IVAN BENADUCE CASELLA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
30 resultados
Resultados de Busca
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bookPart Resultados do tratamento endovascular (resultados)(2017) CASELLA, Ivan Benaduce; FUKUSHIMA, Rodrigo Bono; SILVA, Priscila Urtiga- Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study(2021) AGENO, Walter; CASELLA, Ivan B.; CHEE, Kok Han; SCHELLONG, Sebastian; SCHULMAN, Sam; SINGER, Daniel E.; DESCH, Marc; TANG, Wenbo; VOCCIA, Isabelle; ZINT, Kristina; GOLDHABER, Samuel Z.In randomized clinical trials (RCTs) of nonvitamin K antagonist oral anticoagulants (NOACs) for acute venous thromboembolism (VTE), similar to 12-13% of patients were elderly and similar to 26% had mild-to-moderate renal impairment. Observational studies are not restricted by the selection and treatment criteria of RCTs. In this ancillary analysis of the RE-COVERY DVT/PE global observational study, we aimed to describe patient characteristics, comorbidities, and anticoagulant therapy for subgroups of age (< or >= 75 years) and renal impairment (creatinine clearance [CrCl; estimated with Cockcroft-Gault formula] < 30 [severe], 30 to < 50 [moderate], 50 to < 80 [mild], >= 80 [normal] mL/min). Of 6095 eligible patients, 25.3% were aged >= 75 years; 38.2% (1605/4203 with CrCl values) had mild-to-moderate renal impairment. Comorbidities were more common in older patients (73.9% aged >= 75 vs. 58.1% < 75 years) and in those with mild or moderate versus no renal impairment (75.9%, 80.9%, and 59.3%, respectively). At hospital discharge or 14 days after diagnosis (whichever was later), most patients (53.7% and 55.1%, respectively) in both age groups received NOACs; 20.8% and 23.4%, respectively, received vitamin K antagonists, 19.0% and 21.8% parenteral therapy, 2.3% and 3.8% other anticoagulant treatments. Use of NOACs decreased with worsening renal impairment (none 58.5%, moderate 49.6%, severe 25.7%) and, in younger versus older patients with moderate renal impairment (33.1% vs. 56.1%). In routine practice, there are more elderly and renally impaired patients with VTE than represented in RCTs. Decreasing renal function, but not older age, was associated with less NOAC use. Clinical Trial Registration:. Unique identifier: NCT02596230. Graphic abstract Decreasing renal function, particularly in the subgroup with CrCl < 30 mL/min, but not older age, was associated with less use of nonvitamin K antagonist oral anticoagulants (NOACs). Nevertheless, more than half of the older patients with moderate renal impairment received a NOAC as their oral anticoagulant.
- Carotid stenosis management: a review for the internist(2014) CARMO, Gabriel Assis Lopes; CALDERARO, Daniela; GUALANDRO, Danielle Menosi; CASELLA, Ivan Benaduce; YU, Pai Ching; MARQUES, Andre Coelho; CARAMELLI, BrunoStroke is one of the most important causes of mortality and morbidity worldwide and, for a long time, was the leading cause of death in developed countries. Atherothrombotic carotid stenosis is one of the most important etiologies behind this event. If properly recognized and treated, lives can be saved, as well as long-term disabilities prevented. With population aging and improvements in surgical and clinical care, patients with several comorbidities will be referred for revascularization procedures more frequently, posing a challenge for physicians. The purpose of this review is to provide internists and clinicians with information based on several studies so they can offer to their patients, the best evidence-based care, indicating appropriate medical therapy, as well as referral to a vascular surgeon, or what contraindicates endarterectomy or angioplasty, depending on individual characteristics.
