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Frontiers in Neurology 2023In-stent restenosis (ISR) is an adverse and notable event in the treatment of intracranial atherosclerotic stenosis (ICAS) with percutaneous transluminal angioplasty and...
BACKGROUND
In-stent restenosis (ISR) is an adverse and notable event in the treatment of intracranial atherosclerotic stenosis (ICAS) with percutaneous transluminal angioplasty and stenting (PTAS). The incidence and contributing factors have not been fully defined. This study was performed to evaluate factors associated with ISR after PTAS.
DATA SOURCE
We identified studies on ISR after PTAS from an electronic search of articles in PubMed, Ovid MEDLINE, and the Cochrane Central Database (dated up to July 2022).
RESULTS
A total of 19 studies, including 452 cases of ISR after 2,047 PTAS, were included in the meta-analysis. The pooled incidence rate of in-stent restenosis was 22.08%. ISR was more likely to occur in patients with coronary artery disease (OR = 1.686; 95% CI: 1.242-2.288; = 0.0008), dissection (OR = 6.293; 95% CI: 3.883-10.197; < 0.0001), and higher residual stenosis (WMD = 3.227; 95% CI: 0.142-6.311; = 0.0404). Patients treated with Wingspan stents had a significantly higher ISR rate than those treated with Enterprise stents (29.78% vs. 14.83%; < 0.0001).
CONCLUSIONS
The present study provides the current estimates of the robust effects of some risk factors for in-stent restenosis in intracranial atherosclerotic stenosis. The Enterprise stent had advantages compared with the Wingspan stent for ISR. The significant risk factors for ISR were coronary artery disease, dissection, and high residual stenosis. Local anesthesia was a suspected factor associated with ISR.
PubMed: 37521300
DOI: 10.3389/fneur.2023.1170110 -
Journal of Vascular Surgery Jun 2005Duplex ultrasound is widely used for the diagnosis of internal carotid artery stenosis. Standard duplex ultrasound criteria for the grading of internal carotid artery... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Duplex ultrasound is widely used for the diagnosis of internal carotid artery stenosis. Standard duplex ultrasound criteria for the grading of internal carotid artery stenosis do not exist; thus, we conducted a systematic review and meta-analysis of the relation between the degree of internal carotid artery stenosis by duplex ultrasound criteria and degree of stenosis by angiography.
METHODS
Data were gathered from Medline from January 1966 to January 2003, the Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, ACP Journal Club, UpToDate, reference lists, and authors' files. Inclusion criteria were the comparison of color duplex ultrasound results with angiography by the North American Symptomatic Carotid Endarterectomy Trial method; peer-reviewed publications, and >/=10 adults.
RESULTS
Variables extracted included internal carotid artery peak systolic velocity, internal carotid artery end diastolic velocity, internal carotid artery/common carotid artery peak systolic velocity ratio, sensitivity and specificity of duplex ultrasound scanning for internal carotid artery stenosis by angiography. The Standards for Reporting of Diagnostic Accuracy (STARD) criteria were used to assess study quality. Sensitivity and specificity for duplex ultrasound criteria were combined as weighted means by using a random effects model. The threshold of peak systolic velocity >/=130 cm/s is associated with sensitivity of 98% (95% confidence intervals [CI], 97% to 100%) and specificity of 88% (95% CI, 76% to 100%) in the identification of angiographic stenosis of >/=50%. For the diagnosis of angiographic stenosis of >/=70%, a peak systolic velocity >/=200 cm/s has a sensitivity of 90% (95% CI, 84% to 94%) and a specificity of 94% (95% CI, 88% to 97%). For each duplex ultrasound threshold, measurement properties vary widely between laboratories, and the magnitude of the variation is clinically important. The heterogeneity observed in the measurement properties of duplex ultrasound may be caused by differences in patients, study design, equipment, techniques or training.
CONCLUSIONS
Clinicians need to be aware of the limitations of duplex ultrasound scanning when making management decisions.
Topics: Blood Flow Velocity; Carotid Artery, Internal; Carotid Stenosis; Humans; Radiography; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex
PubMed: 15944595
DOI: 10.1016/j.jvs.2005.02.044 -
Journal of Vascular Surgery Aug 2022Studies have investigated the effects of gender on vascular surgery care. However, to the best of our knowledge, no comprehensive synthesis of the literature has been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Studies have investigated the effects of gender on vascular surgery care. However, to the best of our knowledge, no comprehensive synthesis of the literature has been performed on the presentation severity and postoperative outcomes for abdominal aortic aneurysms (AAAs), carotid artery stenosis (CAS), peripheral artery disease (PAD), and type B aortic dissection (TBAD). We conducted a systematic review and meta-analysis of the sex and gender differences in the presentation severity and outcomes for patients who had undergone major vascular surgery.
