scholarly journals Use and effectiveness of Pioneer re-entry device for subintimal true lumen re-entry: single-centre data and a review of the literature

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Yvonne Tsitsiou ◽  
Jadesola Ekpe ◽  
Laura Harris ◽  
Elika Kashef ◽  
Mohamad Hamady
Keyword(s):  
Clinical Indication ◽  
Technical Failure ◽  
Technical Success ◽  
Single Centre ◽  
Related Complication ◽  
Subintimal Angioplasty ◽  
Technical Success Rate ◽  
Patient Demographics ◽  
Vessel Lumen ◽  
Diseased Vessel

Abstract Introduction During subintimal angioplasty (SIA), it is not always possible to re-enter the vessel lumen due to a variety of factors. Recanalization using hydrophilic wires and catheters alone, apart from its potential technical failure, is also limited by minimal control over the re-entry point. This is frequently well beyond the point of occlusion, thus often compromising important collaterals. In order to bypass the obstruction and attain controlled re-entry into the lumen of the diseased vessel, a re-entry device (RED) may be required. This paper assesses our centre’s experience with the safety and efficacy of the Pioneer re-entry system and systematically reviews the pertinent literature. Method A single centre retrospective study of subintimal angioplasty involving the use of the Pioneer Plus intravascular guided reentry catheter was performed. Patient demographics including age, gender, risk factors, comorbidities clinical indication and complications were recorded. Lesion characteristics, including location and severity of calcification were also assessed. A systematic literature review of all reported studies where the Pioneer RED was used for iliac and lower limb revascularization was conducted by 2 of the authors using the PubMed (MEDLINE) and EMBASE databases. Results The study comprised 30 cases. Technical success was 97%. A small, quickly resolved extravasation was the only device related complication. These results are in line with the systematic review which identified 16 studies using the Pioneer RED, reporting a technical success rate of 87.4–100% (median = 100%) and complication rate of 0–25.8% (median = 0%). However, due to heterogeneity in definitions of technical success, data was not pooled.

scholarly journals Stent-assisted coiling of cerebral aneurysms with the Neuroform Atlas stent

2018 ◽  
Vol 24 (3) ◽  
pp. 263-269 ◽  
Author(s):  
Ferdi Cay ◽  
Ahmet Peker ◽  
Anıl Arat
Keyword(s):  
Cerebral Aneurysms ◽  
Minor Stroke ◽  
Parent Artery ◽  
Technical Success ◽  
Technical Success Rate ◽  
Patient Demographics ◽  
Clinical Events ◽  
Angular Change ◽  
A Minor

Objectives The Neuroform Atlas stent (AS) is the smallest intracranial stent with an open-cell design. This study reports the first clinical experience with AS. Methods All intracranial aneurysms treated by stent-assisted coiling using a single AS in a single institution were retrospectively evaluated. Patient demographics, aneurysm characteristics, angles between the parent artery and stented branch, technical success, and clinical and angiographic follow-up were analyzed. Results Fifty-five consecutive aneurysms treated with AS-assisted coiling were included. Of these, 69.1% were located distal to the circle of Willis. Technical success rate was 100%. The mean diameters of proximal and distal parent arteries were 2.62 mm (range 1.5–4.4) and 1.8 mm (range 0.8–3.5), respectively. Except for a minor stroke in a patient who completely discontinued antiplatelet therapy on postoperative day 4, there were no clinical events with permanent sequelae, and 94.1% of patients had Raymond-Roy score of 1 or 2 aneurysmal occlusion at a mean follow-up duration of 7.9 months. Although the angle between the parent artery and the stented branch increased significantly ( p < 0.001) with time, the angular change at follow-up was only 16.45 ± 11.03 degrees and was inversely correlated both with preoperative angle and the diameter of the distal parent artery ( r = −0.465 and r = −0.433, respectively, p = 0.004 for both). Conclusion AS-assisted coiling was associated with a favorable early clinical outcome and angiographic results in this series. This stent can be used for distally located aneurysms and results in minimal alteration of the arterial anatomy.

