Type of anti-thrombotic therapy for venous stenting in patients with non-thrombotic iliac vein lesions does not influence the development of in-stent restenosis

2020 ◽  
Vol 35 (10) ◽  
pp. 805-813 ◽  
Author(s):  
Maxwell A Tran ◽  
Priya Lakhanpal ◽  
Sanjiv Lakhanpal ◽  
Vinay K Satwah ◽  
Gaurav Lakhanpal ◽  
...  
Keyword(s):  
Medical Records ◽  
Iliac Vein ◽  
Stent Patency ◽  
Venous Stenting ◽  
Stent Restenosis ◽  
In Stent Restenosis

Background In patients receiving stents for symptomatic non-thrombotic iliac vein lesions, many clinicians prescribe anti-thrombotic medications. Whether or not anti-coagulation post-venous stenting improves stent patency is unknown. The aim of this investigation is to determine whether prophylactic post-operative anti-thrombotic therapy improves stent patency and/or prevents in-stent restenosis. Methods The medical records and venous ultrasounds for 389 patients stented for non-thrombotic iliac vein lesions were retrospectively reviewed. Patients were categorized into three anti-thrombotic regimens: Clopidogrel, Aspirin and Clopidogrel, and Apixaban or Rivaroxaban. Patients were routinely assessed for restenosis and stent patency at 6, 26, and 52 weeks and treated with anti-thrombotics for 90 days. Results Freedom from in-stent restenosis at 6, 26, and 52 weeks were Clopidogrel (91.50, 82.91, 80.95%), Aspirin and Clopidogrel (88.68, 80.03, 80.03%), and Apixaban or Rivaroxaban (91.03, 85.11, 83.18%). Primary patencies were Clopidogrel (98.77, 98.77, 98.10%), Aspirin and Clopidogrel (100, 95.74, 95.74%), and Apixaban or Rivaroxaban (98.70, 98.70, 96.71%). There were no statistically significant differences. Conclusions The type of post-operative anti-thrombotic therapy for non-thrombotic iliac vein lesions does not appear to improve stent patency or prevent the development of in-stent restenosis.

Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

2020 ◽  
Vol 12 (11) ◽  
pp. 1127-1131
Author(s):  
Lukas Meyer ◽  
Hannes Leischner ◽  
Goetz Thomalla ◽  
Lars Udo Krause ◽  
Stephan Lowens ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Stroke Prevention ◽  
Balloon Catheter ◽  
Intracranial Stenosis ◽  
Secondary Stroke Prevention ◽  
Stent Patency ◽  
Fatal Stroke ◽  
Stent Restenosis ◽  
In Stent Restenosis

Background and purposeStroke recurrence is high in patients with symptomatic intracranial stenosis despite best medical treatment. Based on evidence from past studies using previous stent generations, elective intracranial stenting (eICS) is considered in a minority of patients. This study aims to report on experience performing eICS with a novel device combination.MethodsWe retrospectively reviewed data from three high volume stroke centers and analyzed patients that were treated with eICS for symptomatic intracranial stenosis using the Acclino (flex) stent and the NeuroSpeed balloon catheter (Acandis GmbH, Pforzheim, Germany). Study endpoints were periprocedural rates of stroke regardless of territory or death at discharge and at the time of follow-up after eICS. Safety evaluation included asymptomatic and symptomatic intracranial hemorrhage, serious adverse events related to the intervention, and evaluation of stent patency at the time of follow-up.ResultsThe median age of patients that met the inclusion criteria (n=76) was 69 years. Target vessels were located in the anterior circulation in 55.3% (42/76) of patients. The periprocedural stroke rate was 6.5% (fatal stroke 2.6%; non-fatal stroke 3.9%) at discharge after eICS. Asymptomatic intracranial hemorrhage was observed in 5.2% (4/76) of patients. Follow-up DSA revealed in-stent restenosis of 25% (15/60), and percutaneous transluminal angioplasty was performed again in 11.6% (7/60) of patients.ConclusionStenting for symptomatic intracranial stenosis with the Acclino (flex)/NeuroSpeed balloon catheter seemed to be safe and reinforces eICS as an endovascular therapy option for secondary stroke prevention. Future studies are warranted to confirm these findings and investigate antithrombotic strategies and in-stent restenosis to minimize periprocedural complications and guarantee long term stent patency.

