Clinical and angiographic long-term outcomes of vertebral artery–subclavian artery transposition to treat symptomatic stenosis of vertebral artery origin

Object Although angioplasty and stent placement for vertebral artery (VA)–origin stenosis have been performed using endovascular techniques, a high likelihood of restenosis has been observed in the long term. Therefore, the authors assessed the long-term clinical and angiographic outcomes in patients after VA–subclavian artery (SA) transposition. Methods Thirty-six patients (31 men, 5 women; mean age 64.3 years, range 46–76 years) underwent clinical evaluation (modified Rankin Scale [mRS]) and cervical angiographic evaluation preoperatively and within 1 month of and 6 months after VA-SA transposition undertaken to treat symptomatic stenosis of VA origin. Results Postoperative neurological deficits due to intraoperative brain ischemia did not occur, and MR imaging demonstrated no new postoperative ischemic lesions in any of the patients. One patient died of acute myocardial infarction 2 months after surgery and another developed a left thalamic hemorrhage (mRS score of 5) at 42 months postsurgery. None of the remaining 34 patients experienced further ischemic events, and the mRS score in all of these patients remained unchanged during a mean follow-up period of 54 months. The degree of VA-origin stenosis (preoperative mean 84%) was reduced to ≤ 30% after surgery (mean 2%). Long-term follow-up angiography in 29 patients (81%) revealed the absence of restenosis, defined as > 50% luminal narrowing, in all of them. Conclusions The clinical and angiographic long-term outcomes demonstrated here suggest that VA-SA transposition will be useful in patients with symptomatic stenosis of VA origin.

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Management of Canine Y-T Humeral Fractures Using Titanium Polyaxial Locking Plates in 17 Dogs

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-7155 ◽

2022 ◽

Vol 58 (1) ◽

pp. 7-16

Author(s):

Claudio Motta ◽

Philip Witte ◽

Andrew Craig

Keyword(s):

Functional Impairment ◽

Complication Rates ◽

Load Testing ◽

Inclusion Criteria ◽

Long Term Outcomes ◽

Long Term Follow Up ◽

Mild Impairment ◽

Condylar Fractures

ABSTRACT The objective of this study was to document the short- and medium-to-long-term outcomes and complication rates of Y-T humeral condylar fractures fixed using titanium polyaxial locking plate (T-PLP). A retrospective review was performed of the medical records and radiographs of dogs with a Y-T humeral condylar fracture treated with T-PLP at a single veterinary referral center (2012–2018). Seventeen cases met the inclusion criteria. Medium- to long-term follow-up (.6 mo) information was derived using the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. Recorded complications were catastrophic (1/17) and minor (2/17). Gait at 10–12 wk following surgery was subjectively assessed as good or excellent for 13 cases. Radiographic bone union was achieved in 7/12 cases at 4–6 wk. LOAD scores obtained a mean of 15 mo (range 6–29 mo) following surgery and indicated no or mild impairment in 15/16 and moderate functional impairment in 1. The application of T-PLP for the treatment of Y-T humeral condylar fractures resulted in adequate stabilization allowing successful fracture healing and medium- to long-term outcomes comparable to previous reports. According to results of LOAD testing, the medium- to long-term follow-up suggests that clients were aware of mild to moderate functional impairment in all cases.

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Balloon-expandable stents for treatment of symptomatic middle cerebral artery stenosis: Clinical outcomes during long-term follow-up

Interventional Neuroradiology ◽

10.1177/1591019918786515 ◽

2018 ◽

Vol 24 (6) ◽

pp. 666-673 ◽

Cited By ~ 3

Author(s):

Sung Hyun Baik ◽

Hyo Sung Kwak ◽

Gyung Ho Chung ◽

Seung Bae Hwang

Keyword(s):

