Three-Year Clinical Outcomes Following Implantation of LifeStent Self-Expanding Nitinol Stents in Patients With Femoropopliteal Artery Lesions

Angiology ◽  
2021 ◽  
pp. 000331972110426
Author(s):  
Michinao Tan ◽  
Mitsuyoshi Takahara ◽  
Yoshimitsu Soga ◽  
Shinsuke Mori ◽  
Taketsugu Tsuchiya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Randomized Study ◽  
Vessel Diameter ◽  
Lesion Length ◽  
Total Occlusion ◽  
Femoropopliteal Artery ◽  
Nitinol Stents ◽  
Independent Risk Factors ◽  
Artery Disease

The aim of this study was to evaluate midterm clinical outcomes after implantation of LifeStent self-expanding nitinol stents for the treatment of femoropopliteal lesions. This retrospective, multicenter, non-randomized study examined 260 femoropopliteal lesions in 250 consecutive patients with peripheral artery disease implanted with LifeStents from April 2016 to April 2017. The prevalence of chronic total occlusion (CTO), lesion length ≥25 cm, and distal reference vessel diameter (RVD) <5 mm was 58%, 35%, and 50%, respectively. The 3-year restenosis rate in the overall population was estimated to be 72.9% and a major adverse limb event was observed in 36.9%. Multivariate analysis revealed that chronic limb-threatening ischemia (CLTI) (odds ratio [OR]: 8.04; 95% confidence interval [CI]: 1.86–34.7), CTO (OR: 4.87; 95% CI: 1.43–16.6), lesion length ≥25 cm (OR: 5.95; 95% CI: 1.11–32.0), and distal RVD <5 mm (OR: 4.43; 95% CI: 1.34–14.6) were independent risk factors for 3-year restenosis. The present study demonstrated the midterm clinical outcomes and risk factors for restenosis after implantation of the LifeStent in femoropopliteal artery lesions. CLTI, CTO, lesion length ≥25 cm, and distal RVD <5 mm predicted decreased patency after a 3-year follow-up.

A Novel Angiographic Risk Score for Femoropopliteal Interventions

2020 ◽  
Vol 27 (6) ◽  
pp. 967-973 ◽  
Author(s):  
Osamu Iida ◽  
Mitsuyoshi Takahara ◽  
Yoshimitsu Soga ◽  
Masahiko Fujihara ◽  
Daizo Kawasaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Multivariable Analysis ◽  
Vessel Diameter ◽  
Primary Patency ◽  
Lesion Length ◽  
Total Occlusion ◽  
Artery Disease ◽  
Angiographic Score

Purpose To present a novel angiographic scoring system that stratifies the risk of restenosis after endovascular therapy (EVT) to inform the decision to use paclitaxel-eluting devices in the femoropopliteal segment. Materials and Methods A prospective, multicenter registry including 1799 limbs of 1578 patients (mean age 74±9 years; 1090 men) with symptomatic peripheral artery disease undergoing intravascular ultrasound–supported femoropopliteal EVT was used as the basis for developing the angiographic score. Multivariable analysis identified baseline patient and limb characteristics associated with restenosis at 12 months. These risk factors for 12-month restenosis were explored using a generalized linear mixed model with a logit-link function in which the inter-institutional and inter-subject variability were treated as random effects. The multiple imputation method was adopted to address missing data. Results of the regression analysis are presented as the odds ratio (OR) with 95% confidence interval (CI). Results Twelve-month primary patency was estimated to be 65.1% (95% CI 62.7% to 67.5%). After multivariable analysis, distal reference vessel diameter per 1 mm (OR 0.71, 95% CI 0.62 to 0.81, p<0.001), lesion length per 10 cm (OR 1.39, 95% CI 1.19 to 1.62, p<0.001), and chronic total occlusion (OR 1.56, 95% CI 1.15 to 2.10, p=0.004) were independently associated with the 12-month restenosis risk, whereas baseline patient risk factors were not. Compared to bare nitinol stent implantation, plain angioplasty (OR 2.31, 95% CI 1.67 to 3.18, p<0.001) was independently associated with a higher risk of 12-month restenosis, while drug-eluting stents (OR 0.65, 95% CI 0.43 to 0.99, p=0.045) and stent-grafts (OR 0.24, 95% CI 0.12 to 0.50, p<0.001) were independently associated with a lower risk of 12-month restenosis. The angiographic score, which was developed by using the 3 angiographic factors but not the TransAtlantic Society Consensus II (TASC) class, was significantly and independently associated with 12-month restenosis. Conclusion The current study demonstrated a novel angiographic score for 12-month restenosis after femoropopliteal EVT in a real-world clinical practice. The developed score was significantly and independently associated with the 12-month restenosis risk, but the TASC class was not.

