RESUMEN
Peripheral artery disease is commonly treated with balloon angioplasty, a procedure involving minimally invasive, transluminal insertion of a catheter to the site of stenosis, where a balloon is inflated to open the blockage, restoring blood flow. However, peripheral angioplasty has a high rate of restenosis, limiting long-term patency. Therefore, angioplasty is sometimes paired with delivery of cytotoxic drugs like paclitaxel to reduce neointimal tissue formation. We pursue intravascular drug delivery strategies that target the underlying cause of restenosis - intimal hyperplasia resulting from stress-induced vascular smooth muscle cell switching from the healthy contractile into a pathological synthetic phenotype. We have established MAPKAP kinase 2 (MK2) as a driver of this phenotype switch and seek to establish convective and contact transfer (coated balloon) methods for MK2 inhibitory peptide delivery to sites of angioplasty. Using a flow loop bioreactor, we showed MK2 inhibition in ex vivo arteries suppresses smooth muscle cell phenotype switching while preserving vessel contractility. A rat carotid artery balloon injury model demonstrated inhibition of intimal hyperplasia following MK2i coated balloon treatment in vivo. These studies establish both convective and drug coated balloon strategies as promising approaches for intravascular delivery of MK2 inhibitory formulations to improve efficacy of balloon angioplasty.
Asunto(s)
Péptidos y Proteínas de Señalización Intracelular , Proteínas Serina-Treonina Quinasas , Ratas Sprague-Dawley , Animales , Proteínas Serina-Treonina Quinasas/metabolismo , Proteínas Serina-Treonina Quinasas/antagonistas & inhibidores , Péptidos y Proteínas de Señalización Intracelular/metabolismo , Masculino , Péptidos/química , Péptidos/farmacología , Ratas , Músculo Liso Vascular/efectos de los fármacos , Músculo Liso Vascular/citología , Angioplastia de Balón/métodos , Miocitos del Músculo Liso/efectos de los fármacos , Miocitos del Músculo Liso/citología , Miocitos del Músculo Liso/metabolismo , Sistemas de Liberación de Medicamentos , Hiperplasia/prevención & control , Angioplastia , Neointima/prevención & control , Neointima/patologíaRESUMEN
Percutaneous transluminal angioplasty (PTA) is the gold standard for treating stenoses with dysfunctional vascular access. Recently, we found that vascular access blood flow (VABF) measured immediately after PTA increased over time without the need for additional procedures in the patients who underwent PTA. Therefore, this study was conducted to confirm an increase in VABF after PTA and identify the factors associated with it. Patients on chronic hemodialysis at a single institution were retrospectively reviewed and those with accesses that had a measurement of VABF immediately after PTA and within 1 month from PTA were included in the study. The relationship between clinical parameters and changes in VABF were analyzed using paired t-test and linear regression. A total of 47 PTA accesses (fistulas, 26; grafts,21) were included. The mean VABF on the day of PTA and the following measurement were 796.9â ±â 329.1 mL/min and 1105.1â ±â 410.3 mL/min, respectively. In the univariate analysis, the diameter of the balloon catheter used in the PTA and serum uric acid (SUA) level were significantly associated with an increase in VABF. Atrial fibrillation was a significant factor for the percentage change in vascular access. In the multivariate analysis, SUA level, balloon catheter diameter, and atrial fibrillation remained independent factors for changes in VABF and percentage change in VABF, respectively. The study identified progressive increases in the VABF after PTA without additional procedures. SUA level, balloon catheter diameter used in PTA, and atrial fibrillation were independently associated with changes in VABF.
Asunto(s)
Diálisis Renal , Humanos , Masculino , Femenino , Diálisis Renal/métodos , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Derivación Arteriovenosa Quirúrgica , Angioplastia de Balón/métodos , Angioplastia/métodos , Flujo Sanguíneo Regional/fisiologíaRESUMEN
Controversy still exists regarding how much the inflow arterial percutaneous transluminal angioplasty (PTA) contributed to maintaining fistula function for hemodialysis. We aimed to analyze patency and risk factors after inflow arterial PTA. Hemodialysis patients with inflow arterial primary stenosis who were admitted to our institution from January 2017 to December 2022 were examined. One group had arterial-venous fistula with inflow artery stenosis alone (AVF + iAS) and another group had AVF with inflow artery stenosis and any vein stenosis (AVF + iAS + VS). The characteristics of patients, stenotic lesions, and PTA procedures were recorded. Kaplan-Meier analysis was used to compare primary patency, assisted primary patency, and secondary patency in the two groups. Cox proportional hazard analysis was used to identify risk factors associated with patency. We examined 213 patients, 53 in the AVF + iAS group (51 radial arterial stenosis and 2 ulnar arterial stenosis) and 160 in the AVF + iAS + VS group (159 radial arterial stenosis and 1 ulnar arterial stenosis). Kaplan-Meier analysis indicated the AVF + iAS group had better primary patency and assisted primary patency (both P < 0.05), but the groups had similar secondary patency. Cox proportional hazard analysis indicated that none of the analyzed clinical and biochemical indexes had clinically meaningful effects on primary patency, assisted primary patency, or secondary patency in either group. The patency and safety after PTA for inflow arterial stenosis were satisfactory, and none of the examined risk factors had a major clinical impact on patency. We recommend PTA as treatment for inflow stenosis of an AVF.