METHODS
The MEDLINE, Embase, and Cochrane CENTRAL databases were searched from their inception to December 2020. All observational studies and randomized controlled trials that had evaluated the gender differences in presentation severity or outcomes for patients who had undergone open or endovascular AAA or TBAD repair, carotid endarterectomy or stenting, or lower extremity bypass or angioplasty were included. The presentation severity was defined as follows: AAA (symptomatic or ruptured vs asymptomatic), carotid artery disease (symptomatic vs asymptomatic), PAD (chronic limb-threatening ischemia [CLTI] vs claudication), and TBAD (complicated vs uncomplicated). The postoperative outcomes included long-term mortality, stroke, amputation, revascularization, and graft and/or stent thrombosis. A random effects model was used to derive the odds ratios (ORs), risk ratios (RRs), and 95% confidence intervals (CIs).
RESULTS
A total of 236 studies met the inclusion criteria for our systematic review. Of the 236 studies, 86 (n = 2,099,534 patients), 62 (n = 2,300,888 patients), 28 (n = 2,394,143 patients), and 4 (n = 4525 patients) had evaluated the effects of gender on the outcomes for patients with AAA, CAS, PAD, and TBAD, respectively. The female patients were more likely to have presented with a ruptured AAA (OR, 1.18; 95% CI, 1.09-1.28) and CLTI (OR, 1.10; 95% CI, 1.02-1.19) than were the male patients. The all-cause mortality for those with an AAA (RR, 1.35; 95% CI, 1.20-1.52) and those with PAD (RR, 1.14; 95% CI, 1.05-1.23) was higher for the women. However, the female patients with CAS had had lower all-cause mortality (RR, 0.85; 95% CI, 0.76-0.94). No sex differences were found in the TBAD outcomes.
CONCLUSIONS
We found that female patients who had undergone vascular surgery were associated with more severe disease at presentation, with a greater proportion of ruptured AAAs and CLTI. This potentially contributes to the higher mortality rates for female patients with AAAs and PAD compared with male patients. Future studies are needed to evaluate the reasons for these disparities, and greater efforts are required to support women in receiving more timely vascular surgical care.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Carotid Stenosis; Endovascular Procedures; Female; Humans; Male; Peripheral Arterial Disease; Risk Factors; Sex Factors; Treatment Outcome
PubMed: 35257798
DOI: 10.1016/j.jvs.2022.02.030 -
Stroke May 2003The purpose of this work was to review and compare published data on the diagnostic value of duplex ultrasonography (DUS), MR angiography (MRA), and conventional digital... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND AND PURPOSE
The purpose of this work was to review and compare published data on the diagnostic value of duplex ultrasonography (DUS), MR angiography (MRA), and conventional digital subtraction angiography (DSA) for the diagnosis of carotid artery stenosis.
METHODS
We performed a systematic review of published studies retrieved through PUBMED, from bibliographies of review papers, and from experts. The English-language medical literature was searched for studies that met the selection criteria: (1) The study was published between 1994 and 2001; (2) MRA and/or DUS was performed to estimate the severity of carotid artery stenosis; (3) DSA was used as the standard of reference; and (4) the absolute numbers of true positives, false negatives, true negatives, and false positives were available or derivable for at least one definition of disease (degree of stenosis).
RESULTS
Sixty-three publications on duplex, MRA, or both were included in the analysis, yielding the test results of 64 different patient series on DUS and 21 on MRA. For the diagnosis of 70% to 99% versus <70% stenosis, MRA had a pooled sensitivity of 95% (95% CI, 92 to 97) and a pooled specificity of 90% (95% CI, 86 to 93). These numbers were 86% (95% CI, 84 to 89) and 87% (95% CI, 84 to 90) for DUS, respectively. For recognizing occlusion, MRA yielded a sensitivity of 98% (95% CI, 94 to 100) and a specificity of 100% (95% CI, 99 to 100), and DUS had a sensitivity of 96% (95% CI, 94 to 98) and a specificity of 100% (95% CI, 99 to 100). A multivariable summary receiver-operating characteristic curve (ROC) analysis for diagnosing 70% to 99% stenosis demonstrated that the type of MR scanner predicted the performance of MRA, whereas the presence of verification bias predicted the performance of DUS. For diagnosing occlusion, no significant heterogeneity was found for MRA; for DUS, the presence of verification bias and type of DUS scanner were explanatory variables. MRA had a significantly better discriminatory power than DUS in diagnosing 70% to 99% stenosis (regression coefficient, 1.6; 95% CI, 0.37 to 2.77). No significant difference was found in detecting occlusion (regression coefficient, 0.73; 95% CI, -2.06 to 3.51).
