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/patología

RESUMEN

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 796.9 ±â€…329.1 mL/min and 1105.1 ±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/fisiología

RESUMEN

Because there is a lack of comparative studies assessing drug-coated balloon (DCB) and drug-eluting stent (DES) outcomes with respect to intraluminal (IL) and subintimal (SI) approaches in femoropopliteal (FP) total occlusive lesions, we compared the outcomes between DCB (including bailout stenting) and DES treatments for this lesion. A total of 487 limbs (434 patients) were divided into the IL (n = 344, DCB: n = 268, DES: n = 76) and SI (n = 143, DCB: n = 83, DES: n = 60) approach groups. The primary outcome was a major adverse limb event (MALE), defined as above-ankle amputation or repeat revascularization of the index limb. Secondary outcomes included clinically driven target lesion revascularization (TLR), loss of clinical patency, and all-cause death. After adjustment, in each IL and SI approach, the 2-year rates of MALE (p = 0.180 and p = 0.236, respectively), TLR, loss of clinical patency, and all-cause death were similar between the DCB and DES groups. In the DCB and DES groups, both primary and secondary outcomes were similar between the IL and SI approaches. DCB and DES strategies for patients presenting with FP total occlusive lesions demonstrated similar outcomes regardless of the IL or SI approach.Clinical Trial Registration: NCT02748226.

Asunto(s)

Stents Liberadores de Fármacos , Arteria Femoral , Arteria Poplítea , Humanos , Masculino , Femenino , Anciano , Arteria Poplítea/cirugía , Arteria Femoral/cirugía , Resultado del Tratamiento , Persona de Mediana Edad , Enfermedad Arterial Periférica/terapia , Angioplastia de Balón/métodos , Anciano de 80 o más Años , Estudios Retrospectivos , Grado de Desobstrucción Vascular

RESUMEN

For endovascular treatment of below-the-knee (BTK) peripheral artery disease (PAD), independently adjudicated real-world outcomes comparing non-stent-based balloon angioplasty (percutaneous transluminal angioplasty) and adjunctive treatments with or without a concomitant ipsilateral femoropopliteal (FP) artery intervention are scarce. A total of 1,060 patients from the multicenter XLPAD registry who underwent non-stent-based BTK PAD intervention between 2006 and 2021 were included. The primary outcome was the 1-year incidence of major adverse limb events (MALEs), a composite of all-cause death, any amputation, or clinically driven repeat revascularization. A total of 566 patients underwent BTK and 494 BTK + FP interventions; 72% were men, with a mean age of 68.4 ± 10.9 years. Diabetes mellitus was more prevalent in the BTK-only group (76.5% vs 69%, p = 0.006). Mean Rutherford class was 4.2 ± 1.18; chronic limb-threatening ischemia was more frequent in the BTK group (55.3% vs 49%, p = 0.040). Moderate to severe calcification was more frequent in the BTK + FP group (21.2% vs 27.1%, p = 0.024), as was lesion length (110.6 ± 77.3 vs 135.4 ± 86.3 mm, p <0.001). Nearly 81% of lesions were treated with percutaneous transluminal angioplasty. Drug-coated balloon (1.6% vs 14%, p <0.001) and atherectomy (38% vs 58.5%, p <0.001) use was more frequent in the BTK + FP group. The rate of procedural success was higher in the BTK + FP group (86% vs 91%, p = 0.009), with amputation being the most common complication at 3.3% within 30 days after the procedure. The rates of 1-year MALE (21.2% vs 22.3%, p = 0.675) and mortality (4.6% vs 3.4%, p = 0.3) were similar between the BTK and BTK + FP groups. Nonstent treatment for BTK PAD with concomitant FP intervention leads to high procedural success and similar rates of 1-year MALE compared with isolated BTK intervention. Condensed Abstract: The vast majority of below-the-knee (BTK) peripheral artery disease (PAD) interventions are performed with balloon angioplasty. Presence of inflow femoropopliteal PAD in patients who undergo BTK interventions can affect the outcome of the procedure. This report explores immediate procedural success and major adverse limb events at 1 year after balloon angioplasty treatment for isolated BTK PAD and in patients who underwent an additional femoropopliteal PAD intervention.

