Nishath AltafRoyal Perth Hospital · Department of Vascular Surgery
Nishath Altaf
MB ChB, BSc (Hons), PhD, FRCS, FRACS
About
78
Publications
14,496
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
1,817
Citations
Introduction
Additional affiliations
February 2014 - present
March 2012 - present
February 2007 - February 2014
Publications
Publications (78)
Background and purpose:
Magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk.
Methods:
One-hu...
OBJECTIVES: To compare the mid-term outcome and secondary intervention rate following elective open and endovascular aortic aneurysm repair (EVAR) in patients aged 65 years and younger. METHODS: A retrospective analysis of patients aged 65 years and younger who had elective abdominal aortic aneurysm repair (AAA) between 1994 and 2012. RESULTS: One...
Objective
There is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis. Methods
One hu...
Objective:
The Covered vs Balloon Expandable Stent Trial (COBEST) is the first multicenter trial to investigate the patency of covered stents (CSs) and bare-metal stents (BMSs) in the treatment of aortoiliac arterial disease. The short-term results demonstrated that CSs were superior to BMSs in maintaining patency for TransAtlantic Inter-Society C...
The last two decades have seen a revolution in the treatment of Aortoiliac Occlusive Disease (AIOD). Acceptable safety and durability outcomes have now been realized with endovascular treatments, which is increasingly finding a place in the treatment of AIOD. Evolution of stent technologies and endovascular techniques is seeing an expansion of AIOD...
Objective
To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak.
Methods
An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services du...
Background:
Frailty predicts adverse perioperative outcomes and increased mortality in patients having vascular surgery. Frailty assessment is a potential tool to inform resource allocation, and shared decision-making about vascular surgery in the resource constrained COVID-19 pandemic environment. This cohort study describes the prevalence of fra...
Background: Living in deprived areas is associated with poorer outcomes after certain vascular procedures and surgical site infection in other specialties. Our primary objective was to determine whether living in more income-deprived areas was associated with groin wound surgical site infection after arterial intervention. Secondary objectives were...
Objective
This study aimed to develop and internally validate risk prediction models for predicting groin wound surgical site infections (SSIs) following arterial intervention and to evaluate the utility of existing risk prediction models for this outcome.
Methods
Data from the Groin wound Infection after Vascular Exposure (GIVE) multicentre cohor...
Purpose
Improvement in long-term outcomes through innovative, cost-effective medical technologies is a focus for endovascular procedures aimed at treating symptomatic lower-limb peripheral arterial disease (PAD). The advent of drug-eluting stents (DES) has improved symptomatic PAD treatment via a reduction in high rates of target lesion revasculari...
Introduction
Improving long-term outcomes like target lesions revascularizations (TLRs) is a focus for endovascular interventions aimed at treating symptomatic lower-limb peripheral arterial disease (PAD). Eluvia TM , a paclitaxel-eluting drug-eluting stent (DES) was shown to further reduce TLRs when compared with the paclitaxel-coated Zilver® PTX®...
Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI.
An international multicentre prospective observational cohort...
Background:
Several studies have reported worse outcomes in women compared to men after endovascular aneurysm repair (EVAR). This study aimed to evaluate sex-specific short-term and 5-year outcomes after EVAR.
Methods:
A total of 409 consecutive patients underwent elective EVAR from 2004 to 2017 at two tertiary hospitals in Western Australia. Ba...
Introduction:
The management of peri-aortitis, a rare complication after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA), is described in a patient with a solitary kidney.
Report:
A 64 year old man who developed peri-aortitis after elective EVAR for a 6.6 cm infrarenal AAA is reported. Peri-aortitis was diagnosed two mont...
Purpose: To assess the incidence and predictors of severe, persistent postprocedural hypotension (PPH) after carotid artery stenting (CAS). Materials and Methods: A total of 146 patients (mean age 72.8 years; 104 men) who underwent 160 CAS procedures using a standardized protocol at 3 vascular centers were retrospectively analyzed. The primary endp...
Background
MRI-defined acute cerebral infarctions (DWI+) and carotid plaque haemorrhage (MRIPH+) are risk factors for cerebrovascular ischaemic events. It is unclear whether their predictive power is independent, and whether a combined score would improve prediction of recurrent events.
Methods
158 patients (mean 74 years, 40% female) with symptom...
An 83-year-old man presented 4 years after right carotid endarterectomy (CEA) with an infection of his prosthetic Dacron patch. Initial scans (CT angiogram and whole body labelled white cell scan) were clear with no infection or collection noted. Systemically, the patient presented well with no recorded fevers. With an occluded left internal caroti...
Introduction
MRI-defined carotid plaque haemorrhage (MRIPH) can predict recurrent cerebrovascular ischaemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification in less severe disease.
Methods
192 symptomatic participants with 30–99% carotid artery stenosis who were clinically deemed not to...
