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2022 ◽  
Vol 29 (1) ◽  
Author(s):  
Septiani Hidianingsih ◽  
Yonas Immanuel Hutasoit

Objective: This study compared several factors that are thought to contribute to the incidence of complications of urethroplasty fistula after urethroplasty, including meatus location, degree of chordee, surgical technique, and postoperative stent type. Material & Methods: This study is an analytical study with retrospective cohort design. After adjusting to the inclusion and exclusion criteria, 89 subjects with proximal hypospadias were subjected to urethroplasty at Fatmawati General Hospital, Jakarta from 2016 to 2019. An analysis of the relationship between several variables and the incidence of uretrocutaneous fistula was analyzed. Results: There was no significant difference between the one-stage and two-stage urethroplasty technique on the incidence of urethrocutaneous fistula (p = 0.063). There was no significant difference between the degree of chordee and complications of urethrocutaneous fistula after urethroplasty (p = 0.677). The relationship between the use of silastic stent, catheter, or cystostomy type was also not significant in complications of urethrocutaneous fistula (p = 0.576). The location of the urethral meatus also did not have a significant role in predicting the incidence of post-urethroplasty urethrocutaneous fistula (p = 0.169). Conclusion: Surgical technique (one stage and two stages), type of stent, degree of chordee, and location of the urethral meatus, did not have a significant correlation with the incidence of urethrocutaneous fistula in hypospadias patients after urethroplasty.


2021 ◽  
pp. 152660282110648
Author(s):  
B. Mishra ◽  
A. K. Pandit ◽  
S. Miyachi ◽  
T. Ohshima ◽  
R. Kawaguchi ◽  
...  

Background: Carotid plaque morphology plays an important role in determining outcome of carotid artery stenting (CAS). Intravascular ultrasound (IVUS) and its extension VH (Virtual Histology)-IVUS evaluate plaque characteristics in real time and guide decision making during stenting. To date, there is no consensus about indications of IVUS and its validated methods. This systematic review and meta-analysis aims to evaluate the clinical utility of IVUS in carotid artery interventions (CAS) and develop a future consensus for research and practice parameters. Methods: A systematic review and meta-analysis was performed of the English literature articles published till February 2021. Studies reporting on IVUS parameters and findings and also its performance compared with other imaging modalities were included in review. Pooled prevalence with 95% confidence intervals (CI) was calculated. The statistical analysis was conducted in R version 3.6.2. Results: A total of 2015 patients from 29 studies were included. Proportional meta-analysis was performed on 1566 patients from 11 studies. In 9 studies, stroke/transient ischemic attack (TIA) had a pooled prevalence of 4% (95% CI 3%–5%) while asymptomatic stroke had a pooled prevalence of 46% (95% CI 31%–62%) in 4 studies following IVUS. Two studies reported that IVUS detected more plaque protrusion compared with angiography (n=33/396 vs 11/396). IVUS led to stent type or size change in 8 of 48 cases which were missed on angiography in 3 other studies. Concordance between VH-IVUS and true histology was good at 80% to 85% reported in 2 studies. Conclusions: This systematic review and meta-analysis showed, though IVUS fared better to computed tomography (CT)/magnetic resonance (MR) angiography for better stent selection during CAS, with low to moderate risk of bias in the studies included. However, large scale, preferably randomized controlled studies are needed to predict its role in determining clinical outcome.


Author(s):  
Bogdan V. Cherpak ◽  
Igor O. Ditkivskyy ◽  
Nataliia S. Yashchuk ◽  
Yuliia V. Yermolovych ◽  
Oleksandr S. Golovenko ◽  
...  

The aim. To analyze the 10-year experience in aortic coarctation endovascular stenting in patients of different age groups. Materials and methods. Examination and endovascular treatment of 194 patients aged 3 days to 60 years with coarctation of the aorta (CoA) with different anatomical and morphological variants was performed. According to the age criterion, the examined patients were divided into 4 study groups. The first group consisted of 84 patients (43.3%) over 25 years of age, group 2 included 33 patients (17.0%) aged 19 to 25 years, group 3 included 71 patients (36.6%) aged 5 to 18 years, and group 4 included 6 patients (3.1%) under 1 year of age. Results and discussion. We presented the clinical features of different anatomical and morphological variants of CoA. Endovascular treatment of CoA with stenting is considered the best method for adolescents and adults, due to the lower risk of aneurysm formation compared to balloon angioplasty. We were able to successfully reduce the invasive pressure gradient in patients of different ages and to establish the dependence of complication rate on the stent type used. The most common complications were aneurysm formation (2.1%) and stent migration (2.1%). Complications occurred more often in cases of uncovered stents compared to stent grafts (5.3% and 2.1%, respectively, p <0.05). No cases of hospital mortality were recorded in patients older than 5 years. Seven endovascular procedures were performed in 5 patients aged 3 days to 11 months (mean age 3.5 ± 1.6 months) with combined heart defects. Complications were documented in 1 child (20.0%). Endovascular intervention in pregnant women is indicated in refractory hypertension. We performed endovascular CoA stenting in 4 pregnant women at 15–23 weeks of gestation (average, 19.8 ± 3.1 weeks), and in 6 women with well-controlled hypertension stenting was performed within 48 hours to 5 years after delivery. In all the presented cases, successful revascularization was achieved. During follow-up (from 2 months to 10 years), all 10 women are alive, did not develop recoarctation or complications. Conclusions. The results of the analysis of CoA endovascular treatment showed that the chosen method and technique of intervention is appropriate and safe for patients of all ages, including pregnant women. Based on the results obtained, we have developed an algorithm for the management of patients who, according to clinical examination and echocardiography, were diagnosed with CoA during pregnancy.