Asunto(s)
Angioplastia , Diálisis Renal , Grado de Desobstrucción Vascular , Humanos , Masculino , Femenino , Estudios Retrospectivos , Angioplastia/métodos , Angioplastia/efectos adversos , Persona de Mediana Edad , Anciano , Constricción Patológica , Derivación Arteriovenosa Quirúrgica/efectos adversos , Factores de Riesgo , Estimación de Kaplan-Meier , Modelos de Riesgos Proporcionales , Resultado del Tratamiento , Arteria Radial , Arteriopatías Oclusivas/terapia , Arteriopatías Oclusivas/etiologíaRESUMEN
INTRODUÇÃO: O Ultrassom Doppler de artérias renais (USD-AR) com análise de velocidade de pico sistólico (VPS) é utilizado na investigação inicial de pacientes com suspeita de hipertensão (HAS) renovascular com sensibilidade de 85% e especificidade de 92%. Se trata, no entanto, de avaliação sujeita a variabilidade examinador-dependente. Apresentamos o caso de uma paciente com HAS refratária com exames ultrassonográficos iniciais discordantes. RELATO DE CASO: Paciente de 60 anos, com diagnóstico de HAS desde os 48 anos, foi encaminhada para centro de referência após episódio de AVC isquêmico por suspeita de HAS secundária. MAPA de 24h na admissão mostrava PA média total de 204/122 mmHg em vigência de Losartana e Hidroclorotiazida. Após ajustes terapêuticos sequenciais, obteve-se redução parcial dos níveis tensionais (PA média total no MAPA de 24h: 164x95 mmHg, em vigência de 7 classes: Olmesartana, Clortalidona, Lercanidipino, Carvedilol, Espironolactona, Hidralazina e Alfametildopa), mantendose, no entanto, fora da meta de PA e configurando quadro de HAS refratária. Dois USD-AR foram realizados em serviços diferentes, revelando resultados contraditórios. O USD-AR1 mostrava rim direito excluído e VPS da AR esquerda de 235 cm/s, enquanto no USD-AR2 a VPS da AR esquerda foi de 22 cm/s e a origem da AR direita não foi visualizada por interposição gasosa. A paciente foi submetida a arteriografia renal que revelou obstrução proximal (70%) da AR esquerda e oclusão total da AR direita. Optouse por angioplastia com implante de stent em AR esquerda com bom resultado angiográfico (Fig.1) e evolução clínico-laboratorial favorável (MAPA: PA total média = 135x75 mmHg na vigência de 6 classes; Creatinina plasmática pré- e pós-angioplastia: 2,2 mg/dL e 1,4 mg/dL, respectivamente). DISCUSSÃO: O exame de USD-AR é útil no rastreio da HAS renovascular, mas sua acurácia é examinador-dependente. Por isso, frente a resultado negativo e alto grau de suspeita clínica a investigação deveria prosseguir com exames como a angiotomografia, a angiorressonância e a arteriografia, que é o padrão-ouro para a identificação de estenose de AR.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Ultrasonografía Doppler , Hipertensión , Hipertensión Renovascular , Angioplastia , Constricción Patológica , Indicadores de Calidad de la Atención de Salud , Accidente Cerebrovascular IsquémicoRESUMEN
The frequency of percutaneous transluminal angioplasty (PTA) procedures has substantially increased, but its effect on vascular access recreation (VAR) remains inconclusive. We conducted a population-based retrospective analysis of Taiwan hemodialysis (HD) centers from 2004 to 2012. Data was accumulated into center-level characteristics, including patients' demographics, baseline characteristics, PTA procedures, and VAR. Center-level characteristics were summarized annually using appropriate measures. A mixed model assessed the association between PTA frequency and VAR rates, considering within-center correlation and adjusting for potential confounders. A total of 82,005 patients (mean age 62.7 ± 13.9 years, 50.5% male, 48.5% with diabetes mellitus) from 820 HD centers were analyzed. From 2004 to 2012, PTA frequency significantly increased from 1.24 to 3.23 per 1000 HD sessions, while VAR rates did not decline as expected (0.5-0.8 per 1000 HD sessions). Compared with the HD centers of infrequent use of PTA (annual lowest quartile, range 0.39-1.20 per 1000 HD sessions), the ones of frequent use (annual highest quartile, range 2.52-5.10 per 1000 HD sessions) didn't have lower VAR (range 0.54-0.99 vs. 0.50-0.91 per 1000 HD sessions, respectively). After controlling the potential confounders, the HD centers' PTA rates were not significantly associated with lower VAR rates (- 2.6, 95% confidence interval: - 30.3; 25.0, p = 0.85). Frequent use of PTA does not seem to improve VA patency at the center level, with no significant association identified with lower VAR. The indication of PTA in daily practice should be re-evaluated in terms of its efficiency in lowering VAR.
