Abstract 1122‐000141: Initial Experience of Using a Large‐Bore (0.096” Inner Diameter) Access Catheter in Neurovascular Interventions

Introduction : Larger‐bore access catheters can improve endovascular therapy by facilitating delivery of interventional devices and reducing the number of exchange maneuvers needed. Advances in technology have allowed for the manufacture of larger‐bore access catheters that maintain necessary performance characteristics, such as a stiffer proximal segment for stability and a flexible distal segment for vessel catheterization. The purpose of this study was to report our initial experience of using a large‐bore (0.096” inner diameter) access catheter in neurovascular interventions. Methods : Data were prospectively collected from 7 sites in the US for procedures performed using a large‐bore (0.096” inner diameter) access catheter from January 15, 2020, to April 21, 2021. Effectiveness outcome was technical success, defined as successful access to the target vessel. Safety outcomes were access‐related and device‐related related complications. Results : One hundred and fourteen patients were included in this study (Table). The mean age of the patients was 67.6 years (SD 16.1), and about half (49.6%, 56/113) were female. The most common treatment conditions were stroke, 64 (56.1%); aneurysm, 24 (21.1%); carotid atherosclerosis, 19 (16.7%); and intracranial atherosclerosis, 3 (2.6%). Most approaches were by the femoral (66.4%, 73/110) or radial (33.6%, 37/110) artery and the most common target vessels were the left (49.1%, 55/112) or right (42.9%, 48/112) carotid artery. Anatomic variations included severe vessel tortuosity (32.1%, 26/81), type 2 aortic arch (19.3%, 17/88), type 3 aortic arch (15.9%, 14/88), bovine arch (15.4%, 16/104), severe angle (<30°) between the subclavian and target vessel (14.9%, 11/74), and subclavian loop (8.9%, 7/79). The median access time to branch was 18 minutes (IQR 11–28, N = 75). The most common treatments were mechanical thrombectomy, 51 (44.7%); stenting, 25 (21.9%); Pipeline/flow diversion, 10 (8.8%); and stent‐assisted coiling, 8 (7.0%). Technical success was achieved in most (94.7%, 108/114) patients. Access site complications occurred in 3 patients (2.6%). Two complications (1.8%) were related to the large‐bore access catheter. Conclusions : A large‐bore (0.096” inner diameter) access catheter could be used with both femoral and radial arterial approaches, had a high technical success rate, and had a low rate of periprocedural complications.

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Clinical outcomes in hybrid repair procedures for pathologies involving the aortic arch

Vascular ◽

10.1177/1708538114525608 ◽

2014 ◽

Vol 23 (1) ◽

pp. 9-16 ◽

Cited By ~ 4

Author(s):

Sebastian Zerwes ◽

Giesbert Leissner ◽

Yvonne Gosslau ◽

Rudolf Jakob ◽

Hans-Kees Bruijnen ◽

...

Keyword(s):

Success Rate ◽

Aortic Arch ◽

Circulatory Arrest ◽

Aortic Disease ◽

Aortic Aneurysms ◽

Type I ◽

Technical Success ◽

Aortic Diseases ◽

Promising Alternative ◽

Technical Success Rate

Objective Fifty patients with complex aortic disease, who received hybrid treatment of the aortic arch with supra-aortic debranching and endovascular stent-graft repair, were evaluated in regard to events of primary (survival and technical success) and secondary (procedure-related complications) interest. Methods The single-center study was conducted over an eight-year period from December 2004 to December 2012. Treated medical conditions included 23 aortic aneurysms (46%), 21 aortic dissections (42%), and six penetrating aortic ulcers (12%). Procedures were divided into groups of elective, urgent, and emergent. Results Twenty-eight (56%) patients were operated electively, 15 (30%) urgently, and seven (14%) emergently. Sternotomy, cardiopulmonary bypass, and deep hypothermic circulatory arrest were required in 12 (24%) patients. The primary technical success rate was 86% and raised to 92% ( n = 46) of secondary technical success rate after therapy of three type I endoleaks. The 30-day mortality added up to 16.0%, and the mean time of survival was 49.3 months. In a total of eight (16%) patients, an endoleak occurred (five endoleaks type I, three endoleaks type II), while nine (18%) of patients suffered a perioperative stroke. Conclusions In severely ill patients with complex aortic diseases, hybrid therapy may offer a promising alternative to conventional open repair.

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Initial experience of coronary angiogram through trans ulnar route in Bangabandhu Sheikh Mujib Medical University

University Heart Journal ◽

10.3329/uhj.v9i2.23427 ◽

2015 ◽

Vol 9 (2) ◽

pp. 80-82

Author(s):

Md Abu Salim ◽

Syed Ali Ahsan ◽

Md Abu Siddique ◽

Sajal Krishna Banerjee ◽

AKM Fazlur Rahman ◽

...

