Gender Differences in the Outcomes of Drug-Coated Balloon Treatment in Symptomatic Femoropopliteal Arterial Disease

2020 ◽  
Vol 54 (4) ◽  
pp. 348-354
Author(s):  
Prakash Krishnan ◽  
Arthur Tarricone ◽  
Bhaskar Purushottam ◽  
Simon Chen ◽  
Vishal Kapur ◽  
...  
Keyword(s):  
Female Gender ◽  
Arterial Disease ◽  
The United States ◽  
Vessel Diameter ◽  
Target Lesion ◽  
Outcome Differences ◽  
Artery Disease ◽  
And Gender ◽  
Simple Logistic ◽  
Drug Coated Balloon

Objectives: To assess 24-month outcome differences based on sex in symptomatic femoro-popliteal arterial disease of patients treated with drug-coated balloon (DCB). Background: Peripheral artery disease affects over 12 million people in the United States. Drug-coated balloons have shown to be effective in treating patients with symptomatic femoropopliteal arterial occlusive disease. Debate remains regarding its safety and efficacy in female gender. We investigated the differential treatment effect between genders. Methods: Patients (93 females and 102 males) with symptomatic femoropopliteal arterial disease treated with DCB from November 2014 to November 2015 were included in this retrospective study. We compared the resting ankle-brachial indices (ABIs) and peak systolic velocities (PSVs) by arterial duplex between the male and female patients at 6, 12, and 24 months postintervention. Results: Females had significantly smaller vessels (4.70 ± 0.9, P = .02) and higher body mass index (BMI; 30.0 ± 3.7, P = .002) than males. Females had significantly decreased ABI and PSV at the 6-month (ABI: 0.90 ± 0.15, P = .05 and PSV: 188.30 ± 103.1, P = .02), 12-month (ABI: 0.86 ± 0.15, P < .0001 and PSV: 219.10 ± 100.10, P = .001), and at 24-month (ABI: 0.84 ± 0.2, P = .0001 and PSV: 251.0 ± 135.9, P < .0001) intervals when compared to males. Females had increased clinically driven target lesion revascularization (TLR) at 6 months (females = 8 vs males = 4, P = .22), 12 months (females = 12 vs males = 4, P = .02), and 24 months (females = 14 vs males = 6, P = .03). In simple logistic regression analysis, BMI, age, reference vessel diameter (RVD), and gender were strongly associated with target lesion restenosis. The final model included the above and it produced the following odds ratios (ORs): BMI (OR = 1.07, 95% confidence interval [CI]: 0.98-1.2), age (OR: 1.0, CI: 0.96-1.03), RVD (OR: 1.6, CI: 1.02-2.4), and gender (OR: 3.5, CI: 1.6-7.8). Conclusion: Females treated with DCBs have significantly decreased ABI, PSVs, and an increased rate of TLR than their male counterparts.

How race and gender shape the development of social prototypes in the United States

2021 ◽  
Author(s):  
Ryan Lei ◽  
Rachel Leshin ◽  
Kelsey Moty ◽  
Emily Foster-Hanson ◽  
Marjorie Rhodes
Keyword(s):  
Middle Eastern ◽  
Female Gender ◽  
The United States ◽  
Asian Woman ◽  
Social Categories ◽  
Race And Gender ◽  
Cultural Ideologies ◽  
Identity Based ◽  
And Gender ◽  
Gender Categories

The present studies examined how gender and race information shape children’s prototypes of various social categories. Children (N=543; Mage=5.81, range=2.75 - 10.62; 281 girls, 262 boys; 193 White, 114 Asian, 71 Black, 50 Hispanic, 39 Multiracial, 7 Middle-Eastern, 69 race unreported) most often chose White people as prototypical of boys and men—a pattern that increased with age. For female gender categories, children most often selected a White girl as prototypical of girls, but an Asian woman as prototypical of women. For superordinate social categories (person and kid), children tended to choose members of their own gender as most representative. Overall, the findings reveal how cultural ideologies and identity-based processes interact to shape the development of social prototypes across childhood.

scholarly journals Efficacy of Low-Pressure Inflation of Oversized Drug-Coated Balloon for Coronary Artery Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Katsumi Ueno ◽  
Norihiko Morita ◽  
Yoshinobu Kojima ◽  
Hiroki Kondo ◽  
Hiroshi Takahashi ◽  
...  
Keyword(s):  
Propensity Score Analysis ◽  
Standard Technique ◽  
Low Pressure ◽  
Target Lesion ◽  
Late Lumen Loss ◽  
Frequent Use ◽  
Significant Difference ◽  
Artery Disease ◽  
Late Restenosis ◽  
Drug Coated Balloon