Background and purpose:
A key factor in predicting recurrent ischemic episodes in patients with carotid artery occlusion is the presence of hemodynamic impairment. There is, however, no consensus on how to best assess this risk in terms of imaging modalities or thresholds used. Here we investigated whether a predefined threshold of hemispheric asy...
MR imaging-detected carotid plaque hemorrhage is associated with an increased risk of recurrent ischemic cerebrovascular events and could be an indicator of disease progression; however, there are limited data regarding the dynamics of the MR imaging-detected carotid plaque hemorrhage signal. We assessed the temporal change of this signal and its i...
Background
The European Carotid Surgery Trial (ECST) risk model is a validated tool for predicting cerebrovascular risk in patients with symptomatic carotid disease. Carotid plaque hemorrhage as detected by MRI (MRIPH) and microembolic signals (MES) detected by transcranial Doppler (TCD) are 2 emerging modalities in assessing instability of the car...
Endovascular repair of popliteal artery aneurysms (PAA) has become increasingly popular; however, long-term patency and limb salvage rates are not fully established.
A retrospective review of all endovascular PAA repairs at our institution (from 2005 to 2012) identified 34 PAAs in 26 patients, of which 32 % presented with acute symptoms. PAA were r...
Whilst malnutrition is prevalent in approximately 40% of general surgical patients, the prevalence of malnutrition and nutritional screening practices amongst vascular patients remain unknown. The Malnutrition Universal Screening Tool (MUST) is recommended for risk screening and provides 3 scores for risk classification: 0=low risk, 1=intermediate...
Objectives: Carotid artery stiffness has been suggested to alter local haemodynamic and arterial remodelling. It has also been shown to be associated with ischaemic stroke. The aim of this pilot study is to assess the feasibility of measuring carotid pulse wave velocity (cPWV) using magnetic resonance imaging (MRI) in patients with carotid stenosis...
Background
The timing of carotid endarterectomy (CEA) following thrombolysis for acute ischemic stroke remains controversial. We have described our unit's experience and performed a systematic review and pooled data synthesis of the safety of CEA in this group of patients.
Methods
Retrospective analysis of patients who had undergone CEA following...
Background:
Recent international guidance recommends the use of catheter-directed thrombolysis (CDT) in selected patients with symptomatic iliofemoral deep vein thrombosis (DVT). The aim of this study was to estimate the potential increase in workload as a result of this recommendation.
Methods:
Using the radiology database, a review was perform...
Background:
Both magnetic resonance detected carotid plaque hemorrhage (MRI PH(+)) and features of inflammation are associated with increased risk of cerebrovascular events in patients with carotid stenosis. To further assess the potential of MRI PH as a biomarker for complicated carotid plaque, its relationship with inflammation needs to be asses...
Women are at lower risk of stroke, and appear to benefit less from carotid endarterectomy (CEA) than men. We hypothesised that this is due to more benign carotid disease in women mediating a lower risk of recurrent cerebrovascular events. To test this, we investigated sex differences in the prevalence of MRI detectable plaque hemorrhage (MRI PH) as...
The Editors welcome topical correspon-dence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250...
The Hardman index is a predictor of 30-day mortality after open ruptured abdominal aneurysm repair through the use of preoperative patient factors. The aim of this study was to assess the Hardman index in patients undergoing endovascular repair of ruptured aortic aneurysms.
A retrospective analysis of 95 patients undergoing emergency endovascular r...
To review the outcomes of patients undergoing emergency endovascular repair of aortocaval fistula (ACF) secondary to abdominal aortic aneurysm (AAA).
Four consecutive patients who underwent emergency endovascular repair of ACF associated with AAA in a tertiary institution between 2002 and 2009. Of the 4 patients, 3 had initially been misdiagnosed a...
To assess whether carotid plaque hemorrhage depicted with magnetic resonance (MR) imaging was associated with thromboembolic activity as assessed with transcranial Doppler imaging.
The local research ethics committee approved the study, and all patients gave informed written consent. Between April 2005 and December 2006, patients with high-grade sy...
In patients with symptomatic carotid artery disease the predominant mechanism causing ischaemic injury is considered to be thromboembolic, however compromise of cerebral haemodynamics is considered to be a significant factor. Removal of the embolic source is accepted as the major benefit from Carotid Endarterectomy (CEA), however improvement in cer...
White matter hyperintense lesions (WMHLs) are related to age, hypertension, and ischemia. They increase the risk of stroke in natural history and perioperatively during carotid endarterectomy. This may reflect an association with impaired cerebral hemodynamics. Hence, the authors studied whether ipsilateral WMHLs predict shunt requirement on clampi...
Endovascular repair of aortic aneurysm (EVAR) has a lower mortality than open repair. The aim of this study was to assess mortality from EVAR for emergency AAA repair and the impact of fitness for operation and adverse anatomy.
