Timothy F. Kirn

SCOTTSDALE, ARIZ. — Carotid stenting results appear to be similar to endarterectomy for at least 5 years after the procedure, according to a cohort of 2,172 patients who were treated at four European centers.

In the cohort, which was enrolled prospectively between 1993 and 2004, the rate of ipsilateral major stroke or death from any cause was 4% at 1 year, 10% by 3 years, and 16% by 5 years, among the 138 patients followed for that long, Dr. Patrick Peeters said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

The restenosis rates were 1% at 1 year, 2% at 3 years, and 3% at 5 years (139 patients), where restenosis was considered to be 50% narrowing imaged with ultrasound.

The results from this series are as good or better than results that have been previously reported for carotid stenting, although many of those procedures were done in the early era, before interventionalists had the experience they have now and before the advent of modern technologies, such as distal protection, noted Dr. Peeters, head of the department of cardiovascular and thoracic surgery at Imelda Hospital, Bonheiden, Belgium.

The previous studies have reported restenosis rates at 1 year ranging from 3% to 8%.

Moreover, although the earliest studies of carotid stenting had major, perioperative complication rates as high as 9%, 99.7% of the cases in this series were technically successful.

The results with stenting also compare well with endarterectomy, he noted. The European Carotid Surgery Trial reported a rate of major stroke or death of 15% at 3 years, very similar to the 13% rate of this series.

A number of different, self-expanding stents were used in the series, chosen by the individual interventionalists at the time of the procedure, with the most common being a closed-cell, cobalt chromium alloy stent, used in 62% of the patients. And 4% of patients received only balloon dilation.

Although stenting did not make a significant difference in the stroke/death rate compared with ballooning only, it did make a significant difference in the restenosis rate.

The rate of restenosis at 5 years was only 3% in the patients who were stented, but it was 15% in the ballooned-only patients.

Moreover, predilatation of the artery before stent placement also made a significant difference, Dr. Peeters said.

Of the stented patients, 30% were predilated. Their stroke and death rate at 5 years was 10% (33 patients) compared with a rate of 17% for those who were not predilated.

“We can't say why,” Dr. Peeters said.

In addition, there was no difference in stroke and death in the series between those patients who were symptomatic or asymptomatic.

SCOTTSDALE, ARIZ. — Carotid stenting results appear to be similar to endarterectomy for at least 5 years after the procedure, according to a cohort of 2,172 patients who were treated at four European centers.

In the cohort, which was enrolled prospectively between 1993 and 2004, the rate of ipsilateral major stroke or death from any cause was 4% at 1 year, 10% by 3 years, and 16% by 5 years, among the 138 patients followed for that long, Dr. Patrick Peeters said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

The restenosis rates were 1% at 1 year, 2% at 3 years, and 3% at 5 years (139 patients), where restenosis was considered to be 50% narrowing imaged with ultrasound.

The results from this series are as good or better than results that have been previously reported for carotid stenting, although many of those procedures were done in the early era, before interventionalists had the experience they have now and before the advent of modern technologies, such as distal protection, noted Dr. Peeters, head of the department of cardiovascular and thoracic surgery at Imelda Hospital, Bonheiden, Belgium.

The previous studies have reported restenosis rates at 1 year ranging from 3% to 8%.

Moreover, although the earliest studies of carotid stenting had major, perioperative complication rates as high as 9%, 99.7% of the cases in this series were technically successful.

The results with stenting also compare well with endarterectomy, he noted. The European Carotid Surgery Trial reported a rate of major stroke or death of 15% at 3 years, very similar to the 13% rate of this series.

A number of different, self-expanding stents were used in the series, chosen by the individual interventionalists at the time of the procedure, with the most common being a closed-cell, cobalt chromium alloy stent, used in 62% of the patients. And 4% of patients received only balloon dilation.

Although stenting did not make a significant difference in the stroke/death rate compared with ballooning only, it did make a significant difference in the restenosis rate.

The rate of restenosis at 5 years was only 3% in the patients who were stented, but it was 15% in the ballooned-only patients.

Moreover, predilatation of the artery before stent placement also made a significant difference, Dr. Peeters said.

Of the stented patients, 30% were predilated. Their stroke and death rate at 5 years was 10% (33 patients) compared with a rate of 17% for those who were not predilated.

“We can't say why,” Dr. Peeters said.

In addition, there was no difference in stroke and death in the series between those patients who were symptomatic or asymptomatic.

SCOTTSDALE, ARIZ. — Carotid stenting results appear to be similar to endarterectomy for at least 5 years after the procedure, according to a cohort of 2,172 patients who were treated at four European centers.

In the cohort, which was enrolled prospectively between 1993 and 2004, the rate of ipsilateral major stroke or death from any cause was 4% at 1 year, 10% by 3 years, and 16% by 5 years, among the 138 patients followed for that long, Dr. Patrick Peeters said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

The restenosis rates were 1% at 1 year, 2% at 3 years, and 3% at 5 years (139 patients), where restenosis was considered to be 50% narrowing imaged with ultrasound.

The results from this series are as good or better than results that have been previously reported for carotid stenting, although many of those procedures were done in the early era, before interventionalists had the experience they have now and before the advent of modern technologies, such as distal protection, noted Dr. Peeters, head of the department of cardiovascular and thoracic surgery at Imelda Hospital, Bonheiden, Belgium.

The previous studies have reported restenosis rates at 1 year ranging from 3% to 8%.

Moreover, although the earliest studies of carotid stenting had major, perioperative complication rates as high as 9%, 99.7% of the cases in this series were technically successful.

The results with stenting also compare well with endarterectomy, he noted. The European Carotid Surgery Trial reported a rate of major stroke or death of 15% at 3 years, very similar to the 13% rate of this series.

A number of different, self-expanding stents were used in the series, chosen by the individual interventionalists at the time of the procedure, with the most common being a closed-cell, cobalt chromium alloy stent, used in 62% of the patients. And 4% of patients received only balloon dilation.

Although stenting did not make a significant difference in the stroke/death rate compared with ballooning only, it did make a significant difference in the restenosis rate.

The rate of restenosis at 5 years was only 3% in the patients who were stented, but it was 15% in the ballooned-only patients.

Moreover, predilatation of the artery before stent placement also made a significant difference, Dr. Peeters said.

Of the stented patients, 30% were predilated. Their stroke and death rate at 5 years was 10% (33 patients) compared with a rate of 17% for those who were not predilated.

“We can't say why,” Dr. Peeters said.

In addition, there was no difference in stroke and death in the series between those patients who were symptomatic or asymptomatic.

