The Modified Bose Method for the Endovascular Treatment of Intracranial Atherosclerotic Arterial Stenoses Using the Enterprise Stent

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 91-101 ◽  
Author(s):  
Zsolt Vajda ◽  
Elisabeth Schmid ◽  
Thomas Güthe ◽  
Christoph Klötzsch ◽  
Alfred Lindner ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Cerebral Artery ◽  
Vessel Diameter ◽  
Radial Force ◽  
Technical Success Rate ◽  
Data Registry ◽  
Stenosis Rate ◽  
Stent Diameter ◽  
Recurrent Ischemia

Abstract BACKGROUND Balloon dilatation and deployment of a self-expanding stent is a safe treatment for intracranial atherosclerotic stenoses. The significant recurrence rate might be related to the high radial force of the Wingspan stent. OBJECTIVE To evaluate the procedural safety and stenosis recurrence rate by the use of a stent with reduced radial force (Enterprise). METHODS Two hundred nine atherosclerotic stenoses (189 patients) were treated (median age, 68 years; 132 male) in a single center. Lesion locations included internal carotid artery (n = 27), middle cerebral artery (n = 62), vertebral artery (n = 64), basilar artery (n = 55), and posterior cerebral artery (n = 1). Pre- and postmedication included acetylsalicylic acid and Clopidogrel for at least 12 months. Preprocedural and follow-up examinations included magnetic resonance imaging (MRI), neurological assessment, and digital subtraction angiography (6, 12, 26, and 52 weeks). Data registry included age, sex, normal vessel diameter, degree of stenosis, residual stenosis after stent, minimal in-stent diameter, and occurrence of ischemic symptoms during follow-up. RESULTS Median pre- and postprocedural stenosis rate was 65.4 ± 1% vs 25.1 ± 1%. Technical success rate was 100%. Major procedural complications occurred in 16 patients (8.1%). Combined neurological morbidity and mortality rate at 30 days was 2 patients (0.9%). In 174 stenoses (83%) angiographic follow-up was obtained (mean, 10.2 months). A restenosis (>50%) was observed in 43 (24.7%) cases after 4.2 months (mean) with 4 (9.3%) symptomatic lesions. Incidence of recurrent ischemia related to the stented artery was 2.2% during 10.2 months of mean follow-up. CONCLUSION Undersized balloon angioplasty and deployment of an Enterprise stent is safe and effective for intracranial stenoses. Follow-up results were equal to or better than those reported for bare-metal balloon-expandable or self-expanding stents and yielded excellent protection from recurrent ischemia.

Abstract 2884: Angiographic Lumen Changes From Oversized Neuroform Stent Implantation

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Marc A Lazzaro ◽  
Omar Katib ◽  
Behrad Golshani ◽  
Osama O Zaidat
Keyword(s):  
Stent Implantation ◽  
Neointimal Hyperplasia ◽  
Vessel Diameter ◽  
Radial Force ◽  
Lumen Diameter ◽  
Paired Data ◽  
Parent Vessel ◽  
Landing Zone ◽  
Neuroform Stent

Introduction: The effect of oversized intracranial stent implantation, and the potential for excessive neointimal hyperplasia from the resulting chronic outward radial force, has not been previously reported. We sought to compare the angiographic narrowing associated with implantation of oversized Neuroform stents overlapping vessels of different diameters. Methods: We reviewed an aneurysm database and identified patients treated with stent-assisted coil embolization involving stent placement overlapping a vessel size transition. Patient demographics and lesion characteristics were extracted from chart review. A submillimeter digital caliper was used for angiogram measurement of lumen diameter at four sites ( figure ). The relationship between lumen diameter and stent oversizing was compared with student’s t-test and Pearson’s correlation. Results: Twenty vessels were identified in 18 patients, providing 80 paired data points. Mean age was 52 years (SD 12), with mean follow-up time of 8 months (SD 6). The distribution of vessel transitions included BA to PCA (n = 8), A1 to A2 or M1 to M2 (n = 8), ICA to ACA or MCA (n = 3), and Vertebral artery to PICA (n = 1). Stent diameter ranged from 3 mm to 4.5 mm, and the average oversizing in the smaller diameter parent vessel landing-zone was 1.75 mm (range 0.8 to 2.9 mm) greater than the vessel diameter. The mean change in lumen size from pre-stent implantation to follow-up was not significantly different for any of the four sites; the proximal end-stent decreased by 5.5% (SD 19.7), proximal mid-stent increased by 7.3% (SD 18.8), distal mid-stent increased by 14.7% (SD 13.8), and the distal end-stent decreased by 0.9% (SD 13.1). Stent oversizing by less than a factor of 1.65 resulted in a mean lumen loss of 4.1% (SD 15.6), while oversizing by greater than a factor of 1.65 resulted in a mean lumen gain of 11.1% (SD = 17.2), (p = 0.006). Conclusions: These data suggest oversized Neuroform stent implantation within the intracranial vasculature does not lead to increased stenosis. Stent oversizing by a factor of 1.65 or more leads to significant persistent luminal gain. The non-significant trend toward lumen loss at the stent tines suggests diminished radial force or greater neointimal hyperplasia at these sites, however persistent luminal gain from the oversized stent radial force likely predominates over any neointimal hyperplasia. Figure . A NF stent overlapping the M1 and M2 segments (A, tines indicated by white arrows). Four points of measurement (B), proximal tines (1.), mid-stent in proximal landing zone (2.), mid-stent in distal landing zone (3.), and distal tines (4.).