conferenceObject Impact of the period of the day on mortality and major cardiovascular complications after vascular surgeries(2020) CARDOZO, F. A. M.; ARTIOLI, T.; CARAMELLI, B.; CALDERARO, D.; YU, P. C.; ROJAS, M. C. E.; CASELLA, I. B.; LUCCIA, N. De; GUALANDRO, D. M.- Combined Angioplasty Technique of the Carotid Territory and Supra-Aortic Trunk by Double Access (Cervical and Limbs) for Tandem Lesions(2020) RIBEIRO, Felipe S.; CASELLA, Ivan Benaduce; LEIDERMAN, Dafne Braga Diamante; PUECH-LEAO, Pedro; LUCCIA, Nelson DeBackground: The carotid stent angioplasty (CAS) has been the main option for patients with high cardiovascular risk and carotid stenosis. The common femoral artery is still the most used access site; however, the aortic arch manipulation is a critical moment for cerebral embolization. Carotid transcervical access should be considered as a good alternative access route for CAS. Tandem lesions combining supra-aortic trunks and ipsilateral carotid bulb critical stenosis pose a great challenge for the vascular surgeon. Methods: This is a retrospective descriptive study based on medical records of our institution. We report 2 cases of complex cerebral vascular insufficiency and discuss therapeutic options and strategies to protect the cerebrovascular territory avoiding microembolization, as well as demonstrate an alternative and safe total endovascular approach for those cases. Results: We describe the approach of 2 complex cerebral vascular insufficiency cases: case 1, a 63-year-old male with previous ischemic stroke, right internal carotid artery (ICA) occlusion, left ICA stenosis >70%, and critical stenosis of the origin of common carotid artery (CCA); case 2, a 68-year-old female with previous ischemic stroke, left ICA occlusion, brachiocephalic trunk critical stenosis, hypoplastic right vertebral artery, and aortobi-iliac chronic occlusion. In both cases reported here a challenging solution was chosen, little described in the literature, with cerebral filter protection as the first step. In addition, a literature review was performed to discuss the different approach options for tandem injuries of the supra-aortic trunk and carotid bulb. Conclusions: Our initial experience with total endovascular treatment of complex tandem lesions of the carotid territory and supra-aortic trunks show that transcervical access, coupled with distal protection filter device on the first step, is a safe and effective technique for preventing neurological events.
- Identifying and managing frailty in Brazil: a scoping review protocol(2020) MELO, Ruth Caldeira de; CERVATO, Carina Junqueira; APRAHAMIAN, Ivan; GAVIN, James; ROBINSON, Katie; FROST, Rachael; AZEVEDO, Paula Schmidt; VILLAS-BOAS, Paulo; HINSLIFF-SMITH, Kathryn; GORDON, Adam L.Objective:The objective of this review is to scope the evidence on how researchers, health, and social care professionals in Brazil currently identify and manage frailty in older adults.Introduction:The rapidly aging population and associated increased healthcare usage by older people with frailty are challenging the sustainability of healthcare for older people in Brazil. Understanding how frailty is identified, measured, categorized, and managed in Brazil is an important part of building a response to the challenge.Inclusion criteria:This scoping review will consider studies that included older Brazilian adults (>= 60 years old) recruited from different settings (community, primary care, health care centers, hospital, and long-term care institutions). Studies will be included if they involved any kind of frailty assessment (tools, scales, and measures) and/or interventions. This review will consider all study designs, regardless of their rigor. National policies for older people will be also be considered for analysis.Methods:Indexed and gray literature in English or Portuguese from 2001 to the present will be considered. The searches will be conducted using bibliographic databases, university repositories, and the Brazilian Government official database. The studies will be independently screened according to the inclusion criteria by two reviewers based on their title, abstract, and full text. In case of disagreement, a third reviewer will be consulted. A customized data extraction form will be used to extract data from the included studies. The results will be presented in tabular form, accompanied by a narrative summary related to the objective of the present scoping review.