Keyword(s):

Ulnar Artery ◽

Artery Occlusion ◽

Initial Experience ◽

Coronary Angiogram ◽

Technical Success ◽

Surgical Revascularization ◽

Access Site ◽

Technical Success Rate ◽

Post Procedure ◽

Medical University

For performing Coronary angiogram and PCI Trans ulnar route is a feasible alternate access. It has got all the advantages of transradial route. Beside that by this approach radial artery can be spared to be used as a conduit for subsequent surgical revascularization. The hardware used for both transulnar and transradial routes are similar. In our study technical success rate is 93.99% through transulnar route, 6.66% case was postponed due to failure to canulate the ulnar artery. The complications such as local hematoma, significant swelling, access site bleeding, ulnar artery perforation and reversible parasthesia was nil (0% of patients). Post procedure asymptomatic ulnar artery occlusion did not occur.University Heart Journal Vol. 9, No. 2, July 2013; 80-82

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Evaluation of percutaneous transcatheter embolization for pulmonary arteriovenous malformations

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01448-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

ZhengZhong Wu ◽

JunQing Lin ◽

WeiZhu Yang ◽

Na Jiang ◽

Ning Huang ◽

...

Keyword(s):

New York ◽

Success Rate ◽

Arteriovenous Malformations ◽

Heart Association ◽

Transcatheter Embolization ◽

Pulmonary Arteriovenous Malformations ◽

Technical Success ◽

Arterial Blood Gas ◽

Technical Success Rate ◽

Arterial Blood

Abstract Background The purpose of this study was to assess the safety and efficacy of percutaneous transcatheter embolization (TCE) for the treatment of pulmonary arteriovenous malformations (PAVMs). Methods Forty-three consecutive patients (n = 17 males; n = 26 females) with 72 untreated PAVMs underwent coil and/or plug embolization between January 2010 and February 2018. The mean patient age was 42 ± 14 years (range 19–71 years). The median size of the feeding artery was 7.9 ± 2.9 mm (range 3.5–14.0 mm). The arterial blood gas level and cardiac function of all patients were analysed. The technical success rate, recanalization rate, and complications were evaluated. Computed tomography angiography (CTA) examinations were scheduled for 12 months after treatment and every 2–4 years thereafter. Results Twenty-five PAVMs were treated with coils alone, twenty-one were treated with plugs alone, and twenty-six were treated with both coils and plugs. The technical success rate was 100%. There were no complications during operation. However, one patient (2.3%) had pulmonary thrombosis and embolism post-operation. The patients’ pre-operative and post-operative PaO2 and SaO2 levels were significantly different (p < 0.01). A comparison of the New York Heart Association (NYHA) grade before and after embolization in all patients showed a significant decrease in the post-operative grade (p < 0.01). The 72 PAVMs were divided into three groups (coils only group [n = 25], plugs only group [n = 21], and coils/plugs combined group [n = 26]). After 12 months of follow-up, there were seven reperfusion PAVMs in the coil group, seven reperfusion PAVMs in the plug group, and 1 reperfusion PAVM in the combined group. There were significant differences between the two groups and the combined group. Conclusion Percutaneous TCE is safe and effective for the treatment of PAVMs. A combination of coils and vascular plugs may be useful for preventing recanalization after the embolization of PAVMs.

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Novel cryoballoon 180° ablation system for treatment of Barrett’s esophagus-related neoplasia: a first-in-human study

Endoscopy ◽

10.1055/a-1381-7562 ◽

2021 ◽

Author(s):

Anouk Overwater ◽

Sanne N. van Munster ◽

Wouter B. Nagengast ◽

Roos E. Pouw ◽

Jacques J. G. H. M. Bergman ◽

...

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Human Study ◽

Dose Finding ◽

The Novel ◽

Single Session ◽

Technical Success ◽

Serious Adverse Events ◽

Technical Success Rate ◽

Starting Dose

Abstract Background The novel 180° cryoballoon (CbAS180) enables semicircumferential treatment over a length of 3 cm per application. This first-in-human study evaluates its feasibility, efficacy, and safety for the treatment of Barrett’s esophagus (BE) neoplasia. Methods This multicenter study consisted of dose-finding and extension phases. Dose-finding started with the lowest dose possible (1.0 mm/s). For each dose, six patients were treated circumferentially over a 3-cm length. The dose was increased until the median BE regression was ≥ 60 % without serious adverse events (SAEs). In the extension phase, the dose was confirmed in 19 new patients. The outcomes were technical success, BE regression after one treatment, and SAEs. Results 25 patients (median Prague C0M3) were included (6 dose-finding/19 extension). In two patients, the CbAS180 could not be applied because of unstable balloon positioning. The technical success rate was 96 % (22 /23). In the six dose-finding patients, the starting dose resulted in median BE regression of 94 % (95 % confidence interval [CI] 60 %–97 %) without SAEs and was thus considered effective. Overall median BE regression was 80 % (95 %CI 60 %–90 %). Conclusion Single-session CbAS180 seems feasible, safe, and effective, and is a promising technique for the treatment of patients with BE neoplasia.