SCOTTSDALE, ARIZ. — In a major study comparing carotid endarterectomy and carotid stenting, 2-year results show similar death and stroke rates for the two procedures, Dr. Rodney A. White said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

And those event rates appear to be better than one would expect based on some previously reported case series and studies, said Dr. White, the vascular surgery division chief at the Harbor-UCLA Medical Center, Los Angeles.

The 1-year results from the study, known as the CARESS (Carotid Revascularization Using Endarterectomy or Stenting Systems) trial, were recently published (J. Vasc. Surg. 2005;42:213–9). At 1 year post procedure, there were 30 deaths or strokes in the group of 254 patients who underwent carotid endarterectomy, for an event rate of 14%, and 13 deaths or strokes among the 143 patients who underwent carotid stenting, for an event rate of 10%.

By including acute myocardial infarctions that occurred among the patients the event rates were increased to 14% and 11%, respectively.

At the 2-year follow-up, the number of events increased somewhat, but the pattern remained the same. The death and stroke rate was 15% for the endarterectomy group and 13% for the stenting group. Adding acute myocardial infarctions did not change the event-rate percentages.

Dr. White did not report on the restenosis or reintervention rates at 2 years. In the previous 1-year follow-up report, restenosis occurred in 4% of the endarterectomy patients and 6% of the stenting patients, a difference that was not statistically significant.

Restenosis was defined as 75% narrowing, or 50% narrowing that required treatment.

A main purpose of the trial was to design a study that reflected current clinical practice, noted Dr. White. Hence, the patients were not randomized, and almost 70% of the patients in both groups had high-grade, carotid stenosis but were asymptomatic.

Moreover, 51% of the participating physicians—who were located in 14 different centers—were individuals who were able to do either procedure, Dr. White said.

“We now have 2-year data that [support] our original premise that we can get lower event rates both with carotid endarterectomy and carotid stents than are being reported in current clinical trials, if you have the option to do both,” Dr. White said.

SCOTTSDALE, ARIZ. — In a major study comparing carotid endarterectomy and carotid stenting, 2-year results show similar death and stroke rates for the two procedures, Dr. Rodney A. White said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

And those event rates appear to be better than one would expect based on some previously reported case series and studies, said Dr. White, the vascular surgery division chief at the Harbor-UCLA Medical Center, Los Angeles.

The 1-year results from the study, known as the CARESS (Carotid Revascularization Using Endarterectomy or Stenting Systems) trial, were recently published (J. Vasc. Surg. 2005;42:213–9). At 1 year post procedure, there were 30 deaths or strokes in the group of 254 patients who underwent carotid endarterectomy, for an event rate of 14%, and 13 deaths or strokes among the 143 patients who underwent carotid stenting, for an event rate of 10%.

By including acute myocardial infarctions that occurred among the patients the event rates were increased to 14% and 11%, respectively.

At the 2-year follow-up, the number of events increased somewhat, but the pattern remained the same. The death and stroke rate was 15% for the endarterectomy group and 13% for the stenting group. Adding acute myocardial infarctions did not change the event-rate percentages.

Dr. White did not report on the restenosis or reintervention rates at 2 years. In the previous 1-year follow-up report, restenosis occurred in 4% of the endarterectomy patients and 6% of the stenting patients, a difference that was not statistically significant.

Restenosis was defined as 75% narrowing, or 50% narrowing that required treatment.

A main purpose of the trial was to design a study that reflected current clinical practice, noted Dr. White. Hence, the patients were not randomized, and almost 70% of the patients in both groups had high-grade, carotid stenosis but were asymptomatic.

Moreover, 51% of the participating physicians—who were located in 14 different centers—were individuals who were able to do either procedure, Dr. White said.

“We now have 2-year data that [support] our original premise that we can get lower event rates both with carotid endarterectomy and carotid stents than are being reported in current clinical trials, if you have the option to do both,” Dr. White said.

SCOTTSDALE, ARIZ. — In a major study comparing carotid endarterectomy and carotid stenting, 2-year results show similar death and stroke rates for the two procedures, Dr. Rodney A. White said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

And those event rates appear to be better than one would expect based on some previously reported case series and studies, said Dr. White, the vascular surgery division chief at the Harbor-UCLA Medical Center, Los Angeles.

The 1-year results from the study, known as the CARESS (Carotid Revascularization Using Endarterectomy or Stenting Systems) trial, were recently published (J. Vasc. Surg. 2005;42:213–9). At 1 year post procedure, there were 30 deaths or strokes in the group of 254 patients who underwent carotid endarterectomy, for an event rate of 14%, and 13 deaths or strokes among the 143 patients who underwent carotid stenting, for an event rate of 10%.

By including acute myocardial infarctions that occurred among the patients the event rates were increased to 14% and 11%, respectively.

At the 2-year follow-up, the number of events increased somewhat, but the pattern remained the same. The death and stroke rate was 15% for the endarterectomy group and 13% for the stenting group. Adding acute myocardial infarctions did not change the event-rate percentages.

Dr. White did not report on the restenosis or reintervention rates at 2 years. In the previous 1-year follow-up report, restenosis occurred in 4% of the endarterectomy patients and 6% of the stenting patients, a difference that was not statistically significant.

Restenosis was defined as 75% narrowing, or 50% narrowing that required treatment.

A main purpose of the trial was to design a study that reflected current clinical practice, noted Dr. White. Hence, the patients were not randomized, and almost 70% of the patients in both groups had high-grade, carotid stenosis but were asymptomatic.

Moreover, 51% of the participating physicians—who were located in 14 different centers—were individuals who were able to do either procedure, Dr. White said.

“We now have 2-year data that [support] our original premise that we can get lower event rates both with carotid endarterectomy and carotid stents than are being reported in current clinical trials, if you have the option to do both,” Dr. White said.

SCOTTSDALE, ARIZ. — Cerebral protection devices used during carotid stenting procedures do not catch small emboli, and may not prevent stroke and brain damage, according to preliminary results from a study that used diffusion-weighted MRI.

“Cerebral protection devices may not reduce the incidence of new ischemic defects on diffusion-weighted MR,” Dr. Michel S. Makaroun said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation. “Further investigation is definitely warranted.”

He presented the results of the first 36 patients treated in a planned larger trial comparing distal-filter protection with no protection; the trial is using MRI of the patients' brains before and after a carotid stenting procedure to visualize lesions that might not be readily clinically apparent.

There was no difference, said Dr. Makaroun, director of the endovascular surgery program at the University of Pittsburgh Medical Center. Of 18 patients who were treated with cerebral protection, 13 had at least one white lesion seen on diffusion-weighted imaging after the procedure that had not been there before. In comparison, 8 of 18 patients treated without protection had any white lesion afterward.