CONCLUSIONS
These results suggest that MRA has a better discriminatory power compared with DUS in diagnosing 70% to 99% stenosis and is a sensitive and specific test compared with DSA in the evaluation of carotid artery stenosis. For detecting occlusion, both DUS and MRA are very accurate.
Topics: Angiography, Digital Subtraction; Carotid Stenosis; Cerebral Infarction; Endarterectomy, Carotid; False Negative Reactions; False Positive Reactions; Humans; Intracranial Embolism; Magnetic Resonance Angiography; Predictive Value of Tests; Prevalence; ROC Curve; Randomized Controlled Trials as Topic; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Ultrasonography, Doppler, Duplex
PubMed: 12690221
DOI: 10.1161/01.STR.0000068367.08991.A2 -
Vascular and Endovascular Surgery Feb 2017Drug-eluting balloon (DEB) and drug-eluting stent (DES) have been proposed for the treatment of infrapopliteal artery disease. We performed a systematic review and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Drug-eluting balloon (DEB) and drug-eluting stent (DES) have been proposed for the treatment of infrapopliteal artery disease. We performed a systematic review and meta-analysis of the current available studies investigating outcomes of DEB and DES in the treatment of infrapopliteal artery disease.
METHODS
Multiple databases were systematically searched to identify studies investigating the outcomes of DEB and DES in the treatment of patients with infrapopliteal artery disease. The quality of studies was assessed by Cochrane Collaboration method. The demographic data, risk factors, outcomes, and antiplatelet strategy were extracted.
RESULTS
Nine studies were identified with 707 and 606 patients in DEB/DES and standard percutaneous balloon angioplasty (PTA)/bare metal stenting (BMS) group, respectively. The risk of target lesion revascularization (TLR; odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.23-0.63, P < .01), restenosis rate (OR = 0.30, 95% CI: 0.18-0.50, P < .01), and amputation rate (OR = 0.49, 95% CI: 0.29-0.83, P < .01) significantly decreased in the DES group. The overall survival (OR = 0.86, 95% CI: 0.56-1.32, P = .50) was similar in DES and standard PTA/BMS group; TLR (OR = 0.59, 95% CI: 0.32-1.09, P = .09), restenosis rate (OR = 0.49, 95% CI: 0.11-2.14, P = .35), amputation rate (OR = 1.32, 95% CI: 0.51-3.40, P = .57), and overall survival (OR = 1.40, 95% CI: 0.72-2.71, P = .32) were similar in DEB and standard PTA group.
CONCLUSION
The present meta-analysis suggests that compared with standard PTA/BMS, DES may decrease the risk of clinically driven TLR, restenosis rate, and amputation rate without any impact on mortality. However, DEB has no obvious advantage in the treatment of infrapopliteal disease. Due to the limitations of our study, more randomized controlled trials, especially those for DEB, are necessary.
Topics: Amputation, Surgical; Angioplasty, Balloon; Chi-Square Distribution; Coated Materials, Biocompatible; Constriction, Pathologic; Drug-Eluting Stents; Humans; Limb Salvage; Odds Ratio; Peripheral Arterial Disease; Popliteal Artery; Prosthesis Design; Recurrence; Risk Factors; Time Factors; Treatment Outcome; Vascular Access Devices; Vascular Patency
PubMed: 28103754
DOI: 10.1177/1538574416689426 -
Heart & Lung : the Journal of Critical... 2017We aimed to evaluate the safety and feasibility of PCI (percutaneous coronary intervention) for coronary artery disease (CAD) in patients undergoing transcatheter aortic... (Meta-Analysis)
Meta-Analysis Review
We aimed to evaluate the safety and feasibility of PCI (percutaneous coronary intervention) for coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR) by performing a meta-analysis. A systemic search of the database was performed. Studies were included comparing TAVR versus TAVR with PCI for significant CAD in patients undergoing TAVR for severe aortic stenosis. The primary outcome was 30 day mortality and secondary outcomes were myocardial infarction, stroke, life threatening bleeding, major access site vascular complications and renal failure. There were no significant differences in 30 day and six months-one year mortality between TAVR and TAVR with PCI group. There were also no significant differences in myocardial infarction, stroke, and life threatening bleeding and major access site vascular complications between the two groups. PCI in addition to TAVR in patients with concomitant severe aortic stenosis and CAD is safe and feasible and does not increase procedural risk.