Cardiology ◽  
2021 ◽  
Author(s):  
Per Morten Mølstad ◽  
Jan Erik Nordrehaug ◽  
Terje K. Steigen ◽  
Tom Wilsgaard ◽  
Rune Wiseth ◽  
...  

Abstract. Background. Drug-eluting stents (DES) reduce target lesion revascularization (TLR) with no effect on mortality or myocardial infarction (MI) compared to bare metal stents (BMS) in native vessels. Randomized stent studies in saphenous vein grafts (SVG) are few and the reported effects are ambiguous. The NORSTENT study is the first to randomize lesions to percutaneous coronary intervention (PCI) in native vessels and SVG. Aims. To compare rate of mortality, MI and TLR across stent and vessel types. Methods. In this substudy 6087 patients with a single lesion in native vessels and 164 in SVG, were followed for 5 years. Results. MI was more frequent in SVG (subdistributional hazard ratio (SHR) 4.95 (3.75 – 6.54, p<0.001), but not affected by stent type. In the first 500 days DES reduced TLR in native vessels (SHR 0.21 ( 0.15 – 0.30)p<0.001) and SVG (SHR 0.18 (0.04 – 0.80) p=0.02). Thereafter DES and BMS were equivalent in native vessels, but DES had a higher TLR rate than BMS in SVG (SHR 3.31 (1.23 – 8.94) p=0.02). After 5 years the TLR rate was still significantly lower for DES in native vessels (3.2 % versus 7.8 %, p<0.001) but not in SVG (21.4 % vs 18. 4%). Conclusion: In SVG no difference in TLR between DES and BMS was observed after 5 years in contrast to persistent benefit in native vessels. The high rate of TLR and myocardial infarction in SVG makes treatment of native vessels a preference whenever feasible and better treatment options for SVG are warranted.  


2021 ◽  
Vol 25 (3) ◽  
pp. 71
Author(s):  
S. S. Sapoznikov ◽  
N. A. Galeeva ◽  
I. S. Bessonov ◽  
N. A. Musikhina ◽  
T. I. Petelina ◽  
...  

<p><strong>Aim.</strong> To examine the process of neointimal formation after bioresorbable scaffolds (BRS) implantation using optical coherence tomography (OCT) in patients with stable coronary artery disease (SCAD) and to determine relationship between neointimal healing and biochemical parameters of inflammation.<br /><strong>Methods.</strong> Patients with SCAD (n = 20) who were indicated for percutaneous coronary intervention (PCI) were enrolled. Patients were randomised into two groups as per the stent type. The treatment group comprised 10 patients who were implanted with BRS ABSORB (Abbott Laboratories, Abbott Park, USA) during PCI. The comparison group comprised 10 patients who were implanted with DES XIENCE (Abbott Laboratories, Abbott Park, USA) during PCI. All the patients underwent OCT imaging during PCI. Subsequently, 18 patients were subjected to coronary angiography with OCT imaging in 12 mon. The primary endpoint was the 12-month neointimal healing (NIH) score. Secondary endpoints were clinical outcomes (all-cause hospitalisation, myocardial infarction, probable stent thrombosis and death), OCT parameters at the 12-month follow-up and biochemical markers dynamics.<br /><strong>Results.</strong> Initial angiographic data analysis indicated a higher rate of balloon pre-dilatation (100% vs. 30%; р = 0,003) and post-dilatation (100% vs. 20% р = 0,001) in patients of the treatment group. According to OCT, the NIH score was significantly higher in the XIENCE group [0 versus 9,14 (1,63–17,55); р = 0,008] at 12 mon. There was no significant difference in the clinical outcomes between the two groups. However, the ABSORB group had an increased CD40 level after 4–5 d of PCI. In agreement with the results of correlation analysis, there was an inverse correlation between the NIH score and CD40 level at 4–5 d after PCI (r = −0,576; р = 0,016). The cut-off value of CD40 level at 4–5 d after PCI was 47,5 ng/mL for the detection of optimal neointimal healing.<br /><strong>Conclusion.</strong> In patients with SCAD, BRS demonstrated higher rate of neointimal healing than everolimus-coated stents. There was a registered inverse correlation of the NIH score with the CD40 level at 4–5 days after PCI. CD40 level &gt; 47,5 ng/mL at 4–5 d after PCI increases the likelihood of optimal neointimal healing as per OCT data.</p><p>Received 19 February 2021. Revised 7 June 2021. Accepted 16 June 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors</strong><br />Conception and study design: I.S. Bessonov, N.A. Musikhina, T.I. Petelina<br />Data collection and analysis: S.S. Sapoznikov, I.S. Bessonov, N.А. Galeeva, A.O. Dyakova<br />Statistical analysis: S.S. Sapoznikov, E.A. Gorbatenko<br />Drafting the article: S.S. Sapoznikov, N.А. Galeeva, A.O. Dyakova<br />Critical revision of the article: I.S. Bessonov, S.S. Sapoznikov, E.A. Gorbatenko, N.A. Musikhina<br />Final approval of the version to be published: S.S. Sapoznikov, N.А. Galeeva, I.S. Bessonov, N.A. Musikhina, T.I. Petelina, A.O. Dyakova, E.A. Gorbatenko</p>


