scholarly journals Percutaneous, endovascular treatment of innominate artery lesions is a safe and effective procedure

2011 ◽  
Vol 152 (43) ◽  
pp. 1745-1750 ◽  
Author(s):  
Tamás Mirkó Paukovits ◽  
Balázs Nemes ◽  
Kálmán Hüttl ◽  
Viktor Bérczi
Keyword(s):  
Endovascular Treatment ◽  
Upper Limb ◽  
Balloon Angioplasty ◽  
Stent Implantation ◽  
Neurological Complication ◽  
Innominate Artery ◽  
Safe Procedure ◽  
Duplex Scan ◽  
Excellent Outcome

Percutaneous endovascular treatment (transluminar balloon angioplasty with or without stent implantation) of innominate artery lesions has become the treatment of choice prior to surgery in the past decades. Authors present the diagnostics, treatment and follow-up of two patients as examples from their largest series in the literature. A 74-year-old male patient with a history of hyperlipidemia, hypertension, nicotine abuse and lower limb claudication was admitted because of acute upper limb claudication and dizziness. Physical examination revealed blood pressure difference of 30 mmHg between his arms, and poststenotic flow pattern in the common carotid artery with retrograde flow in the vertebral artery on carotid duplex scan. Diagnostic angiography showed 80% stenosis of the innominate artery, which was treated with percutaneous transluminar balloon angioplasty with stent implantation. Follow-up examination at 5 months showed no significant restenosis or neurological complication. The second patient was a 59-year-old smoker female patient with hypertension and type 2 diabetes mellitus, who was evaluated for her upper limb claudication. Initial finding was the absence of radial pulse in the right side. Color duplex scan revealed proximal subocclusion, which was confirmed by angiography. In one stage, balloon angioplasty was made, with immediate pain relief. After 15 months the patient was symptom-free. These two cases demonstrate an excellent outcome of endovascular treatment of innominate artery lesions, as authors already reported in two retrospective studies. Balloon angioplasty with, or without stent deployment appears to be a safe procedure with excellent primary success rate. Review of international studies also indicates that endovascular therapy of the innominate artery is safe and effective. Orv. Hetil., 2011, 152, 1745–1750.

scholarly journals Serial angiographic follow-up after palmaz-schatz stent implantation: Comparison with conventional balloon angioplasty

1993 ◽  
Vol 21 (7) ◽  
pp. 1557-1563 ◽  
Author(s):  
Takeshi Kimura ◽  
Hideyuki Nosaka ◽  
Hiroyoshi Yokoi ◽  
Masashi Iwabuchi ◽  
Masakiyo Nobuyoshi
Keyword(s):  
Balloon Angioplasty ◽  
Stent Implantation ◽  
Conventional Balloon Angioplasty

Abstract P478: One-Year Outcome After Endovascular Treatment for Acute Basilar Artery Occlusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Fengli Li ◽  
Hongfei Sang ◽  
Jiaxing Song ◽  
Zhangbao Guo ◽  
Shuai Liu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Conventional Treatment ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Treatment Groups ◽  
Excellent Outcome ◽  
Follow Up Study

Background and Objective: To report the results of clinical follow-up at 1 year among patients in the BASILAR registry. Design, Setting, and Participants: The BASILAR study was an investigator-initiated prospective registry, which consecutively enrolled stroke patients with acute basilar artery occlusion from 47 comprehensive stroke centers in China between January, 2014, and May, 2019. Patients were divided into conventional treatment or endovascular treatment groups according to the treatment their received. We assessed clinical outcomes 1 year after patients were enrolled in the BASILAR registry. Main Outcomes and Measures: The primary outcome was the score on the modified Rankin scale (range, 0 to 6 points, with higher scores indicating more severe disability) at 1 year assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. Secondary outcomes included categories scores of the modified Rankin scale at 1 year (0 to 1 [excellent outcome], 0 to 2 [good outcome], and 0 to 3 [favorable outcome]), and death from any cause during the 1-year period after enrollment. Results: Of the 829 patients who were enrolled in the original study, 1-year data for this extended follow-up study were available for 785 patients (94.7%). The distribution of outcomes on the modified Rankin scale favored endovascular treatment over conventional treatment (adjusted common odds ratio, 4.50; 95% confidence interval [CI], 2.81 to 7.29; P < 0.001). There were significant differences between the treatment groups in the percentage of patients who had excellent outcome, good outcome and favorable outcome. The cumulative 1-year mortality rate was 54.6% in the endovascular treatment group and 83.5% in the conventional treatment group (adjusted hazard ratio, 4.36; 95% CI, 2.69 to 7.29; P < 0.001). Conclusions and Relevance: In this extended follow-up study, the beneficial effect of endovascular treatment on functional outcome at 1 year in patients with acute basilar artery occlusion was similar to that reported at 90 days in the original study.