Topics: Aortic Valve; Aortic Valve Stenosis; Coronary Artery Disease; Feasibility Studies; Global Health; Humans; Kaplan-Meier Estimate; Percutaneous Coronary Intervention; Severity of Illness Index; Survival Rate; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 28088437
DOI: 10.1016/j.hrtlng.2016.12.003 -
International Journal of Stroke :... Aug 2013An important proportion of transient ischemic attack or ischemic stroke is attributable to moderate or severe (50-99%) atherosclerotic carotid stenosis or occlusion.... (Review)
Review
An important proportion of transient ischemic attack or ischemic stroke is attributable to moderate or severe (50-99%) atherosclerotic carotid stenosis or occlusion. Platelet biomarkers have the potential to improve our understanding of the pathogenesis of vascular events in this patient population. A detailed systematic review was performed to collate all available data on ex vivo platelet activation and platelet function/reactivity in patients with carotid stenosis. Two hundred thirteen potentially relevant articles were initially identified; 26 manuscripts met criteria for inclusion in this systematic review. There was no consistent evidence of clinically informative data from urinary or soluble blood markers of platelet activation in patients with symptomatic moderate or severe carotid stenosis who might be considered suitable for carotid intervention. Data from flow cytometry studies revealed evidence of excessive platelet activation in patients in the early, sub-acute, or late phases after transient ischemic attack or stroke in association with moderate or severe carotid stenosis and in asymptomatic moderate or severe carotid stenosis compared with controls. Furthermore, pilot data suggest that platelet activation may be increased in recently symptomatic than in asymptomatic severe carotid stenosis. Excessive platelet activation and platelet hyperreactivity may play a role in the pathogenesis of first or subsequent transient ischemic attack or stroke in patients with moderate or severe carotid stenosis. Larger longitudinal studies assessing platelet activation status with flow cytometry and platelet function/reactivity in symptomatic vs. asymptomatic carotid stenosis are warranted to improve our understanding of the mechanisms responsible for transient ischemic attack or stroke.
Topics: Animals; Carotid Artery Diseases; Carotid Stenosis; Humans; Platelet Activation
PubMed: 23013536
DOI: 10.1111/j.1747-4949.2012.00866.x -
Hypertension (Dallas, Tex. : 1979) Sep 2010In patients with fibromuscular dysplasia and renal artery stenosis, renal artery revascularization has been used to cure hypertension or to improve blood pressure... (Meta-Analysis)
Meta-Analysis Review
In patients with fibromuscular dysplasia and renal artery stenosis, renal artery revascularization has been used to cure hypertension or to improve blood pressure control. To provide an up-to-date assessment of the benefits and risks associated with revascularization in this condition, we performed a systematic review of studies in which hypertensive patients with fibromuscular dysplasia renal artery stenosis underwent percutaneous transluminal renal angioplasty or surgical reconstruction. We assessed how often periprocedural complications and hypertension cure and improvement occurred. We selected 47 angioplasty studies (1616 patients) and 23 surgery studies (1014 patients). Combined rates of hypertension cure, defined according to the criteria in each study, after angioplasty or surgery were estimated to be 46% (95% CI: 40% to 52%) and 58% (95% CI: 53% to 62%), respectively, with substantial variations across studies. The probability of being cured was negatively associated with patient age and time of publication. Cure rates using current definitions of hypertension cure (blood pressure <140/90 mm Hg without treatment) were only 36% and 54% after angioplasty and surgery, respectively. The combined risks of periprocedural complications were 12% and 17% after angioplasty and surgery, respectively, with less major complications after angioplasty than surgery (6% versus 15%). In conclusion, angioplasty or surgical revascularization yielded moderate benefits in patients with fibromuscular dysplasia renal artery stenosis, with substantial variation across studies. The blood pressure outcome was strongly influenced by patient age.