Extravascular Recanalization of Chronic Total Occlusions

2018 ◽  
Author(s):  
S. Lowell Kahn
Keyword(s):  
Lower Extremity ◽  
Success Rate ◽  
Technical Failure ◽  
Technical Success ◽  
Contrast Injection ◽  
True Lumen ◽  
Chronic Total Occlusions ◽  
Technical Success Rate ◽  
The Wire

Subintimal revascularization is a mainstay of therapy for lower extremity interventions. This stems from the realization that true lumen traversal is not always possible, subintimal revascularization has a high technical success rate, and the subintimal space may confer advantages over a heavily calcified true lumen. Most commonly in the tibial vasculature, there are times when subintimal recanalization is not possible because the wire and catheter may leave the subintimal plane and enter the periadventitial tissue. Although this is not intentional, exit from the vessel historically results in a technical failure because future passes of the wire and catheter are likely to follow suit, as evidenced by extravasation on contrast injection. This chapter describes two techniques to salvage this scenario and accept an extravascular tract for revascularization: the Outback® extravascular revascularization technique and the percutaneous gun-sight extravascular revascularization technique.

Outcome of endovascular revascularisation in patients with acute obstructive mesenteric ischaemia - a single-centre experience

VASA ◽  
2015 ◽  
Vol 44 (5) ◽  
pp. 363-370 ◽  
Author(s):  
Gilbert Dominique Puippe ◽  
Julian Suesstrunk ◽  
Antonio Nocito ◽  
Roger Pfiffner ◽  
Michael Glenck ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Complication Rate ◽  
Mesenteric Ischaemia ◽  
Technical Success ◽  
Related Complication ◽  
Aspiration Thrombectomy ◽  
Technical Success Rate ◽  
Explorative Laparotomy ◽  
Catheter Directed Thrombolysis ◽  
Picture Archiving And Communication

Abstract. Summary: Background: Acute embolic or thrombotic mesenteric ischaemia (AMI) is a rare but life-threatening clinical condition. Despite diagnostic and therapeutic advances, the mortality rate remains high, between 60 % and 90 %. Over the last years revascularisation was increasingly performed by endovascular techniques. The aim of this study was to retrospectively analyse the clinical outcome of catheter-directed thrombolysis (CDT) and aspiration thrombectomy (AT) in patients with AMI with regard to technical success, intervention-related complication rate, need for secondary abdominal surgery, clinical course and 30-day mortality rate. Patients and methods: Thirteen patients (4 men, 9 women; mean age 74.5 ± 17 years) with 12 embolic and one thrombotic occlusion of the superior mesenteric artery (SMA) underwent emergent endovascular revascularisation of SMA. Clinical data including all imaging reports, laboratory analysis and follow-up data were derived from the electronic patient file and images were reviewed on a Picture Archiving and Communication System. Results: Eleven patients (n = 11; 84.6 %) underwent CDT and AT, and two patients (n = 2; 15.4 %) had AT alone. Technical success with complete restoration of SMA perfusion was achieved in 38.5 % (n = 5). Adjunctive angioplasty ± stenting was mandatory in 2 patients. Overall, the intervention-related complication rate was 38.5 %. In total, 46.2 % (n = 6) clinically improved following the intervention, while 38.5 % required explorative laparotomy after the intervention, with 2 colectomies and 2 small bowel resections. Overall, the 30-day mortality rate was 30.8 %. Conclusions: Endovascular revascularisation with CDT in combination with AT is feasible, with a technical success rate of 38.5 % (n = 5). Endovascular revascularisation was beneficial for 46.2 % (n = 6) of the patients, who clinically improved following the intervention. The need for secondary explorative laparotomy was rather low, with 38.5 % (n = 5) of the patients. The 30-day-mortality remains high with 30.8 %.

scholarly journals Subintimal angioplasty for superficial femoral artery occlusions: first experience in Kaunas University of Medicine Hospital

Medicina ◽  
2006 ◽  
Vol 43 (6) ◽  
pp. 447
Author(s):  
Nerijus Aleksynas ◽  
Rytis Kaupas
Keyword(s):  
Success Rate ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Ankle Brachial Index ◽  
Invasive Procedure ◽  
Technical Success ◽  
Subintimal Angioplasty ◽  
Technical Success Rate ◽  
Early Results ◽  
The Mean

Objective. To assess prospectively the first experience of subintimal angioplasty of superficial femoral artery occlusions. Patients and methods. Within a period of 36 months, 45 patients with 45 chronic occlusions in superficial femoral artery were treated at Kaunas University of Medicine Hospital. Results. The technical success rate was 84.4%, and four failures were treated by conventional surgery. The following complications occurred: one hematoma at the arterial puncture site, one artery spasm, and two distal embolizations. The mean length of occlusions was 14.2±1.4 cm. The mean ankle-brachial index improved from 0.41±0.15 to 0.81±0.04 after successful subintimal angioplasty (P<0.001). Primary assisted patency rates were 94.7%, 92.1%, 84.2%, 81.6%, and 81.6% at 1, 3, 6, 12, and 24 months, respectively. The limb salvage rates were 100% and 97.8% at 1–3 and 6–12–24 months, respectively. There were no treatmentrelated amputations. Conclusions. Subintimal angioplasty of occluded superficial femoral artery is a safe and minimally invasive procedure with a high initial technical success rate, low complication rate, and good early results, and in case of failure, subsequent surgery can be performed.