Asunto(s)
Angioplastia , Diálisis Renal , Humanos , Masculino , Femenino , Persona de Mediana Edad , Diálisis Renal/métodos , Anciano , Estudios Retrospectivos , Angioplastia/métodos , Angioplastia/estadística & datos numéricos , Taiwán/epidemiología , Estudios Longitudinales , Dispositivos de Acceso VascularRESUMEN
BACKGROUND: The ASTRAL trial (Angioplasty and Stenting for Renal Artery Lesions) recruited 806 patients between 2000 and 2007. Patients with atherosclerotic renal artery stenosis (RAS) and clinician uncertainty about the benefit of revascularization were randomized 1:1 to medical therapy with or without renal artery stenting. The initial results were presented in 2009 at a median 33.6-month follow-up, with no benefit of revascularization on renal or cardiovascular outcomes. Surviving patients remained under follow-up until the end of 2013, and the long-term results are presented in this study. METHODS: Data were analyzed to assess whether there was a later impact of revascularization on renal function, cardiovascular events, and survival, including a composite outcome of renal and cardiovascular outcomes and death (as in the CORAL trial [Cardiovascular Outcomes in Renal Atherosclerotic Lesions]). Prespecified subgroup analyses included different categories of renal function, rapid deterioration in kidney function, and degree of RAS. Post hoc analyses of patients with severe RAS (bilateral 70% or >70% in a solitary kidney), those with or without proteinuria, and a per-protocol analysis were performed. RESULTS: The mean age of the entry population was 70.5 years, the mean estimated glomerular filtration rate was 40 mL/min/1.73 m2, the mean RAS was 76%, and the mean blood pressure was 150/76 mmâ Hg; 83% of the revascularization group underwent attempted stenting. The median follow-up was 56.4 months, with 108 patients lost to follow-up. By the end of follow-up, 50% of the evaluable population had died, 18% had suffered a first renal event, and 40% had suffered a first cardiovascular event. No statistical difference was observed for any outcome in the intention-to-treat and per-protocol analyses. CONCLUSIONS: The long-term follow-up of the ASTRAL trial showed no overall benefit of renal revascularization to renal and cardiovascular outcomes. It has been highlighted that a proportion of the population had lower-risk RAS, and there is likely to be merit in further study in a higher-risk population. REGISTRATION: URL: https://www.isrctn.com; Unique identifier: ISRCTN59586944.
Asunto(s)
Aterosclerosis , Tasa de Filtración Glomerular , Riñón , Obstrucción de la Arteria Renal , Stents , Humanos , Obstrucción de la Arteria Renal/fisiopatología , Obstrucción de la Arteria Renal/mortalidad , Obstrucción de la Arteria Renal/terapia , Obstrucción de la Arteria Renal/diagnóstico por imagen , Obstrucción de la Arteria Renal/cirugía , Anciano , Masculino , Femenino , Resultado del Tratamiento , Factores de Tiempo , Persona de Mediana Edad , Riñón/irrigación sanguínea , Riñón/fisiopatología , Aterosclerosis/mortalidad , Aterosclerosis/fisiopatología , Aterosclerosis/cirugía , Aterosclerosis/complicaciones , Factores de Riesgo , Índice de Severidad de la Enfermedad , Arteria Renal/cirugía , Arteria Renal/fisiopatología , Anciano de 80 o más Años , Angioplastia/efectos adversos , Angioplastia/mortalidadRESUMEN
BACKGROUND: Cerebral vasospasm is a leading source of delayed morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Angioplasty may improve vasospasm, while optimal target and device selection remains controversial. This study aimed to identify features and devices associated with sustained efficacy. METHODS: We identified consecutive patients who underwent angioplasty for aSAH vasospasm. The primary outcome was a composite of adequate angioplasty (residual narrowing < 50 %) without complications. Secondary outcomes included rates of refractory/recurrent vasospasm and sustained improvement at follow-up. Associated features were identified through multivariable analysis. Outcomes were compared between balloon and Comaneci/stentriever in a propensity-score-matched cohort. RESULTS: A total of 149 vasospastic segments underwent angioplasty: 61.7 % in the proximal anterior circulation (ICA, M1, A1), 20.1 % in distal segments (A2 and M2) and 18.1 % in the posterior circulation. Adequate angioplasty was achieved without complication in 83.2 % of vessels, with a sustainable effect in 84.3 % at follow-up. Refractory/recurrent vasospasm was observed in 17.4 %, yielding a 10.1 % retreatment rate. Notably, only 35.3 % of vessels undergoing inadequate angioplasty demonstrated improvement at follow-up. Angioplasty targeting distal MCA (adjusted OR, 0.10) or BA-V4 (aOR, 0.10), and inadequate angioplasty (aOR, 0.03) were unfavorable predictors for sustained improvement. Efficacy outcomes were similar between balloon and Comaneci/stentriever in a matched subgroup analysis. CONCLUSION: Angioplasty, when achieving residual narrowing < 50 %, demonstrated sustained improvement for vasospasm. Novel devices may exhibit comparable efficacy to balloon angioplasty for selected segments.