The difference was not statistically significant, given the small number of patients, noted Dr. Makaroun.

The average number of new lesions was the same for both groups, six, and the average size of the lesions was the same as well. Two perioperative strokes occurred, one in each treatment group.

SCOTTSDALE, ARIZ. — Cerebral protection devices used during carotid stenting procedures do not catch small emboli, and may not prevent stroke and brain damage, according to preliminary results from a study that used diffusion-weighted MRI.

“Cerebral protection devices may not reduce the incidence of new ischemic defects on diffusion-weighted MR,” Dr. Michel S. Makaroun said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation. “Further investigation is definitely warranted.”

He presented the results of the first 36 patients treated in a planned larger trial comparing distal-filter protection with no protection; the trial is using MRI of the patients' brains before and after a carotid stenting procedure to visualize lesions that might not be readily clinically apparent.

There was no difference, said Dr. Makaroun, director of the endovascular surgery program at the University of Pittsburgh Medical Center. Of 18 patients who were treated with cerebral protection, 13 had at least one white lesion seen on diffusion-weighted imaging after the procedure that had not been there before. In comparison, 8 of 18 patients treated without protection had any white lesion afterward.

The difference was not statistically significant, given the small number of patients, noted Dr. Makaroun.

The average number of new lesions was the same for both groups, six, and the average size of the lesions was the same as well. Two perioperative strokes occurred, one in each treatment group.

SCOTTSDALE, ARIZ. — Cerebral protection devices used during carotid stenting procedures do not catch small emboli, and may not prevent stroke and brain damage, according to preliminary results from a study that used diffusion-weighted MRI.

“Cerebral protection devices may not reduce the incidence of new ischemic defects on diffusion-weighted MR,” Dr. Michel S. Makaroun said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation. “Further investigation is definitely warranted.”

He presented the results of the first 36 patients treated in a planned larger trial comparing distal-filter protection with no protection; the trial is using MRI of the patients' brains before and after a carotid stenting procedure to visualize lesions that might not be readily clinically apparent.

There was no difference, said Dr. Makaroun, director of the endovascular surgery program at the University of Pittsburgh Medical Center. Of 18 patients who were treated with cerebral protection, 13 had at least one white lesion seen on diffusion-weighted imaging after the procedure that had not been there before. In comparison, 8 of 18 patients treated without protection had any white lesion afterward.

The difference was not statistically significant, given the small number of patients, noted Dr. Makaroun.

The average number of new lesions was the same for both groups, six, and the average size of the lesions was the same as well. Two perioperative strokes occurred, one in each treatment group.

SCOTTSDALE, ARIZ. — The flow reversal technique may be a better way to prevent emboli from reaching the brain during a carotid stenting procedure, but not all the evidence is in, Dr. Juan Carlos Parodi said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

In 200 high-risk patients treated so far at his institution, using the Parodi Anti-Emboli system to create flow reversal, 30-day stroke and mortality has been 1.5%, with no ipsilateral ischemic strokes, said Dr. Parodi, professor of surgery and radiology at Washington University, St. Louis.

Those results are good, but not definitive, because clinical outcome is only one way to measure that a technology is truly intercepting emboli created by the procedure, he said. The other ways are diffusion-weighted MRI and transcranial Doppler, both of which have shown that when a distal filter is used during the procedure, it appears that some small emboli do escape and reach the brain, where they do block vessels.

The SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High-Risk for Endarterectomy) trial is the only randomized, controlled trial of a distal filter, Dr. Parodi said. It reported a 30% reduction in 30-day stroke, death, and myocardial infarction with the filter.

But, diffusion-weighted MR studies suggest that even with a filter somewhere between 9% and 43% will still develop new clinical or subclinical lesions, and transcranial Doppler studies suggest that every procedure releases emboli showers, not all of which is caught by a filter. By comparison, new lesions are seen with the MR technique in 6%–12% of patients who have undergone endarterectomy.

How important these small lesions are remains an open question. Most disappear over time. However, studies have reported that necrotic tissue is sometimes seen around the sites of the lesions, and silent infarctions are associated with a doubling of the risk of dementia, Dr. Parodi said.

Dr. Parodi's flow reversal device, the Parodi Anti-Emboli system, uses a balloon inflated in the common carotid proximal to the lesion being treated, obstructing the flow and creating a negative pressure gradient. A second balloon is inflated in the external carotid artery for internal carotid procedures to prevent back-flow, and suction is applied, Dr. Parodi said. The device was recently sold to W. L. Gore and Associates Inc.

SCOTTSDALE, ARIZ. — The flow reversal technique may be a better way to prevent emboli from reaching the brain during a carotid stenting procedure, but not all the evidence is in, Dr. Juan Carlos Parodi said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

In 200 high-risk patients treated so far at his institution, using the Parodi Anti-Emboli system to create flow reversal, 30-day stroke and mortality has been 1.5%, with no ipsilateral ischemic strokes, said Dr. Parodi, professor of surgery and radiology at Washington University, St. Louis.

Those results are good, but not definitive, because clinical outcome is only one way to measure that a technology is truly intercepting emboli created by the procedure, he said. The other ways are diffusion-weighted MRI and transcranial Doppler, both of which have shown that when a distal filter is used during the procedure, it appears that some small emboli do escape and reach the brain, where they do block vessels.

The SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High-Risk for Endarterectomy) trial is the only randomized, controlled trial of a distal filter, Dr. Parodi said. It reported a 30% reduction in 30-day stroke, death, and myocardial infarction with the filter.

But, diffusion-weighted MR studies suggest that even with a filter somewhere between 9% and 43% will still develop new clinical or subclinical lesions, and transcranial Doppler studies suggest that every procedure releases emboli showers, not all of which is caught by a filter. By comparison, new lesions are seen with the MR technique in 6%–12% of patients who have undergone endarterectomy.

How important these small lesions are remains an open question. Most disappear over time. However, studies have reported that necrotic tissue is sometimes seen around the sites of the lesions, and silent infarctions are associated with a doubling of the risk of dementia, Dr. Parodi said.

Dr. Parodi's flow reversal device, the Parodi Anti-Emboli system, uses a balloon inflated in the common carotid proximal to the lesion being treated, obstructing the flow and creating a negative pressure gradient. A second balloon is inflated in the external carotid artery for internal carotid procedures to prevent back-flow, and suction is applied, Dr. Parodi said. The device was recently sold to W. L. Gore and Associates Inc.