Author(s):  
Mohamad Bashir ◽  
Hadi Abo Aljadayel ◽  
Mostafa Mousavizadeh ◽  
Mahdi Daliri ◽  
Yousef Rezaei ◽  
...  

Background: The advent of Frozen elephant trunk (FET) for reconstruction of elective and non-elective aortic arch surgery has augmented the treatment of complex aortic pathologies in a single-stage operation. To date, no studies have been focused on the prevalence and predictors of coagulopathy potentiated by FET procedure. Methods: In a systematic review, we searched databases up to June 2020 for studies reporting coagulopathy complications after FET procedure. A proportional meta-analysis was carried out using STATA software (StataCorp, TX, USA). Results: In total, 46 studies including 6313 patients were eligible. The pooled estimation of reoperation for postoperative bleeding was 7% (95% confidence interval [CI] 5 to 8; I2 = 84.73%; reported by 39 studies including 4796 patients). The mean volume of transfused packed blood cells and fresh frozen plasma was 1677 ml (95% CI 1066.4-2287.6) and 1016.5 ml (95% CI 450.7-1582.3). The subgroup by stent type showed a decrease in the heterogeneity (I2 = 0.01%, I2 = 53.95%, I2 = 0.01%, and I2 = 54.41% for Thoraflex® Hybrid, E-vita®, Frozenix®, and Cronus®, respectively). The subgroup by chronicity of operation resulted in less heterogeneity among patients undergoing elective compared to non-elective operation (I2 = 29.22% versus I2 = 80.56% in non-elective). Meta-regression analysis showed that age and male gender significantly impacted on the reoperation for postoperative bleeding. Conclusions: The FET procedure for arch replacement is associated with coagulopathy and the transfusion of blood products. Male, age, and selective choice of FET use were identified as heterogeneity sources of reoperation for postoperative bleeding.


Author(s):  
Brian A. Bergmark ◽  
Deepak L. Bhatt ◽  
P. Gabriel Steg ◽  
Andrzej Budaj ◽  
Robert F. Storey ◽  
...  

Background Coronary stent type and risk of stent thrombosis remain important factors affecting recommended duration of dual antiplatelet therapy. We investigated the efficacy and safety of long‐term ticagrelor in patients with prior coronary stenting enrolled in the PEGASUS‐TIMI 54 (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54) trial. Methods and Results Patients in PEGASUS‐TIMI 54 had a myocardial infarction 1 to 3 year prior and were randomized 1:1:1 to ticagrelor 60 or 90 mg BID or placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, or stroke (major adverse cardiovascular events). Stent thrombosis was prospectively adjudicated (Academic Research Consortium definition). Baseline characteristics were compared by most recent stent type (bare metal versus drug‐eluting stent and first‐ versus later‐generation drug‐eluting stent). Treatment arms were compared using Cox proportional hazards models. Of 21 162 patients randomized, 80% (n=16 891) had prior coronary stenting. Following randomization, myocardial infarction was the most frequent ischemic event in patients with prior stenting in the placebo arm, occurring in 5.2% of patients (Type 1: 4.1%), followed by cardiovascular death (2.3%), stroke (1.7%), and stent thrombosis (0.9%). Ticagrelor pooled reduced major adverse cardiovascular events (7.0% versus 8.0%; hazard ratio [HR], 0.85; 95% CI, 0.75–96) regardless of stent type (bare metal stent versus drug‐eluting stent: p interaction =0.767; first versus later generation: p interaction =0.940). The rate of any stent thrombosis was numerically lower with ticagrelor pooled (0.7% versus 0.9%; HR, 0.73; 95% CI, 0.50–1.05) and Thrombolysis in Myocardial Infarction major bleeding was increased (HR, 2.65; 95% CI, 1.90–3.68). Conclusions Long‐term ticagrelor reduces major adverse cardiovascular events in patients with prior myocardial infarction and coronary stenting regardless of stent type, with the benefit driven predominantly by reduction in de novo events. Nonfatal major bleeding is increased with ticagrelor. Registration Information clinicaltrials.gov. Identifier: NCT01225562.


