Abstract 1122‐000088: Vertebral Origin Stenting Appears Safe and is Associated with Improved Functional Outcome at 3 Months

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Milagros Galecio‐Castillo ◽  
Milagros Galecio‐Castillo ◽  
Mudassir Farooqui ◽  
Kara Christopher ◽  
Cynthia B Zevallos ◽  
...  
Keyword(s):  
Adverse Events ◽  
Vertebral Artery ◽  
Stent Migration ◽  
Adverse Outcomes ◽  
Posterior Circulation ◽  
Cerebellar Infarction ◽  
Vascular Territory ◽  
Permanent Disability ◽  
Tandem Stenosis

Introduction : Stenosis of the vertebral artery origin (VAOS), while under‐diagnosed, is common and may cause up to 25% of posterior circulation infarctions. Stenting is widely employed as a secondary prevention strategy, but clinical studies of safety and efficacy are limited compared to carotid interventions. Methods : This is a retrospective observational cohort study of subjects who underwent vertebral origin stenting at two large academic centers. The demographic profile of the subjects, medical comorbidities, and radiological parameters were all collected. Primary safety outcome was defined as 30‐day post‐procedure complications. Secondary safety outcomes included periprocedural complications and change in the pre‐procedure Modified Rankin score (mRS) at 3 months of follow‐up. Results : There were 80 subjects who underwent vertebral artery stenting in this cohort. Mean age was 66.6 +10.2 years, 72.5% (n = 58) were male, 70% (n = 56) were Caucasian. 53.8% (n = 43) were treated for the right VA, 72.5% (n = 58) received second‐generation drug‐eluting stents (DES). Hypertension 67.5% (n = 54) and hyperlipidemia 65% (n = 52) were the most prevalent vascular risk factors. 76.3% (m = 61) of subjects were symptomatic at presentation. There were 8 adverse events identified at 30 days (10%): 3 strokes in the same vascular territory (2 minor and without permanent disability), 1 stroke in a different vascular territory, 2 subjects with worsening of symptoms attributable to the posterior circulation, 1 GI bleed, and 1 femoral thrombosis. 3 of these subjects were found to have ipsilateral tandem stenosis and 1 patient died due to distal occlusion and large cerebellar infarction. There were 4 (5%) adverse events identified in the immediate periprocedural period: 1 vertebral dissection, 1 in‐stent thrombosis, 1 SCA embolism, and 1 stent migration. mRS of these patients remained the same at 30 days and 3 months of follow‐up. Overall, the Modified Rankin score was significantly lower at 3 months versus the pre‐procedure (Z = ‐2.45, p = 0.01). Conclusions : This large cohort of subjects undergoing vertebral origin stenting demonstrates a low incidence of procedural complications and adverse outcomes at 30 days. mRS was significantly lower at 3 months. While disability seemed to decrease in this population, longer prospective efficacy endpoints are needed to better evaluate this therapy.

Long-term outcomes after endoscopic retrograde pancreatic drainage for symptomatic pancreaticojejunal anastomotic stenosis

2020 ◽  
Author(s):  
Akihiko Kida ◽  
Taro Kawane ◽  
Hitoshi Omura ◽  
Tatsuo Kumai ◽  
Masaaki Yano ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stent Placement ◽  
Stent Migration ◽  
Anastomotic Stenosis ◽  
Technical Success ◽  
Long Term Outcomes ◽  
Endoscopic Retrograde ◽  
Technical Success Rate

Abstract 【Background】 There is limited evidence demonstrating the usefulness of endoscopic retrograde pancreatic drainage (ERPD) for symptomatic pancreaticojejunal anastomotic stenosis (sPJS). We examined the usefulness of ERPD for sPJS. 【Methods】 We conducted a retrospective analysis of 10 benign sPJS patients. Following items were evaluated: technical success, adverse events and clinical outcome of ERPD. 【Results】 Technical success rate was 100% (10/10); 9 patients had a pancreatic stent (no-internal-flap: n=4, internal-flap: n=5). Median follow-up was 920 days. Four patients developed recurrence. Among them, 3 patients had a stent with no-internal-flap in initial ERPD and the stent migrated in 3 patients at recurrence, and a stent was not placed in 1 patient in initial ERPD. Four follow-up ERPD were performed. No recurrence was observed in 6 patients. Among them, none of the stents migrated (no-internal-flap: n=1, internal-flap: n=5), and none were replaced stents due to stent failure. A stent placement with no-internal-flap was associated with recurrence (p=0.042). Mild adverse events developed in 14.3% (2/14). 【Conclusions】 ERPD was performed safely with high technical success. Recurrence was common in a stent placement with no-internal-flap, which was associated with stent migration. Long-term stent placement didn’t result in stent failure.