SCOTTSDALE, ARIZ. — The flow reversal technique may be a better way to prevent emboli from reaching the brain during a carotid stenting procedure, but not all the evidence is in, Dr. Juan Carlos Parodi said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

In 200 high-risk patients treated so far at his institution, using the Parodi Anti-Emboli system to create flow reversal, 30-day stroke and mortality has been 1.5%, with no ipsilateral ischemic strokes, said Dr. Parodi, professor of surgery and radiology at Washington University, St. Louis.

Those results are good, but not definitive, because clinical outcome is only one way to measure that a technology is truly intercepting emboli created by the procedure, he said. The other ways are diffusion-weighted MRI and transcranial Doppler, both of which have shown that when a distal filter is used during the procedure, it appears that some small emboli do escape and reach the brain, where they do block vessels.

The SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High-Risk for Endarterectomy) trial is the only randomized, controlled trial of a distal filter, Dr. Parodi said. It reported a 30% reduction in 30-day stroke, death, and myocardial infarction with the filter.

But, diffusion-weighted MR studies suggest that even with a filter somewhere between 9% and 43% will still develop new clinical or subclinical lesions, and transcranial Doppler studies suggest that every procedure releases emboli showers, not all of which is caught by a filter. By comparison, new lesions are seen with the MR technique in 6%–12% of patients who have undergone endarterectomy.

How important these small lesions are remains an open question. Most disappear over time. However, studies have reported that necrotic tissue is sometimes seen around the sites of the lesions, and silent infarctions are associated with a doubling of the risk of dementia, Dr. Parodi said.

Dr. Parodi's flow reversal device, the Parodi Anti-Emboli system, uses a balloon inflated in the common carotid proximal to the lesion being treated, obstructing the flow and creating a negative pressure gradient. A second balloon is inflated in the external carotid artery for internal carotid procedures to prevent back-flow, and suction is applied, Dr. Parodi said. The device was recently sold to W. L. Gore and Associates Inc.

SCOTTSDALE, ARIZ. — Patients who undergo endovascular repair of an abdominal aortic aneurysm are significantly less likely to experience myocardial damage than are patients undergoing open repair, Dr. James May said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

In a review of 149 consecutive patients undergoing elective abdominal aortic aneurysm (AAA) repair, Dr. May and colleagues found that 25% of 36 patients undergoing an open repair had elevated levels of troponin T following the procedure. By contrast, only 8% of 113 patients undergoing endovascular repair had elevated troponin T levels post procedure.

“This finding should be taken into account when deciding on the method of AAA repair, even when the patient is considered low risk for an open repair,” said Dr. May, of the department of vascular surgery at the Royal Prince Alfred Hospital, Sydney, Australia.

He said although it has been assumed that endovascular repair of AAAs is generally less traumatic, this hypothesis had never been measured biochemically. Serum troponin T level is an accepted indicator of subclinical myocardial damage.

The study considered a positive finding of myocardial damage to be a 50% of greater increase in serum troponin T after the procedure, compared with before, without a significant increase in serum creatinine. Only one patient had clinically obvious myocardial ischemia after the procedure, and that patient was in the open repair group.

There were no significant differences in age between the two groups of patients, but the patients who underwent endovascular repair were significantly more likely to have had a previous myocardial infarction (41% vs. 21%).

SCOTTSDALE, ARIZ. — Patients who undergo endovascular repair of an abdominal aortic aneurysm are significantly less likely to experience myocardial damage than are patients undergoing open repair, Dr. James May said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

In a review of 149 consecutive patients undergoing elective abdominal aortic aneurysm (AAA) repair, Dr. May and colleagues found that 25% of 36 patients undergoing an open repair had elevated levels of troponin T following the procedure. By contrast, only 8% of 113 patients undergoing endovascular repair had elevated troponin T levels post procedure.

“This finding should be taken into account when deciding on the method of AAA repair, even when the patient is considered low risk for an open repair,” said Dr. May, of the department of vascular surgery at the Royal Prince Alfred Hospital, Sydney, Australia.

He said although it has been assumed that endovascular repair of AAAs is generally less traumatic, this hypothesis had never been measured biochemically. Serum troponin T level is an accepted indicator of subclinical myocardial damage.

The study considered a positive finding of myocardial damage to be a 50% of greater increase in serum troponin T after the procedure, compared with before, without a significant increase in serum creatinine. Only one patient had clinically obvious myocardial ischemia after the procedure, and that patient was in the open repair group.

There were no significant differences in age between the two groups of patients, but the patients who underwent endovascular repair were significantly more likely to have had a previous myocardial infarction (41% vs. 21%).

SCOTTSDALE, ARIZ. — Patients who undergo endovascular repair of an abdominal aortic aneurysm are significantly less likely to experience myocardial damage than are patients undergoing open repair, Dr. James May said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

In a review of 149 consecutive patients undergoing elective abdominal aortic aneurysm (AAA) repair, Dr. May and colleagues found that 25% of 36 patients undergoing an open repair had elevated levels of troponin T following the procedure. By contrast, only 8% of 113 patients undergoing endovascular repair had elevated troponin T levels post procedure.

“This finding should be taken into account when deciding on the method of AAA repair, even when the patient is considered low risk for an open repair,” said Dr. May, of the department of vascular surgery at the Royal Prince Alfred Hospital, Sydney, Australia.

He said although it has been assumed that endovascular repair of AAAs is generally less traumatic, this hypothesis had never been measured biochemically. Serum troponin T level is an accepted indicator of subclinical myocardial damage.

The study considered a positive finding of myocardial damage to be a 50% of greater increase in serum troponin T after the procedure, compared with before, without a significant increase in serum creatinine. Only one patient had clinically obvious myocardial ischemia after the procedure, and that patient was in the open repair group.

There were no significant differences in age between the two groups of patients, but the patients who underwent endovascular repair were significantly more likely to have had a previous myocardial infarction (41% vs. 21%).

SCOTTSDALE, ARIZ. — Type II endoleaks after endovascular aneurysm repair were prevented by using fibrin glue in all but 2 of 84 consecutive patients, Dr. Mauro Zanchetta said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

The patients were treated over a 2-year period, up to December 2005, with a mean follow-up period of 14 months, at which time 76 of the patients had no complications, he said. The complications that did occur were not due to the fibrin glue, which induces thrombosis of the side branch vessels. There were graft-deployment problems in two patients, implantation problems in two patients, and systemic complications in three patients. One patient died during the procedure.