scholarly journals Clinical outcome of the patients with femoropopliteal artery disease after endovascular therapy: focused on drug-coated-balloon-related distal embolism detected by laser doppler flowmetry

2021 ◽  
Author(s):  
Kuniyoshi Fukai ◽  
Takuo Nakagami ◽  
Tetsuro Hamaoka ◽  
Masakazu Kikai ◽  
Shinichiro Yamaguchi
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Laser Doppler Flowmetry ◽  
Endovascular Therapy ◽  
Previous History ◽  
Laser Doppler ◽  
Lesion Length ◽  
Doppler Flowmetry ◽  
Femoropopliteal Artery ◽  
Artery Disease

AbstractSeveral trials have shown that paclitaxel drug-coated balloons (DCBs) significantly reduce restenosis rates. However, some reports have shown distal embolisms occurring after DCBs. No study has analyzed the clinical outcomes of patients with DCB-induced distal embolism. This study aimed to investigate the clinical outcomes of DCB-induced distal embolism in patients with femoropopliteal artery disease. Between February 2018 and April 2019, consecutive patients (n = 32) who presented with de novo femoropopliteal artery disease and underwent endovascular therapy using DCB were retrospectively reviewed in a single-center study. Patients were divided into two groups based on whether distal embolism was detected using laser doppler flowmetry (DEL group) or not (non-DEL group). Baseline characteristics and 1-year clinical outcomes were compared between the groups. DEL was found in 44% of limbs (DEL group: n = 15, non-DEL group: n = 19). Below-the-knee arterial runoff ≤ 1 (p = 0.033), popliteal lesion (p = 0.044), ambulation difficulty (p = 0.021), and previous history of coronary artery disease (p = 0.013) were identified as predictive factors of DEL. Procedural factors, reference vessel diameter, lesion length, and total drug amount were not predictive of DEL. The overall target lesion restenosis (TLR) rate was 17.4% (n = 5). The TLR rate was not significantly different between the DEL and non-DEL groups (13.3% vs. 15.8%, p = 0.55). Severe calcification was the only significant factor for TLR (4.2% vs. 40.0%, p = 0.02). Among patients with femoropopliteal disease, there was no difference in 1-year clinical outcome between patients who underwent DEL and those who did not.

Long-Term Follow-Up of Patients With Isolated Side Branch Coronary Artery Disease

Angiology ◽  
2021 ◽  
pp. 000331972110280
Author(s):  
Sukru Arslan ◽  
Ahmet Yildiz ◽  
Okay Abaci ◽  
Urfan Jafarov ◽  
Servet Batit ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vessel Diameter ◽  
Side Branch ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Artery Disease

The data with respect to stable coronary artery disease (SCAD) are mainly confined to main vessel disease. However, there is a lack of information and long-term outcomes regarding isolated side branch disease. This study aimed to evaluate long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients with isolated side branch coronary artery disease (CAD). A total of 437 patients with isolated side branch SCAD were included. After a median follow-up of 38 months, the overall MACCE and all-cause mortality rates were 14.6% and 5.9%, respectively. Among angiographic features, 68.2% of patients had diagonal artery and 82.2% had ostial lesions. In 28.8% of patients, the vessel diameter was ≥2.75 mm. According to the American College of Cardiology lesion classification, 84.2% of patients had either class B or C lesions. Age, ostial lesions, glycated hemoglobin A1c, and neutrophil levels were independent predictors of MACCE. On the other hand, side branch location, vessel diameter, and lesion complexity did not affect outcomes. Clinical risk factors seem to have a greater impact on MACCE rather than lesion morphology. Therefore, the treatment of clinical risk factors is of paramount importance in these patients.

Clinical characteristics and prognosis in patients with premature coronary artery disease of different genders after intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.F Tang ◽  
Y Yao ◽  
S.D Jia ◽  
Y Liu ◽  
B Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Coronary Intervention ◽  
Premature Coronary Artery Disease ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Cerebrovascular Events ◽  
Independent Risk Factors ◽  
Artery Disease