Asunto(s)

Angioplastia de Balón , Enfermedad Arterial Periférica , Arteria Poplítea , Sistema de Registros , Humanos , Masculino , Femenino , Enfermedad Arterial Periférica/terapia , Anciano , Angioplastia de Balón/métodos , Persona de Mediana Edad , Resultado del Tratamiento , Amputación Quirúrgica , Arteria Femoral , Recuperación del Miembro

RESUMEN

Multiple clinical trials have reported favorable outcomes after drug-coated balloon therapy for peripheral artery disease in above-the-knee and below-the-knee lesions and in both de novo and in-stent restenosis. However, there are still insufficient data to identify and tackle the risk factors associated with a higher risk of restenosis, which is the primary concern for patients who are treated with an endovascular approach. A modern armamentarium, which includes improved lesion preparation techniques such as plaque modification balloons, mechanical atherectomy, intravascular lithotripsy, and imaging, is crucial for obtaining better long-term clinical outcomes. Moreover, a better understanding of the molecular properties of drug-coated balloons has led to improved devices that could tackle the shortcomings of previous generations. This comprehensive review focuses on drug-coated balloon technology as a tool to treat peripheral artery disease and the effects of the molecular mechanisms involved in preventing vascular restenosis.

Asunto(s)

Angioplastia de Balón , Enfermedad Arterial Periférica , Humanos , Enfermedad Arterial Periférica/terapia , Angioplastia de Balón/métodos , Materiales Biocompatibles Revestidos/química , Stents Liberadores de Fármacos

RESUMEN

BACKGROUND AND AIMS: Endothelial-to-mesenchymal transition (EndMT) is an important reason for restenosis but the underlying mechanisms need to be further explored. Therefore, the purpose of this study is to screen significantly different microRNAs (miRNAs) and assess their functions and downstream pathways. METHODS: This study screened several miRNAs with significant differences between human arterial segments from restenosis patients and healthy volunteers using whole transcriptome resequencing and real-time quantitative reverse transcription PCR (qRT-PCR). We explored the correlation between miR-1290 and EndMT using Western blot, qRT-PCR, Pearson correlation analysis and further functional gain and loss experiments. Subsequently, we identified the direct downstream target of miR-1290 by bioinformatics analysis, RNA pull-down, double Luciferase reporter gene and other functional experiments. Finally, rat carotid artery balloon injury model demonstrated the therapeutic potential of miR-1290 regulator. RESULTS: We screened 129 differentially expressed miRNAs. Among them, miR-1290 levels were significantly higher in restenosis arteries than in healthy arteries, and as expected, EndMT was functionally enhanced with miR-1290 overexpression and comparatively weakened when miR-1290 was knocked down. In addition, fibroblast growth factor-2 (FGF2) was established as the downstream target of miR-1290. Finally, we utilized an animal model and found that low miR-1290 levels could alleviate EndMT and the progression of restenosis. CONCLUSIONS: Our study demonstrated the strong regulatory effects of miR-1290 on EndMT, endometrial hyperplasia and restenosis, which could be useful as biomarker and therapeutic target for stent implantation in patients with arterial occlusive disease of the lower extremities.

Asunto(s)

Factor 2 de Crecimiento de Fibroblastos , MicroARNs , Animales , Femenino , Humanos , Masculino , Ratas , Angioplastia de Balón/efectos adversos , Traumatismos de las Arterias Carótidas/genética , Traumatismos de las Arterias Carótidas/patología , Traumatismos de las Arterias Carótidas/metabolismo , Traumatismos de las Arterias Carótidas/terapia , Estudios de Casos y Controles , Proliferación Celular , Modelos Animales de Enfermedad , Células Endoteliales/metabolismo , Células Endoteliales/patología , Transición Epitelial-Mesenquimal , Factor 2 de Crecimiento de Fibroblastos/metabolismo , Factor 2 de Crecimiento de Fibroblastos/genética , Regulación de la Expresión Génica , Células Endoteliales de la Vena Umbilical Humana/metabolismo , MicroARNs/metabolismo , MicroARNs/genética , Ratas Sprague-Dawley , Transducción de Señal