scholarly journals Japanese multicenter registry evaluating the antegrade dissection reentry with cardiac computerized tomography for chronic coronary total occlusion

2021 ◽  
Author(s):  
Maoto Habara ◽  
◽  
Etsuo Tsuchikane ◽  
Kazuki Shimizu ◽  
Yoshifumi Kashima ◽  
...  
Keyword(s):  
Success Rate ◽  
Cardiac Computed Tomography ◽  
Coronary Intervention ◽  
Technical Failure ◽  
Technical Success ◽  
Conventional Angiography ◽  
Total Occlusion ◽  
Cardiac Computed Tomography Angiography ◽  
Technical Success Rate ◽  
Ct Evaluation

AbstractRecently, antegrade dissection re-entry (ADR) with re-entry device for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has evolved to become one of the pillar techniques of the hybrid algorithm. Although the success rate of the device is high, it could be improved. We sought to evaluate the current trends and issues associated with ADR in Japan and evaluate the potential of cardiac computed tomography angiography (CCTA) for ADR procedure. A total 48 patients with CTO suitable for ADR evaluated by baseline conventional angiography and CCTA were enrolled. Procedural success and technical success were evaluated as the primary and secondary observations. Furthermore, all puncture points were analyzed by CCTA. CT score at each punctured site depended on the location of plaque deposition (none; + 0, at isolated myocardial site; + 1, at epicardial site; + 2) and the presence of calcification (none; + 0, presence; + 1) was analyzed and calculated (score 0–3). Overall procedure success rate was 95.8%. Thirty-two cases were attempted with the ADR procedure and 25 cases of them were successful. The technical success rate was 78.1% and myocardial infarction or other major complications were not observed in any cases. CT score at 60 puncture sites in 32 cases were analyzed and the score at technical success points was significantly smaller compared to that at technical failure points (0.68 ± 1.09 vs 1.77 ± 1.09, p < 0.0001). CTO-PCI with Stingray device in Japan could achieve a high procedure success and technical success rate. Pre procedure cardiac CT evaluation might support ADR procedure for appropriate patient selection or puncture site selection.

scholarly journals Trans-Scapular Approach Coil Localization for Scapular-Blocked Pulmonary Nodules: A Retrospective Study

2020 ◽  
Author(s):  
Juan Wu ◽  
Min-Ge Zhang ◽  
Jin Chen ◽  
Wen-Bin Ji
Keyword(s):  
Success Rate ◽  
Thoracoscopic Surgery ◽  
Pulmonary Nodules ◽  
Adenocarcinoma In Situ ◽  
Technical Failure ◽  
Technical Success ◽  
Ct Guided ◽  
Technical Success Rate ◽  
Preoperative Ct ◽  
The Mean

Abstract Background: Preoperative computed tomography (CT)-guided coil localization (CL) is commonly employed to facilitate the video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection (WR) of pulmonary nodules (PNs). When a scapular-blocked PN (SBPN) will be localized, the trans-scapular CL (TSCL) should be performed. In this study, we investigated the safety, feasibility, and clinical efficacy of preoperative CT-guided TSCL for SBPNs.Materials and Methods: From January 2014 to September 2020, a total of 152 patients with PNs underwent CT-guided CL prior to VATS-guided WR. Among them, 14 patients had the SBPNs and underwent TSCL procedure. Results: A total of 14 SBPNs were localized in the 14 patients. The mean diameter of the 14 SBPNs was 7.4 ± 2.4 mm. Technical success rate of puncture of the scapula was 100%. No complications occurred near the scapula. Technical success rate of CL was 92.9%. One coil dropped off when performing the VATS procedure. The mean duration of the TSCL was 14.2 ± 2.7 min. Two patient (14.3%) developed aysmptomatic pneumothorax after TSCL. Technical success rate of VATS-guided WR was 92.9%. The patient who experienced technical failure of TSCL directly underwent lobectomy. The mean VATS procedure duration and blood loss were 90.0 ± 42.4 min and 62.9 ± 37.2 ml, respectively. The final diagnoses of the 14 SBPNs included invasive adenocarcinoma (n = 4), adenocarcinoma in situ (n = 9), and benign (n = 1).Conclusions: Preoperative CT-guided TSCL can be safely and simply used to facilitate high successful rates of VATS-guided WR of SBPNs.

