Manuel Maynar-Moliner

University of Santiago de Compostela, Santiago, Galicia, Spain

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Publications (10)12.49 Total impact

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    ABSTRACT: INTRODUCTION. Hemodynamic depression is a frequent complication related to carotid artery stenting with angioplasty. The aim of this study was to assess our results regarding hemodynamic depression, in patients who underwent carotid artery stenting without angioplasty. PATIENTS AND METHODS. Between October 2002 and April 2010, 261 carotid stenosis (in 242 patients) were treated with the use of self-expanding stents without angioplasty. Inclusion criteria were symptomatic carotid stenosis > 50%, asymptomatic carotid stenosis > 70%, and stenosis ranging between 50-70% with evidence of high risk plaque morphology or micro-embolism. Outcomes during hospitalization and 30 days after procedure were registered. Hemodynamic depression was defined as hypotension (systolic blood pressure < 90 mm Hg) or bradycardia (heart rate < 60 beats/min). RESULTS. During the procedure 7 (2.9%) patients presented bradycardia and 3 (1.2%) hypotension. No patient required vasopressor drugs or ICU for hemodynamic monitoring. No patient developed asystole or other types of arrhythmia. During hospitalization, hemodynamic depression was not observed in any patients. During the first 30 days post-procedure, there were 11 TIAs (4.5%), 1 disabling stroke (0.4%), 1 non disabling stroke (0.4%), and 1 death (0.4%) (1 stent thrombosis at 11 days). CONCLUSION. The incidence of hemodynamic depression is low when carotid stenting procedure is performed without balloon angioplasty. The incidence of neurological complications post procedure was also low. This report highlights the need for performing randomized trials comparing both techniques.
    Revista de neurologia 02/2013; 56(4):200-4. · 1.18 Impact Factor
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    ABSTRACT: The segmentation of three-dimensional vascular trees is an important topic in medical image processing. Although it may seem to be an easy task, many different techniques have been proposed in the literature during the last decade and many difficulties remain. One can wonder why the human eye is usually able to understand the connectivity and the topology of the different structures while most algorithms fail to do so. In this paper, we propose an original approach that classifies the different contours by applying a geodesic distance transform on the contours of the vessels, where the evolution speed depends directly on the maximal curvature of the contours. This proposition comes from the observation that the maximal curvature on a standard vessel is usually positive and almost constant while it approaches zero or becomes negative on the contour at the contact with other structures. We describe our method in details and present promising results on synthetic and real images, where the method has been able to detect complex vascular structures without leaking into bones or mixing different vascular networks.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2011; 2011:8001-4.
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    ABSTRACT: To analyse the outcome of the proactive management of patients with diabetes, critical limb ischaemia and foot ulcers using percutaneous transluminal angioplasty as the only vascular procedure and adjuvant conservative surgery when indicated. A retrospective study of patients with diabetes included in our database who sought a second opinion in our unit and met the following criteria: foot ulcer and critical limb ischaemia in patients for whom any proactive vascular treatment had not previously been considered by other teams. Twenty patients underwent endovascular procedures. Success was achieved in 19 cases (95%). No post-operative mortality (within 30 days after the procedure) was found. Additional surgery was required in eight cases (40%): one calcaneal ostectomy and seven minor amputations. The need for surgery was associated with infection (P < 0.01). Limb salvage was sustained during a mean period of follow-up of 642 days (SD 488) in 19 cases (95%). Healing was achieved in 14 cases (70%), four are still healing (20%), one underwent major amputation (5%) and the last one died before being healed (5%). Three patients died during follow-up (15%). Management of patients with diabetes, foot ulcers and critical limb ischaemia by means of a proactive approach including endovascular procedures in specialized settings provides a high rate of limb salvage. This may result in lowering the number of lower limb amputations in our community.
    Diabetic Medicine 06/2011; 28(10):1249-52. · 3.24 Impact Factor
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    ABSTRACT: The purpose of this study was to analyze the outcomes of major lower extremity amputations (MLEAs) in a series, including diabetic patients, with the aim to study whether diabetes mellitus is a risk factor of in-hospital mortality and perioperative complications. A retrospective analysis of 283 MLEAs (221 of these patients were diabetic and 62 were nondiabetic) performed between January 1, 1998, and December 31, 2008, at the General Surgery Department and Diabetic Foot Unit of La Paloma Hospital in Las Palmas de Gran Canaria (Canary Islands) was done. The significant risk factors of mortality were >" xbd="324" xhg="301" ybd="1481" yhg="1446"/>75 years of age (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 1.4-11.7), postoperative cardiac complications (OR = 12.3, 95% CI = 3.7-40.2) and postoperative respiratory complications (OR = 3.8, 95% CI = 1.0-13.3). No statistically significant risk factors were found related to the presence of systemic and wound-related complications. In diabetic patients, the significant risk factors of mortality were postoperative cardiological complications (OR = 13.6, 95% CI = 3.1-59.6), postoperative respiratory complications (OR = 5.9, 95% CI = 1.0-35.5), and first episode of amputation (OR = 5.9, 95% CI = 1.4-24.3). There were no statistically significant differences in the outcome of major amputations between diabetic and nondiabetic patients. Hospital stay was significantly longer in diabetic patients (P < .01) though when the patients with diabetic foot infections were excluded, this difference was not found.
    The International Journal of Lower Extremity Wounds 03/2010; 9(1):16-23. · 1.25 Impact Factor
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    ABSTRACT: We have studied the rate of lower extremity amputations (LEAs) in the south of Gran Canaria. The incidence rate was 319.7 per 100,000 (95% CI, 258.6-380.8) per year in the diabetic subjects. The incidence of both diabetic and non-diabetic LEAs is the highest reported in Spain.
    Diabetes research and clinical practice 08/2009; 86(1):e6-8. · 2.74 Impact Factor
  • Seminars in Interventional Radiology - SEMIN INTERVENT RADIOL. 01/1991; 8(01):82-84.
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    ABSTRACT: We performed balloon urethroplasty in six older normal dogs and 10 patients with benign prostatic hypertrophy to establish the mechanism by which this technique results in relief of bladder outlet obstruction. Thirty-millimeter balloon catheters were used in both the animal and human studies. Autopsy studies showed disruption of the anterior prostatic commissure in four of the six dogs, disruption of both anterior and posterior commissures in one dog, and no disruption in the remaining dog. In all 10 patients, cystoscopy and urethrography showed disruption of the anterior commissure. Separation of the prostatic lobes by disruption of the prostatic commissures may be the most important mechanism by which balloon urethroplasty relieves urethral obstruction.
    American Journal of Roentgenology 01/1990; 153(6):1301-4. · 2.90 Impact Factor
  • Seminars in Interventional Radiology - SEMIN INTERVENT RADIOL. 01/1988; 5(04):289-292.
  • Revista de neurologia 44(8):510-2. · 1.18 Impact Factor
  • John C. Hulbert, Imre Rep, Manuel Maynar-Moliner, David W. Hunter