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Modified percutaneous radiologic gastrostomy technique without endoscopic or nasogastric access

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0086-8 ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Reda Tabashy ◽

Amira Darwish ◽

Ashraf Ibrahim ◽

Mohamed Gad El-Mola

Keyword(s):

Esophageal Cancer ◽

Success Rate ◽

Nasogastric Tube ◽

Conventional Technique ◽

Fluoroscopic Guidance ◽

Efficacy And Safety ◽

Technical Success ◽

Technical Success Rate ◽

Major Complications ◽

Percutaneous Radiologic Gastrostomy

Abstract Background The aim of this study is to evaluate the efficacy and safety of a modified percutaneous radiologic gastrostomy (MPRG) technique under ultrasound and fluoroscopic guidance without endoscopic or nasogastric access. Results The study included 24 patients: 10 males and 14 females whose ages ranged from 44 to 80 years old. Ten patients had esophageal cancer and 14 patients had neck cancer. Technical success was achieved in 23 out of the 25 procedures (92%). Two procedures failed (8%) and were converted to the conventional technique by using the nasogastric tube. No major complications were reported. Minor complications were observed in 5 patients (20%): intraperitoneal air and contrast leakage in 4 patients and focal mucosal dissection by the contrast in 1 patient. Conclusion The MPRG has high technical success rate, is safe with no major complications, and is most feasible when endoscopic or nasogastric access cannot be performed.

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Endoscopic Ultrasound-Guided Angiotherapy for Gastric Varices—A Small Retrospective Study

Journal of Digestive Endoscopy ◽

10.1055/s-0040-1717823 ◽

2020 ◽

Vol 11 (03) ◽

pp. 201-204

Author(s):

Kapil Sharma ◽

Mamta Sharma ◽

Sanchit Singh

Keyword(s):

Endoscopic Ultrasound ◽

Case Series ◽

Gastric Varices ◽

Secondary Prophylaxis ◽

Limited Data ◽

Technical Success ◽

Ultrasound Guided ◽

Retrospective Case ◽

Technical Success Rate ◽

Complete Obliteration

Abstract Introduction Conventional n-butyl-cyanoacrylate (CYA) recommended for secondary prophylaxis of gastric varices (GV) is associated with significant rebleeding and glue embolism. Limited data are available on more successful and less risky endoscopic ultrasound-guided coils and CYA (EUS-Coils-CYA) injection in GV. Methods We present a retrospective case series of 12 patients with GV bleeding managed successfully with EUS-Coils-CYA injection leading to variceal eradication in 11 patients. Results From January 2018 to June 2019, 12 cases of GV, which were either bleeding or bled recently, were included. Complete obliteration was achieved in 91.6% of patients with 100% technical success. Mean number of deployed coils and volume of injected CYA glue were 1.16 and 1.58 mL, respectively. Conclusions EUS-guided angiotherapy is an effective and safe intervention for managing GV bleeding with high technical success rate.

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

Scientific Reports ◽

10.1038/s41598-021-84024-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Akihiko Kida ◽

Yukihiro Shirota ◽

Taro Kawane ◽

Hitoshi Omura ◽

Tatsuo Kumai ◽

...

Keyword(s):

Adverse Events ◽

Anastomotic Stenosis ◽

Technical Success ◽

Long Term Outcomes ◽

Endoscopic Retrograde ◽

Technical Success Rate ◽

Registration Number ◽

Clinical Trial Register

AbstractThere is limited evidence supporting the usefulness of endoscopic retrograde pancreatic drainage (ERPD) for symptomatic pancreaticojejunal anastomotic stenosis (sPJS). We examined the usefulness of ERPD for sPJS. We conducted a retrospective analysis of 10 benign sPJS patients. A forward-viewing endoscope was used in all sessions. Following items were evaluated: technical success, adverse events, and clinical outcome of ERPD. The technical success rate was 100% (10/10) in initial ERPD; 9 patients had a pancreatic stent (no-internal-flap: n = 4, internal-flap: n = 5). The median follow-up was 920 days. Four patients developed recurrence. Among them, 3 had a stent with no-internal-flap in initial ERPD, the stent migrated in 3 at recurrence, and a stent was not placed in 1 patient in initial ERPD. Four follow-up interventions were performed. No recurrence was observed in 6 patients. None of the stents migrated (no-internal-flap: n = 1, internal-flap: n = 5) and no stents were replaced due to stent failure. Stenting with no-internal-flap was associated with recurrence (p = 0.042). Mild adverse events developed in 14.3% (2/14). In conclusions, ERPD was performed safely with high technical success. Recurrence was common after stenting with no-internal-flap. Long-term stenting did not result in stent failure.Clinical trial register and their clinical registration number: Nos. 58-115 and R2-9.