scholarly journals Temporal pattern of aortic remodelling after endovascular treatment for chronic DeBakey IIIb dissection

2020 ◽  
Vol 31 (2) ◽  
pp. 232-238
Author(s):  
Tae-Hoon Kim ◽  
Suk-Won Song ◽  
Woon Heo ◽  
Kwang-Hun Lee ◽  
Kyung-Jong Yoo ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Abdominal Aorta ◽  
Temporal Pattern ◽  
False Lumen ◽  
Significant Risk ◽  
Type A ◽  
Safe Procedure ◽  
Coeliac Trunk ◽  
Infrarenal Abdominal Aorta

Abstract OBJECTIVES Endovascular treatment has emerged as a safe procedure for treating chronic DeBakey IIIb dissection. The objective of this study was to investigate the mid-term outcome and temporal pattern of aortic remodelling after endovascular treatment for DeBakey IIIb dissection. METHODS From 2012 to 2017, 85 patients who underwent endovascular aortic repair for DeBakey IIIb dissection were enrolled. The temporal pattern of aortic remodelling in terms of false lumen (FL) thrombosis [level 1 (∼T7), level 2 (T7 ∼ coeliac axis) and level 3 (coeliac trunk ∼ aortic bifurcation)] and aortic diameter [mid-thoracic level (T7), coeliac axis and the largest infrarenal abdominal aorta] was investigated on serial follow-up computed tomography scan. RESULTS Eighty-five patients underwent endovascular treatment during the study period. Male sex was a significant risk factor for repetitive reintervention and segments 2 and 3 FL thrombosis. The preoperative FL diameter at T7 was significantly associated with FL diameter regression. The number of visceral vessels from the FL and residual DeBakey IIIb dissection after type A repair were significant factors for FL growth at the coeliac trunk and at the largest infrarenal abdominal aorta. The overall mortality was 3 (3.6%). CONCLUSIONS Endovascular treatment is a safe strategy in the management of DeBakey IIIb dissection. However, unfavourable aortic remodelling and repetitive reintervention were expected in male patients with a large number of visceral vessels from the FL and residual DeBakey IIIb dissection after type A repair. Endovascular treatment should be cautiously considered, and close follow-up is required for these patients.

scholarly journals Microstent-Assisted Coiling for Wide-Necked Intracranial Aneurysms

2005 ◽  
Vol 32 (1) ◽  
pp. 71-81 ◽  
Author(s):  
Marlise Peruzzo dos Santos Souza ◽  
Ronit Agid ◽  
Robert A. Willinsky ◽  
Michael Cusimano ◽  
Walter Montanera ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Neurological Complication ◽  
Posterior Circulation ◽  
Technical Failure ◽  
Anterior Circulation ◽  
Neck Size ◽  
Clinical Complications ◽  
Class 1