In all patients without endoleak, subsequent examinations showed sustained aneurysm shrinkage. The fibrin glue treatment is “easy, effective, and durable,” said Dr. Zanchetta of the Ospedale di Cittadella in Padua, Italy. “This approach reveals a new strategy for routine prevention of type II endoleaks.” He said the bifurcated grafts were deployed from a right femoral access. The fibrin sealant (5 mL) was injected directly into the aneurysm sac using a double-syringe delivery system inserted through a 23-cm, 5-F sheath, and advanced from a left access over a guidewire that remained in place after angiography between the aorta and the graft. A balloon was inflated in the left limb of the stent graft to prevent the sealant from leaking and causing distal embolization. It was left in place for 1 minute after injection. Intraoperative angiography and color Doppler ultrasound showed the majority of the patent side branches found and treated were peripheral lumbar arteries, with a range of one to three per patient. Ten patients also had patent inferior mesenteric arteries treated.

SCOTTSDALE, ARIZ. — Type II endoleaks after endovascular aneurysm repair were prevented by using fibrin glue in all but 2 of 84 consecutive patients, Dr. Mauro Zanchetta said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

The patients were treated over a 2-year period, up to December 2005, with a mean follow-up period of 14 months, at which time 76 of the patients had no complications, he said. The complications that did occur were not due to the fibrin glue, which induces thrombosis of the side branch vessels. There were graft-deployment problems in two patients, implantation problems in two patients, and systemic complications in three patients. One patient died during the procedure.

In all patients without endoleak, subsequent examinations showed sustained aneurysm shrinkage. The fibrin glue treatment is “easy, effective, and durable,” said Dr. Zanchetta of the Ospedale di Cittadella in Padua, Italy. “This approach reveals a new strategy for routine prevention of type II endoleaks.” He said the bifurcated grafts were deployed from a right femoral access. The fibrin sealant (5 mL) was injected directly into the aneurysm sac using a double-syringe delivery system inserted through a 23-cm, 5-F sheath, and advanced from a left access over a guidewire that remained in place after angiography between the aorta and the graft. A balloon was inflated in the left limb of the stent graft to prevent the sealant from leaking and causing distal embolization. It was left in place for 1 minute after injection. Intraoperative angiography and color Doppler ultrasound showed the majority of the patent side branches found and treated were peripheral lumbar arteries, with a range of one to three per patient. Ten patients also had patent inferior mesenteric arteries treated.

SCOTTSDALE, ARIZ. — Type II endoleaks after endovascular aneurysm repair were prevented by using fibrin glue in all but 2 of 84 consecutive patients, Dr. Mauro Zanchetta said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

The patients were treated over a 2-year period, up to December 2005, with a mean follow-up period of 14 months, at which time 76 of the patients had no complications, he said. The complications that did occur were not due to the fibrin glue, which induces thrombosis of the side branch vessels. There were graft-deployment problems in two patients, implantation problems in two patients, and systemic complications in three patients. One patient died during the procedure.

In all patients without endoleak, subsequent examinations showed sustained aneurysm shrinkage. The fibrin glue treatment is “easy, effective, and durable,” said Dr. Zanchetta of the Ospedale di Cittadella in Padua, Italy. “This approach reveals a new strategy for routine prevention of type II endoleaks.” He said the bifurcated grafts were deployed from a right femoral access. The fibrin sealant (5 mL) was injected directly into the aneurysm sac using a double-syringe delivery system inserted through a 23-cm, 5-F sheath, and advanced from a left access over a guidewire that remained in place after angiography between the aorta and the graft. A balloon was inflated in the left limb of the stent graft to prevent the sealant from leaking and causing distal embolization. It was left in place for 1 minute after injection. Intraoperative angiography and color Doppler ultrasound showed the majority of the patent side branches found and treated were peripheral lumbar arteries, with a range of one to three per patient. Ten patients also had patent inferior mesenteric arteries treated.

SCOTTSDALE, ARIZ. — Vascular interventionalists may soon routinely implant pressure sensors that can detect endoleaks during both thoracic and abdominal aneurysm repair.

“Remote pressure sensing for endovascular repair is feasible,” Dr. Ross Milner said at an international symposium on endovascular interventions sponsored by the Arizona Heart Foundation. The sensors have no battery. They are activated by energy waves generated by external probes, which also read the measurement.

In a recent publication, Dr. Milner, of the division of vascular surgery at Emory University, Atlanta, said there are two devices in development, one that uses ultrasound waves and the other, radio waves. Both devices—the ImPressure ultrasound device, Remon Medical Technologies Inc., and the Endosensor, CardioMEMS Inc.—have been implanted in human trials.

The Endosensor device was approved for U.S. marketing in November, based on a 12-center trial. In a report on the trial at the most recent Society for Vascular Surgery meeting, the investigators said the device was implanted in 70 patients undergoing endovascular repair of abdominal aortic aneurysms without complication. It accurately measured pressure in 65 of the patients and detected all 15 endoleaks that occurred during the procedure.

Dr. Milner and his colleagues at Emory have begun using the ImPressure device in thoracic aneurysm repairs, with the first implant done in Brazil last July. That device continued to function well 8 months after implantation, and it has shown a dramatic, continued drop in pulse pressure within the aneurysm sac.

He predicted that, in time, use of these pressure devices may omit the need for CT angiography at the end of procedures to be sure the graft has completely sealed off the aneurysm, thus sparing patients some exposure to contrast agent. “Pressure sensing will be feasible in the thoracic aorta and may add a lot to the follow-up of these patients as it allows for appropriate intraoperative exclusion as well as long-term follow-up,” he said. The sensors are compatible with any graft system, he added.

SCOTTSDALE, ARIZ. — Vascular interventionalists may soon routinely implant pressure sensors that can detect endoleaks during both thoracic and abdominal aneurysm repair.

“Remote pressure sensing for endovascular repair is feasible,” Dr. Ross Milner said at an international symposium on endovascular interventions sponsored by the Arizona Heart Foundation. The sensors have no battery. They are activated by energy waves generated by external probes, which also read the measurement.

In a recent publication, Dr. Milner, of the division of vascular surgery at Emory University, Atlanta, said there are two devices in development, one that uses ultrasound waves and the other, radio waves. Both devices—the ImPressure ultrasound device, Remon Medical Technologies Inc., and the Endosensor, CardioMEMS Inc.—have been implanted in human trials.

The Endosensor device was approved for U.S. marketing in November, based on a 12-center trial. In a report on the trial at the most recent Society for Vascular Surgery meeting, the investigators said the device was implanted in 70 patients undergoing endovascular repair of abdominal aortic aneurysms without complication. It accurately measured pressure in 65 of the patients and detected all 15 endoleaks that occurred during the procedure.

Dr. Milner and his colleagues at Emory have begun using the ImPressure device in thoracic aneurysm repairs, with the first implant done in Brazil last July. That device continued to function well 8 months after implantation, and it has shown a dramatic, continued drop in pulse pressure within the aneurysm sac.