Abstract Objective To investigate the clinical characteristics and long-term prognosis of coronary intervention in patients with premature coronary artery disease (PCAD) between different genders. Methods From January 2013 to December 2013, 4 744 patients diagnosed as PCAD with percutaneous coronary intervention (PCI) in our hospital were enrolled. The general clinical data, laboratory results and interventional treatment data of all patients were collected, and the occurrence of major adverse cardio-cerebrovascular events (MACCE) within 2 years after PCI was followed up. Results Of the 4 744 patients undergoing PCI, 3 390 (71.5%) were males and 1 354 (28.5%) were females. The 2-year follow-up results showed that the incidence of BARC grade 1 hemorrhage in female patients was significantly higher than that in male patients (6.9% vs. 3.7%; P&lt;0.001); however, there was no significant difference in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), all-cause death, cardiac death, recurrent myocardial infarction, revascularization (target vessel revascularization and target lesion revascularization), stent thrombosis, stroke and BARC grade 2–5 hemorrhage between the two groups (P&gt;0.05). Multivariate COX regression analysis showed that gender was an independent risk factor for BARC grade 1 bleeding events in PCAD patients (HR=2.180, 95% CI: 1.392–3.416, P&lt;0.001), but it was not an independent risk factor for MACCE and BARC grade 2–5 bleeding. Hyperlipidemia, preoperative SYNTAX score, multivessel lesions and NSTE-ACS were the independent risk factors for MACCE in PCAD patients with PCI (HR=1.289, 95% CI: 1.052–1.580, P=0.014; HR=1.030, 95% CI: 1.019–1.042, P&lt;0.001; HR=1.758, 95% CI: 1.365–2.264, P&lt;0.001; HR=1.264, 95% CI: 1.040–1.537, P=0.019); gender, hyperlipidemia, anticoagulant drugs like low molecular weight heparin or sulfonate were the independent risk factors for bleeding events (HR=1.579,95% CI 1.085–2. 297, P=0.017; HR=1.305, 95% CI 1.005–1.695, P=0.046; HR=1.321, 95% CI 1.002–1.741, P=0.048; HR=1.659, 95% CI 1.198–2.298, P=0.002). Conclusion The incidence of minor bleeding in women with PCAD is significantly higher than that in men; After adjusting for various risk factors, gender is an independent risk factor for minor bleeding events, but not an independent risk factor for MACCE in patients with PCAD. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science and Technology Support Program of China

Ventricular Fibrillation After Release of an Aortic Cross-Clamp in Valvular Surgery: Independent Risk Factors, Outcomes, and Incidence from Access Routes

2021 ◽  
Author(s):  
Weichao LI ◽  
heng li ◽  
Jianping Gong ◽  
Weihua Liu ◽  
BaoJun Fu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Fibrillation ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Smoking Status ◽  
Left Ventricular ◽  
Aortic Cross Clamp ◽  
Valvular Surgery ◽  
Htk Solution ◽  
Independent Risk Factors

Abstract Background Predictors and clinical outcomes of VF-ACC and the relative VF-ACC incidence with various access routes have not been well documented. This study aimed to identify predictors, clinical outcomes, and relative incidences of ventricular fibrillation after the release of an aortic cross-clamp (VF-ACC) with various access routes in valvular surgery.Patients and methods In this single-center and retrospective cohort study, we screened 228 consecutive patients undergoing valve surgery, and a total of 119 patients were included in the study. The primary outcomes were the relative incidence and predictors of VF-ACC with access routes, and secondary endpoints included effects of VF-ACC on 30-day mortality, perioperative ventricular arrhythmias (VAs), and heart failure with ejection fraction < 50% (HFEF < 50%).Results VF-ACC incidence varied on the basis of access routes. VF-ACC occurred in 58.3% of patients with aortic valve replacement via transverse aortotomy (TAo-AVR), in 48.6% of patients with aortic and mitral replacements via transseptal and transverse aortotomy access (TSAo-MAVR), and in 20% of patients with mitral valve replacement via transseptal access (TS-MVR). Seven independent risk factors were identified: HTK solution (AOR: 4.90, p = 0.002), smoking status (AOR: 6.30, p = 0.001), cerebrovascular disease (CBD) [(AOR: 7.08, p = 0.022)], regional wall motion abnormality (RWMA) [(AOR: 8.33, p < 0.001)], perioperative VAs (AOR: 4.85, p = 0.001), HFEF < 50% (AOR: 5.66, p = 0.002), and left ventricular mass index (LVMI) [(AOR: 0.962, CI: 0.941–0.984)].Conclusions VF-ACC was the most common in TAo-AVR and the least common in TS-MVR. HTK solution, smoking status, CBD, perioperative VAs, HFEF < 50%, and RWMA were associated with an increased risk of VF-ACC, and low LVMI acted as a protective factor. Patients with VF-ACC commonly experienced perioperative VAs or HFEFs < 50%.Clinical trial registration: ChiCTR2100050961.

scholarly journals Impact of chronic total occlusion lesion length on six-month angiographic and 2-year clinical outcomes

PLoS ONE ◽  
2018 ◽  
Vol 13 (11) ◽  
pp. e0198571 ◽  
Author(s):  
Jihun Ahn ◽  
Seung-Woon Rha ◽  
ByoungGeol Choi ◽  
Se Yeon Choi ◽  
Jae Kyeong Byun ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Chronic Total Occlusion ◽  
Lesion Length ◽  
Total Occlusion