2021 ◽  
Vol 17 (5) ◽  
pp. e360-e361
Author(s):  
Martine Gilard ◽  
Romain Didier

2021 ◽  
Author(s):  
Wenbo He ◽  
Changwu Xu ◽  
Xiaoying Wang ◽  
Jiyong Lei ◽  
Qinfang Qiu ◽  
...  

Abstract Background: This study aimed to develop and validate a nomogram to predict probability of in-stent restenosis (ISR) in patients undergoing percutaneous coronary intervention (PCI). Methods: Patients undergoing PCI with drug-eluting stents between July 2009 and August 2011 were retrieved from a cohort study in a high-volume PCI center, and further randomly assigned to training and validation sets. The least absolute shrinkage and selection operator (LASSO) regression model was used to screen out significant features for construction of nomogram. Multivariable logistic regression analysis was applied to build a nomogram-based predicting model incorporating the variables selected in the LASSO regression model. The area under the curve (AUC) of the receiver operating characteristics (ROC), calibration plot and decision curve analysis (DCA) were performed to estimate the discrimination, calibration and utility of the nomogram model respectively.Results: A total of 463 patients with DES implantation were enrolled and randomized in the development and validation sets. The predication nomogram was constructed with five risk factors including prior PCI, hyperglycemia, stents in left anterior descending artery (LAD), stent type, and absence of clopidogrel, which proved reliable for quantifying risks of ISR for patients with stent implantation. The AUC of development and validation set were 0.706 and 0.662, respectively, indicating that the prediction model displayed moderate discrimination capacity to predict restenosis. The high quality of calibration plots in both datasets demonstrated strong concordance performance of the nomogram model. Moreover, DCA showed that the nomogram was clinically useful when intervention was decided at the possibility threshold of 9%, indicating good utility for clinical decision-making.Conclusions: The individualized prediction nomogram incorporating 5 commonly clinical and angiographic characteristics for patients undergoing PCI can be conveniently used to facilitate early identification and improved screening of patients at higher risk of ISR.


2021 ◽  
Vol 12 ◽  
pp. 302
Author(s):  
Sophie M. Peeters ◽  
Daniel Nagasawa ◽  
Bilwaj Gaonkar ◽  
Tianyi Niu ◽  
Alexander Tucker ◽  
...  

Background: Performing emergent spinal surgery within 6 months of percutaneous placement of drug-eluting coronary stent (DES) is complex. The risks of spinal bleeding in a “closed space” must be compared with the risks of stent thrombosis or major cardiac event from dual antiplatelet therapy (DAPT) interruption. Methods: Eighty relevant English language papers published in PubMed were reviewed in detail. Results: Variables considered regarding surgery in patients on DAPT for DES included: (1) surgical indications, (2) percutaneous cardiac intervention (PCI) type (balloon angioplasty vs. stenting), (3) stent type (drug-eluting vs. balloon mechanical stent), and (4) PCI to noncardiac surgery interval. The highest complication rate was observed within 6 weeks of stent placement, this corresponds to the endothelialization phase. Few studies document how to manage patients with critical spinal disease warranting operative intervention within 6 months of their PCI for DES placement. Conclusion: The treatment of patients requiring urgent or emergent spinal surgery within 6 months of undergoing a PCI for DES placement is challenging. As early interruption of DAPT may have catastrophic consequences, we hereby proposed a novel protocol involving stopping clopidogrel 5 days before and aspirin 3 days before spinal surgery, and bridging the interval with a reversible P2Y12 inhibitor until surgery. Moreover, postoperatively, aspirin could be started on postoperative day 1 and clopidogrel on day 2. Nevertheless, this treatment strategy may not be appropriate for all patients, and multidisciplinary approval of perioperative antiplatelet therapy management protocols is essential.


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