Long-term outcomes of angioplasty for pediatric renovascular hypertension: A single-center experience

Vascular ◽  
2021 ◽  
pp. 170853812110596
Author(s):  
Julong Guo ◽  
Sensen Wu ◽  
Fan Zhang ◽  
Chengchao Zhang ◽  
Yongquan Gu ◽  
...  
Keyword(s):  
Renovascular Hypertension ◽  
Lesion Length ◽  
Single Center ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Residual Stenosis ◽  
Technical Success Rate ◽  
Stenosis Rate

Objectives We used single-center data to evaluate the long-term outcome of percutaneous transluminal angioplasty (PTA) for pediatric renovascular hypertension (RVH) and to analyze the factors that influence effectiveness. Methods We retrospectively evaluated 33 pediatric RVH patients (18 boys; mean age: 9.1 ± 4 years, range: 2–16) who underwent PTA from January 2007 to December 2019. 15 patients had Takayasu arteritis (TA) and 18 were non-TA. The median follow-up from the initial PTA was 69 months (range: 12–157; IQR: 25.5–89). Results The technical success rate of 52 PTA procedures was 90.4% in 33 children. Renal artery stents were implanted in two patients, external guidewires were used in two patients, and a drug-coated balloon was used in only one patient. The overall effective rate of PTA was 63.6%, including cured 39.4% and improved 24.2%, at the end of follow-up. Overall clinical outcomes were not statistically different between the TA and non-TA groups ( p = 0.316), nor were cure rates ( p = 0.072). 15 patients received reintervention due to restenosis after the first successful PTA; the interval was 2–56 months (median: 12 months). Four patients received reintervention due to a failed PTA. A total of four patients received open surgery. Binary logistics regression analysis showed that stenosis length and residual stenosis rate were strongly correlated with effective PTA ( p = 0.045, p = 0.044). Conclusions As a primary treatment for pediatric RVH, PTA can achieve satisfactory results, which are influenced by lesion length and residual stenosis rate.

scholarly journals Medium- and Long-Term Effects of Endovascular Treatments for Severely Stenotic Basilar Arteries Supported by Multimodal Imaging

2020 ◽  
Author(s):  
Yuanzhi Li ◽  
Weimin Xie ◽  
Xianghao Gong ◽  
Dongliang He ◽  
Xin Zhang ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Neurological Dysfunction ◽  
Long Term Effects ◽  
Technical Success ◽  
Technical Success Rate ◽  
Atherosclerotic Stenosis ◽  
Stenosis Rate ◽  
Basilar Artery Stenosis