Asunto(s)
Angioplastia , Hemorragia Subaracnoidea , Vasoespasmo Intracraneal , Humanos , Vasoespasmo Intracraneal/etiología , Vasoespasmo Intracraneal/terapia , Hemorragia Subaracnoidea/complicaciones , Hemorragia Subaracnoidea/terapia , Hemorragia Subaracnoidea/cirugía , Masculino , Femenino , Persona de Mediana Edad , Angioplastia/métodos , Resultado del Tratamiento , Estudios Retrospectivos , Anciano , Adulto , Stents , Angioplastia de Balón/métodosRESUMEN
BACKGROUND: Despite the widespread use of the Wingspan stent system for treating severe medically refractory intracranial artery stenosis (SMR-ICAS), a new Credo stent system was approved because it could integrate stent delivery within the balloon catheter. However, the therapeutic outcomes of these two systems have not been compared. This preliminary study aimed to compare the results of percutaneous angioplasty and stenting (PTAS) in SMR-ICAS patients treated with either Wingspan or Credo stents within the anterior cerebral circulation. METHODS: SMR-ICAS patients with >70% stenosis in the anterior circulation who underwent PTAS using either the Wingspan or Credo stent system were retrospectively analyzed. We evaluated the technical success, safety, and outcomes of the two-stent systems. RESULTS: A total of 29 patients were analyzed, including 17 patients treated with Wingspan stents and 12 with Credo stents. The outcomes of the Wingspan stent vs Credo stent were as follows: technical success (16/17 [94%] vs 11/12 [92%], p = 1.00); periprocedural intracranial hemorrhage (2/17 [12%] vs 0/12 [0%], p = 0.50); silent embolic ischemic lesions on periprocedural magnetic resonance imaging (MRI) (13/17 [76%] vs 7/12 [58%], p = 0.42); and significant (>50%) in-stent restenosis in 1 year (4/17 [24%] vs 2/12 [17%], p = 1.00). No recurrent stroke or mortality was noted within 30 days after the procedures or during the 1-year follow-up period. CONCLUSION: The technical success, safety, and outcomes of the Credo stent system were comparable to those of the Wingspan stent system in the management of SMR-ICAS patients. Further large-scale studies are warranted to substantiate these findings.
Asunto(s)
Angioplastia , Estenosis Carotídea , Stents , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Estudios Retrospectivos , Angioplastia/métodos , Estenosis Carotídea/terapia , Anciano de 80 o más AñosRESUMEN
OBJECTIVES: To compare carotid endarterectomy patch angioplasty (p-CEA) with eversion carotid endarterectomy (e-CEA) and associated risks of early cardio-cerebrovascular complications. METHODS: The study was a prospective randomized single-blind trial, monocentric, clinically applicable, descriptive analytical and comparative. From June 2021 to June 2023, 62 consecutive patients with symptomatic and asymptomatic stenosis of the internal carotid artery, admitted to our department and randomized into two groups: carotid endarterectomy with patch angioplasty and eversion carotid endarterectomy. Follow-up for 30 days after surgery. RESULTS: During surgery e-CEA, 70% patients had an arrhythmia, and 24 hours after 66.7%, seven days after 46.7% and month after 13.3%. During surgery p-CEA, 33.3% patients had an arrhythmia, 24 hours later 33.3%, 7 days after 13.3% and 30 days after 13.3% patients. Statistically significant difference observed during surgery (Fishers p=0.004). One day after the surgery rate of patients with arrhythmia that were treated e-CEA has decreased, but it was still higher than after p-CEA (Fishers p=0.010). CONCLUSION: The frequency and categorization of postoperative cardiac arrhythmias after eversion carotid endarterectomy, the clinical implications of various postoperative heart rhythm disturbances and their long-term effects on patients need to be further investigate through sufficiently powered randomized controlled studies.