Objectives. This study sought to assess the efficacy of oversized drug-coated balloon (DCB) inflation at low pressure for the prevention of acute dissections and late restenosis. Background. The major limitation of DCB coronary angioplasty is the occurrence of severe dissection after inflation of DCB. Methods. Between 2014 and 2018, 273 consecutive patients were retrospectively studied. 191 lesions (154 patients) treated by oversized DCB inflation at low pressure (<4 atm, 2.4 ± 1.2 atm, DCB/artery ratio 1.14 ± 0.22; LP group) were compared with 135 lesions (119 patients) treated by the standard DCB technique (7.1 ± 2.2 atm, DCB/artery ratio 1.03 ± 0.16; SP group). Results. Although the lesions in the LP group were more complex than those in the SP group (smaller reference diameter (2.38 mm vs. 2.57 mm, P = 0.011 ), longer lesions (11.7 mm vs. 10.5 mm, P = 0.10 ), and more frequent use of rotational atherectomy (45.0% vs. 28.1%, P = 0.003 ), there was no significant difference in the NHLBI type of dissections between the two groups (11.5%, 12.0%, 5.2% vs. 12.6%, 12.6%, 2.2% in type A, B, and C, P = 0.61 ), and no bailout stenting was required. In 125 well-matched lesion pairs after propensity score analysis, the cumulative incidence of target lesion revascularization at 3 years was 4.5% vs. 7.0%, respectively ( P = 0.60 ). Late lumen loss (−0.00 mm vs. −0.01 mm, P = 0.94 ) and restenosis rates (7.4% vs. 7.1%, P = 1.0 ) were similar in both of the groups. Conclusion. The application of oversized DCB at low pressure is effective and feasible for preventing late restenosis comparative to the standard technique of DCB.

scholarly journals A Comparison of Measures of Endothelial Function in Patients with Peripheral Arterial Disease and Age and Gender Matched Controls

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Richard B. Allan ◽  
Simon V. Vun ◽  
J. Ian Spark
Keyword(s):  
Endothelial Function ◽  
Reactive Hyperemia ◽  
Arterial Disease ◽  
Peripheral Artery ◽  
Flow Mediated Dilatation ◽  
Hyperaemic Response ◽  
Artery Disease ◽  
And Gender ◽  
Peripheral Arterial ◽  
And Control

This study compared flow-mediated dilatation (FMD), peripheral artery tonometry (PAT), and serum nitric oxide (NO) measures of endothelial function in patients with peripheral artery disease (PAD) against age/gender matched controls. 25 patients (mean age: 72.4 years, M : F 18 : 7) with established PAD and an age/gender matched group of 25 healthy controls (mean age: 72.4 years, M : F 18 : 7) were studied. Endothelial function was measured using the % FMD, reactive hyperemia index (RHI) using PAT and serum NO (μmol). Difference for each method between PAD and control patients and correlation between the methods were investigated. FMD and RHI were lower in patients with PAD (median FMD for PAD = 2.16% versus control = 3.77%,p=0.034and median RHI in PAD = 1.64 versus control = 1.92,p=0.005). NO levels were not significantly different between the groups (PAD median = 7.70 μmol, control median = 13.05 μmol,p=0.662). These results were obtained in elderly patients and cannot be extrapolated to younger individuals. FMD and PAT both demonstrated a lower hyperaemic response in patients with PAD; however, FMD results in PAD patients were unequivocally reduced whereas half the PAD patients had RHI values above the established threshold for endothelial dysfunction. This suggests that FMD is a more appropriate method for the measurement of NO-mediated endothelial function.

scholarly journals An analysis of the economic impact of drug-coated balloon use for the treatment of peripheral artery disease

2015 ◽  
Vol 3 ◽  
pp. 20 ◽  
Author(s):  
Antonio Micari ◽  
Giuseppe Vadalà ◽  
Mara Corbo ◽  
Gianluigi D'Alessandro ◽  
Fausto Castriota ◽  
...  
Keyword(s):  
Economic Impact ◽  
Arterial Disease ◽  
Target Lesion ◽  
Decision Analytic Model ◽  
Disease Costs ◽  
Budget Impact Model ◽  
Artery Disease ◽  
One Year ◽  
Plain Old Balloon Angioplasty ◽  
Peripheral Arterial