Asunto(s)

Angioplastia de Balón , Embolización Terapéutica , Hemoptisis , Humanos , Hemoptisis/terapia , Hemoptisis/etiología , Angioplastia de Balón/métodos , Embolización Terapéutica/métodos , Esponja de Gelatina Absorbible , Estudios de Factibilidad , Arteria Pulmonar/diagnóstico por imagen

RESUMEN

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/métodos

Asunto(s)

Angioplastia de Balón , Hipertensión Pulmonar , Embolia Pulmonar , Humanos , Hipertensión Pulmonar/terapia , Embolia Pulmonar/terapia , Angioplastia de Balón/métodos , Enfermedad Crónica

RESUMEN

This study aimed to evaluate the long-term clinical outcomes of drug-coated drug (DCB) angioplasty for long femoropopliteal lesions in older patients with chronic limb-threatening ischemia (CLTI). In this multi-center retrospective study, we enrolled 119 patients with CLTI due to Trans-Atlantic Inter-Society Consensus (TASCII) C/D femoropopliteal lesions who underwent DCB angioplasty. A total of 119 patients with 122 limbs (TASCII C = 67, 54.9%; TASCII D = 55, 45.1%) were enrolled. At 36-month follow-up, primary patency, assisted primary patency, secondary patency, and freedom from target lesion revascularization were 47.3%, 49.8%, 59.5%, and 62.7%, respectively, and there was a significant improvement over baseline in Rutherford class (P < .001) and ankle-brachial index measurements (P < .001). Complex target lesions (P = .017) and 1 stenosis-free outflow vessel (P = .001) were risk predictors of freedom from clinically driven target lesion revascularization. Complex target lesions (P = .044), diabetes (P = .007), and 1 stenosis-free outflow vessel (P = .003) were risk predictors of restenosis. At 2 months, the ulcer healing rate was 96.3% (26/27). At 36 months, the limb salvage and survival rates were 85.8% and 83.3%, respectively. DCB angioplasty were safe and effective for older patients with CLTI attributable to femoropopliteal TASCII C/D lesions.

Asunto(s)

Angioplastia de Balón , Arteria Femoral , Arteria Poplítea , Humanos , Masculino , Femenino , Estudios Retrospectivos , Anciano , Angioplastia de Balón/métodos , Arteria Poplítea/diagnóstico por imagen , Anciano de 80 o más Años , Resultado del Tratamiento , Isquemia Crónica que Amenaza las Extremidades/terapia , Enfermedad Arterial Periférica/terapia , Grado de Desobstrucción Vascular , Materiales Biocompatibles Revestidos , Persona de Mediana Edad

Asunto(s)

Angioplastia de Balón , Stents , Humanos , Resultado del Tratamiento , Angioplastia de Balón/instrumentación , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/terapia , Enfermedades de la Aorta/cirugía , Masculino , Diseño de Prótesis , Anciano

RESUMEN

PURPOSE: This research evaluates the effect of balloon pulmonary angioplasty (BPA) on cardiac electrophysiological changes in patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: Involving a retrospective analysis of 39 CTEPH patients (average age 61 ± 11), who had at least two BPAs and paired ECGs pre- and post-surgery, we examined changes in ECG indicators of right ventricular hypertrophy and their correlation with hemodynamic results. RESULTS: BPA yielded marked improvements in cardiac function and hemodynamics. ECG parameters, specifically the Lewis criteria and Butler-Leggett score, correlated strongly with hemodynamics and were predictive of a mean pulmonary arterial pressure (mPAP) ≥ 35mmHg. Notably, QRS complex axis normalization was observed in 25 patients, with 14 fully normalizing (range - 30° to + 90°). The qR pattern in V1 vanished in 9 cases, and 75% of the patients in qR pattern in V1 group had QRS complex electrical axis completely returned to normal range. The qR V1 group had higher mPAP and pulmonary vascular resistance (PVR), and lower cardiac output and index compared to the non-qR V1 group, alongside a higher Butler-Leggett score. CONCLUSIONS: BPA enhances cardiac function and hemodynamics in CTEPH patients, with certain ECG measures such as Lewis criteria and Butler-Leggett score reflecting the severity of hemodynamic impairment. The reversal of QRS axis deviation and the disappearance of the qR pattern in lead V1 may serve as valuable indicators for assessing post-BPA satisfaction in CTEPH patients.