Middle Cerebral Artery ◽

Clinical Outcomes ◽

Cerebral Artery ◽

Reperfusion Therapy ◽

Stent Insertion ◽

Recurrence Rates ◽

Long Term Follow Up ◽

Ischemic Events

Background Insertion of a balloon-expandable stent (BES) in patients with symptomatic intracranial atherosclerosis is a treatment option for reperfusion therapy. In this study, we retrospectively reviewed clinical outcomes during long-term follow-up after insertion of balloon-expandable stents in patients with symptomatic middle cerebral artery (MCA) stenosis. Methods Institutional review board approval was obtained for retrospective review of patient data. Thirty-four patients (15 men, 19 women; median age, 67.5 years) with symptomatic MCA stenosis underwent balloon-expandable stent insertion between June 2008 and December 2010. Patient records were reviewed for angiographic findings and clinical outcomes during long-term follow-up. Results Of these patients, 22 presented with acute ischemic stroke with underlying MCA atherosclerosis and had good clinical outcomes (modified Rankin Scale score (mRS): 0–2) after reperfusion therapy. Indications for stenting for the remaining 12 patients were recurrent transient ischemic attacks (TIAs) refractory to medical therapy and MCA stenosis greater than 70%. During the poststenting follow-up period, which ranged from 61 to 108 months (median, 67.5 months), a TIA occurred in five patients. Of these five patients, one experienced a complete reocclusion of the MCA stent, and three had symptomatic restenosis. The remaining 29 patients did not experience any further ischemic events or restenosis during the follow-up period. Conclusions In our study, treatment with balloon-expandable stents in patients with symptomatic MCA stenosis resulted in low recurrence rates for both ischemic events and restenosis during long-term follow-up.

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Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.714638 ◽

2021 ◽

Vol 8 ◽

Author(s):

Congcong Luo ◽

Ruidong Qi ◽

Yongliang Zhong ◽

Suwei Chen ◽

Hao Liu ◽

...

Keyword(s):

Overall Survival ◽

Aortic Dissection ◽

Type B ◽

Frozen Elephant Trunk ◽

Long Term Outcomes ◽

Chronic Type ◽

Elephant Trunk ◽

Long Term Follow Up

Background: This study aimed to evaluate the early and long-term outcomes of a single center using a frozen elephant trunk (FET) procedure for chronic type B or non-A non-B aortic dissection.Methods: From February 2009 to December 2019, 79 patients diagnosed with chronic type B or non-A non-B aortic dissection who underwent the FET procedure were included in the present study. We analyzed operation mortality and early and long-term outcomes, including complications, survival and interventions.Results: The operation mortality rate was 5.1% (4/79). Spinal cord injury occurred in 3.8% (3/79), stroke in 2.5% (2/79), and acute renal failure in 5.1% (4/79). The median follow-up time was 53 months. The overall survival rates were 96.2, 92.3, 88.0, 79.8, and 76.2% at 1/2, 1, 3, 5 and 7 years, respectively. Moreover, 79.3% of patients did not require distal aortic reintervention at 7 years. The overall survival in the subacute group was superior to that in the chronic group (P = 0.047).Conclusion: The FET technique is a safe and feasible approach for treating chronic type B and non-A non-B aortic dissection in patients who have contraindications for primary endovascular aortic repair. The technique combines the advantages of both open surgical repair and endovascular intervention, providing comparable early and long-term follow-up outcomes and freedom from reintervention.

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Long-term outcomes of coil embolization of unruptured intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/2017.6.jns17174 ◽

2018 ◽

Vol 129 (6) ◽

pp. 1492-1498 ◽

Cited By ~ 6

Author(s):

Masaomi Koyanagi ◽

Akira Ishii ◽

Hirotoshi Imamura ◽

Tetsu Satow ◽

Kazumichi Yoshida ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Additional Treatment ◽