scholarly journals Coiling Occlusion of the Vertebral Artery for a Patient with Recurrent Posterior Circulation TIAs

2013 ◽  
Vol 26 (1) ◽  
pp. 80-83 ◽  
Author(s):  
J. Chembala ◽  
C. Jadun ◽  
I. Natarajan ◽  
C. Roffe
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Left Vertebral Artery ◽  
Antithrombotic Treatment ◽  
Artery Embolization ◽  
Transient Ischaemic Attacks ◽  
Cerebral Embolization ◽  
One Year

Recurrent posterior circulation infarcts frequently involve multiple vascular territories, suggesting an embolic source. We describe a patient with left vertebral artery occlusion who had recurrent transient ischaemic attacks due to cerebral embolization originating from the occluded vertebral artery in spite of optimal anticoagulant and antithrombotic treatment. This was successfully managed by coiling occlusion of the vertebral artery with no recurrence of symptoms over one year of follow-up. To our knowledge, this is the first report of coiling occlusion in the treatment of recurrent vertebral artery embolization.

P2853Contemporary reporting of acute complications from implantable cardioverter defibrillator surgery

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Hassan ◽  
D Birnie ◽  
P Nery ◽  
G Nair ◽  
D Davis ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pulse Generator ◽  
De Novo ◽  
Care Center ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Physician Remuneration ◽  
Major Adverse Events ◽  
Lead Dislodgement

Abstract Background Defibrillator placement carries an inherent risk to the patient. Traditionally, major adverse events defined as cardiac arrest, tamponnade, pneumothorax, infection requiring re-operation, MI and CVA within 30 days are reported to occur between 3 and 4%. Minor complications such as heamatomae or lead dislodgement are reported between 8 and 13%. Novel lead technologies, protocolised programming and reduced use of Heparin bridging have been reported to reduce adverse outcomes. However, patients are still typically monitored in hospital for 24 hours to mitigate these risks. There is little evidence that discharge delay is effective yet incurs significant additional costs. Purpose We sought to evaluate the frequency and timing of adverse events relating to defibrillator surgery (ICD and CRT-D) at a large Canadian tertiary care center (UOHI). Methods We retrospectively reviewed all patients who received a defibrillator placed from 1st April 2013 to 31st March 2018 inclusive. Patient comorbidities were extracted from the hospital electronic medical record (EMR) system. Device related information and complications were extracted from UOHI PaceartTM system and EMR and cross referenced with physician remuneration databases. Results A total of 2221 procedures were performed on 2153 patients (78% male, mean age 65 years). The majority (60%) of defibrillator implants were de novo, with 884 (40%) pulse generator replacements/ upgrades and 868 (39%) defibrillators had CRT capability. Patients were routinely discharged within 24 hours of ICD surgery. Post-operative follow up ≥30 days was complete in 97% patients. Major adverse events occurred within 30 days in 9 patients (0.4%); 9 (100%) were infection requiring re-operation. An additional 32 patients (1.5%) required repeat interventions or readmission within 30 days of implant, most commonly due to lead dislodgement. Only 2 patients required readmission within 24 hours of surgery (0.1%). All procedure-related adverse events during clinical follow up (≤5 years) were 131 (5.9%) occurring in 122 patients. There were no apparent predictors of adverse events in this cohort. Conclusion(s) Contemporary risks to patients undergoing defibrillator surgery are considerably lower than that reported in 2010. The risk of infection appears constant despite increased antibiosis. Patients receiving an ICD or CRT-D can safely be discharged within 24 hours if no complications are apparent. Acknowledgement/Funding None

Abstract 14733: Influence of High Risk Adrenergic Receptor Genotypes on Outcome in Infants With Single Ventricle

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ronand Ramroop ◽  
Dorin Manase ◽  
George Manase ◽  
Cory Simmons ◽  
Jane W Newburger ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Outcomes ◽  
Confidence Intervals ◽  
Adrenergic Receptor ◽  
Single Ventricle ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Serious Adverse Events ◽  
Free Survival