Asunto(s)

Angioplastia de Balón , Electrocardiografía , Hipertensión Pulmonar , Embolia Pulmonar , Humanos , Estudios Retrospectivos , Persona de Mediana Edad , Masculino , Angioplastia de Balón/métodos , Hipertensión Pulmonar/fisiopatología , Hipertensión Pulmonar/cirugía , Hipertensión Pulmonar/terapia , Femenino , Embolia Pulmonar/fisiopatología , Embolia Pulmonar/complicaciones , Anciano , Enfermedad Crónica , Hemodinámica/fisiología , Arteria Pulmonar/fisiopatología , Arteria Pulmonar/cirugía

RESUMEN

Objective: To investigate the factors affecting primary patency time in arteriovenous graft (AVG) patients receiving percutaneous transluminal balloon angioplasty (PTA). Methods: Hemodialysis patients who underwent AVG placement at the First Affiliated Hospital of Chongqing Medical University between February 2018 and December 2021 were included. The factors including age, gender, total duration of AVG use, site of stenosis, degree of stenosis, length of stenosis, residual stenosis, and presence of thrombosis were analyzed, and influencing factors of primary patency time in AVG were determined using a multiple linear regression model. Results: A total of 101 patients who underwent 331 PTA treatments were enrolled, including 35 males and 66 females. The median age of patients undergoing PTA for the first time was 61 (51, 68) years, and the primary patency time after PTA was 5 (3, 10) months. The patients were followed up for (38.5±15.3) months. Multivariable linear regression analysis revealed that severe stenosis at the venous anastomosis and reflux veins (ß=-2.773, 95%CI:-5.440--0.105, P=0.042), female (ß=-2.247, 95%CI:-3.853--0.642, P=0.006), and previous multiple PTA treatments (ß=-0.516, 95%CI:-0.978--0.054, P=0.029) were risk factors for a shorter primary patency time after PTA. Conclusion: Severity of stenosis at the venous anastomosis and reflux veins of the AVG, female, and a history of multiple previous PTA treatments are associated with a shorter primary patency time in AVG patients.

Asunto(s)

Angioplastia de Balón , Derivación Arteriovenosa Quirúrgica , Diálisis Renal , Grado de Desobstrucción Vascular , Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Oclusión de Injerto Vascular , Factores de Riesgo , Constricción Patológica

RESUMEN

BACKGROUND: This retrospective study aimed to compare the efficacy of balloon angioplasty alone (BAA) with carotid artery stenting (CAS) for severe extracranial carotid artery stenosis. The primary outcomes assessed were restenosis requiring retreatment and symptomatic stroke occurrence within a 4-year follow-up period. METHODS: A total of 77 patients with 89 carotid artery stenoses undergoing endovascular carotid revascularization between January 2015 and December 2019 were included. Neuroradiologic evaluations, including computed tomography angiography or magnetic resonance angiography, were performed at defined intervals. Statistical analyses were conducted to compare patient characteristics, angiographic outcomes, and clinical outcomes between the BAA and CAS groups. RESULTS: The study demonstrated successful outcomes in both groups with low adverse event rates. The overall restenosis rate was 40.2%, but severe restenosis requiring retreatment occurred in only 10 cases (7 in BAA, and 3 in CAS). No significant difference was found in retreatment rates between the 2 groups (P = 0.53). Stroke occurrence within the 4-year follow-up period was observed in 3 patients, with no statistically significant difference between BAA and CAS groups. CONCLUSIONS: This study provides valuable insights into the comparative effectiveness of BAA and CAS for severe extracranial carotid artery stenosis. Despite slightly shorter intervals to restenosis in the BAA group, there was no significant difference in retreatment or stroke occurrence rates between the 2 procedures. BAA offers advantages in terms of retreatment options.