Long Term Outcomes ◽

Unruptured Intracranial Aneurysms ◽

Risk Of Rupture ◽

Long Term Follow Up ◽

Multiple Stroke

OBJECTIVELong-term follow-up results of the treatment of unruptured intracranial aneurysms (UIAs) by means of coil embolization remain unclear. The aim of this study was to analyze the frequency of rupture, retreatment, stroke, and death in patients with coiled UIAs who were followed for up to 20 years at multiple stroke centers.METHODSThe authors retrospectively analyzed data from cases in which patients underwent coil embolization between 1995 and 2004 at 4 stroke centers. In collecting the late (≥ 1 year) follow-up data, postal questionnaires were used to assess whether patients had experienced rupture or retreatment of a coiled aneurysm or any stroke or had died.RESULTSOverall, 184 patients with 188 UIAs were included. The median follow-up period was 12 years (interquartile range 11–13 years, maximum 20 years). A total of 152 UIAs (81%) were followed for more than 10 years. The incidence of rupture was 2 in 2122 aneurysm-years (annual rupture rate 0.09%). Nine of the 188 patients with coiled UIAs (4.8%) underwent additional treatment. In 5 of these 9 cases, the first retreatment was performed more than 5 years after the initial treatment. Large aneurysms were significantly more likely to require retreatment. Nine strokes occurred over the 2122 aneurysm-years. Seventeen patients died in this cohort.CONCLUSIONSThis study demonstrates a low risk of rupture of coiled UIAs with long-term follow-up periods of up to 20 years. This suggests that coiling of UIAs could prevent rupture for a long period of time. However, large aneurysms might need to be followed for a longer time.

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Case of nivolumab-induced sclerosing cholangitis: lessons from long-term follow-up

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000487 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000487

Author(s):

Tess McClure ◽

Wanyuan Cui ◽

Khashayar Asadi ◽

Thomas John ◽

Adam Testro

Keyword(s):

Sclerosing Cholangitis ◽

Immune Checkpoint Inhibitor ◽

Checkpoint Inhibitor ◽

Solid Organ ◽

Long Term Outcomes ◽

Durable Response ◽

Long Term Follow Up ◽

Proven Case

Nivolumab is an immune checkpoint inhibitor used to treat multiple solid-organ malignancies. While many of its immune-related adverse events are well established, nivolumab-induced sclerosing cholangitis remains poorly characterised, with no defined diagnostic criteria. Moreover, data regarding long-term outcomes are particularly lacking. We present a biopsy-proven case of nivolumab-induced sclerosing cholangitis, which uniquely captures 18 months of follow-up post-treatment. Our case highlights key features of intrahepatic subtype sclerosing cholangitis and suggests durable response to corticosteroid therapy.

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ACLR GRAFT STRAND NUMBER: LONG-TERM FOLLOW-UP ON 400 PATIENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00174 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0017

Author(s):

Julien T Aoyama ◽

Joshua T Bram ◽

John Todd R. Lawrence ◽

Theodore J Ganley

Keyword(s):

Multivariate Regression ◽

Normal Weight ◽

Obese Patients ◽

Long Term Outcomes ◽

Post Surgery ◽

Graft Rupture ◽

Long Term Follow Up ◽

Graft Diameter

Background: Studies on pediatric anterior cruciate ligament reconstructions (ACLRs) often focus on graft choice, as rates of these injuries have risen in recent years. Large multicenter studies have found younger age and smaller graft size to be risk factors for graft failure and contralateral tears, but despite large sample sizes these studies have not looked specifically at graft strand number. Therefore the purpose of this study was to use a large sample size to ask whether ACLR graft strand number affects long-term outcomes. Hypothesis/Purpose: Examine long-term effects of ACLR graft strand number using a large cohort. Methods: This was a retrospective comparison study of all patients presenting between 1/1/2008 and 12/31/16 for a first-time ACLR at a single pediatric hospital. After querying medical records for all ACLRs using CPT codes, graft strand number, graft diameter, and other variables were abstracted. Long-term outcomes on graft rupture, contralateral ACL tear, and subsequent meniscus injury were collected via phone calls and REDCap emails. Patient groups were compared for differences in graft strand number and diameter using bivariate analyses, and differences in long-term outcomes were analyzed using multivariate regression. Results: 436 patients met the inclusion criteria also completed the long-term follow-up on outcomes. Long-term follow-up ranged from 18 months post surgery to 10 years post surgery. Patients with larger graft diameter were significantly less likely to suffer a complication (graft rupture, contralateral ACL tear, or subsequent meniscus injury) in multivariate regression (p=0.03), while strand number, sex, weight, and age showed no significant difference. Transphyseal reconstructions had larger graft diameters (8.8mm) than partial hybrid (8.6mm) and all-epiphyseal reconstructions (8.3mm) (p<0.001), but had no differences in graft strand number. Males had larger graft diameters (8.9mm) than females (8.6mm) (p=0.03), but also had no differences in graft strand number. Obese patients had larger graft diameters (9.1mm) than overweight (8.9mm) and normal weight patients (8.6mm) (p=0.002). Obese patients also had more graft strands (6.9) than overweight (6.2) or normal weight patients (6.1), but this difference was not significant (p=0.051). Conclusion: This data supports the existing literature that pediatric ACLR patients with larger graft diameters are less likely to suffer long-term complications. Using both a large patient cohort and long-term follow-up, this data also showed that graft strand number was not significantly correlated with outcomes. This suggests that strand number is not important when constructing ACLR grafts, as long as sufficient graft diameter can be achieved.

