scholarly journals Variation in Antiplatelet Usage after Peripheral Vascular Intervention and Carotid Artery Stenting in the Vascular Quality Initiative

2021 ◽  
Vol 233 (5) ◽  
pp. S317
Author(s):  
Mohammad Rajaei ◽  
Zdenek Novak ◽  
Emily L. Spangler ◽  
Danielle C. Sutzko ◽  
Adam W. Beck ◽  
...  
2020 ◽  
Vol 133 (6) ◽  
pp. 1830-1836 ◽  
Author(s):  
Gavin W. Britz ◽  
Sandip S. Panesar ◽  
Peter Falb ◽  
Johnny Tomas ◽  
Virendra Desai ◽  
...  

OBJECTIVEThe aim of this study was to evaluate new, neuroendovascular-specific engineering and software modifications to the CorPath GRX Robotic System for their ability to support safer and more effective cranial neurovascular interventions in a preclinical model.METHODSActive device fixation (ADF) control software, permitting automated manipulation of the guidewire relative to the microcatheter, and a modified drive cassette suitable for neuroendovascular instruments were the respective software and hardware modifications to the current CorPath GRX robot, which was cleared by the FDA for percutaneous coronary and peripheral vascular intervention. The authors then trialed the modified system in a live porcine model with simulated neuroendovascular pathology. Femoral access through the aortic arch to the common carotid artery was accomplished manually (without robotic assistance), and the remaining endovascular procedures were performed with robotic assistance. The system was tested for the enhanced ability to navigate and manipulate neurovascular-specific guidewires and microcatheters. The authors specifically evaluated the movement of the wire forward and backward during the advancement of the microcatheter.RESULTSNavigation of the rete mirabile and an induced aneurysm within the common carotid artery were successful. The active device fixation feature enabled independent advancement and retraction of the guidewire and working device relative to the microcatheter. When ADF was inactive, the mean forward motion of the guidewire was 5 mm and backward motion was 0 mm. When ADF was active, the mean forward motion of the guidewire was 0 mm and backward motion was 1.5 mm. The modifications made to the robotic cassette enabled the system to successfully manipulate the microcatheter and guidewire safely and in a manner more suited to neuroendovascular procedures than before. There were no occurrences of dissection, extravasation, or thrombosis.CONCLUSIONSThe robotic system was originally designed to navigate and manipulate devices for cardiac and peripheral vascular intervention. The current modifications described here improved its utility for the more delicate and tortuous neurovascular environment. This will set the stage for the development of a neurovascular-specific robot.


Author(s):  
Niveditta Ramkumar ◽  
Bjoern D Suckow ◽  
Jack L Cronenwett ◽  
Philip P Goodney

Introduction: While men and women are at equal risk for peripheral arterial disease (PAD), studies suggest that women present at an older age and with more advanced disease. The purpose of this analysis is to evaluate gender-based differences in disease presentation and its effect on treatment modality among patients who underwent peripheral vascular intervention (PVI) for PAD. Methods: Using national registry data from the Vascular Quality Initiative, univariate analysis, of patient-, limb- and artery-specific characteristics were performed by gender for procedures from 2010-2013. Statistical significance was determined by the Student’s T-test or Chi-squared test. Results: In this real-world cohort, there were 26,873 eligible procedures for 23,940 patients that had 30,668 limbs and 44,927 arteries treated. Compared to men, women presented at an older age (69 vs 71 years, p<0.001) and with more rest pain and tissue loss than claudication (RR=1.13, 95% CI: 1.10-1.16). Women had more severe lesions than men, as measured by TASC classification (TASC C or D RR= 1.81, 95% CI: 1.74-1.87) ( Table 1 ). There were no meaningful gender-based differences in artery treated or treatment modality ( Figure 1 ). Treatment modality was determined by disease severity (indication and TASC classification) and artery treated rather than gender. Conclusion: Although gender-based differences in PAD presentation exist, these differences do not extend to treatment modality, which is determined by disease severity and artery treated. Further investigation is required to appreciate the effect of disease severity and treatment modality on patient outcomes after PVI.


2021 ◽  
Vol 74 (4) ◽  
pp. e380
Author(s):  
Katherine E. Hawkins ◽  
R. James Valentine ◽  
Julie M. Duke ◽  
Amy B. Reed

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