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Feasibility and Techniques of Securing 3D-Safety Margin in Superselective Transarterial Chemoembolization to Improve Local Tumor Control for Small Hepatocellular Carcinoma: An Intend-to-Treat Analysis

Liver Cancer ◽

10.1159/000512337 ◽

2021 ◽

Vol 10 (1) ◽

pp. 63-71

Author(s):

Ching Charoenvisal ◽

Toshihiro Tanaka ◽

Hideyuki Nishiofuku ◽

Hiroshi Anai ◽

Takeshi Sato ◽

...

Keyword(s):

Success Rate ◽

Tumor Recurrence ◽

Safety Margin ◽

Small Hepatocellular Carcinoma ◽

Technical Success ◽

Local Tumor ◽

Local Tumor Recurrence ◽

3D Images ◽

Technical Success Rate ◽

Treat Analysis

Introduction: The aim of this study was to investigate the technical success rate of obtaining 3D-safety margin in superselective conventional transarterial chemoembolization (cTACE) using 3D images for small hepatocellular carcinoma (HCC). Methods: Consecutive 48 HCC nodules (diameter, 1–3 cm) in 44 patients were intentionally treated by superselective cTACE in an attempt to achieve 3D-safety margin. Superselective CT during hepatic arteriography (CTHA) was obtained before cTACE. When negative 3D-safety margin was found, branches supplied into the margin area were detected by using a 3D workstation. The technical success rate to obtain 3D-safety margin was investigated by intend-to-treat analysis. Local tumor recurrence rate and adverse events were also evaluated. Result: Nine of 48 tumors (18.8%) had 3D-safety margin in the initial superselective CTHA. After pulling back of the catheter and/or selection of another branch based on 3D images, 3D-safety margin was finally achieved in 45 (93.8%). There were 8 of 46 tumors (17.4%) with local recurrence after 5-year follow-up. Grade 3–4 of aspartate aminotransferase, alanine aminotransferase, and total bilirubin were found in 38.6, 36.4, and 2.3%, respectively. One portal vein thrombus and 3 biliary dilation or biloma were developed. Conclusion: Superselective cTACE obtaining 3D-safety margin in small HCC was feasible with a high success rate by using 3D images, which could be tolerable and prevent local tumor recurrence.

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Packing Technique with or without Remodeling for Endovascular Coil Embolization of Renal Artery Aneurysms: Safety, Efficacy and Mid-Term Outcomes

Journal of Clinical Medicine ◽

10.3390/jcm10020326 ◽

2021 ◽

Vol 10 (2) ◽

pp. 326

Author(s):

Grégory Secco ◽

Olivier Chevallier ◽

Nicolas Falvo ◽

Kévin Guillen ◽

Pierre-Olivier Comby ◽

...

Keyword(s):

Renal Artery ◽

Success Rate ◽

Coil Embolization ◽

Preventive Treatment ◽

Parent Artery ◽

Technical Success ◽

Technical Success Rate ◽

Endovascular Coil Embolization ◽

Lower Morbidity

The endovascular treatment of renal artery aneurysms (RAAs) has lower morbidity and shorter stay lengths compared to surgical repair. Here, we describe coil packing with or without remodeling and assess outcomes and complications. We retrospectively identified the 19 consecutive preventive endovascular RAA coil embolizations done in 18 patients at our center in 2010–2020. Patient and aneurysm characteristics, technical success rate, complications, and recurrences were recorded. Mean patient age was 63 ± 13 years. The RAA was >1.5 cm in 11 cases, and in four cases, the aneurysm-to-parent artery size ratio was >2. Simple coiling was performed for 11 (57.9%) aneurysms, stent-assisted coiling for seven (36.8%) aneurysms, and balloon-assisted coiling for one (5.3%) aneurysm. Technical success rate was 100%. Complete definitive RAA exclusion was achieved with a single procedure for 17 (89.5%) aneurysms, whereas two (10.5%) aneurysms required a repeat procedure. Four minor complications occurred but resolved with no long-term consequences. No major complications occurred during the mean follow-up of 41.1 ± 29.7 months. Coil embolization by sac packing or remodeling proved very safe and effective. Together with the known lower morbidity and shorter stay length compared to open surgery, these data indicate that this endovascular procedure should become the preventive treatment of choice for RAAs.

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