Introduction: Variants in adrenergic receptor (ADR) genes are associated with adverse clinical outcomes in patients with heart failure. We evaluated the association of variants in ADR receptor genes with outcomes in infants with single ventricle lesions. Methods: Infants with single ventricle lesions participating in the Pediatric Heart Network Single Ventricle Reconstruction Trial (randomized to Norwood with modified Blalock-Taussig shunt versus right ventricle-pulmonary artery shunt) underwent genotyping for 4 single nucleotide polymorphisms (SNPs) in 3 ADR genes: ADRB1-A/G (rs1801252), ADRB1-C/G (rs1801253), ADRB2-C/G (rs1042714) and ADRA2A-C/T (rs553668). Linear and logistic regression, deviance tests, t-tests and F-tests were used to analyze association of genotype with clinical outcomes including hospital length of stay (LOS) at Norwood, occurrence of serious adverse events (SAE), and transplant-free survival during 14 months follow-up using a dominant model. Results: The study included 347 eligible patients (62% male; 83% white). The mean age at Norwood procedure was 6±3.6 days and median Norwood LOS was 8 days. During 14 months follow-up, 147 patients had SAEs, 94 patients died and 14 were transplanted. ADRB1 AA (rs1801252) genotype was associated with longer Norwood LOS. The difference in LOS between AA vs AG/GG was 7.99 days (confidence intervals, 0.27, 15.71; p=0.043). ADRA2A CC (rs553668) genotype was associated with higher odds of SAEs i.e. 103/216 (47.6%) in CC compared to 36/106 (34%) in CT/TT [Odds ratio 1.77 (confidence intervals, 1.09, 2.87), p=0.018]. Transplant-free survival was not different between genotype groups. Combined analysis of risk genotypes did not confer an additive risk of adverse outcomes. Conclusions: ADR genotypes known to cause adrenergic upregulation were associated with prolonged Norwood hospitalization and/or serious adverse events in infant single ventricles. This may be secondary to adverse effects of adrenergic overexpression on cardiac function and systemic hemodynamics. Analysis is ongoing to replicate these findings for utility as predictive markers for outcomes in infant single ventricles.

Midterm outcomes of paclitaxel-eluting stents for the treatment of intracranial posterior circulation stenoses

2007 ◽  
Vol 106 (2) ◽  
pp. 222-225 ◽  
Author(s):  
Brendan Steinfort ◽  
Perry P. Ng ◽  
Kenneth Faulder ◽  
Timothy Harrington ◽  
Verity Grinnell ◽  
...  
Keyword(s):  
Bare Metal Stents ◽  
Posterior Circulation ◽  
Metal Stents ◽  
Permanent Disability ◽  
Technical Success Rate ◽  
Telephone Interviews ◽  
Drug Eluting ◽  
Clinically Significant ◽  
Maximal Medical Therapy

Object Symptomatic intracranial vertebral and basilar artery atherosclerotic stenoses carry a high risk of stroke and permanent disability if refractory to maximal medical therapy. The authors conducted a study to determine the technical feasibility and midterm clinical and angiographic outcomes in patients in whom paclitaxel-eluting stents were placed for the treatment of symptomatic intracranial posterior circulation stenoses. Methods A retrospective review of medical records and imaging studies was performed for 13 consecutive patients in whom paclitaxel-coated stents were used to treat symptomatic posterior circulation intracranial stenoses between 2002 and 2005. Clinical follow-up data were supplemented by telephone interviews. The technical success rate for stent placement was 100%. One patient (8%) suffered a periprocedural stroke. Twelve patients (92%) underwent clinical follow up for a minimum of 3 months postsurgery, and 11 (92%) of these patients remained asymptomatic after a mean period of 10.9 months. Nine patients (69%) underwent catheter angiographic follow up, and no patient had significant in-stent recurrence of stenosis after a mean period of 5.4 months. Conclusions Treatment of intracranial posterior circulation stenoses with drug-eluting stents is technically feasible, and the rate of clinically significant periprocedural complications is low. Rates of stenosis recurrence are reduced compared with those of bare-metal stents in the midterm. Midterm clinical outcome is excellent; no symptom recurrence was observed in this patient cohort.