scholarly journals An International, Multicenter Retrospective Observational Study to Assess Technical Success and Clinical Outcomes of Patients Treated with an Endovascular Aneurysm Sealing Device for Type III Endoleak

2021 ◽  
pp. 152660282110319
Author(s):  
Aleksandra C. Zoethout ◽  
Shirley Ketting ◽  
Clark J. Zeebregts ◽  
Dimitri Apostolou ◽  
Barend M.E. Mees ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Success ◽  
Technical Failure ◽  
Technical Success ◽  
Technical Success Rate ◽  
Type Iii ◽  
Type Iiia ◽  
Postoperative Myocardial Infarction ◽  
Type Ia

Introduction: Type III endoleaks post-endovascular aortic aneurysm repair (EVAR) warrant treatment because they increase pressure within the aneurysm sac leading to increased rupture risk. The treatment may be difficult with regular endovascular devices. Endovascular aneurysm sealing (EVAS) might provide a treatment option for type III endoleaks, especially if located near the flow divider. This study aims to analyze clinical outcomes of EVAS for type III endoleaks after EVAR. Methods: This is an international, retrospective, observational cohort study including data from 8 European institutions. Results: A total of 20 patients were identified of which 80% had a type IIIb endoleak and the remainder (20%) a type IIIa endoleak. The median time between EVAR and EVAS was 49.5 months (28.5–89). Mean AAA diameter prior to EVAS revision was 76.6±19.9 mm. Technical success was achieved in 95%, 1 patient had technical failure due to a postoperative myocardial infarction resulting in death. Mean follow-up was 22.8±15.2 months. During follow-up 1 patient had a type Ia endoleak, and 1 patient had a new type IIIa endoleak at an untreated location. There were 5 patients with aneurysm growth. Five patients underwent AAA-related reinterventions indications being: growth with type II endoleak (n=3), type Ia endoleak (n=1), and iliac aneurysm (n=1). At 1-year follow-up, the freedom from clinical failure was 77.5%, freedom from all-cause mortality 94.7%, freedom from aneurysm-related mortality 95%, and freedom from aneurysm-related reinterventions 93.8%. Conclusion: The EVAS relining can be safely performed to treat type III endoleaks with an acceptable technical success rate, a low 30-day mortality rate and no secondary ruptures at short-term follow-up. The relatively low clinical success rates, related to reinterventions and AAA enlargement, highlight the need for prolonged follow-up.

scholarly journals EUS-guided gallbladder drainage in patients with cirrhosis: results of a multicenter retrospective study

2019 ◽  
Vol 07 (09) ◽  
pp. E1099-E1104 ◽  
Author(s):  
Theodore W. James ◽  
Matthew Krafft ◽  
Michael Croglio ◽  
John Nasr ◽  
Todd Baron
Keyword(s):  
Clinical Success ◽  
Technical Success ◽  
Alcoholic Fatty Liver ◽  
Gallbladder Drainage ◽  
Technical Success Rate ◽  
Patient Demographics ◽  
Underlying Malignancy ◽  
Pugh Class ◽  
Alcoholic Fatty Liver Disease

Abstract Background and study aims Cirrhosis has historically been considered a relative, if not absolute, contraindication to cholecystectomy. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been developed for use in non-operative candidates with cholecystitis; however, little data exist for use of the procedure in patients with cirrhosis. Patients and methods This was a retrospective series involving two large tertiary referral centers performing EUS-GBD. Patients with cirrhosis who underwent EUS-GBD for cholecystitis between August 2014 and December 2018 were identified. The primary endpoint was the rate of technical success, defined as EUS-guided placement of a lumen-apposing metal stent (LAMS) from duodenum to gallbladder. Patient demographics, procedural details, adverse events (AEs), post-procedural symptoms, and clinical success were recorded. Results Fifteen patients (9 females, 6 males) with cirrhosis underwent EUS-GBD during the study period. Mean patient age was 61 ± 17.1yrs, mean MELD-Na 15 ± 7. Etiology of cirrhosis was HCV (n = 2), alcohol (n = 4), non-alcoholic fatty liver disease (n = 8), and autoimmune hepatitis (n = 1).The technical success rate was 93.3 % and mean procedure time was 64 ± 59 minutes. Initial puncture site was duodenum (n = 11), stomach (n = 3) and jejunum (n = 1) and portion of gallbladder used for drainage was neck (n = 4) and body (n = 11). Fourteen patients went on to clinical success and two AEs occurred in this cohort. One decompensation event occurred in a patient with Child-Pugh class C disease 3 weeks post-procedure. Mean length of follow-up was 373 ± 367.3 days; one death occurred due to underlying malignancy. Conclusion EUS-GBD is safe and efficacious in managing cholecystitis in patients with Child-Pugh A and B cirrhosis who are non-operative candidates. Further studies are needed to determine optimal patient selection and procedural technique.