Asunto(s)
Angioplastia , Estenosis Carotídea , Endarterectomía Carotidea , Complicaciones Posoperatorias , Humanos , Endarterectomía Carotidea/métodos , Endarterectomía Carotidea/efectos adversos , Masculino , Femenino , Estenosis Carotídea/cirugía , Estudios Prospectivos , Anciano , Angioplastia/métodos , Persona de Mediana Edad , Método Simple Ciego , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Arritmias Cardíacas/etiologíaRESUMEN
OBJECTIVES: Transplant renal artery stenosis (TRAS) is now recognized as a curable disease with a good prognosis if intervention occurs in the early stage. However, the mid-term outcomes of TRAS when treated by percutaneous transluminal angioplasty with stent placement have yet to be fully elucidated. The purpose of this study was to compare mid-term graft and patient survival of TRAS group with a control group. PATIENTS AND METHODS: Ninety-two patients were diagnosed of TRAS between January 2016 and January 2022 in our center. Fifty-six pairs of recipients with grafts from the same donor were selected as a study group with TRAS and a control group without TRAS, respectively. All donor kidneys were from deceased organ donation rather than living donors. The primary endpoints were graft and patient survival. The secondary outcomes were changes in renal graft function. RESULTS: The mean follow-up time for the TRAS group was 43.6 months, while the mean follow-up time for the control group was 45.3 months. In the TRAS group, the age of patients ranged from 11 to 62 years with 39 males and 17 females. In the control group, the age of patients ranged from 18 to 67 years with 40 males and 16 females. In the TRAS group, there were more patients with diabetic nephropathy as the primary renal disease compared to the control group (5/56 vs 0/56), and the incidence of acute rejection was higher in the TRAS group than in the control group (12/56 vs 3/56). Eight patients in the TRAS group and one patient in the control group experienced graft loss (p = .019). Four patients in the TRAS group and four patients in the control group died with functional renal allograft during the follow-up time (p = .989). The levels of eGFR did not differ significantly between the two groups in the first three years after kidney transplant (p > .05). Patients in the TRAS group had worse graft functionality (eGFR, 44.96 ± 18.9 vs 54.9 ± 19.6 mL/min) in the fourth year when compared with the control group (p = .01). CONCLUSIONS: The graft function deteriorated faster, and graft survival was lower in the TRAS group treated by stent placement when compared with a control group without TRAS over the mid-term.
Asunto(s)
Supervivencia de Injerto , Trasplante de Riñón , Obstrucción de la Arteria Renal , Stents , Humanos , Masculino , Femenino , Obstrucción de la Arteria Renal/cirugía , Obstrucción de la Arteria Renal/etiología , Obstrucción de la Arteria Renal/terapia , Obstrucción de la Arteria Renal/mortalidad , Persona de Mediana Edad , Trasplante de Riñón/efectos adversos , Adulto , Estudios Retrospectivos , Anciano , Adulto Joven , Adolescente , Niño , Cadáver , Angioplastia/métodos , Tasa de Filtración GlomerularRESUMEN
OBJECTIVE: Computed tomography angiography (CTA) is a well-established diagnostic modality for carotid stenosis. However, false-positive CTA results may expose patients to unnecessary procedural complications in cases where surgical intervention is not warranted. We aim to assess the correlation of CTA to digital subtraction angiography (DSA) in carotid stenosis and characterize patients who were referred for intervention based on CTA and did not require it based on DSA. METHODS: We retrospectively reviewed 186 patients who underwent carotid angioplasty and stenting following preprocedural CTA at our institution from April 2017 to December 2022. RESULTS: Twenty-one of 186 patients (11.2%) were found to have <50% carotid stenosis on DSA (discordant group). Severe plaque calcification on CTA was associated with a discordant degree of stenosis on DSA (LR+=7.4). Among 186 patients, agreement between the percentage of stenosis from CTA and DSA was weak-moderate (r2=0.27, P<0.01). Among concordant pairs, we found moderate-strong agreement between CTA and DSA (adj r2=0.37) (P < 0.0001). Of 186 patients, 127 patients had CTA stenosis of ≥70%, and 59 had CTA of 50%-69%. Correlation between CTA and DSA in severe CTA stenosis was weak (r2=0.11, P<0.01). CONCLUSIONS: In patients with stenosis found on CTA, over 88% also had stenosis on DSA, with this positive predictive value in line with previous studies. The percent-stenosis value from CTA and DSA was weakly correlated but does not affect the overall clinical judgement of stenosis. Severe calcification found on CTA may potentially indicate nonstenosis on DSA.