Pipeline embolization device for the treatment of vertebral artery aneurysms: the fate of covered branch vessels

2015 ◽  
Vol 8 (10) ◽  
pp. 1041-1047 ◽  
Author(s):  
Marcus D Mazur ◽  
Craig Kilburg ◽  
Victor Wang ◽  
Philipp Taussky
Keyword(s):  
Vertebral Artery ◽  
Vessel Wall ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Pipeline Embolization Device ◽  
Safety And Efficacy ◽  
Cerebellar Artery ◽  
Flow Through ◽  
Flow Diverting Stent

IntroductionPreliminary studies suggest that flow-diverting stents may be suitable for the treatment of aneurysms of the posterior circulation. The safety and efficacy of using flow-diverting stents for vertebral artery (VA) aneurysms is not well defined.ObjectiveTo examine the fate of covering the posterior inferior cerebellar artery (PICA) in patients undergoing placement of a flow-diverting stent for VA aneurysm.MethodsConsecutive patients who underwent placement of a Pipeline Embolization Device (PED) for treatment of an aneurysm of the V4 segment of the VA between April 2012 and June 2015 at our institution were retrospectively evaluated. Angiograms were reviewed to determine the patency of the PICA when the vessel origin was covered by the PED.Results11 patients with VA aneurysms who underwent treatment with the PED were identified. In each case the device covered the origin of the PICA. Follow-up angiography in eight patients demonstrated thrombosis of the aneurysm with patency of the PICA.ConclusionsFlow-diverting stents can be used for the treatment of VA aneurysms. When appropriately sized to the vessel wall and positioned in the VA, the device may cover the origin of the PICA without impairing flow through the branching artery.

Selective application of fully covered biliary stents and narrow-diameter esophageal stents for proximal esophageal indications

Endoscopy ◽  
2018 ◽  
Vol 51 (02) ◽  
pp. 169-173 ◽  
Author(s):  
Maoyin Pang ◽  
Michael Bartel ◽  
Donnesha Clayton ◽  
Bhaumik Brahmbhatt ◽  
Timothy Woodward
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Stent Migration ◽  
Metal Stents ◽  
Biliary Stents ◽  
Esophageal Stents ◽  
Dysphagia Score

Abstract Background Proximal esophageal stents are poorly tolerated and have a high risk of complications. We report our experience using fully covered, biliary, self-expandable metal stents (B-SEMS) and narrow-diameter, esophageal, self-expandable metal stents (NDE-SEMS) for this group of patients. Methods 24 patients underwent placement of B-SEMS or NDE-SEMS for proximal esophageal lesions between 1 January 2011 and 31 July 2016. The outcomes included improvement of dysphagia, healing of fistulas, and adverse events. Results 10 patients received B-SEMS and 14 had NDE-SEMS. Median follow-up time was 11.5 months (range 0.5 – 62 months). In both cohorts, stents were left in place for a mean of 6 weeks. The dysphagia score decreased in 7 (70 %) and 10 (71.4 %) patients, and fistulas resolved in 3/5 (60.0 %) and 5/8 (62.5 %) patients with B-SEMS and NDE-SEMS, respectively. Stent migration occurred in three patients (30.0 %) with B-SEMS and five patients (35.7 %) with NDE-SEMS. Conclusions Both stents were well tolerated and resulted in overall improvement of dysphagia in 70.8 % of patients. B-SEMS appeared to be more favorable for cervical esophageal lesions with narrower diameters, while NDE-SEMS may be better for more distal lesions.

Abstract 1122‐000155: Vertebral Artery Origin Treatment by Endovascular Techniques Registry (VOTER): Safety in the First 20 Cases

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Randall Edgell ◽  
Santiago Ortega‐Gutierrez ◽  
Kara M Christopher ◽  
Ahmed Abdelsalam ◽  
Mudassir Farooqui ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Vertebral Artery ◽  
Posterior Circulation ◽  
Prevention Strategy ◽  
Secondary Outcome ◽  
Visual Field Defects ◽  
Endovascular Techniques ◽  
Presenting Symptoms ◽  
Early Results