<p><strong>Background</strong>: Drug-coated balloons (DCBs) are an alternative for patients with peripheral arterial disease. Costs and re-intervention rates are potentially reduced compared to other technologies. We assessed the economic impact of these endovascular therapies.</p><p><strong>Methods</strong>: An Italian National Healthcare Service-perspective budget impact model with a 5-year horizon was developed to compare relative costs of 4 index procedures (plain old balloon angioplasty (POBA), DCBs, and bare-metal and drug-eluting stents (BMSs, DESs)) based on 1-year repeat-procedure rates (target-lesion revascularization (TLR)). A published systematic review of TLR rates in patients with femoral-popliteal disease undergoing these treatments was used to measure effectiveness. Costs associated with each treatment were derived from diagnosis-related group tariffs. A decision analytic model was developed to estimate 1-year costs for index procedures and possible revascularizations.</p><p> </p><p><strong>Results</strong>: Pooled TLR rates show clear patient benefits for DCBs (6.9%) compared with POBA (21.6%) and BMSs (14.2%) and non-inferiority vs. DESs (7.3%). One-year payments for index and repeat interventions (by TLR rate) showed that DCBs were the least costly strategy, saving ~€1,000/patient vs. POBA. The potential savings were €8.7M, assuming 5% annual increase in DCB adoption over 5 years. <strong></strong></p><p><strong>Conclusions</strong>: Despite initial higher investment, DCB represent a cost-saving alternative to other technologies. <strong></strong></p>

Predictors of Favorable Angiographic Outcomes After Drug-Coated Balloon Use for de novo Small Vessel Coronary Disease (DCB-ONLY)

Angiology ◽  
2021 ◽  
pp. 000331972110155
Author(s):  
Woong Chol Kang ◽  
Sang Min Park ◽  
Albert Youngwoo Jang ◽  
Pyung Chun Oh ◽  
Eun-Seok Shin ◽  
...  
Keyword(s):  
De Novo ◽  
Small Vessel Disease ◽  
Vessel Diameter ◽  
Target Lesion ◽  
Small Vessel ◽  
Luminal Diameter ◽  
Minimal Luminal Diameter ◽  
Late Luminal Loss ◽  
Drug Coated Balloon

We evaluated the angiographic parameter and clinical outcomes of drug-coated balloon (DCB) to assess the optimal angiographic criteria in de novo small vessel disease (SVD). Patients (n = 424, mean age: 64.4 ± 11.2 years, men: 69.8%) at 20 sites in Korea were prospectively enrolled. The primary end point was late luminal loss (LLL) at 9-month follow-up angiography. Secondary end points included restenosis rates, target lesion failure (TLF), and DCB-related thrombosis during the 12-month follow-up period. We included 403 patients for analysis excluding 21 patients who required bailout stenting. Baseline mean reference vessel .diameter was 2.52 ± 0.39 mm and mean minimal luminal diameter (MLD) was 0.71 ± 0.40 mm. The mean MLD was 1.54 ± 0.37 mm after DCB. Late luminal loss was −0.01 ± 0.43 mm and restenosis was noted in 26 patients (12.2%). Minimal luminal diameter >1.6 mm and % diameter stenosis (DS ) <45% after DCB was associated maintenance of MLD without LLL at 9-months. Multivariate analysis demonstrated that %DS at baseline and post-MLD was associated with the restenosis. During 12-month follow-up, TLF was 2.6% including 1 cardiac death, 1 myocardial infarction, and 10 ischemia-driven target lesion revascularizations. Drug-coated balloon showed a low restenosis and lower LLL despite high in-segment DS. Post-MLD and % DS may be helpful to get optimal results in de novo SVD after DCB.

Bench-to-Bedside in Vascular Medicine: Optimizing the Translational Pipeline for Patients With Peripheral Artery Disease

2021 ◽  
Vol 128 (12) ◽  
pp. 1927-1943 ◽  
Author(s):  
Tom Alsaigh ◽  
Belinda A. Di Bartolo ◽  
Jocelyne Mulangala ◽  
Gemma A. Figtree ◽  
Nicholas J. Leeper
Keyword(s):  
Peripheral Arterial Disease ◽  
Wide Spectrum ◽  
Arterial Disease ◽  
The United States ◽  
Clinical Severity ◽  
Development Programs ◽  
Vascular Medicine ◽  
Technology Platforms ◽  
Artery Disease ◽  
Peripheral Arterial

Peripheral arterial disease is a growing worldwide problem with a wide spectrum of clinical severity and is projected to consume >$21 billion per year in the United States alone. While vascular researchers have brought several therapies to the clinic in recent years, few of these approaches have leveraged advances in high-throughput discovery screens, novel translational models, or innovative trial designs. In the following review, we discuss recent advances in unbiased genomics and broader omics technology platforms, along with preclinical vascular models designed to enhance our understanding of disease pathobiology and prioritize targets for additional investigation. Furthermore, we summarize novel approaches to clinical studies in subjects with claudication and ischemic ulceration, with an emphasis on streamlining and accelerating bench-to-bedside translation. By providing a framework designed to enhance each aspect of future clinical development programs, we hope to enrich the pipeline of therapies that may prevent loss of life and limb for those with peripheral arterial disease.