He predicted that, in time, use of these pressure devices may omit the need for CT angiography at the end of procedures to be sure the graft has completely sealed off the aneurysm, thus sparing patients some exposure to contrast agent. “Pressure sensing will be feasible in the thoracic aorta and may add a lot to the follow-up of these patients as it allows for appropriate intraoperative exclusion as well as long-term follow-up,” he said. The sensors are compatible with any graft system, he added.

SCOTTSDALE, ARIZ. — Vascular interventionalists may soon routinely implant pressure sensors that can detect endoleaks during both thoracic and abdominal aneurysm repair.

“Remote pressure sensing for endovascular repair is feasible,” Dr. Ross Milner said at an international symposium on endovascular interventions sponsored by the Arizona Heart Foundation. The sensors have no battery. They are activated by energy waves generated by external probes, which also read the measurement.

In a recent publication, Dr. Milner, of the division of vascular surgery at Emory University, Atlanta, said there are two devices in development, one that uses ultrasound waves and the other, radio waves. Both devices—the ImPressure ultrasound device, Remon Medical Technologies Inc., and the Endosensor, CardioMEMS Inc.—have been implanted in human trials.

The Endosensor device was approved for U.S. marketing in November, based on a 12-center trial. In a report on the trial at the most recent Society for Vascular Surgery meeting, the investigators said the device was implanted in 70 patients undergoing endovascular repair of abdominal aortic aneurysms without complication. It accurately measured pressure in 65 of the patients and detected all 15 endoleaks that occurred during the procedure.

Dr. Milner and his colleagues at Emory have begun using the ImPressure device in thoracic aneurysm repairs, with the first implant done in Brazil last July. That device continued to function well 8 months after implantation, and it has shown a dramatic, continued drop in pulse pressure within the aneurysm sac.

He predicted that, in time, use of these pressure devices may omit the need for CT angiography at the end of procedures to be sure the graft has completely sealed off the aneurysm, thus sparing patients some exposure to contrast agent. “Pressure sensing will be feasible in the thoracic aorta and may add a lot to the follow-up of these patients as it allows for appropriate intraoperative exclusion as well as long-term follow-up,” he said. The sensors are compatible with any graft system, he added.

SNOWMASS, COLO. — In the absence of clear indications for bisphosphonate therapy to prevent bone loss in long-term corticosteroid users, all patients prescribed corticosteroids should be advised to take vitamin D and calcium supplements, Dr. Lenore Buckley said at a symposium sponsored by the American College of Rheumatology.

Whether a patient is a long-term, low-dose corticosteroid user or a new user starting at a high dosage, “calcium and vitamin D supplements make a big difference,” said Dr. Buckley, a professor in the division of rheumatology at the Medical College of Virginia, Richmond. Supplementation appears to cut bone loss by at least 50%, she added.

Dr. Buckley followed a cohort of 65 rheumatoid arthritis patients who were taking an average of 5 mg of prednisone a day for 1 year. Those who received calcium and vitamin D supplementation had a mean 0.7% gain in bone mineral density in the lumbar spine, while those who did not use the supplements lost a mean of 2% (Ann. Intern. Med. 1996;125:961–8).

In a study of alendronate in patients taking an average of 7.5 mg of prednisone per day, those assigned to alendronate had increases in bone density measures. Nevertheless, the placebo group, which received only vitamin D and calcium supplements, still had no change in lumbar-spine bone mineral density over 2 years (N. Engl. J. Med. 1998;339:292–9). The same was true at the trochanter, and somewhat at the femoral neck.

Physician surveys suggest that rheumatologists do somewhat better than other specialists at tracking bone deterioration associated with corticosteroids. Still, patient surveys suggest that less than half of long-term steroid users take vitamin D and calcium supplementation, Dr. Buckley said.

Bisphosphonate therapy has been shown to protect bone density and should be considered for some patients taking corticosteroids, but it is not exactly clear when it needs to be instituted, Dr. Buckley said. The American College of Rheum-atology recommends considering bisphosphonates for any adult taking more than 5 mg of prednisone, or the equivalent, daily for more than 3 months. However, not all guidelines are in agreement with this advice.

Patient surveys suggest that less than half of long-term steroid users take vitamin D and calcium supplementation. DR. BUCKLEY

SNOWMASS, COLO. — In the absence of clear indications for bisphosphonate therapy to prevent bone loss in long-term corticosteroid users, all patients prescribed corticosteroids should be advised to take vitamin D and calcium supplements, Dr. Lenore Buckley said at a symposium sponsored by the American College of Rheumatology.

Whether a patient is a long-term, low-dose corticosteroid user or a new user starting at a high dosage, “calcium and vitamin D supplements make a big difference,” said Dr. Buckley, a professor in the division of rheumatology at the Medical College of Virginia, Richmond. Supplementation appears to cut bone loss by at least 50%, she added.

Dr. Buckley followed a cohort of 65 rheumatoid arthritis patients who were taking an average of 5 mg of prednisone a day for 1 year. Those who received calcium and vitamin D supplementation had a mean 0.7% gain in bone mineral density in the lumbar spine, while those who did not use the supplements lost a mean of 2% (Ann. Intern. Med. 1996;125:961–8).

In a study of alendronate in patients taking an average of 7.5 mg of prednisone per day, those assigned to alendronate had increases in bone density measures. Nevertheless, the placebo group, which received only vitamin D and calcium supplements, still had no change in lumbar-spine bone mineral density over 2 years (N. Engl. J. Med. 1998;339:292–9). The same was true at the trochanter, and somewhat at the femoral neck.

Physician surveys suggest that rheumatologists do somewhat better than other specialists at tracking bone deterioration associated with corticosteroids. Still, patient surveys suggest that less than half of long-term steroid users take vitamin D and calcium supplementation, Dr. Buckley said.

Bisphosphonate therapy has been shown to protect bone density and should be considered for some patients taking corticosteroids, but it is not exactly clear when it needs to be instituted, Dr. Buckley said. The American College of Rheum-atology recommends considering bisphosphonates for any adult taking more than 5 mg of prednisone, or the equivalent, daily for more than 3 months. However, not all guidelines are in agreement with this advice.

Patient surveys suggest that less than half of long-term steroid users take vitamin D and calcium supplementation. DR. BUCKLEY

SNOWMASS, COLO. — In the absence of clear indications for bisphosphonate therapy to prevent bone loss in long-term corticosteroid users, all patients prescribed corticosteroids should be advised to take vitamin D and calcium supplements, Dr. Lenore Buckley said at a symposium sponsored by the American College of Rheumatology.

