Shockwave Intravascular Lithotripsy for the Treatment of Severe Vascular Calcification

Angiology ◽  
2020 ◽  
Vol 71 (8) ◽  
pp. 677-688 ◽  
Author(s):  
George Kassimis ◽  
Matthaios Didagelos ◽  
Giovanni Luigi De Maria ◽  
Nestoras Kontogiannis ◽  
Grigoris V. Karamasis ◽  
...  
Keyword(s):  
Vascular Calcification ◽  
Cardiovascular Events ◽  
Percutaneous Intervention ◽  
Advanced Technology ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Peripheral Artery ◽  
Long Term Outcomes ◽  
Short And Long Term

Vascular calcification is a highly prevalent pathophenotype that is associated with aging, atherosclerotic cardiovascular disease, diabetes mellitus, and chronic kidney disease. When present, it portends a worse clinical outcome and predicts major adverse cardiovascular events. Heavily calcified coronary and peripheral artery lesions are difficult to dilate appropriately with conventional balloons during percutaneous intervention, and the use of several adjunctive strategies of plaque modification has been suggested. Intravascular lithotripsy (IVL) offers a novel option for lesion preparation of severely calcified plaques in coronary and peripheral vessels. It is unique among all technologies in its ability to modify calcium circumferentially and transmurally, thus modifying transmural conduit compliance. In this article, we summarize the currently available evidence on this technology, and we highlight its best clinical application through appropriate patient and lesion selection, with the main objective of optimizing stent delivery and implantation, and subsequent improved short- and long-term outcomes. We believe that the IVL balloon will transform the market, as it is easy to use, with predictable results. However, cost-effectiveness of such advanced technology will need to be considered.

Blood Pressure Changes in a Chinese Population Have a Greater Impact on Short-Term Outcomes Rather Than Long-Term Outcomes of Major Adverse Cardiovascular Events

2020 ◽  
pp. 101053952095508
Author(s):  
Qianyi Xu ◽  
Yali Wang ◽  
Yanxia Xie ◽  
Jia Zheng ◽  
Rongrong Guo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Stroke Risk ◽  
Rural China ◽  
Major Adverse Cardiovascular Events ◽  
Long Term Outcomes ◽  
Short Term ◽  
Initial Examination ◽  
The Difference

The purpose of our study was to explore the association of blood pressure (BP) changes on short-and long-term outcomes of major adverse cardiovascular events (MACEs) in rural China. This study was designed to learn the effects of BP changes (2004-2008) on short-term (2008-2010, within 2 years of the initial examination) and long-term (2008-2017) outcomes of MACE, including 24 285 and 27 290 participants, respectively. In this study, 423 (short-term) and 1952 (long-term) MACEs were identified. For prehypertension to hypertension, the risk of long-term stroke was increased (hazard ratio [HR] = 1.18 [1.00-1.39]). For hypertension to prehypertension, the short-term MACE risk (0.65 [0.47-0.90]), short-term stroke risk (0.45 [0.26-0.76]), and long-term stroke risk (0.83 [0.70-0.99]) all decreased. Short-term outcomes conferred a stronger impact than long-term outcomes (Fisher Z test, measured as the difference of β coefficients, all P < .05).

Abstract WP352: Factors Affecting Short and Long-Term Outcome of Patients Diagnosed as Stroke Mimic at Index Event

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Naveed Akhtar ◽  
Saadat Kamran ◽  
Rajvir Singh ◽  
Zain Bhutta ◽  
Debby Morgan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Survival Function ◽  
Long Term Outcomes ◽  
Long Term Outcome ◽  
Index Event ◽  
Stroke Mimics ◽  
Short And Long Term