Asunto(s)

Angioplastia de Balón , Estenosis Carotídea , Stents , Humanos , Estenosis Carotídea/cirugía , Estenosis Carotídea/diagnóstico por imagen , Masculino , Estudios Retrospectivos , Femenino , Anciano , Angioplastia de Balón/métodos , Persona de Mediana Edad , Resultado del Tratamiento , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/cirugía , Anciano de 80 o más Años

RESUMEN

This study aimed to report the 5-year outcomes from the ILLUMENATE Pivotal randomized controlled trial of the lower dose (2 µg/mm2) Stellarex drug-coated balloon (DCB) (Philips, formerly Spectranetics Corp, Colorado Springs, Colorado) compared with percutaneous transluminal angioplasty (PTA) for the treatment of symptomatic peripheral arterial disease. Long-term safety and effectiveness data for DCBs remains limited. The ILLUMENATE Pivotal was a prospective, randomized, multi-center, single-blinded study. Patients (Rutherford Clinical Category 2 to 4) were randomized 2:1 to Stellarex DCB or PTA. Follow-up was through 60 months. In total, 300 patients were enrolled. The mean age was 68.8 ± 10.2 years. At 60 months, freedom from a primary safety event was 69.2% in the Stellarex DCB arm and 68.2% in the PTA arm (log-rank, p = 0.623). The cumulative rate of major adverse events was 41.0% compared with 44.6% (p = 0.597), respectively. Freedom from clinically-driven target lesion revascularization (CD-TLR) was 70.3% in the Stellarex DCB arm compared with 68.2% in the PTA arm (p = 0.505). Time to first CD-TLR was 768.3 ± 478.9 days compared with 613.5 ± 453.4 days, respectively (p = 0.161). Kaplan-Meier estimates of freedom from all-cause mortality were 80.1% in the Stellarex DCB arm and 80.2% in the PTA arm (log-rank, p = 0.980). In conclusion, the 5-year results of the ILLUMENATE Pivotal randomized controlled trial add to the consistent safety data from the broader ILLUMENATE clinical program. These are the first data to report the 5-year safety and efficacy of a lower dose (2 µg/mm2) DCB for the treatment of symptomatic peripheral arterial disease. Clinicaltrials.gov Registration:NCT01858428.

Asunto(s)

Angioplastia de Balón , Enfermedad Arterial Periférica , Humanos , Enfermedad Arterial Periférica/terapia , Masculino , Femenino , Anciano , Angioplastia de Balón/métodos , Estudios Prospectivos , Método Simple Ciego , Resultado del Tratamiento , Persona de Mediana Edad , Materiales Biocompatibles Revestidos , Estudios de Seguimiento , Paclitaxel/administración & dosificación , Factores de Tiempo

RESUMEN

BACKGROUND: Decreased diffusing capacity of the lungs for carbon monoxide (DLco) is associated with microvascular damage in chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) is an effective treatment for CTEPH, but the efficacy of BPA in patients with CTEPH with low DLco remains unclear because BPA does not directly address microvascular damage. This study investigates the influence of microvasculopathy on BPA in CTEPH according to DLco. METHODS: We retrospectively analysed data from patients with inoperable CTEPH who underwent BPA at the University of Tokyo Hospital from July 2011 to August 2023. The patients were classified into two groups based on their preprocedural DLco (normal DLco (ND) and low DLco (LD) groups), with a DLco cut-off value of 80%. We compared the patient characteristics and effectiveness of BPA between the groups. RESULTS: Among the 75 patients, 36 were in the LD group. The LD group had a shorter 6-minute walking distance (324±91 vs 427±114 m) than the ND group but the mean pulmonary artery pressure (mPAP) was similar (38.9±7.3 vs 41.1±9.2 mm Hg) before BPA. BPA improved the haemodynamic status and exercise tolerance in both groups. The LD group exhibited a higher mPAP (25.1±7.4 vs 21.5±5.6 mm Hg) and required more sessions of BPA (median 6 vs 4). Based on the analysis of covariance adjusted for baseline values, low DLco significantly correlated with mPAP (sß=-0.304, 95% CI -7.015 to -1.132, p=0.007) and pulmonary vascular resistance (sß=-0.324, 95% CI -141.0 to -29.81, p=0.003). CONCLUSIONS: BPA was associated with an improvement in the haemodynamic status and exercise tolerance in patients with CTEPH even with low DLco. However, low DLco may attenuate the effect of BPA on mPAP and pulmonary vascular resistance and require more treatment sessions.