Whether a patient is a long-term, low-dose corticosteroid user or a new user starting at a high dosage, “calcium and vitamin D supplements make a big difference,” said Dr. Buckley, a professor in the division of rheumatology at the Medical College of Virginia, Richmond. Supplementation appears to cut bone loss by at least 50%, she added.

Dr. Buckley followed a cohort of 65 rheumatoid arthritis patients who were taking an average of 5 mg of prednisone a day for 1 year. Those who received calcium and vitamin D supplementation had a mean 0.7% gain in bone mineral density in the lumbar spine, while those who did not use the supplements lost a mean of 2% (Ann. Intern. Med. 1996;125:961–8).

In a study of alendronate in patients taking an average of 7.5 mg of prednisone per day, those assigned to alendronate had increases in bone density measures. Nevertheless, the placebo group, which received only vitamin D and calcium supplements, still had no change in lumbar-spine bone mineral density over 2 years (N. Engl. J. Med. 1998;339:292–9). The same was true at the trochanter, and somewhat at the femoral neck.

Physician surveys suggest that rheumatologists do somewhat better than other specialists at tracking bone deterioration associated with corticosteroids. Still, patient surveys suggest that less than half of long-term steroid users take vitamin D and calcium supplementation, Dr. Buckley said.

Bisphosphonate therapy has been shown to protect bone density and should be considered for some patients taking corticosteroids, but it is not exactly clear when it needs to be instituted, Dr. Buckley said. The American College of Rheum-atology recommends considering bisphosphonates for any adult taking more than 5 mg of prednisone, or the equivalent, daily for more than 3 months. However, not all guidelines are in agreement with this advice.

Patient surveys suggest that less than half of long-term steroid users take vitamin D and calcium supplementation. DR. BUCKLEY

Black female smokers are less likely to smoke to control their weight than white female smokers, according to a survey conducted to explore differences between the groups.

Because previous studies on the reasons why people smoke have involved almost entirely subjects enrolled in a smoking cessation program, this survey purposely queried individuals not trying to quit in addition to those who were.

The main hypothesis of the research was that white women would be more likely to cite weight control as a primary reason for smoking, and black women would be more likely to cite tension reduction.

The survey found that although the first premise was true, the second was not. White and black women cited tension reduction as a reason for smoking equally, and, in fact, it was the most frequently cited reason for both groups, reported Lisa Sánchez-Johnsen, Ph.D., of the University of Hawaii-Manoa, Honolulu, and her colleagues (Addict. Behav. 2006;31:544–8).

The survey queried 100 smokers attempting to quit and 100 not attempting to quit. Half of each group was white and half was black. A slightly lower percentage of black females smoke (20.8% vs. 23.1% of white females), and they tend to smoke fewer cigarettes per day (an average of 15 cigarettes vs. 20 cigarettes), the researchers noted.

Black smokers are more likely to report a desire to quit smoking and are less likely to be successful, they also said.

Black females have a higher prevalence of obesity than white females, and they tend to gain more weight when they quit smoking, Dr. Sánchez-Johnsen wrote in another recent paper.

Black female smokers are less likely to smoke to control their weight than white female smokers, according to a survey conducted to explore differences between the groups.

Because previous studies on the reasons why people smoke have involved almost entirely subjects enrolled in a smoking cessation program, this survey purposely queried individuals not trying to quit in addition to those who were.

The main hypothesis of the research was that white women would be more likely to cite weight control as a primary reason for smoking, and black women would be more likely to cite tension reduction.

The survey found that although the first premise was true, the second was not. White and black women cited tension reduction as a reason for smoking equally, and, in fact, it was the most frequently cited reason for both groups, reported Lisa Sánchez-Johnsen, Ph.D., of the University of Hawaii-Manoa, Honolulu, and her colleagues (Addict. Behav. 2006;31:544–8).

The survey queried 100 smokers attempting to quit and 100 not attempting to quit. Half of each group was white and half was black. A slightly lower percentage of black females smoke (20.8% vs. 23.1% of white females), and they tend to smoke fewer cigarettes per day (an average of 15 cigarettes vs. 20 cigarettes), the researchers noted.

Black smokers are more likely to report a desire to quit smoking and are less likely to be successful, they also said.

Black females have a higher prevalence of obesity than white females, and they tend to gain more weight when they quit smoking, Dr. Sánchez-Johnsen wrote in another recent paper.

Black female smokers are less likely to smoke to control their weight than white female smokers, according to a survey conducted to explore differences between the groups.

Because previous studies on the reasons why people smoke have involved almost entirely subjects enrolled in a smoking cessation program, this survey purposely queried individuals not trying to quit in addition to those who were.

The main hypothesis of the research was that white women would be more likely to cite weight control as a primary reason for smoking, and black women would be more likely to cite tension reduction.

The survey found that although the first premise was true, the second was not. White and black women cited tension reduction as a reason for smoking equally, and, in fact, it was the most frequently cited reason for both groups, reported Lisa Sánchez-Johnsen, Ph.D., of the University of Hawaii-Manoa, Honolulu, and her colleagues (Addict. Behav. 2006;31:544–8).

The survey queried 100 smokers attempting to quit and 100 not attempting to quit. Half of each group was white and half was black. A slightly lower percentage of black females smoke (20.8% vs. 23.1% of white females), and they tend to smoke fewer cigarettes per day (an average of 15 cigarettes vs. 20 cigarettes), the researchers noted.

Black smokers are more likely to report a desire to quit smoking and are less likely to be successful, they also said.

Black females have a higher prevalence of obesity than white females, and they tend to gain more weight when they quit smoking, Dr. Sánchez-Johnsen wrote in another recent paper.

SNOWMASS, COLO. — Gathering data suggest that using glucocorticoid steroids in children may cost them height but not necessarily bone density, Dr. Lenore Buckley said at a symposium sponsored by the American College of Rheumatology.

“The issue of what glucocorticoids do to bone mass in children is an area where we are only just beginning to get some data,” said Dr. Buckley of the Medical College of Virginia, Richmond.

One such cross-sectional study looked at 60 children with isolated, idiopathic nephrotic syndrome being treated with glucocorticoids, and compared them with 195 matched controls, mean age 9–10 years. Children treated with glucocorticoids were found to lose height but not necessarily bone density (N. Engl. J. Med. 2004;351: 868–75). In the group treated with glucocorticoids, 26 study participants were black, and 39 control group participants were black, according to the study data.

Previous studies have found that children lose bone mineral density when treated with glucocorticoids. But those studies looked at children with systemic illnesses, such as juvenile rheumatoid arthritis and inflammatory bowel disease, so it is not clear whether their low density was due to their treatment with glucocorticoids or to their systemic condition.

The mean height z score of the children in the control group was positive (0.35), whereas the mean height z score of the glucocorticoid treated children was negative (−0.17), the study found.

