scholarly journals Endoscopic Internal Thoracic Artery Harvesting with Changes in Scope Position

2021 ◽  
Vol 24 (6) ◽  
pp. E950-E951
Author(s):  
Goto Yoshihiro ◽  
Sho Takagi ◽  
Junji Yanagisawa ◽  
Akio Nakasu ◽  
Yasuhide Okawa
Keyword(s):  
Internal Thoracic Artery ◽  
Harmonic Scalpel ◽  
Artery Bypass ◽  
Three Dimensional ◽  
Invasive Procedure ◽  
Camera Port ◽  
Stent Restenosis ◽  
Enhanced Computed Tomography ◽  
Process Level ◽  
In Stent Restenosis

Although minimally invasive direct coronary artery bypass (MIDCAB) is a less invasive procedure, internal thoracic artery (ITA) harvesting is difficult. A 65-year-old woman was advised to undergo MIDCAB for recurrent in-stent restenosis. We harvested the ITA using three-dimensional endoscopy without robotics and determined the scope position using enhanced computed tomography. We changed the camera installation between the wound and the camera port, according to the harvesting site with a harmonic scalpel using the skeletonized technique. We harvested the ITA from the subclavian vein level superiorly to the xyphoid process level inferiorly.

In-stent restenosis: surgical and histopathological perspective

2018 ◽  
Vol 26 (2) ◽  
pp. 114-119
Author(s):  
Balaji Srimurugan ◽  
Matthias Sigler ◽  
Nainar Madhu Sankar ◽  
Kotturathu Mammen Cherian
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Thrombus Formation ◽  
Artery Bypass ◽  
Coronary Vessels ◽  
Coronary Endarterectomy ◽  
Stent Restenosis ◽  
Diffuse Coronary Artery Disease ◽  
Artery Disease ◽  
In Stent Restenosis

Background In-stent restenosis has been recognized as a distinct clinical entity that warrants a repeat procedure either in the form of percutaneous reintervention or coronary artery bypass grafting. Multivessel grafting with endarterectomy and explantation of the stent is rarely performed, with few cases reported in the literature. We aim to study the pathomorphology of the stent-vascular interface in coronary vessels undergoing in-stent restenosis. Methods Over a period of 3 years, 3 patients who had undergone angioplasty for diffuse coronary artery disease developed in-stent restenosis and were advised coronary artery bypass. The mean age was 53 years, the average time from the previous intervention was 77 months. Coronary endarterectomy with stent removal and concomitant multivessel coronary artery bypass was performed. Results Histology showed significant proliferation of the well-endothelialized intima as the reason for in-stent restenosis. There were no signs of local thrombus formation or increased inflammatory activity in any of the specimens. After coronary artery bypass, all patients were asymptomatic at a mean follow-up of 32 months. Conclusion Coronary endarterectomy with stent explantation and multivessel coronary artery bypass is a procedure that requires attention because the need is increasing due to the rise in the number of angioplasties. The complexity of this procedure increases to the extent that the adventitia is involved during stent explantation.

scholarly journals Treatment of the Carotid In-stent Restenosis: A Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Hao Huang ◽  
Lingshan Wu ◽  
Yinping Guo ◽  
Yi Zhang ◽  
Jing Zhao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Artery Bypass ◽  
External Beam Radiotherapy ◽  
Transluminal Angioplasty ◽  
Stent Restenosis ◽  
Postoperative Risk ◽  
Significant Difference ◽  
Percutaneous Transluminal ◽  
In Stent Restenosis

Background and Purpose: In-stent restenosis (ISR) after carotid artery stent (CAS) is not uncommon. We aimed to evaluate therapeutic options for ISR after CAS.Methods: We searched PubMed and EMBASE until November 2, 2020 for studies including the treatment for ISR after CAS.Results: In total, 35 studies, covering 1,374 procedures in 1,359 patients, were included in this review. Most cases (66.3%) were treated with repeat CAS (rCAS), followed by percutaneous transluminal angioplasty (PTA) (17.5%), carotid endarterectomy (CEA) (14.3%), carotid artery bypass (1.5%), and external beam radiotherapy (0.4%). The rates of stroke & TIA within the postoperative period were similar in three groups (PTA 1.1%, rCAS 1.1%, CEA 1.5%). CEA (2.5%) was associated with a slightly higher rate of postoperative death than rCAS (0.7%, P = 0.046). Furthermore, the rate of long-term stroke & TIA in PTA was 5.7%, significantly higher than rCAS (1.8%, P = 0.036). PTA (27.8%) was also associated with a significantly higher recurrent restenosis rate than rCAS (8.2%, P = 0.002) and CEA (1.6%, P < 0.001). The long-term stroke & TIA and recurrent restenosis rates showed no significant difference between rCAS and CEA.Conclusions: rCAS is the most common treatment for ISR, with low postoperative risk and low long-term risk. CEA is an important alternative for rCAS. PTA may be less recommended due to the relatively high long-term risks of stroke & TIA and recurrent restenosis.

Macrocalcification of intracranial vertebral artery may be related to in-stent restenosis: lessons learned from optical coherence tomography

2021 ◽  
pp. neurintsurg-2021-017913
Author(s):  
Ran Xu ◽  
Bin Yang ◽  
Long Li ◽  
Tao Wang ◽  
Xia Lu ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Vertebral Artery ◽  
Large Scale ◽  
Three Dimensional ◽  
Case Series ◽  
Lessons Learned ◽  
Optical Coherence ◽  
Stent Restenosis ◽  
Increased Risk ◽  
In Stent Restenosis

BackgroundCalcification has been proven to be a marker of atherosclerosis and is related to an increased risk of ischemic stroke. Additionally, calcification was reported to be prevalent in patients with stenotic lesions of the intracranial vertebral artery. Thus, reliable imaging facilities for evaluating plaque calcification have remarkable significance in guiding stenting and predicting patient outcomes. Optical coherence tomography (OCT) has a unique advantage in its ability to detect calcium and to achieve three-dimensional volumetric calcium characterization.MethodsFrom March 2017 to September 2018, seven cases of calcified lesions with intracranial vertebral artery stenosis were investigated using OCT, before and after the placement of an Apollo balloon-mounted stent. Transcranial color-coded duplex sonography was performed to identify restenosis with a mean follow-up time of 13.3 months in this case series.ResultsAll calcified lesions were evaluated quantitatively and qualitatively using OCT. Among all cases, five had macrocalcifications and two had spotty calcifications. Severe in-stent restenosis was observed in two cases, both with macrocalcifications.ConclusionsThis study suggests a potential relationship between macrocalcifications and the risk of in-stent restenosis of the intracranial vertebral artery. These preliminary findings obtained from a limited sample should be verified by prospective large-scale studies.

Sign in / Sign up

Export Citation Format

Share Document