conferenceObject Predictors of acute heart failure after vascular surgery(2015) GUALANDRO, D. M.; MARCONDES-BRAGA, F. G.; YU, P. C.; CARDOZO, F. A. M.; LLOBET, G. B.; CALDERARO, D.; MELO, E. S.; CASELLA, I. B.; LUCCIA, N.; CARAMELLI, B.conferenceObject Long-term Results of Endovascular Treatment of Chronic Type B Aortic Dissection by Closure of the Primary Tear(2023) ESTENSSORO, Andre E. V.; PUECH-LEAO, Pedro; WAKASSA, Tais B.; CASELLA, Ivan Benaduce; DELUCCIA, Nelson- Carotid Plaque Morphology in Asymptomatic Patients with and without Metabolic Syndrome(2017) CURY, Marcus Vinicius Martins; PRESTI, Calogero; BONADIMAN, Suellen Stevam Timotheo; CASELLA, Ivan Benaduce; BENABOU, Joseph Elias; SILVA, Erasmo Simao da; LUCCIA, Nelson de; PUECH-LEAO, PedroBackground: The aim of this study was to determine the impact of metabolic syndrome (MetS) on the morphology of carotid plaques, as evaluated using duplex ultrasound (DUS) with computer-assisted analysis. Methods: In this cross-sectional observational study, we analyzed 148 carotid artery plaques in asymptomatic patients. Data were obtained via clinical and laboratory examinations, and DUS was performed by a single operator. All plaques were scanned in a longitudinal fashion, and the best segment was selected, recorded, and evaluated using dedicated software. The main software-based analyses included gray-scale median (GSM) measurements and carotid plaque morphology histograms. Results: MetS was identified in 51.8% of patients. Comparisons of patients with MetS and patients without MetS indicated that the former patients used more classes of antihypertensive drugs (2.49 vs. 1.93; P = 0.004) and were treated with statins for a longer period (71.08 vs. 49.17 months; P = 0.003). Most patients of both types exhibited moderate carotid artery stenosis ranging from 50% to 69% (n = 62; 37.3%), and MetS was not associated with an increased prevalence of severe carotid artery stenosis. The mean GSM was greater in the MetS group than in the non-MetS group (74.18 vs. 61.63; P = 0.012). The histogram analysis revealed that there were lower quantities of blood and fat (2.91 vs. 3.88; P = 0.006; 10.21 vs. 15.08; P = 0.004, respectively) and more fibrous tissue (19.93 vs. 14.55; P = 0.015) in the carotid plaques of patients with MetS than in the carotid plaques of patients without MetS. Conclusions: The present study demonstrated that MetS did not affect the stenosis grade or did it lead to unstable carotid plaques.
- Rationale and design for the study Apixaban versus ClopidoGRel on a background of aspirin in patient undergoing InfraPoPliteal angioplasty for critical limb ischemia: AGRIPPA trial(2020) BIAGIONI, Rodrigo Bruno; LOPES, Renato Delascio; AGATI, Leandro Barile; SACILOTTO, Roberto; WOLOSKER, Nelson; SOBREIRA, Marcone Lima; SOARES, Bruno Leonardo de Freitas; JOVILIANO, Edwaldo Edner; BERNARDI, Walkiria Hueb; CASTELLI JUNIOR, Valter; CAFFARO, Roberto Augusto; FIORANELLI, Alexandre; BELLEN, Bonno Van; CASELLA, Ivan Benaduce; FIDELIS, Ronald Jose Ribeiro; FLUMIGNAN, Ronald Luiz Gomes; COMEROTA, Anthony James; RAMACCIOTTI, EduardoBackground New antithrombotic strategies that reduce primary thrombosis and restenosis might improve vascular outcomes in patients with peripheral artery disease (PAD) undergoing arterial angioplasty. The study objective is to evaluate the potential benefit of apixaban plus aspirin compared with standard of care dual antiplatelet therapy (DAPT) in reducing thrombotic restenosis and artery re-occlusion in patients undergoing endovascular infrapopliteal revascularization. Study design This multicenter, parallel-group, prospective, randomized, open-label, blinded-endpoint adjudication, proof-of-concept, exploratory trial aims to randomize 200 patients 72 hours after successful infrapopliteal angioplasty for critical limb ischemia (CLI). Patients will be randomly assigned in a 1:1 ratio to receive oral apixaban (2.5mg twice daily) plus aspirin (100 mg once daily) for 12months or clopidogrel (75 mg daily) for at least 3 months on a background of aspirin (100 mg once daily) for 12months. The primary endpoint is the composite of target lesion revascularization (TLR), major amputation, or restenosis/occlusion (RAS) in addition to major adverse cardiovascular events - MACE (myocardial infarction, stroke or cardiovascular death) at 12 months. The primary safety endpoint is the composite of major bleeding or clinically relevant non-major bleeding at 12 months. Summary This study will evaluate the efficacy and safety of apixaban 2.5 mg twice daily plus aspirin compared with DAPT (clopidogrel plus aspirin) in patients with CLI undergoing endovascular infrapopliteal revascularization and might prove the concept of an alternative antithrombotic regimen for these patients to be tested in a future large randomized clinical trial.
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