scholarly journals Hybrid Recanalization for the Treatment of Carotid/Vertebral In-stent Restenosis or Occlusion: Pilot Surgery Experiences From One Single Center

2020 ◽  
Vol 11 ◽  
Author(s):  
Chao Wang ◽  
Peng Zhao ◽  
Tao Sun ◽  
Mengtao Han ◽  
Yunyan Wang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Medical Records ◽  
Endovascular Intervention ◽  
Hybrid Technique ◽  
Technical Success ◽  
Presenting Symptoms ◽  
Stent Restenosis ◽  
V1 Segment ◽  
In Stent Restenosis

Background : The hybrid recanalization of internal carotid artery (ICA) and vertebral artery (VA) in-stent restenosis or occlusion using a combination of endarterectomy and endovascular intervention has achieved technical success. We present our surgical experiences to further evaluate the safety and efficacy of the hybrid technique for the treatment of in-stent restenosis and occlusion.Methods : A cohort of 12 refractory patients with in-stent restenosis or occlusion who underwent hybrid recanalization, a combination of endarterectomy and endovascular intervention, were retrospectively analyzed. Medical records, including presenting symptoms, comorbidities, contralateral ICA/VA findings, use of antiplatelet drugs, postoperative complications, and angiographic outcomes, were collected.Results : Among 415 consecutive patients with ICA, common carotid artery, and V1 segment lesions, 12 refractory patients (2.89%) with 13 cases were enrolled in our study (1 female and 11 male). All patients underwent successful hybrid recanalization. There were no cases of postoperative stroke or death. Only two patients sustained hoarseness, but it resolved within 2 weeks after surgery. Three patients were treated with dual antiplatelet (aspirin and clopidogrel), seven with single antiplatelet (aspirin), one with single antiplatelet (clopidogrel), and one with single antiplatelet (ticagrelor). All patients were followed up in the outpatient department according to the protocol, with a mean follow-up period of 13 months (range, 6–24 months). No death or recurrent symptoms occurred during the regular follow-up period.Conclusion : The hybrid technique maybe a safe and feasible treatment option to recanalize in-stent restenosis or occlusion with acceptable complications.

scholarly journals Endovascular Deep Vein Stenting of Symptomatic Post-Thrombotic and Non-Thrombotic Iliac Vein Stenotic Lesions: A Multicentre Cohort Experience from Singapore

2020 ◽  
Vol 49 (8) ◽  
pp. 551-560
Author(s):  
Mervin Nathan Han Hui Lim ◽  
Karthikeyan Damodharan ◽  
Sze Ling Chan ◽  
Ming Ren Toh ◽  
Charyl Jia Qi Yap ◽  
...  
Keyword(s):  
Patency Rate ◽  
Iliac Vein ◽  
Clinical Severity ◽  
Venous Disease ◽  
Secondary Patency ◽  
Stent Patency ◽  
Venous Stenting ◽  
Post Thrombotic Syndrome ◽  
Venous Clinical Severity Score ◽  
Deep Vein