Abstract Background: To evaluate the medium-and long-term effect of intravascular interventional therapy for symptomatic severe basilar artery stenosis supported by multimodal imaging.Method: After strict screening of 67 patients with symptomatic severe basilar artery stenosis (70%- 99%) with atherosclerotic stenosis, 67 patients with symptomatic recurrence after intensive drug treatment were treated with intravascular balloon dilatation and Enterprise stent implantation. Any stroke or death within 30 days after operation and any stroke and restenosis during medium-and long-term follow-up were followed up.Results: The mean age of 67 patients(67lesions) was 57 ± 8 years old, and the technical success rate was 100%; ②Preoperative angiography showed that the collateral circulation was poor, and TICI was 1-2a while postoperative angiography showed that TICI was significantly improved to 2b-3; ③The average preoperative stenosis rate was 82 ± 9%, and the postoperative stenosis rate was reduced to 17 ± 10%; ④Before surgery, abnormal perfusion was found in the posterior circulation CTP; After the postoperative re-examination, the posterior circulation of CTP perfusion was significantly improved; ⑤Postoperative symptoms and neurological conditions improved significantly; ⑥Complications of perforating branch event occurred in 1 case after operation, and symptoms were relieved after more than 1 month of active treatment, and mild neurological dysfunction remained. 1 case developed subacute thrombosis in the stent, which improved after active intra-arterial thrombolysis, and there was no residual neurological dysfunction; and 1 case of microlead wire being clamped by the distal vasospasm. ⑦67 patients were followed up by telephone, WeChat or imaging for 36–66 months. 55 cases were regularly reviewed with images. Intrastenting stenosis occurred in 4 cases, and 12 cases were followed up by phone or WeChat.The average follow-up period was 56 ± 21 months (36–66 months). No TIA or stroke occurred during follow-up.Conclusions: In summary intravascular balloon dilation + Enterprise stent implantation is safe and effective for the treatment of symptomatic severe atherosclerotic stenosis of the basilar artery, with high technical success rate, low perioperative complications, and good mid-term and long-term effects.

scholarly journals The use of single low-profile visualized intraluminal support stent-assisted coiling in the treatment of middle cerebral artery bifurcation unruptured wide-necked aneurysm

2020 ◽  
Vol 26 (4) ◽  
pp. 461-467 ◽  
Author(s):  
Yazhou Yan ◽  
Zhangwei Zeng ◽  
Yina Wu ◽  
Jiachao Xiong ◽  
Kaijun Zhao ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Thromboembolic Event ◽  
Perioperative Complications ◽  
Stent Deployment ◽  
Technical Success Rate ◽  
Hemorrhagic Event ◽  
Low Profile

Objective Endovascular treatment of unruptured wide-necked aneurysms located at the middle cerebral artery bifurcation remains challenging. This study aimed to evaluate the safety and efficacy of endovascular treatment for middle cerebral artery bifurcation unruptured wide-necked aneurysms using a low-profile visualized intraluminal support (LVIS) stent. Methods We retrospectively reviewed all patients with middle cerebral artery bifurcation unruptured wide-necked aneurysms treated using an LVIS device at our institution between October 2014 and December 2018. Clinical presentation, aneurysmal characteristics, technical feasibility, perioperative complications, clinical outcome, and angiographic and clinical follow-up results were evaluated. Results Fifty-seven patients with 57 wide-necked aneurysms arising from the middle cerebral artery bifurcation were identified. The technical success rate of stent deployment was 100%. Immediate postoperative angiograms showed Raymond 1 in 26 aneurysms (45.6%), Raymond 2 in 10 (17.6%), and Raymond 3 in 21 (36.8%). Perioperative complications developed in two patients (3.5%), including one procedure-related hemorrhagic event and one thromboembolic event. The follow-up angiogram was available for 47 aneurysms obtained at an average of 11.7 months (range, 5 to 49 months) after intervention; the latest follow-up angiograms revealed complete occlusion in 37 (78.7%) aneurysms, improvement in three (6.4%), stabilization in five (10.6%), and recanalization in two (4.3%). During the follow-up, one patient was found to have in-stent stenosis and two patients were found to have slow flow or occlusion of the jailed branch. All three of these patients were asymptomatic. No hemorrhagic or thromboembolic events occurred during clinical follow-up. Conclusions Our experience suggests that endovascular treatment of middle cerebral artery bifurcation unruptured wide-necked aneurysms with an LVIS stent is safe and effective, but the effect on branches needs to be further studied.