Objective:To describe the results, technical feasibility, efficacy and challenges encountered in our preliminary experience using a self-expandable microstent, optimized for intracranial use, as an adjunct in the endovascular treatment of wide-necked aneurysms.Methods:Only broad-necked aneurysms (dome-to-neck ratio £2, or an isolated neck size > 4.5 mm) were treated with Neuroform microstent from July 2003 to May 2004. The techniques used for stent deployment were either parallel or sequential. Angiographic results were recorded immediately for all patients and classified as Class 1 (complete occlusion), Class 2 (neck remnant) or Class 3 (sac remnant) by three interventional neuroradiologists not involved in the procedure. Follow-up angiography at six months was obtained for one case. Modified Rankin Score scale was assessed for all patients.Results:Seventeen intracranial aneurysms in a total of 18 patients were treated (mean age, 52.2 yr). Eight patients (44.4%) presented with acute subarachnoid hemorrhage. Eleven aneurysms (61.1%) were in the posterior circulation. Average dome size was 10.2 mm (range, 3.7-19.8 mm) and average neck size was 5.36 mm (range, 3.0-10.0 mm). Six out of seven aneurysms of the anterior circulation were approached with parallel technique. Eight aneurysms of the posterior circulation were approached with sequential technique. Average number of coils deployed was 9.64 (range, 4-23 coils). Eleven aneurysms (64.8%) resulted in Class 1 and/or Class 2. One technical failure was observed. Technical complications were recognized in four patients (23.5%), all of them with unruptured aneurysms in the anterior circulation. Two patients (11.7%) presented transient immediate clinical complications. One patient (5.8%) had minor permanent neurological complication. Neither major clinical complications nor death were encountered. Favorable clinical outcome (Modified Rankin Scale score 0-2) was observed in 88.2% of the patients (average follow-up time, 4.72 months).Conclusion:Absence of major permanent complications and satisfactory immediate obliteration degree in our preliminary experience indicates that microstent-assisted coiling technique is useful for the minimally invasive treatment of broad-necked complex aneurysms that are not ideal for conventional endovascular treatment and are at a high risk for conventional surgical treatment.

scholarly journals Aortos rekoarktacijos gydymas angioplastika ir stentais

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Lina Gumbienė ◽  
Sigitas Čibiras ◽  
Alicija Dranenkienė ◽  
Živilė Katliorienė ◽  
Giedrė Nogienė ◽  
...  
Keyword(s):  
Key Words ◽  
Balloon Angioplasty ◽  
Stent Implantation ◽  
Heart Surgery ◽  
Coarctation Of The Aorta ◽  
Endovascular Stent ◽  
Endovascular Stents ◽  
Vilnius University ◽  
Key Words Coarctation

Lina Gumbienė, Sigitas Čibiras, Alicija Dranenkienė, Živilė Katliorienė, Giedrė Nogienė, Eugenijus KosinskasVilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Aprašomas naujo metodo – balioninės angioplastikos ir kraujagyslinių stentų – pritaikymas gydant aortos rekoarktaciją, atsiradusią po chirurginės ydos korekcijos. Ligoniai ir metodai Atlikta retrospektyvi duomenų analizė dešimties ligonių, kuriems Vilniaus universiteto Širdies chirurgijos centre 1994–2006 metais aortos rekoarktacija buvo gydyta balionine angioplastika ar stentavimu. Aprašoma centre taikyta aortos angioplastikos ir stentų implantavimo metodika. Rezultatai Aortos rekoarktacijos angioplastika atlikta keturiems ligoniams. Intraaortinis gradientas aortos koarktacijos vietoje po procedūros sumažėjo vidutiniškai 82,15%. Vėlyvuoju stebėjimo periodu (vid. 6,14 ± 5,2 metai) rekoarktacija buvo trims ligoniams. Aortos rekoarktacijos stentavimas atliktas septyniems ligoniams, vienam iš jų dėl atsinaujinusios rekoarktacijos po angioplastikos. Dviem ligoniams procedūra nepavyko. Kitiems penkiems ligoniams intraaortinis gradientas reAoCo vietoje vidutiniškai sumažėjo nuo 29,6 ± 11,6 mm Hg iki 2,6 ± 3,7 mm Hg. Stebėjimo laikotarpiu 0,58–3,75 metų po procedūros rekoarktacija nustatyta tik vienam ligoniui. Jam atliktas stento plėtimas. Išvada Perkateterinė balioninė angioplastika ir balionais išplečiami kraujagysliniai stentai veiksmingi ir saugūs aortos rekoarktacijų gydymo metodai. Pagrindiniai žodžiai: aortos koarktacija, rekoarktacija, perkateterinis gydymas Treatment of recurrent coarctation of the aorta employing balloon angioplasty and endovascular stents Lina Gumbienė, Sigitas Čibiras, Alicija Dranenkienė, Živilė Katliorienė, Giedrė Nogienė, Eugenijus KosinskasVilnius University, Centre of Heart Surgery, Santariškių g. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / objective We present a new method of treatment – balloon angioplasty and endovascular stent – for patients with aortic re-coarctation following surgical correction. Patients and methods Ten patients with re-coarctation of the aorta after surgery underwent balloon angioplasty or stent implantation at Vilnius University Heart Surgery Centre in 1994–2006. Results Balloon angioplasty was performed in 4 patients. The intraaortic gradient in the site of coarctation decreased on average by 82.15% after the procedure. Re-coarctation developed in 3 patients in the late follow-up period (mean 6.14 ± 5.2 years). Stents were implanted in 7 patients (one developed re-coarctation after angioplasty). The procedure failed in two. The intraaortic gradient at the site of re-coarctation decreased on average from 29.6 ± 11.6 mm Hg to 2.6 ± 3.7 mm Hg. Re-coarctation was diagnosed only in one patient during the follow-up (0.58–3.75 years), and stent dilatation was performed in this case. Conclusions Balloon angioplasty and endovascular stents are effective and safe methods for the treatment of re-coarctation of the aorta. Key words: coarctation of the aorta, recurrent coarctation, transcatheter treatment