Introduction: This paper presents our experience with deep venous stenting in a multi-ethnic Asian cohort of patients with symptomatic Non-Thrombotic Iliac Vein Lesions (NIVL) and Post-Thrombotic Syndrome (PTS). Materials and Methods: This was a multicentre retrospective cohort study of patients who had symptomatic deep venous disease. Stent patency rate was evaluated using Duplex ultrasonography immediately post-intervention and at 3, 6 and 12 months. Clinical outcomes were evaluated using the revised Venous Clinical Severity Score (rVCSS) and Visual Analogue Scale (VAS) pain score at baseline and 3 months post-procedure. Results: 87 patients (males = 47/87 (54.0%)); median age = 62 years (IQR 55 – 70)) and 115 limbs were analysed (left = 76/115 (66.1%)). Median follow-up time was 175 (IQR 57 – 257) days. 97/115 (84.3%) had NIVLs and 55/115 (47.8%) had May-Thurner-Syndrome. 43/115 (37.4%) had Clinical, Etiology, Anatomy and Pathophysiology (CEAP) 6 disease. Primary stent patency rates were 98.2% (112/114), 97.9% (93/95), 95.7% (89/93) and 92.8% (64/69) immediately postintervention, 3, 6 and 12 months, respectively. The 6-month secondary patency rate was 99.1% (114/115). Mean rVCSS and VAS improved from 11.52 (±3.54) to 5.77 (±2.36) (P < 0.01) and 6.62 (±1.93) to 2.92 (±1.50) (P < 0.01) respectively, at 3 months. 41/43 (95.3%) venous ulcers healed over a median time of 169 days (IQR 120 – 253). Conclusions: Short term primary patency rates following deep venous stenting are excellent, with few re-interventions. Patients presented with NIVLs rather than PTS. There was excellent clinical improvement at 3 months, with a high and expedient venous ulcer healing rate. Key words: Deep vein stenting, May-Thurner Syndrome, Non-thrombotic iliac vein lesion, Post-thrombotic syndrome, Vascular patency

Does 16-slice multidetector computed tomography improve stent patency and in-stent restenosis evaluation?

2007 ◽  
Vol 8 (6) ◽  
pp. 438-444 ◽  
Author(s):  
Guido Ligabue ◽  
Federica Fiocchi ◽  
Sonia Ferraresi ◽  
Rosario Rossi ◽  
Maria Grazia Modena ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Stent Patency ◽  
Stent Restenosis ◽  
In Stent Restenosis

scholarly journals Increased levels of MMP-3, MMP-9 and MPO represent predictors of in-stent restenosis, while increased levels of ADMA, LCAT, ApoE and ApoD predict bare metal stent patency

2015 ◽  
Vol 159 (4) ◽  
pp. 586-594 ◽  
Author(s):  
Leos Pleva ◽  
Pavlina Kusnierova ◽  
Pavlina Plevova ◽  
Jana Zapletalova ◽  
Michal Karpisek ◽  
...  
Keyword(s):  
Bare Metal Stent ◽  
Bare Metal ◽  
Metal Stent ◽  
Stent Patency ◽  
Stent Restenosis ◽  
In Stent Restenosis

Long-term antithrombotic therapy after venous stent placement

2019 ◽  
Vol 35 (6) ◽  
pp. 402-408 ◽  
Author(s):  
Chenyu Lin ◽  
Karlyn A Martin ◽  
Mei Wang ◽  
Brady L Stein ◽  
Kush R Desai
Keyword(s):  
Triple Therapy ◽  
Stent Thrombosis ◽  
Stent Placement ◽  
Antithrombotic Therapy ◽  
Vena Cava ◽  
Prescribing Patterns ◽  
Bleeding Events ◽  
Venous Stenting ◽  
Stent Restenosis ◽  
In Stent Restenosis

Objectives To examine the prescribing patterns and outcomes of antithrombotic regimens after venous stent placement. Methods A total of 87 patients who received inferior vena cava or iliofemoral venous stents were included in the study. A retrospective review was performed to determine the antithrombotic regimens and the subsequent rates of in-stent restenosis, stent thrombosis, and bleeding. Results The prescribing patterns of specific antithrombotic regimens were highly variable. In-stent restenosis and stent thrombosis events were observed in 13 of 63 patients (21%) with available follow-up imaging, while major bleeding events were noted in 6 of 87 patients (7%). Triple therapy appeared to reduce the odds of in-stent restenosis/ stent thrombosis when compared to dual antiplatelet therapy (OR = 0.07, P = 0.01). Conclusions Substantial variability exists in antithrombotic therapy following venous stenting at our institution. This study demonstrated a reduction of in-stent restenosis/thrombosis events when utilizing triple therapy compared to antiplatelet-only regimens. However, larger prospective trials are needed to more accurately determine the relative risks and benefits of each antithrombotic regimen.

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