scholarly journals Safety and efficacy of arteriovenous fistula angioplasties performed by nephrologists: report from a Brazilian interventional nephrology center

2021 ◽  
Author(s):  
Ricardo P. Franco ◽  
Miguel C. Riella ◽  
Domingos C. Chula ◽  
Marcia T. de Alcântara ◽  
Marcelo M. do Nascimento
Keyword(s):  
Success Rate ◽  
Low Income ◽  
Complication Rates ◽  
Technical Failure ◽  
Success Rates ◽  
Technical Success ◽  
Safety And Efficacy ◽  
Technical Success Rate ◽  
Venous Stenosis ◽  
First Choice

ABSTRACT Introduction: Arteriovenous fistulas (AVF) are the first choice vascular access for hemodialysis. However, they present a high incidence of venous stenosis leading to thrombosis. Although training in interventional nephrology may improve accessibility for treatment of venous stenosis, there is limited data on the safety and efficacy of this approach performed by trained nephrologists in low-income and developing countries. Methods: This study presents the retrospective results of AVF angioplasties performed by trained nephrologists in a Brazilian outpatient interventional nephrology center. The primary outcome was technical success rate (completion of the procedure with angioplasty of all stenoses) and secondary outcomes were complication rates and overall AVF patency. Findings: Two hundred fifty-six angioplasties were performed in 160 AVF. The technical success rate was 88.77% and the main cause of technical failure was venous occlusion (10%). The incidence of complications was 13.67%, with only one patient needing hospitalization and four accesses lost due to the presence of hematomas and/or thrombosis. Grade 1 hematomas were the most frequent complication (8.2%). The overall patency found was 88.2 and 80.9% at 180 and 360 days after the procedure, respectively. Conclusion: Our findings suggest that AVF angioplasty performed by trained nephrologists has acceptable success rates and patency, with a low incidence of major complications as well as a low need for hospitalization.

scholarly journals EUS-guided fiducial marker placement for radiotherapy in rectal cancer: feasibility of two placement strategies and four fiducial types

2019 ◽  
Vol 07 (11) ◽  
pp. E1357-E1364 ◽  
Author(s):  
Lisanne S. Rigter ◽  
Eva C. Rijkmans ◽  
Akin Inderson ◽  
Roy P.J. van den Ende ◽  
Ellen M. Kerkhof ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Success Rate ◽  
Cancer Patients ◽  
Fiducial Marker ◽  
Retention Rates ◽  
Technical Failure ◽  
Technical Success ◽  
Serious Adverse Events ◽  
Technical Success Rate ◽  
Clinical Consequences

Abstract Background and study aims To facilitate image guidance during radiotherapy of rectal cancer, we investigated the feasibility of fiducial marker placement. This study aimed to evaluate technical success rate and safety of two endoscopic ultrasound (EUS)-guided placement strategies and four fiducial types for rectal cancer patients. Patients and methods This prospective multicenter study included 20 participants who were scheduled to undergo rectal cancer treatment with neoadjuvant short-course radiotherapy or chemoradiation. EUS-guided endoscopy was used for fiducial placement at the tumor site (n = 10) or in the mesorectal fat and in the tumor (n = 10). Four fiducial types were used (Visicoil 0.75 mm, Visicoil 0.50 mm, Cook, Gold Anchor). The endpoints were technical success rate and retention of fiducials, the latter of which was evaluated on cone-beam computed tomography scans during the first five radiotherapy fractions. Results A total of 64 fiducials were placed in 20 patients. For each fiducial type, at least three fiducials were successfully placed in all patients. Technical failure consisted of fiducial blockage within the needle (n = 2) and ejection of two preloaded fiducials at once (n = 4). No serious adverse events were reported. In three patients, one of the fiducials was misplaced without clinical consequences; two in the prostate and one in the intraperitoneal cavity. After a median time of 17 days after placement (range 7 – 47 days), a total of 42/64 (66 %) fiducials were still present (24/44 intratumoral vs. 18/20 mesorectal fiducials, P = 0.009). Conclusions Placement of fiducials in rectal cancer patients is feasible, however, retention rates for intratumoral fiducials were lower (55 %) than for mesorectal fiducials (90 %).

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