Asunto(s)
Angiografía de Substracción Digital , Estenosis Carotídea , Angiografía por Tomografía Computarizada , Humanos , Angiografía de Substracción Digital/métodos , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Femenino , Masculino , Anciano , Angiografía por Tomografía Computarizada/métodos , Estudios Retrospectivos , Persona de Mediana Edad , Anciano de 80 o más Años , Stents , Angioplastia/métodos , Angiografía Cerebral/métodosRESUMEN
PURPOSE: Although thrombolysis obliterans (TAO) has been recognized for more than a century, there is no optimal treatment for this disease. The aim of this report was to compare the short-term efficacies of catheter-directed thrombolysis (CDT), percutaneous transluminal angioplasty (PTA) and CDT+PTA in treating TAO disease. METHOD: Consecutive patients with TAO treated at Ganzhou People's Hospital between 2012 and 2022 were included in this retrospective study. According to the information provided in the medical records, endovascular procedures included CDT, PTA or CDT+PTA. One-year follow-up outcomes of the patients with TAO who underwent endovascular procedures were compared. The primary outcome was major adverse limb event (MALE) and the secondary outcomes were the technical success, complications, ABI at 1 week after surgery and minor amputation. RESULTS: Sixty-nine patients with TAO were assessed for inclusion in our single-center study from 2012 to 2022 and received endovascular procedures. Among them, 22 patients underwent CDT, 21 patients underwent PTA, and 26 patients underwent PTA+CDT. The one-year follow-up revealed significant differences in the MALE-free survival rates among the three groups, particularly between the CDT group and the PTA+CDT group (the hazard ratio (HR) for MALE-free survival was 0.173, 95% CI [0.050-0.599], p = 0.006). The technical success rates of the three groups were 63.6%, 90.5%, and 92.3%, respectively. There were differences in the ABI at one week after surgery among the three groups. CONCLUSIONS: Endovascular procedures are effective for TAO in the short term. The effectiveness of CDT alone is suboptimal; combining CDT with PTA achieves the most favorable endovascular treatment outcome; while the effectiveness of PTA falls in between these two procedures.
Asunto(s)
Procedimientos Endovasculares , Extremidad Inferior , Tromboangitis Obliterante , Humanos , Tromboangitis Obliterante/terapia , Tromboangitis Obliterante/cirugía , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Extremidad Inferior/cirugía , Extremidad Inferior/irrigación sanguínea , Procedimientos Endovasculares/métodos , Resultado del Tratamiento , Terapia Trombolítica/métodos , Amputación Quirúrgica/estadística & datos numéricos , Angioplastia/métodosAsunto(s)
Estenosis Carotídea , Toma de Decisiones Conjunta , Participación del Paciente , Stents , Humanos , Estenosis Carotídea/cirugía , Estenosis Carotídea/terapia , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/complicaciones , Toma de Decisiones Clínicas , Resultado del Tratamiento , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Factores de Riesgo , Angioplastia/instrumentación , Angioplastia/efectos adversosRESUMEN
PURPOSE: This study aimed to investigate the effectiveness and safety of endovascular revascularisation of intracranial artery occlusion and stenosis in moyamoya disease using stent angioplasty. MATERIALS AND METHODS: We recruited 12 patients (8 women and 4 men) with occlusion and stenosis of intracranial arteries in the context of moyamoya disease who underwent endovascular stent angioplasty. Clinical data, baseline conditions, lesion location, treatment outcomes, periprocedural complications, and follow-up outcomes were analysed. RESULTS: The occlusion was located at the M1 segment of the middle cerebral artery in 8 patients, at both the M1 and A2 segments in one patient, and at the C7 segment of the internal carotid artery in 3. Thirteen stents were deployed at the occlusion site, including the low-profile visualized intraluminal support (LVIS) device in 8 patients, an LVIS device and a Solitaire AB stent in one, and a Leo stent in 3, with a success rate of 100% and no intraprocedural complications. Plain CT imaging after stenting revealed leakage of contrast agent, which disappeared on the second day, resulting in no clinical symptoms or neurological sequelae. Follow-up angiography studies were performed in all patients for 6-12 months (mean, 8.8). Slight asymptomatic in-stent stenosis was observed in 2 patients (16.7%), and no neurological deficits were observed in the other patients. All preoperative ischaemic symptoms completely disappeared at follow-up. CONCLUSION: Stent angioplasty is a safe and effective treatment for occlusion and stenosis of intracranial arteries in moyamoya disease.