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Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease

Vascular and Endovascular Surgery ◽

10.1177/1538574418824444 ◽

2019 ◽

Vol 53 (4) ◽

pp. 284-291

Author(s):

Hirokazu Onishi ◽

Toru Naganuma ◽

Koji Hozawa ◽

Tomohiko Sato ◽

Hisaaki Ishiguro ◽

...

Keyword(s):

Subclavian Artery ◽

Stent Implantation ◽

De Novo ◽

Clinical Success ◽

Primary Patency ◽

Success Rates ◽

Long Term Outcomes ◽

Procedural Success

Introduction: The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. Material and Methods: We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. Results: There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). Conclusion: Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.

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P183 The prevalence of incidental terminal ileitis in persons undergoing non-diagnostic colonoscopy: a meta-analysis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.312 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S230-S230

Author(s):

M Agrawal ◽

M Bento-Miranda ◽

S Walsh ◽

J F Colombel ◽

R Ungaro

Keyword(s):

Meta Analysis ◽

Scientific Meeting ◽

Long Term Outcomes ◽

Diagnostic Colonoscopy ◽

Terminal Ileitis ◽

Prevalence Studies ◽

Therapeutic Implications ◽

Long Term Follow Up

Abstract Background Incidentally diagnosed terminal ileitis has been reported among asymptomatic persons undergoing non-diagnostic colonoscopy. The purpose of our study was to determine the prevalence and long-term outcomes of asymptomatic terminal ileitis. Methods We developed and executed a systematic search strategy in three biomedical databases (Medline, Embase and Web of Science) and relevant scientific meeting abstracts, from inception to May 1, 2019, to identify observational studies that reported the prevalence of asymptomatic terminal ileitis in adults undergoing screening or polyp surveillance colonoscopy, and/or the long-term outcomes of such lesions. A random-effects meta-analysis was conducted to determine the pooled prevalence rate, confidence interval (CI), and report the heterogeneity score I2. Risk factors for progression to overt CD were abstracted. Results Of 2388 eligible studies, 1784 were screened after excluding duplicates, 84 were reviewed in full text and 14 studies were eligible for inclusion. Eight studies reported the prevalence of asymptomatic terminal ileitis in 46,460 persons undergoing non-diagnostic colonoscopy, and eight (two of eight reporting prevalence) studies reported follow-up data. The pooled rate of asymptomatic terminal ileitis was 1.5% (CI 1.0%, 16.3%), with I2 of 0 (Figure). The use of non-steroidal anti-inflammatory drugs varied between 0% and 37%. Of 147 persons with asymptomatic terminal ileitis with follow-up data (range 13–63.6 months in three studies), five had progression to CD, three were treated for CD with steroids, 5-amino salicylates, azathioprine and vedolizumab, and lesions resolved in four. Three studies reported the absence of symptoms as a predictor of lack of progression. Conclusion Asymptomatic terminal ileitis can be found incidentally in 1.5% of non-diagnostic colonoscopies. Based on limited data, the rate of its progression to overt CD seems low, and watchful waiting could likely be a reasonable strategy. More long-term follow-up studies are needed to inform the natural history of incidental terminal ileitis, factors that predict progression to CD and therapeutic implications.