Background: Stroke mimics (SM) is a stroke-like clinical picture due to a disease other than cerebrovascular diseases. The causes of SM are diverse. Distinguishing SM from stroke is important to avoid unnecessary acute treatment and secondary prevention. PURPOSE: We hypothesized to evaluate short and long-term outcomes in terms of major adverse cardiovascular events (MACE) in patients who presented with SM. Methods: We evaluated a prospective cohort of Qatari patients with confirmed diagnosis of SM who presented to our hospital as suspected acute stroke between January 2014 and February 2019. We investigated the associated risk factors, short- and long-term risk of MACE in these patients. We calculated the modified Rankin score (mRS) at discharge and 90-days (short-term) and MACE (long-term) outcomes. To determine the independent predictor for MACE, the Cox proportional hazards regression analysis was used and summarized as hazard ratio and 95% confidential interval. Results: A total of 481 Qatari patients (mean age 57.5 ±18.0; 56.3% male) with diagnosis of SM were identified, of whom 126 (26.2%) patients were found to have MACE during follow up (36.7 months (95% CI 35.5-37.8). Patients who develop MACE were older (62.4 ±17.5 vs 55.7 ±17.9, p<0.001). Hypertension, diabetes and prior stroke and coronary artery disease was significantly more common in patients with MACE. High NIHSS on admission (2.5 ±4.1 vs 1.2 ±3.0, p<0.001), high glucose (7.5 ±2.2 vs 6.8 ±2.0, p= 0.005), lower HDL (1.0 ±0.3 vs 1.2 ±0.3, p<0.001) and extended length of stay at index event (3.9 ±5.6 vs 2.4 ±2.1, p<0.001) was higher in MACE. Patients with MACE had significantly worse outcome at discharge (46.0 vs 23.7%, p<0.001) and at 90-days (38.1 vs 0.4%, p<0.001). Once corrected, the long-term MACE-free survival function did not show any statistical difference between two groups Conclusions: Stroke mimics if associated with cardiovascular risk factors carry a poorer short and long-term prognosis after the first presentation. More aggressive reduction of cardiovascular risk may help in preventing such major cardiovascular events.

Effectiveness of continuous unsupervised exercise therapy after above-knee femoropopliteal bypass

Vascular ◽  
2020 ◽  
pp. 170853812095748
Author(s):  
Taira Kobayashi ◽  
Masaki Hamamoto ◽  
Takanobu Okazaki ◽  
Tomoaki Honma ◽  
Kazutoshi Iba ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Study Cohort ◽  
Secondary Patency ◽  
Femoropopliteal Bypass ◽  
Long Term Outcomes ◽  
Propensity Matching

Objective Exercise therapy has acceptable outcomes for patients with intermittent claudication, although few reports exist regarding the results of continuous exercise therapy after surgical reconstruction for intermittent claudication. This study aimed to analyze the long-term outcomes of unsupervised exercise therapy for patients after above-knee femoropopliteal bypass. Material and methods We retrospectively analyzed 69 patients (69 limbs, 69 grafts) who underwent above-knee femoropopliteal bypass from April 2009 to March 2018 in our hospital. At six months after above-knee femoropopliteal bypass, we evaluated the maintenance of unsupervised exercise therapy. Patients who continued unsupervised exercise therapy or discontinued unsupervised exercise therapy were assessed via 1:1 propensity matching. Long-term outcomes such as patency, survival, and major adverse cardiovascular events were compared between the groups after matching. We also analyzed the maintaining rate of unsupervised exercise therapy in a study cohort. Results Twenty-nine (42%) patients continued unsupervised exercise therapy until six months after above-knee femoropopliteal bypass. The discontinued unsupervised exercise therapy had higher proportions of female sex ( p =  0.015) and cerebrovascular disease ( p =  0.025) than did the continued unsupervised exercise therapy. The mean follow-up period was 65 ± 36 months. After propensity matching, the rates of the following factors were significantly higher in the continued unsupervised exercise therapy than in the discontinued unsupervised exercise therapy: primary patency (97% vs. 61%, p =  0.0041), secondary patency (100% vs. 69%, p =  0.0021), and freedom from major adverse cardiovascular events (61% vs. 24%, p =  0.0071) at five years. Both groups had a similar survival rate. The maintaining rate of unsupervised exercise therapy in the study cohort was 44% at six months, 41% at one year, 36% at three years, 25% at five years, and 25% at seven years. Conclusion The findings of this study suggested superior long-term outcomes, including graft patency and freedom from major adverse cardiovascular events, with unsupervised exercise therapy after open bypass than with the usual therapy. Unsupervised exercise therapy may be recommended for the patients after open bypass.

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