scholarly journals Gender Differences in Peripheral Vascular Disease

2018 ◽  
Vol 35 (01) ◽  
pp. 009-016 ◽  
Author(s):  
Kristofer Schramm ◽  
Paul Rochon
Keyword(s):  
The Elderly ◽  
The United States ◽  
Peripheral Vascular ◽  
Specific Data ◽  
The Past ◽  
Dominant Disease ◽  
Gender Specific Differences ◽  
Artery Disease ◽  
And Gender ◽  
Gender Specific

AbstractIn the past 20 years, peripheral artery disease (PAD) has been increasingly recognized as a significant cause of morbidity and mortality in the United States. PAD has traditionally been identified as a male-dominant disease; however, recent population trends and studies in PAD suggest that women are affected at least as often as men. Women comprise a larger population of the elderly than men, as well as an increasing proportion of patients with PAD. Much of the existing research on PAD has focused on whole populations, and gender-specific data on PAD is sparse. This review focuses on gender-specific differences in presentation, management, and outcomes of PAD intervention that are important considerations for the interventional radiologist.

scholarly journals Characteristics of Peripheral Arterial Disease Patients in Vascular and Endovascular Surgery Department Dr. Mohammad Hoesin General Hospital between January 2018 - December 2019

2021 ◽  
Vol 4 (2) ◽  
pp. 256-262
Author(s):  
Gayuh Prasetya ◽  
Fahmi Jaka Yusuf ◽  
Kemas Dahlan
Keyword(s):  
Peripheral Arterial Disease ◽  
Disease Patient ◽  
Arterial Disease ◽  
The United States ◽  
Endovascular Surgery ◽  
Early Prevention ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
Surgery Department ◽  
Stage 1

Background: Peripheral artery disease (PAD) is a chronic occlusive arterial disease of the extremities caused by atherosclerosis leading to stenosis or occlusion characterized by decreased blood flow to the limb, due to obstruction or narrowing of the blood vessels. PAD often underdiagnosed and poorly understood. ​​Median annual expenditure per individual for patients with PAD was $ 11.553 to $ 42.613 in the United States. The lack of data on PAD in South Sumatra was the based for investigators to conducting this study. Methods: This research is a retrospective descriptive study. The purpose of this study was to describe the characteristics of PAD patient based on the Rutherford classification. There are 33 cases in this study. Result: The dominant patient was male, the youngest age was 28 years old and the oldest age was 71 years, with a mean age of 55.8 years. Diabetes mellitus, stage 1 hypertension, LDL more than 100 mg/dL, ABI results that showed PAD, and stage 2 Rutherford were the dominant cases in the sample of this study. Conclusion: Early prevention and treatment from vascular and endovascular surgery can be considered as the most important for the management of peripheral arterial disease patient.

Intracoronary Imaging Versus Coronary Angiography to Guide Drug-Coated Balloon Intervention in Coronary Artery Disease: A Propensity-Matched Pilot Study Analysis

Angiology ◽  
2021 ◽  
pp. 000331972110125
Author(s):  
Sai Lv ◽  
Xiaoteng Ma ◽  
Yujie Zhou ◽  
Yingxin Zhao ◽  
Xiaoli Liu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Death ◽  
Target Lesion ◽  
Target Vessel ◽  
Intracoronary Imaging ◽  
End Point ◽  
Significant Difference ◽  
Artery Disease ◽  
Drug Coated Balloon

Limited data exist about the effect of intracoronary imaging (ICI)-guided drug-coated balloon (DCB) intervention on clinical end points. In all, 1157 patients with coronary artery disease treated with DCB between December 2014 and December 2017 at Beijing Anzhen Hospital were included in the final analysis in this cohort study. The primary end point was the incidence of target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (MI), and target lesion revascularization, and the key secondary end point was the incidence of cardiac death or target vessel MI. The median follow-up for clinical events was 32.0 months (IQR 25.0-40.0). Intracoronary imaging was used in 90 (7.8%) patients. There was no statistically significant difference in TLF (12.2% vs 12.5%, P = .80) between ICI-guided and angiography-guided group. Cardiac death or target vessel MI rates (1.1% vs 3.7%, P = .17) were numerically lower for the ICI-guided cohort. In the propensity score–based analysis, TLF (10.5% vs 16.2%, P = .19) and cardiac death or target vessel MI rates (1.2% vs 2.3%, P = .51) tended to be lower for the ICI-guided cohort. In this observational study, TLF rate tended to decrease in the ICI-guided DCB treatment group compared with angiography-guided procedures. Larger studies are needed.

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