MANAGEMENT OF DISTAL ANTERIOR CEREBRAL ARTERY ANEURYSMS

Neurosurgery ◽  
2007 ◽  
Vol 61 (5) ◽  
pp. 909-917 ◽  
Author(s):  
Aditya Pandey ◽  
Robert H. Rosenwasser ◽  
Erol Veznedaroglu
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Recurrence Rate ◽  
Scale Score ◽  
Cerebral Artery ◽  
Glasgow Outcome Scale ◽  
Patient Population ◽  
Anterior Cerebral Artery ◽  
The Mean ◽  
Distal Anterior Cerebral Artery

Abstract OBJECTIVE Our goal was to assess the clinical and angiographic outcomes among patients undergoing treatment for distal anterior cerebral artery aneurysms at the Jefferson Hospital for Neuroscience (1997–2005). METHODS Forty-one patients (1.5% of all aneurysms treated) with distal anterior cerebral artery aneurysms had undergone treatment. The clinical and angiographic outcomes of these patients were studied retrospectively using chart reviews, operative reports, and angiographic reports. The mean clinical and angiographic follow-up periods were 16 months (range, 3–74 mo) and 16.5 months (range, 6–81 mo), respectively. RESULTS Twenty-eight (68%) patients had undergone endovascular embolization (22 women, six men; mean age, 58.2 yr), whereas 13 (32%) had undergone microsurgery for clip ligation (six men, seven women; mean age, 47.4 yr). Within the coiled group, 50% of the patients belonged in the Hunt and Hess (HH) III and IV groups, whereas 46.2% of the patients in the clipped group were elective patients (HH Grade 0). The mean aneurysmal sizes among the clipped and coiled groups were 4.9 and 5.5 mm, respectively. Among the clipped patient population, 100% of the patients had successful clip ligation as evidenced by intraoperative cerebral angiography, there was a 0% recurrence rate among the two patients who have had long-term follow-up, 0% recurrent subarachnoid hemorrhage, and 92% patients achieved a modified Glasgow Outcome Scale score of I to II. Among the coiled patient population, there was an 89% rate of successful embolization, 18% recurrence rate, 0% recurrent subarachnoid hemorrhage, and 64% achieved a modified Glasgow Outcome Scale score of I to II. None of the patients had clinically symptomatic vasospasm. A strong correlation existed between having a ventriculostomy and requiring a shunt in patients with HH Grade IV compared with patients in HH Grades I through III. CONCLUSION In our analysis, clinical outcomes were better in the clipped group; however, the differences are not statistically significant (P = 0.3675) and are explained by the selection bias. Statistically significant predictors of outcomes were age (<60 yr), size of the aneurysm (>5 mm), absence of ventriculostomy, and presenting HH grade.

Mid-term outcome after endovascular therapy in the superficial femoral and popliteal artery using long stents

VASA ◽  
2012 ◽  
Vol 41 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Schoenefeld ◽  
P. Donas ◽  
Schönefeld ◽  
Osada ◽  
Austermann ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Popliteal Artery ◽  
Primary Patency ◽  
Stent Fracture ◽  
Fracture Rate ◽  
Term Outcome ◽  
Technical Success Rate ◽  
Endovascular Interventions ◽  
Artery Disease

Background: Peripheral artery disease (PAD) affecting the femoropopliteal artery is treated by endovascular interventions [2, 5, 13] increasingly. Aim of the study was to evaluate mid-term efficacy and patency of long stents in the superficial femoral and popliteal artery. Patients and methods: Between September 2006 and September 2007 103 patients received 128 stents for endovascular treatment of femoropopliteal vascular stenosis or occlusion. Clinical and hemodynamic parameters were collected. Risk factors, popliteal involvement and TASC classification, were documented and evaluated. Results: Immediate outcome was satisfactory with a technical success rate of 100 %. After a mean follow-up period of 21 months, primary patency was 83.6 %. Potential risk factor analysis for restenosis and fracture demonstrated hypertension to have borderline significance (P = 0.06). In normotensive patients no restenosis occurred. Further pre-conditions, e.g. smoking, metabolic syndrome, age, gender and previous intervention did not show any influence on restenosis or stent fracture. TASC C and D lesion had similar patency rates compared to TASC A and B lesions. Most of the restenoses (13 out of 16) were observed within the first six months of follow-up. Six stent fracture were observed (4.7 %). Conclusions: Long stents had convincing results after endovascular treatment of the femoropopliteal PAD. The used stent was an efficacious endovascular tool for long athersclerotic lesions in the superficial femoral and popliteal artery. Fracture rate was low with an incidence of 4.7 %. Most restenoses occurred within the first six months so that careful follow-up would be necessary.

