer a post-operative stroke, a new study has found. . Heart-bypass surgery reroutes blood flow around clogged arteries, while carotid endarterectomy, the most commonly used stroke-prevention surgery, removes plaque in the carotid arteries, which supply blood to the brain, the study authors said. The idea behind combining the procedures is to protect the carotid artery from becoming blocked during the heart-bypass surgery and to reduce the overall risk by having just one surgery. But while the frequency of combined surgery has increased, evidence of any real benefit is unclear. "

Transplantation

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