Topics: Angioplasty, Balloon; Fibromuscular Dysplasia; Humans; Hypertension, Renovascular; Renal Artery Obstruction; Treatment Outcome
PubMed: 20625080
DOI: 10.1161/HYPERTENSIONAHA.110.152918 -
European Journal of Vascular and... May 2014To evaluate 1 to 36 month follow-up outcomes of different endovascular treatment strategies in above-the-knee (ATK) arterial segments in patients with intermittent... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate 1 to 36 month follow-up outcomes of different endovascular treatment strategies in above-the-knee (ATK) arterial segments in patients with intermittent claudication (IC) and critical limb ischemia (CLI).
METHODS
Studies indexed in Medline and Embase from 1980 to November 2013 of randomized controlled trials comparing balloon angioplasty (PTA) or drug-eluting balloon (DEB) with optional bailout stenting, or primary stenting using a bare stent (BS) or drug-eluting stent (DES) to one another were included. Methodological quality of each trial was assessed using the Cochrane Collaboration tool, and quality of evidence was assessed using the GRADE system. Outcomes assessed were quality of life, walking capacity evaluated by treadmill or questionnaire, change in Rutherford classification, target lesion revascularization (TLR), bypass, binary restenosis, late lumen loss, stenosis grade, amputation, death, major adverse cardiac events, or event-free survival with follow-up periods of at least 1 month.
RESULTS
Twenty-three trials including 3314 patients in total were identified. Eighty-five per cent patients had IC and 15% CLI. Fifteen trials showed no systematic benefit of BS over PTA. One trial comparing DES and PTA reported no significant differences in walking capacity or Rutherford classification. Four trials showed a beneficial effect on TLR rate, but not on Rutherford classification of DEB compared with PTA. In four trials DES did not systematically perform better than BS.
CONCLUSION
In general, performing PTA with optional bailout stenting for ATK lesions is the preferred strategy in patients with IC. For CLI, more studies are needed for recommending an optimal treatment strategy.
Topics: Arterial Occlusive Diseases; Blood Vessel Prosthesis; Endovascular Procedures; Femoral Artery; Humans; Randomized Controlled Trials as Topic
PubMed: 24656874
DOI: 10.1016/j.ejvs.2014.02.011 -
Catheterization and Cardiovascular... Oct 2014To study the economic impact on payers and providers of the four main endovascular strategies for the treatment of infrainguinal peripheral artery disease. (Review)
Review
OBJECTIVES
To study the economic impact on payers and providers of the four main endovascular strategies for the treatment of infrainguinal peripheral artery disease.
BACKGROUND
Bare metal stents (BMS), drug-eluting stents (DES), and drug-coated balloons (DCB) are associated with lower target lesion revascularization (TLR) probabilities than percutaneous transluminal angioplasty (PTA), but the economic impact is unknown.
METHODS
In December 2012, PubMed and Embase were systematically searched for studies with TLR as an endpoint. The 24-month probability of TLR for each treatment was weighted by sample size. A decision-analytic Markov model was used to assess the budget impact from payers' and facility-providers' perspectives of the four index procedure strategies (BMS, DES, DCB, and PTA). Base cases were developed for U.S. Medicare and the German statutory sickness fund perspectives using current 2013 reimbursement rates.
RESULTS
Thirteen studies with 2,406 subjects were included. The reported probability of TLR in the identified studies varied widely, particularly following treatment with PTA or BMS. The pooled 24-month probabilities were 14.3%, 19.3%, 28.1%, and 40.3% for DCB, DES, BMS, and PTA, respectively. The drug-eluting strategies had a lower projected budget impact over 24 months compared to BMS and PTA in both the U.S. Medicare (DCB: $10,214; DES: $12,904; uncoated balloons $13,114; BMS $13,802) and German public health care systems (DCB €3,619; DES €3,632; BMS €4,026; PTA €4,290).
CONCLUSIONS
DCB and DES, compared to BMS and PTA, are associated with lower probabilities of target lesion revascularization and cost savings for U.S. and German payers.
Topics: Angioplasty, Balloon; Budgets; Cardiovascular Agents; Coated Materials, Biocompatible; Constriction, Pathologic; Cost Savings; Cost-Benefit Analysis; Decision Support Techniques; Drug Costs; Drug-Eluting Stents; Femoral Artery; Germany; Health Care Costs; Humans; Insurance, Health, Reimbursement; Markov Chains; Medicare; Metals; Models, Economic; Outcome and Process Assessment, Health Care; Peripheral Arterial Disease; Popliteal Artery; Stents; Treatment Outcome; United States; Vascular Access Devices
PubMed: 24782424
DOI: 10.1002/ccd.25536