One-hundred and forty two patients who had EVAR for a ruptured AAA (80, REVAR) or a symptomatic AAA (62, SEVAR) between 19...
The aim of the study was to assess the suitability of radiofrequency ablation (RFA), endovenous laser ablation (EVLA), and foam sclerotherapy (FS) for patients with symptomatic varicose veins (VVs). The study comprised 403 consecutive patients with symptomatic VVs. Data on 577 legs from 403 consecutive patients with symptomatic VVs were collected f...
Sir, We would like to present a case of a 73-year-old female who underwent right-sided carotid endarterectomy (CEA) and 5 days later developed headache, vomiting, tonic–clonic seizures and hypertension. Cranial computed tomography was unremarkable and carotid duplex examination showed a patent carotid artery. Magnetic resonance imaging (MRI) of the...
To retrospectively assess the relationship between carotid intraplaque hemorrhage (IPH), which indicates plaque instability, and brain white matter hyperintense lesions (WMHLs) by using a within-patient design.
All patients gave written informed consent for the initial magnetic resonance (MR) studies, and the institutional review board and local re...
Carotid endarterectomy is beneficial in severe (>70%) symptomatic carotid stenosis. The risk of stroke in moderate carotid stenosis (50%-69%) is modest, and so the role of carotid endarterectomy in this group is unclear. Intraplaque hemorrhage is associated with advanced atherosclerosis and can be detected in the carotid arteries by magnetic resona...
Contrast-enhanced magnetic resonance angiography (CE-MRA) is a commonly used technique to assess the extracranial carotid arteries. We describe two patients (investigated for carotid artery atherosclerotic disease) who underwent CE-MRA. Results suggested pseudoaneurysms of the extracranial carotid arteries. Magnetic resonance direct thrombus imagin...
Background and Purpose—Carotid intraplaque hemorrhage (IPH), known to be associated with plaque instability, may convey a higher stroke risk. The aim of this study was to assess whether the identification of IPH by MRI predicts recurrent clinical cerebrovascular events. Methods—Sixty-six patients with high-grade symptomatic carotid stenosis underwe...
Microembolization detected during the dissection phase of carotid endarterectomy (CEA) is associated with plaque instability and might be associated with perioperative morbidity. Intraplaque hemorrhage is found in unstable plaques and is detectable using magnetic resonance imaging (MRI). We aimed to ascertain whether intraplaque hemorrhage as seen...
Carotid intraplaque hemorrhage (IPH), known to be associated with plaque instability, may convey a higher stroke risk. The aim of this study was to assess whether the identification of IPH by MRI predicts recurrent clinical cerebrovascular events.
Sixty-six patients with high-grade symptomatic carotid stenosis underwent MRI of the carotid arteries...
To the Editor:
Wasserman et al1 present a proof-of-concept case elegantly demonstrating that high-resolution MRI of carotid plaque can identify a lesion that was highly likely to be causing cerebrovascular symptoms even though it was not causing significant stenosis of the carotid lumen. The authors also acknowledge that acquiring high-resolution...
The aim of this study was to determine whether unstable carotid plaques, a known risk factor for cerebral emboli, are associated with cerebral white matter lesions.
Seventy-one symptomatic patients undergoing magnetic resonance imaging prior to carotid endarterectomy for high grade carotid stenosis were included in this study. The number and volume...
A rectus sheath haematoma is a difficult condition to diagnose and is usually treated by conservative measures. However, significant sized haematomas can result in severe haemodynamic repercussions, especially in those patients with co-morbidities and anticoagulation.
The case reported here is of a 68 year old anticoagulated patient with severe med...
variety of resultant symptoms. Contrast enhanced MRI is the imaging procedure of choice for diagnosis and follow-up. Gallium scanning and ACE measurement in serum and cerebrospinal fluid may be helpful but lack sensitivity and specificity. The same is true of increased protein and mild pleocytosis (usually lymphocytosis) in the cerebrospinal fluid....
A small decrease in cerebral blood flow (approximately 10%) in response to 100% oxygen (O2) administration is well recognized. This observation was based on human volunteer studies, which employed a nitrous oxide washout method for the measurement of cerebral blood flow. Because this method is now appreciated to be subject to potential errors we ha...
BACKGROUND Leukoaraiosis or the presence of white matter hyperintense lesions (WMHL) in fluid attenuated inversion recovery brain scans (FLAIR) is a risk factor for stroke and vascular death. However, controversy currently exists regarding the pathogenesis of WMHL. Theories mainly focus on small vessel disease or loss of autoregulation related to h...
Background Magnetic Resonance Direct Thrombus Imaging (MRDTI) has been shown to identify the histological complicated carotid plaque (1). This T1-weighted technique visualizes met-hemoglobin present in areas of intraplaque haemorrhage and thrombus found within the complicated carotid plaque (fig.1). However the true thromboembolic activity of the p...