6111Optical coherence tomography derived predictors of restenosis after non-stenting coronary intervention with drug-coated balloon

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Nakagama ◽  
T Niida ◽  
Y Matsuda ◽  
T Nakamura ◽  
T Sasaoka ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Stent Implantation ◽  
De Novo ◽  
Quantitative Coronary Angiography ◽  
Coronary Intervention ◽  
Laser Angioplasty ◽  
Metallic Stents ◽  
Directional Atherectomy ◽  
Drug Coated Balloon

Abstract Background One of the limitations of metallic stents including contemporary drug eluting stents lies in the permanent existence of metallic materials within the coronary arteries, which may lead to neoatherosclerosis and a long-term use of dual antiplatelet therapy. Some reports have recently suggested the efficacy and safety of non-stent strategy with drug-coated balloon (DCB) angioplasty in combination with debulking devices for de novo lesions. However, little is known about the potential risk of restenosis after percutaneous coronary intervention (PCI) with DCB. Purpose We sought to assess the predictive factors of restenosis by optical coherence tomography (OCT) after PCI with DCB instead of metallic stents. Methods We retrospectively investigated 49 de novo lesions in 38 patients treated by DCB without stent implantation in whom OCT was performed immediately after PCI and follow-up angiography was performed at median of 5.6 (3.7–6.9) months. OCT findings after PCI and the incidence of restenosis at follow-up angiography were evaluated. By means of OCT images, medial coronary dissection was defined as a dissection which reached the medial layer of the vessel, and major dissection was defined as a dissection with more than 60 degrees of the circumference of the vessel or more than 3mm in length. Restenosis was defined as more than 50% diameter stenosis evaluated by Quantitative Coronary Angiography. Results Restenosis was observed in 13 of 49 lesions (27%). In univariate logistic regression analysis, major dissection and medial dissection at the final OCT were associated with restenosis (Odds ratio [OR] 10.0; 95% confidence interval [CI] 2.5–52.6; p<0.01 and OR 5.8; 95% CI 1.5–25.1; p=0.01, respectively). Lesion preparation prior to DCB were performed with rotational atherectomy (n=9), orbital atherectomy (n=2), directional atherectomy (n=4), excimer laser angioplasty (n=17), scoring balloon angioplasty (n=13), or balloon angioplasty (n=4). OCT-defined major dissection remained a significant predictor for restenosis independent of debulking devices used for the preparation (OR 8.1; 95% CI 1.2–70.2; p=0.03). Conclusions Major dissection was associated with restenosis after non-stenting PCI with DCB. Stent implantation should be considered in cases of OCT-defined major dissection. Acknowledgement/Funding None

Recurrent Carotid Disease: Will Stents Be an Alternative to Surgery?