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A New Role of Staged Tympanoplasty for Cholesteatoma

Otolaryngology ◽

10.1016/j.otohns.2008.05.169 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P52-P52

Author(s):

Yasuyuki Hinohira ◽

Naoaki Yanagihara ◽

Naohito Hato

Keyword(s):

Mastoid Cavity ◽

Pathological Findings ◽

Long Term Outcomes ◽

Retraction Pocket ◽

Endoscopic Observation ◽

Middle Ear Cholesteatoma ◽

Long Term Follow Up

Objective 1) Investigate a correlation between pathological findings at the 2nd stage operation and long-term outcomes in a staged canal wall-up tympanoplasty (SCUT) for middle ear cholesteatoma. 2) Advocate a new role of the staged manner based on the study. Methods SCUT was performed on 90 ears with cholesteatoma involving both the ossicles and the mastoid cavity. The 1st stage operation included scutum plasty and mastoid cortex plasty with bone pate following removal of cholesteatoma and ossicles involved. The 2nd stage operation records were reviewed regarding the pathological findings associated with retraction pocket (RP) and residual cholesteatoma (RC) formation. The scutum defect was revised with auricular cartilage, and the mastoid cortex plasty was again performed after removal of RC. Postoperative follow-up with endoscopic observation and CT was performed for all patients. Results At the 2nd stage, RP was seen in 15 ears (16.7%) which all showed partial or total absorption of the scutum reconstructed. Aeration grade of the mastoid cavity reconstructed did not correlate with RP or RC formation. RC was found in 28 ears (31.1%) regardless of RP formation. The long-term follow up study revealed that the statistically higher incidence of RP re-formation (26.7%) and RC (3.2%) was seen in ears which had been identified at the 2nd stage, respectively. Conclusions The present study showed that the long-term outcomes after SCUT were correlated with RP and RC formation at the 2nd stage. This indicates the 2nd stage operation has a role of the long-term prognosis in addition to exploration of RC.

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Gamma Knife surgery for incidental cerebral arteriovenous malformations

Journal of Neurosurgery ◽

10.3171/2014.7.jns131397 ◽

2014 ◽

Vol 121 (5) ◽

pp. 1015-1021 ◽

Cited By ~ 42

Author(s):

Chun-Po Yen ◽

Dale Ding ◽

Ching-Hsiao Cheng ◽

Robert M. Starke ◽

Mark Shaffrey ◽

...

Keyword(s):

Gamma Knife ◽

Arteriovenous Malformations ◽

Latency Period ◽

Invasive Procedure ◽

Gamma Knife Surgery ◽

Neurological Deficits ◽

Cerebral Arteriovenous Malformations ◽

Long Term Follow Up

Object A relatively benign natural course of unruptured cerebral arteriovenous malformations (AVMs) has recently been recognized, and the decision to treat incidentally found AVMs has been questioned. This study aims to evaluate the long-term imaging and clinical outcomes of patients with asymptomatic, incidentally discovered AVMs treated with Gamma Knife surgery (GKS). Methods Thirty-one patients, each with an incidentally diagnosed AVM, underwent GKS between 1989 and 2009. The nidus volumes ranged from 0.3 to 11.1 cm3 (median 3.2 cm3). A margin dose between 15 and 26 Gy (median 20 Gy) was used to treat the AVMs. Four patients underwent repeat GKS for still-patent AVM residuals after the initial GKS procedure. Clinical follow-up ranged from 24 to 196 months, with a mean of 78 months (median 51 months) after the initial GKS. Results Following GKS, 19 patients (61.3%) had a total AVM obliteration on angiography. In 7 patients (22.6%), no flow voids were observed on MRI but angiographic confirmation was not available. In 5 patients (16.1%), the AVMs remained patent. A small nidus volume was significantly associated with increased AVM obliteration rate. Thirteen patients (41.9%) developed radiation-induced imaging changes: 11 were asymptomatic (35.5%), 1 had only headache (3.2%), and 1 developed seizure and neurological deficits (3.2%). Two patients each had 1 hemorrhage during the latency period (116.5 risk years), yielding an annual hemorrhage rate of 1.7% before AVM obliteration. Conclusions The decision to treat asymptomatic AVMs, and if so, which treatment approach to use, remain the subject of debate. GKS as a minimally invasive procedure appears to achieve a reasonable outcome with low procedure-related morbidity. In those patients with incidental AVMs, the benefits as well as the risks of radiosurgical intervention will only be fully defined with long-term follow-up.

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