Asunto(s)
Procedimientos Endovasculares , Enfermedad de Moyamoya , Stents , Humanos , Enfermedad de Moyamoya/cirugía , Femenino , Masculino , Adulto , Resultado del Tratamiento , Persona de Mediana Edad , Angioplastia , Adulto Joven , AdolescenteRESUMEN
To investigate the effect and safety of percutaneous endovascular angioplasty (PEA) with optional stenting for the treatment of severe stenosis or occlusion of subclavian artery, patients with severe stenosis ≥ 70% or occlusion of subclavian artery treated with PEA were retrospectively enrolled. The clinical data were analyzed. A total of 222 patients were retrospectively enrolled, including 151 males (68.0%) and 71 females (32.0%) aged 48-86 (mean 63.9 ± 9.0) years. Forty-seven (21.2%) patients had comorbidities. Subclavian artery stenosis ≥ 70% was present in 201 (90.5%) patients and complete subclavian occlusion in 21 (9.5%) cases. Angioplasty was successfully performed in all (100%) patients. Balloon-expandable stents were used in 190 (85.6%) cases, and self-expandable stents in 20 (9.0%) cases. Only 12 (5.4%) cases were treated with balloon dilation only. Among 210 patients treated with stent angioplasty, 71 (33.8% or 71/210) cases underwent balloon pre-dilation, 139 (66.2% or 139/210) had direct deployment of balloon-expandable stents, and 2 (1.0% or 2/210) experienced balloon post-dilation. Distal embolization protection devices were used in 5 (2.3% or 5/222) cases. Periprocedural complications occurred in 3 (1.4%) patients, including aortic dissection in 2 (0.9%) cases and right middle cerebral artery embolism in 1 (0.5%). No hemorrhage occurred. Among 182 (82.0%) patients with 6-month follow-up, restenosis > 70% occurred in 1 (0.5%) patient, and among 68 (30.6%) patients with 12-month follow-up, restenosis > 70% took place in 11 (16.2%) patients. Percutaneous endovascular angioplasty can be safely and efficiently performed for the treatment of severe stenosis ≥ 70% or occlusion of subclavian artery.
Asunto(s)
Stents , Arteria Subclavia , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Arteria Subclavia/cirugía , Estudios Retrospectivos , Stents/efectos adversos , Resultado del Tratamiento , Síndrome del Robo de la Subclavia/terapia , Síndrome del Robo de la Subclavia/cirugía , Procedimientos Endovasculares/métodos , Procedimientos Endovasculares/efectos adversos , Angioplastia/métodos , Angioplastia/efectos adversos , Constricción Patológica/terapia , Angioplastia de Balón/métodos , Angioplastia de Balón/efectos adversos , Arteriopatías Oclusivas/terapia , Arteriopatías Oclusivas/cirugíaRESUMEN
BACKGROUND: Unsuccessful recanalisation or reocclusion after thrombectomy is associated with poor outcomes in patients with large vessel occlusion (LVO) acute ischaemic stroke (LVO-AIS). Bailout angioplasty or stenting (BAOS) could represent a promising treatment for these patients. We conducted a randomised controlled trial with the aim to investigate the safety and efficacy of BAOS following thrombectomy in patients with LVO. METHODS: ANGEL-REBOOT was an investigator-initiated, multicentre, prospective, randomised, controlled, open-label, blinded-endpoint clinical trial conducted at 36 tertiary hospitals in 19 provinces in China. Participants with LVO-AIS 24 h after symptom onset were eligible if they had unsuccessful recanalisation (expanded Thrombolysis In Cerebral Infarction score of 0-2a) or risk of reocclusion (residual stenosis >70%) after thrombectomy. Eligible patients were randomly assigned by the minimisation method in a 1:1 ratio to undergo BAOS as the intervention treatment, or to receive standard therapy (continue or terminate the thrombectomy procedure) as a control group, both open-label. In both treatment groups, tirofiban could be recommended for use during and after the procedure. The primary outcome was the change in modified Rankin Scale score at 90 days, assessed in the intention-to-treat population. Safety outcomes were compared between groups. This trial was completed and registered at ClinicalTrials.gov (NCT05122286). FINDINGS: From Dec 19, 2021, to March 17, 2023, 706 patients were screened, and 348 were enrolled, with 176 assigned to the intervention group and 172 to the control group. No patients withdrew from the trial or were lost to follow-up for the primary outcome. The median age of patients was 63 years (IQR 55-69), 258 patients (74%) were male, and 90 patients (26%) were female; all participants were Chinese. After random allocation, tirofiban was administered either intra-arterially, intravenously, or both in 334 [96%] of 348 participants. No between-group differences were observed in the primary outcome (common odds ratio 0·86 [95% CI 0·59-1·24], p=0·41). Mortality was similar between the two groups (19 [11%] of 176 vs 17 [10%] of 172), but the intervention group showed a higher risk of symptomatic intracranial haemorrhage (eight [5%] of 175 vs one [1%] of 169), parenchymal haemorrhage type 2 (six [3%] of 175 vs none in the control group), and procedure-related arterial dissection (24 [14%] of 176 vs five [3%] of 172). INTERPRETATION: Among Chinese patients with unsuccessful recanalisation or who are at risk of reocclusion after thrombectomy, BAOS did not improve clinical outcome at 90 days, and incurred more complications compared with standard therapy. The off-label use of tirofiban might have affected our results and their generalisability, but our findings do not support the addition of BAOS for such patients with LVO-AIS. FUNDING: Beijing Natural Science Foundation, National Natural Science Foundation of China, National Key R&D Program Beijing Municipal Administration of Hospitals Incubating Program, Shanghai HeartCare Medical Technology, HeMo (China) Bioengineering, Sino Medical Sciences Technology.