1996 ◽  
Vol 3 (1) ◽  
pp. 76-79 ◽  
Author(s):  
Patrice Bergeron ◽  
Pascal Chambran ◽  
Hubert Benichou ◽  
Christian Alessandri
Keyword(s):  
Balloon Angioplasty ◽  
Internal Carotid ◽  
Neurological Complication ◽  
Carotid Disease ◽  
Long Term Follow Up ◽  
Carotid Occlusive Disease ◽  
The Common ◽  
Internal Carotid Arteries

Purpose: To report the results of balloon angioplasty in recurrent carotid occlusive disease and evaluate the potential for stent implantation. Methods and Results: Between April 1991 and September 1995, 15 patients with carotid restenosis underwent 17 endoluminal procedures in 3 common carotid and 14 internal carotid arteries. Two postdilation complications (dissection and acute occlusion) required prompt stenting; one common carotid artery was stented for postdilation residual stenosis. One recurrent lesion was also stented 6 months after initial angioplasty. One stroke, 1 silent cerebral infarction, and 3 transient ischemic attacks occurred in the balloon angioplasty patients (33% neurological complication rate). The common carotid stent patient died 3 days postoperatively due to hyperperfusion syndrome. Long-term follow-up in two stent patients showed no restenosis at 18 and 48 months, respectively. The 11 balloon angioplasty patients likewise have not demonstrated restenosis. Conclusions: Balloon angioplasty alone appears too risky for treating recurrent carotid disease. Stents may offer a safer alternative, particularly when implanted primarily.

Endovascular treatment of symptomatic intracranial stenosis with the Wingspan stent system and Gateway PTA balloon: a multicenter series of 60 patients with acute and midterm results

2011 ◽  
Vol 115 (4) ◽  
pp. 686-693 ◽  
Author(s):  
Vincent Costalat ◽  
Igor Lima Maldonado ◽  
Jean-François Vendrell ◽  
Carlos Riquelme ◽  
Paolo Machi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Recurrent Stroke ◽  
Neurological Complication ◽  
Arterial Stenosis ◽  
Technical Failure ◽  
Stent Restenosis ◽  
Stent System ◽  
The Mean ◽  
In Stent Restenosis

Object The limitations of the medical management of symptomatic intracranial arterial stenosis (SIAS) have encouraged the development of new strategies, such as endovascular treatment. In this study, the authors report and analyze a series of 63 endovascular procedures in which the Wingspan stent system was used. Methods Data from 60 patients presenting with refractory SIAS, treated in 5 French neurointerventional centers between September 2006 and August 2009, were retrieved. An angiogram was systematically obtained 6 months after the procedure and yearly thereafter. The clinical neurological status was assessed and reported using the modified Rankin scale at 1-month, 6-month, and 1-year follow-up visits. Results A total of 63 stenotic lesions was treated. The mean age of the patients was 65.3 years, and the mean diameter of the stenosis was 80.2%. Technical success was achieved in 95.2% of cases. The overall incidence of procedural complications was 20.6%, with a 4.8% rate of permanent postoperative morbidity and death. In-stent restenosis (ISR)/occlusion occurred in 11 cases (17.4%), of which 10 were asymptomatic and 9 were detected less than 1 year from the endovascular treatment. In 1 case, the patient presented with a recurrent transient ischemic attack and was treated again with angioplasty. The mean follow-up was 13.2 months. Conclusions Endovascular treatment of SIAS demonstrates a moderate risk of neurological complication. Nevertheless, considering the critical natural history of severe refractory lesions, this may be considered the first alternative in cases of failed medical therapy. Technical failure, residual stenosis, or in-stent restenosis did not lead to systematic recurrent stroke in this series, which suggests the importance of plaque stabilization and neoendothelialization.

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