Abstract 16969: Burden of Cardiovascular Disease, ECG Patterns and Echocardiographic Data Among COVID-19 Survivors and Non-Survivors at a Large Health System in New York

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Arvind Devanabanda ◽  
Eitezaz Mahmood ◽  
Avneet SINGH ◽  
Perwaiz Meraj ◽  
Haisam Ismail ◽  
...  
Keyword(s):  
Risk Factors ◽  
New York ◽  
New York City ◽  
Clinical Outcomes ◽  
Inflammatory Markers ◽  
Bundle Branch Block ◽  
Icu Stay ◽  
Prognostic Importance ◽  
Artery Disease ◽  
Metabolic Comorbidities

Introduction: The prognostic importance of cardiac and metabolic risk factors among COVID-19 patients is unknown. The aim of our investigation is to report clinical significance of risk factors, ECG patterns, inflammatory markers and LVEF for survival with COVID-19. Methods: 10,018 patients and ECGs, from 13 hospitals in New York City area were included in this retrospective analysis between March 1 and April 30, 2020. Survivors and non-survivors were studied for presence of comorbidities and clinical outcomes of length of stay (LOS), ICU stay, ventilator use, inotrope use and pressor use. Differences between the groups were compared with the Student t test. Results: There were 7,837 survivors and 2,181 non-survivors. Table shows more patients with age > 65 died. Hypertension, diabetes, obesity, coronary artery disease, heart failure and peripheral vascular disease, COPD, chronic kidney disease were significantly elevated in non-survivors. Admission Inflammatory markers were significantly elevated in non-survivors. Significantly increased ECG intervals of QRS, QTc, atrial fibrillation, atrial flutter, and bundle branch block were noted in non-survivors. LVEF < 40% was significantly higher in non-survivors. ICU stay, LOS, pressor use and ventilator use were significantly elevated in non-survivors. Conclusions: More patients with age > 65 were survivors. Among non-survivors, cardiac, metabolic comorbidities, burden of atrial arrhythmias, admission inflammatory markers, LVEF< 40%, and clinical outcomes were significantly worse.

scholarly journals 116. Risk Factors and Clinical Outcomes of Carbapenem Non-Susceptible Gram-Negative Bacteremia in Patients with Acute Myelogenous Leukemia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S89-S89
Author(s):  
Dong Hoon Shin ◽  
Kang Il Jun ◽  
Song Mi Moon ◽  
Wan Beom Park ◽  
Ji Hwan Bang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Resistant Organism ◽  
Time Interval ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Acute Myelogenous ◽  
Independent Risk Factors

Abstract Background Early administration of susceptible antibiotics is crucial in Gram-negative bacteremia (GNB), especially in immunocompromised patients. We aimed to explore risk factors and clinical outcomes of carbapenem non-susceptible (Carba-NS) GNB in patients with acute myelogenous leukemia (AML). Methods Cases of all GNB during induction or consolidation chemotherapy for AML in a 15-year period in a tertiary hospital were retrospectively reviewed. Independent risk factors for Carba-NS GNB were sought and its clinical outcomes were compared with those of carbapenem susceptible (Carba-S) GNB. Results Among 485 GNB cases from 930 patients, 440 (91%) were Carba-S and 45 (9%) were Carba-NS GNB. Frequent Carba-NS isolates were Stenotrophomonas maltophilia (n = 23), Pseudomonas aeruginosa (n = 11), and Acinetobacter baumannii (n = 10). Independent risk factors for Carba-NS GNB were carbapenem use at the onset of GNB (aOR [95% CI], 78.6 [24.4–252.8]; P < 0.001), the isolation of imipenem-resistant A. baumannii in the prior 1 year (aOR [95% CI], 14.6 [2.7–79.9]; P = 0.002), time interval from chemotherapy to GNB ≥20 days (aOR [95% CI], 4.7 [1.7–13.1]; P = 0.003), and length of hospital stay ≥30 days (aOR [95% CI], 3.4 [1.3–9.1]; P = 0.013). Except breakthrough GNBs which occurred during carbapenem treatment, the frequency of Carba-NS GNB was 48% (19/40) in cases having ≥2 risk factors other than carbapenem use. 30-day overall mortality (Carba-NS, 36% vs. Carba-S, 6%; P < 0.001) and in-hospital mortality (Carba-NS, 47% vs. Carba-S, 9%; P < 0.001) were significantly higher in Carba-NS GNB. Conclusion Carba-NS GNB in AML patients was independently associated with the use of carbapenem, the past isolation of resistant organism, and late onset of GNB, and its clinical outcomes were poorer than those of Carba-S GNB. Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors. Disclosures All authors: No reported disclosures.

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