At the lumbar spine, the same bone mineral density per unit area was found in both the control and glucocorticoid treated groups, however.

“For what bone [both groups] have, the density is the same, but [the glucocorticoid group doesn't] have as much bone because they don't grow as much,” Dr. Buckley said. The bone density for the treatment group could be due to the glucocorticoid, which causes weight gain, and weight stimulates bone density growth, she noted.

The mean body mass index z score for children with nephrotic syndrome was 1.24, while the score for controls was 0.34. There was also a higher percentage of obese children in the nephrotic syndrome group, compared with the control group (38% vs. 16%, respectively).

A more detailed look at the children's bone density found that those with nephrotic syndrome had slightly lower trabecular bone density (mean z score - 0.27, vs. 0), but much greater cortical bone density (mean z score 0.87, vs. 0). This situation also suggests that while there may be a process interfering with bone accumulation, there is also some compensation due to weight gain, Dr. Buckley said.

Children with nephrotic syndrome go on and off glucocorticoid treatment, which could allow for some periods of recovery, so these findings may not extrapolate to children treated chronically, Dr. Buckley noted. “What it tells us is that in the short run, these kids are not at risk for fracture—they have pretty good density,” she said. “But what it doesn't tell us is the risk of fracture in the future.”

Adults not taking glucocorticoids whose rate was one standard deviation below the mean as a child have a four times higher risk of fracture, studies show, noted Dr. Buckley.

SNOWMASS, COLO. — Gathering data suggest that using glucocorticoid steroids in children may cost them height but not necessarily bone density, Dr. Lenore Buckley said at a symposium sponsored by the American College of Rheumatology.

“The issue of what glucocorticoids do to bone mass in children is an area where we are only just beginning to get some data,” said Dr. Buckley of the Medical College of Virginia, Richmond.

One such cross-sectional study looked at 60 children with isolated, idiopathic nephrotic syndrome being treated with glucocorticoids, and compared them with 195 matched controls, mean age 9–10 years. Children treated with glucocorticoids were found to lose height but not necessarily bone density (N. Engl. J. Med. 2004;351: 868–75). In the group treated with glucocorticoids, 26 study participants were black, and 39 control group participants were black, according to the study data.

Previous studies have found that children lose bone mineral density when treated with glucocorticoids. But those studies looked at children with systemic illnesses, such as juvenile rheumatoid arthritis and inflammatory bowel disease, so it is not clear whether their low density was due to their treatment with glucocorticoids or to their systemic condition.

The mean height z score of the children in the control group was positive (0.35), whereas the mean height z score of the glucocorticoid treated children was negative (−0.17), the study found.

At the lumbar spine, the same bone mineral density per unit area was found in both the control and glucocorticoid treated groups, however.

“For what bone [both groups] have, the density is the same, but [the glucocorticoid group doesn't] have as much bone because they don't grow as much,” Dr. Buckley said. The bone density for the treatment group could be due to the glucocorticoid, which causes weight gain, and weight stimulates bone density growth, she noted.

The mean body mass index z score for children with nephrotic syndrome was 1.24, while the score for controls was 0.34. There was also a higher percentage of obese children in the nephrotic syndrome group, compared with the control group (38% vs. 16%, respectively).

A more detailed look at the children's bone density found that those with nephrotic syndrome had slightly lower trabecular bone density (mean z score - 0.27, vs. 0), but much greater cortical bone density (mean z score 0.87, vs. 0). This situation also suggests that while there may be a process interfering with bone accumulation, there is also some compensation due to weight gain, Dr. Buckley said.

Children with nephrotic syndrome go on and off glucocorticoid treatment, which could allow for some periods of recovery, so these findings may not extrapolate to children treated chronically, Dr. Buckley noted. “What it tells us is that in the short run, these kids are not at risk for fracture—they have pretty good density,” she said. “But what it doesn't tell us is the risk of fracture in the future.”

Adults not taking glucocorticoids whose rate was one standard deviation below the mean as a child have a four times higher risk of fracture, studies show, noted Dr. Buckley.

SNOWMASS, COLO. — Gathering data suggest that using glucocorticoid steroids in children may cost them height but not necessarily bone density, Dr. Lenore Buckley said at a symposium sponsored by the American College of Rheumatology.

“The issue of what glucocorticoids do to bone mass in children is an area where we are only just beginning to get some data,” said Dr. Buckley of the Medical College of Virginia, Richmond.

One such cross-sectional study looked at 60 children with isolated, idiopathic nephrotic syndrome being treated with glucocorticoids, and compared them with 195 matched controls, mean age 9–10 years. Children treated with glucocorticoids were found to lose height but not necessarily bone density (N. Engl. J. Med. 2004;351: 868–75). In the group treated with glucocorticoids, 26 study participants were black, and 39 control group participants were black, according to the study data.

Previous studies have found that children lose bone mineral density when treated with glucocorticoids. But those studies looked at children with systemic illnesses, such as juvenile rheumatoid arthritis and inflammatory bowel disease, so it is not clear whether their low density was due to their treatment with glucocorticoids or to their systemic condition.

The mean height z score of the children in the control group was positive (0.35), whereas the mean height z score of the glucocorticoid treated children was negative (−0.17), the study found.

At the lumbar spine, the same bone mineral density per unit area was found in both the control and glucocorticoid treated groups, however.

“For what bone [both groups] have, the density is the same, but [the glucocorticoid group doesn't] have as much bone because they don't grow as much,” Dr. Buckley said. The bone density for the treatment group could be due to the glucocorticoid, which causes weight gain, and weight stimulates bone density growth, she noted.

The mean body mass index z score for children with nephrotic syndrome was 1.24, while the score for controls was 0.34. There was also a higher percentage of obese children in the nephrotic syndrome group, compared with the control group (38% vs. 16%, respectively).

A more detailed look at the children's bone density found that those with nephrotic syndrome had slightly lower trabecular bone density (mean z score - 0.27, vs. 0), but much greater cortical bone density (mean z score 0.87, vs. 0). This situation also suggests that while there may be a process interfering with bone accumulation, there is also some compensation due to weight gain, Dr. Buckley said.

Children with nephrotic syndrome go on and off glucocorticoid treatment, which could allow for some periods of recovery, so these findings may not extrapolate to children treated chronically, Dr. Buckley noted. “What it tells us is that in the short run, these kids are not at risk for fracture—they have pretty good density,” she said. “But what it doesn't tell us is the risk of fracture in the future.”

Adults not taking glucocorticoids whose rate was one standard deviation below the mean as a child have a four times higher risk of fracture, studies show, noted Dr. Buckley.