Asunto(s)

Angioplastia de Balón , Hipertensión Pulmonar , Arteria Pulmonar , Embolia Pulmonar , Humanos , Masculino , Femenino , Angioplastia de Balón/métodos , Embolia Pulmonar/fisiopatología , Embolia Pulmonar/terapia , Embolia Pulmonar/complicaciones , Estudios Retrospectivos , Persona de Mediana Edad , Enfermedad Crónica , Anciano , Hipertensión Pulmonar/fisiopatología , Hipertensión Pulmonar/terapia , Hipertensión Pulmonar/etiología , Arteria Pulmonar/fisiopatología , Resultado del Tratamiento , Tolerancia al Ejercicio/fisiología , Capacidad de Difusión Pulmonar , Hemodinámica/fisiología , Resistencia Vascular/fisiología

RESUMEN

Vascular access for hemodialysis is the lifeline for patients with end-stage renal disease (ESRD); therefore, maintenance of the vascular access is of the utmost importance. The dialysis circuit can be complicated by stenosis or thrombosis. In particular, central venous stenosis is frequently encountered in the vascular access of patients with ESRD, and this complication may require endovascular management. Conventional catheter-based venography may be inadequate for identifying dynamic forms of extrinsic compression and intravascular webs associated with these lesions. For these types of access complications, balloon angioplasty remains the first-line intervention, with stenting reserved for selected scenarios. Accurate assessment of the venous configuration is therefore important to ensure an adequate treatment response. Intravascular ultrasound (IVUS) has been shown to be beneficial in lower extremity venous interventions. The use of IVUS in dialysis access interventions is currently limited but may be indicated in selected challenging clinical situations. In this article, we discuss the potential uses of IVUS in the ESRD population based on our institutional experience and on the current literature.

Asunto(s)

Derivación Arteriovenosa Quirúrgica , Fallo Renal Crónico , Valor Predictivo de las Pruebas , Diálisis Renal , Ultrasonografía Intervencional , Humanos , Fallo Renal Crónico/terapia , Fallo Renal Crónico/diagnóstico , Derivación Arteriovenosa Quirúrgica/efectos adversos , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/terapia , Oclusión de Injerto Vascular/fisiopatología , Resultado del Tratamiento , Factores de Riesgo , Angioplastia de Balón/instrumentación , Grado de Desobstrucción Vascular , Stents

RESUMEN

BACKGROUND: After drug-coated balloon (DCB) treatment of the femoropopliteal artery in-stent restenosis (ISR), a certain proportion of patients also experience target lesion restenosis. The purpose of this study was to explore the efficacy and safety of rivaroxaban combined with aspirin in the treatment of ISR after DCB intervention. METHODS: Patients who underwent DCB treatment for ISR after femoropopliteal artery intervention at our center from March 2017 to February 2022 were included consecutively. According to the drug treatment after DCB intervention of ISR, the patients were divided into rivaroxaban and aspirin group (RA Group) and dual antiplatelet therapy (DAPT) group. The outcomes of 2 groups during the 12-month follow-up after DCB intervention were compared. RESULTS: A total of 92 patients were included in final analysis, with 43 in RA group and 49 in DAPT group. During 12-month follow-up, a total of 15 cases of recurrent ISR were detected, and the recurrence rate of ISR and clinically driven target lesion revascularization in the RA group were lower than those in the DAPT group (P < 0.05). The vascular patency rate in the RA group was higher than that in the DAPT group at 6 and 12 months of follow-up (P < 0.05). During the follow-up, there were no adverse events such as death, myocardial infarction, stroke, amputation, or major bleeding, and only a total of 5 cases of minor bleeding occurred. CONCLUSIONS: Compared with the standard DAPT regimen, rivaroxaban combined with aspirin can safely improve the follow-up outcome after DCB for femoropopliteal ISR.