Introduction : Background: Stenosis of the vertebral artery origin (VAOS), while under‐diagnosed, is common and may cause up to 25% of posterior circulation infarction. Stenting is widely employed as a secondary prevention strategy, but prospective clinical studies of safety and efficacy are limited. Objective: To report periprocedural and 30‐day outcomes after stenting of the vertebral origin in the first 20 patients of the Vertebral Artery Origin Treatment by Endovascular Techniques Registry (VOTER). Methods : VOTER is a prospective, multicenter, cohort study of patients with symptomatic vertebral artery stenosis > = 50%. Demographic, clinical, and procedural data is collected via a RedCap constructed, cloud‐based, data entry portal. In addition, there is clinical follow‐up data collected at 30 days and 1 year. Lesion stenosis[OGS1] percentage along with representative images are collected pre‐stent, post‐stent, and at 1 year for validation by an independent core laboratory. The primary outcome is stroke and death at 30 days. The secondary outcome is restenosis > = 50% at 1 year follow‐up. Results : A total of 10 sites have been activated to enroll in the study. Of these, 3 sites have enrolled a total of 20 subjects. The median age was 64 (range 47–87) years; 14 (70%) were male, and 16 (80%) were white. 19 patients (95%) were hypertensive, with 5 patients (25%) having a history of ischemic heart disease. The median Modified Rankin score (mRS) at admission was 1 (range 0–3). Presenting symptoms included dizziness/vertigo (43%), visual field defects (14.3%), hemiparesis (14.3%), dysarthria (19.0%), diplopia (4.8%), ataxia (4.8%), and dysphasia (4.8%). All patients were treated with dual antiplatelet therapy. All stents utilized were drug eluting. The median pre‐stent stenosis was 80% (range 60–99%) with a median of 15% (range 0–33%) post‐stent residual. There were no periprocedural strokes, death, or technical complications. One month follow up was available in 15 patients (75%), with 2 reporting new neurological symptoms: 1 with blurred vision and 1 with dizziness and facial numbness. No new imaging confirmed infarctions occurred. Symptomatic improvement was noted in 40% of subjects although there was no change in the median 30 day mRS. Conclusions : VOTER is the first large prospective registry of vertebral origin stenting in North America. These early results from the first 20 subjects are consistent with procedural safety and the importance of continued study of stenting as a secondary prevention strategy for posterior circulation infarction in the setting of VAOS.

Abstract 20158: Long-Term Device-Related Adverse Events After Implantable Cardioverter-Defibrillator Therapy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Isuru Ranasinghe ◽  
Craig Parzynski ◽  
James V Freeman ◽  
Rachel P Dreyer ◽  
Joseph S Ross ◽  
...  
Keyword(s):  
Adverse Events ◽  
Implantable Cardioverter Defibrillator ◽  
End Of Life ◽  
Adverse Outcomes ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Risk Of Death ◽  
Device Malfunction

Background: Long-term implantable cardioverter-defibrillator (ICD) adverse events are poorly documented. In the NCDR ICD Registry™, a nationally representative cohort, we calculated the rate of long-term post-discharge device related adverse events. Methods: We included first-time ICD implants from 2006-2010 that could be matched with Medicare fee-for-service claims data to identify outcomes. We excluded patients if they had a previous ICD or pacemaker, CABG during their procedure, or were not discharged alive. The primary outcome was device reoperation (involving the generator, leads, pocket, or a combination) for device malfunction, infection, other complications (wound disruption, cardiac perforation, etc.), or reoperation for battery end-of-life and/or device upgrade. Analysis was performed using unadjusted cumulative incidence functions taking into consideration the competing risk of death. Results: We identified 185,263 ICD implants of which 114,649 (19.7% single-chamber, 41.3% dual-chamber, 38.8% CRT-D) could be matched to Medicare data (mean age 74.8±6.2 years, 72.5% male).Of these, 83.5% were for primary prevention of sudden cardiac death. The median follow up was 2.7 yrs (max follow-up 6 yrs). At least 1 reoperation occurred in 15.5% of patients by 6 yrs and more than 80% of these reoperations occurred after the early (>90 days) post-implantation period (Figure). Reoperation rates for specific complications (per 1000 patient yrs) were device malfunction (14.3), infection (5.1), other device related complications (18.4) and reoperation for generator battery end-of-life and/or device upgrade (12.9). The crude reoperation rate (for any cause) was similar among device types (P=0.19). Conclusion: Patients continue to have adverse outcomes in the years post ICD implantation, predominately from device malfunction. Our next steps are to identify patient, device, and provider factors associated with these long-term adverse events.

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