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

scholarly journals Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hu Li ◽  
Seung-Woon Rha ◽  
Byoung Geol Choi ◽  
Se Yeon Choi ◽  
Sang Ki Moon ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Distal Segment ◽  
Vessel Diameter ◽  
Distal Portion ◽  
Control Group ◽  
Stent Restenosis ◽  
Histopathologic Analysis ◽  
Stent Diameter ◽  
The Impact

Abstract Background Self-expanding nitinol stent (SENS) implantation is commonly oversized in the superficial femoral artery (SFA), and leads to chronic outward force (COF) and in-stent restenosis (ISR). This study aimed to investigate the impact of COF of oversizing SENS on ISR of SFA. Methods In patients with implanted SENS in SFA, intimal hyperplasia especially between proximal segment and distal segment was evaluated by quantitative angiography, and the impact of COF on mid-term angiographic outcomes was investigated. In addition, porcine model with implanted SENS was used to evaluate the impact of COF on angiographic and histopathologic outcomes at 1 month. Excised stented arteries were evaluated by histopathologic analysis. Results We analyzed 65 SENS in 61 patients with follow-up angiography at 6 months to 1 year. The baseline diameter was 6.8 ± 0.71 mm and length were 97.0 ± 33.8 mm for the SENS. The ratio of the diameter of the stent to the reference vessel was 1.3 ± 0.24 at the proximal portion and 1.53 ± 0.27 at the distal portion (P < 0.001). In the long SFA stent, stent-to-vessel ratio was significantly higher in the distal stent than in the proximal stent (1.3 ± 0.2 vs. 1.55 ± 0.25, P = 0.001). ISR incidence was higher at the distal stent (37.3% vs 52.6%, P = 0.029). All 11 pigs survived for 4 weeks after SENS implantation. The vessel diameter was 4.04 ± 0.40 mm (control group) vs 4.45 ± 0.63 mm (oversized group), and the implanted stent diameter was 5.27 ± 0.46 mm vs. 7.18 ± 0.4 mm (P = 0.001). The stent-to-vessel diameter ratio was 1.31 ± 0.12 versus 1.63 ± 0.20 (P < 0.001). After 4 weeks, restenosis % was 29.5 ± 12.9% versus 46.8 ± 21.5% (P = 0.016). The neointimal area was 5.37 ± 1.15 mm2 vs. 8.53 ± 5.18 mm2 (P = 0.05). The restenosis % was 39.34 ± 8.53% versus 63.97 ± 17.1% (P = 0.001). Conclusions COF is an important cause of restenosis in the distal portion of the SFA stent. Optimal sizing of the SFA stent is important to reduce the incidence of restenosis. Therefore, COF was an important factor of restenosis following distal SFA stenting.

scholarly journals Characteristics and recurrence of pterygium in Saudi Arabia: a single center study with a long follow‐up

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Waleed Alsarhani ◽  
Saeed Alshahrani ◽  
Mahmood Showail ◽  
Nawaf Alhabdan ◽  
Osama Alsumari ◽  
...  
Keyword(s):  
Mitomycin C ◽  
Recurrence Rate ◽  
Dry Eye ◽  
Amniotic Membrane ◽  
Univariate Analysis ◽  
Dry Eye Disease ◽  
Eye Disease ◽  
First Year ◽  
Conjunctival Autografting

Abstract Background This study described the clinical features of patients with pterygium and analyzed the recurrence rate of conjunctival autografting alone, conjunctival autografting combined with intraoperative mitomycin C, and amniotic membrane grafting. Methods A retrospective cohort study of primary pterygium was conducted between January 2017 and February 2020. Factors associated with pterygium severity and recurrence were analyzed by univariate analysis and logistic regression models. Results The study included 292 patients with an average age of 53.3 ± 14.1 years, while the number of operated cases was 94. Pterygia involving the cornea were observed in 55 % of the cases. The overall rate of recurrence for the three procedures was 17 %. The average time of recurrence was 14.2 ± 11.9 months, with 37 % of the recurrences occurring after the first year. The only factor associated with a significant risk of recurrence was dry eye disease in both univariate (p = 0.021) and multivariate analysis (p = 0.026). The recurrence rates following conjunctival autografting with and without mitomycin C were 15.6 and 15.8 %, respectively. The recurrence rate following the amniotic membrane graft was  twofold (OR= 2.02)  (27 %) that following the conjunctival autograft (15.8 %). Conclusions The only factor associated with the recurrence of pterygium was dry eye disease. More than one-third of recurrences developed after the first year, which stresses the importance of a long follow-up. The recurrence rate in our study following conjunctival graft was slightly higher compared to the literature mainly due to differences in study areas, populations, and follow-up periods.

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