Asunto(s)
Angioplastia , Accidente Cerebrovascular Isquémico , Stents , Trombectomía , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Trombectomía/métodos , China , Accidente Cerebrovascular Isquémico/cirugía , Accidente Cerebrovascular Isquémico/terapia , Angioplastia/métodos , Resultado del Tratamiento , Estudios ProspectivosRESUMEN
BACKGROUND: Peripheral arterial disease can progress to critical limb ischemia, which is associated with high amputation rates and requires revascularization. The endovascular approach has lower long-term patency because of restenosis due to neointimal hyperplasia. Statins are significantly advantageous for patients undergoing percutaneous interventions; however, only few studies have reported surgical improvements with statin therapy after endovascular treatment in such patients. This retrospective cohort study assessed the effects of preprocedural statins on lower limb arterial angioplasty outcomes by evaluating patency and amputation rates and comparing with those without statins. METHODS: Patients who underwent percutaneous transluminal angioplasty of the lower limbs for critical ischemia of the lower limbs or for limiting claudication were included in this retrospective cohort study. Patients were categorized according to statin use prior to and during hospitalization. Patient demographics, lesion morphology, primary patency, and limb salvage rates were compared between these groups. Statistical analyses were performed using Kaplan-Meier and multivariate regression analysis. RESULTS: A total of 178 patients undergoing endovascular intervention by critical ischemia or limiting claudication were included. Approximately 80% of the procedures were ballon angioplasty. Primary patency was 73% in 1 year and preprocedural statin usage was not associated with improved primary patency rates (P = 0.2798). After adjusting the amputation outcomes for pre-established variables, such as prehospitalization statin use, diabetes, procedure indication, disease location, Trans-Atlantic Inter-Society Consensus classification, and current smoking, there was no statistically significant difference associated with preprocedural statin use in primary patency (hazard ratio: 0.87 [0.33-2.29], P = 0.79) or amputation (hazard ratio: 0.70 [0.40-1.23], P = 0.22). CONCLUSIONS: The use of preprocedural statin did not improve primary patency or amputation rates in patients undergoing peripheral angioplasty.
Asunto(s)
Amputación Quirúrgica , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Recuperación del Miembro , Extremidad Inferior , Enfermedad Arterial Periférica , Grado de Desobstrucción Vascular , Humanos , Estudios Retrospectivos , Masculino , Femenino , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/diagnóstico por imagen , Anciano , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Factores de Tiempo , Resultado del Tratamiento , Factores de Riesgo , Persona de Mediana Edad , Extremidad Inferior/irrigación sanguínea , Anciano de 80 o más Años , Claudicación Intermitente/fisiopatología , Claudicación Intermitente/terapia , Claudicación Intermitente/diagnóstico por imagen , Claudicación Intermitente/diagnóstico , Enfermedad Crítica , Estimación de Kaplan-Meier , Angioplastia/efectos adversos , Isquemia Crónica que Amenaza las ExtremidadesRESUMEN
BACKGROUND: Stent angioplasty of carotid stenosis has become established as a safe and efficient treatment method alongside carotid endarterectomy due to developments in stent design and refinement of interventional techniques. Today, the protocol for stent angioplasty is largely standardized. OBJECTIVE: The aim of this article is to provide sound insight into the development and current practice of stent angioplasty. Particular attention is paid to technical implementation and periprocedural management.
Asunto(s)
Angioplastia , Estenosis Carotídea , Stents , Humanos , Angioplastia/instrumentación , Angioplastia/métodos , Arteria Carótida Interna/cirugía , Estenosis Carotídea/cirugíaRESUMEN
OBJECTIVE: To investigate the feasibility and efficacy of combining ultrasound-guided sharp needle technique with percutaneous transluminal angioplasty (PTA) for treating outflow stenosis or dysfunction in arteriovenous fistula (AVF) among hemodialysis patients. METHODS: From October 2021 to March 2023, patients with occluded or malfunctional fistula veins not amenable to regularly angioplasty were retrospectively enrolled in the study. They underwent ultrasound-guided sharp needle intervention followed by PTA. Data on the location and length between the two veins, technical success, clinical outcomes, and complications were collected. Patency rates post-angioplasty were calculated through Kaplan-Meier analysis. RESULTS: A total of 23 patients were included. The mean length of the reconstructed extraluminal segment was 3.18 cm. The sharp needle opening was performed on the basilic vein (60.9%), brachial vein (26.1%), or upper arm cephalic vein (13%) to create outflow channels. Postoperatively, all cases presented with mild subcutaneous hematomas around the tunneling site and minor diffuse bleeding. The immediate patency rate for the internal fistulas was 100%, with 3-month, 6-month, and 12-month patency rates at 91.3%, 78.3%, and 43.5%, respectively. CONCLUSION: Sharp needle technology merged with PTA presents an effective and secure minimally invasive method for reconstructing the outflow tract, offering a new solution for recanalizing high-pressure or occluded fistulas.