Asunto(s)

Angioplastia de Balón , Aspirina , Materiales Biocompatibles Revestidos , Inhibidores del Factor Xa , Arteria Femoral , Enfermedad Arterial Periférica , Inhibidores de Agregación Plaquetaria , Arteria Poplítea , Recurrencia , Rivaroxabán , Grado de Desobstrucción Vascular , Humanos , Masculino , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/fisiopatología , Rivaroxabán/administración & dosificación , Rivaroxabán/efectos adversos , Estudios Retrospectivos , Anciano , Aspirina/administración & dosificación , Aspirina/efectos adversos , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/diagnóstico por imagen , Angioplastia de Balón/instrumentación , Angioplastia de Balón/efectos adversos , Arteria Poplítea/fisiopatología , Arteria Poplítea/diagnóstico por imagen , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Persona de Mediana Edad , Resultado del Tratamiento , Factores de Tiempo , Inhibidores del Factor Xa/administración & dosificación , Inhibidores del Factor Xa/efectos adversos , Stents , Dispositivos de Acceso Vascular , Factores de Riesgo , Anciano de 80 o más Años , Terapia Antiplaquetaria Doble

Asunto(s)

Angioplastia de Balón , Hipertensión Pulmonar , Embolia Pulmonar , Humanos , Hipertensión Pulmonar/terapia , Angioplastia de Balón/métodos , Embolia Pulmonar/complicaciones , Embolia Pulmonar/terapia , Enfermedad Crónica , Arteria Pulmonar/cirugía , Masculino , Femenino

RESUMEN

BACKGROUND: Vessel injury is a common complication during balloon pulmonary angioplasty (BPA). For persistent hemoptysis, gelatin sponge embolization (GSE) is considered, but its impact on subsequent perfusion in embolized vessels remains unknown. This study explores the feasibility of revascularization in vessels post-GSE. METHODS: We included 64 vessels from 50 patients with chronic thromboembolic pulmonary hypertension who experienced hemoptysis during BPA in 2012-2023. Twenty-four vessels were treated conservatively (conservative group), while 40 were treated with GSE for persistent hemoptysis or desaturation despite conservative treatment (GSE group). We assessed hemoptysis-related parameters, perfusion of injured vessels pre- and post-treatment, and hemodynamic parameters through multiple BPA sessions. RESULTS: Hemoptysis resolved immediately after the procedure in 67% of patients, including 70% of those in the GSE group, and all cases resolved by the next day. Of 37 embolized vessels, 41% showed spontaneous perfusion improvement in subsequent sessions. BPA was reperformed in 22 embolized vessels, with 86% showing further improvement, resulting in 70% of all embolized vessels finally showing improvement in perfusion. In both groups, clinical and hemodynamic parameters significantly improved after BPA. CONCLUSIONS: Perfusion of embolized vessels improved after GSE, suggesting that GSE is safe for the treatment of severe persistent hemoptysis after conservative treatment.

Asunto(s)

Angioplastia de Balón , Embolización Terapéutica , Estudios de Factibilidad , Hemoptisis , Humanos , Hemoptisis/terapia , Hemoptisis/etiología , Masculino , Femenino , Persona de Mediana Edad , Angioplastia de Balón/métodos , Angioplastia de Balón/efectos adversos , Embolización Terapéutica/métodos , Anciano , Esponja de Gelatina Absorbible , Estudios Retrospectivos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/terapia , Resultado del Tratamiento , Adulto , Embolia Pulmonar/terapia , Embolia Pulmonar/etiología , Arteria Pulmonar