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Scientific Reports Jun 2024To investigate the effect and safety of percutaneous endovascular angioplasty (PEA) with optional stenting for the treatment of severe stenosis or occlusion of...
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.
Topics: Humans; Male; Female; Aged; Middle Aged; Aged, 80 and over; Subclavian Artery; Retrospective Studies; Stents; Treatment Outcome; Subclavian Steal Syndrome; Endovascular Procedures; Angioplasty; Constriction, Pathologic; Angioplasty, Balloon; Arterial Occlusive Diseases
PubMed: 38906992
DOI: 10.1038/s41598-024-65302-y -
Journal of Neurointerventional Surgery Jun 2024To investigate associations between individual embolic protection device (EPD) use and respective center policy with periprocedural outcomes after carotid artery...
OBJECTIVE
To investigate associations between individual embolic protection device (EPD) use and respective center policy with periprocedural outcomes after carotid artery stenting (CAS).
METHODS
This analysis is based on the nationwide German statutory quality assurance database and was funded by Germany's Federal Joint Committee Innovation Fund (G-BA Innovationsfonds, 01VSF19016 ISAR-IQ). According to their policy towards EPD use, hospitals were categorized as (>90%), (10-90%), or (<10%) . Primary study outcome was in-hospital stroke or death. Univariate and multivariate regression analyses were performed.
RESULTS
Overall, 19 302 patients who had undergone CAS between 2013 and 2016 were included. The highest in-hospital stroke or death rate was found in centers, followed by and centers (3.1% vs 2.9% vs 1.8%; P<0.001). Across the whole cohort, EPD use was associated with a lower in-hospital stroke or death rate (OR=0.60; 95% CI 0.50 to 0.72). In the multivariate regression analysis, EPD use was independently associated with a lower in-hospital stroke rate (aOR=0.66; 95% CI 0.46 to 0.94). Regarding center policy, centers showed a significantly lower in-hospital mortality compared with centers (aOR=0.44; 95% CI 0.22 to 0.88).
CONCLUSIONS
In a contemporary real-world cohort with low risk of selection bias, EPD use was associated with a lower in-hospital risk of stroke. A center policy of routine EPD use was associated with lower mortality. These data support routine use of EPD during CAS to enhance patient safety.
PubMed: 38906691
DOI: 10.1136/jnis-2024-021722 -
JACC. Cardiovascular Interventions May 2024
PubMed: 38904609
DOI: 10.1016/j.jcin.2024.04.046 -
Frontiers in Cardiovascular Medicine 2024Left atrial appendage occluder (LAAO) dislodgement with embolization is a rare occurrence. If the LAAO migrates into the left atrium or ventricle, it can lead to acute...
Left atrial appendage occluder (LAAO) dislodgement with embolization is a rare occurrence. If the LAAO migrates into the left atrium or ventricle, it can lead to acute heart failure or even death in a person, necessitating urgent surgical intervention. Currently, most cases of LAAO dislodgement are managed through open-heart surgery, while percutaneous retrieval of the LAAO has been reported only in a few cases with limited associated experience. This article reports a case of a patient in whom a migrated LACbes device was successfully retrieved using a catheter-based approach, demonstrating an innovative and minimally invasive treatment strategy.
PubMed: 38903969
DOI: 10.3389/fcvm.2024.1364376 -
Interventional Neuroradiology : Journal... Jun 2024This study is the first multicentric report on the safety, efficacy, and technical performance of utilizing a large bore (0.081″ inner diameter) access catheter in...
INTRODUCTION
This study is the first multicentric report on the safety, efficacy, and technical performance of utilizing a large bore (0.081″ inner diameter) access catheter in neurovascular interventions.
METHODS
Data were retrospectively collected from seven sites in the United States for neurovascular procedures via large bore 0.081″ inner diameter access catheter (Benchmark BMX81, Penumbra, Inc.). The primary outcome was technical success, defined as the access catheter reaching its target vessel. Safety outcomes included periprocedural device-related and access site complications.
RESULTS
There were 90 consecutive patients included. The median age of the patients was 63 years (IQR: 53, 68); 53% were female. The most common interventions were aneurysm embolization (33.3%), carotid stenting (12.2%), and arteriovenous malformation embolization (11.1%). The transradial approach was most used (56.7%), followed by transfemoral (41.1%). Challenging anatomic variations included severe vessel tortuosity (8/90, 8.9%), type 2 aortic arch (7/90, 7.8%), type 3 aortic arch (2/90, 2.2%), bovine arch (2/90, 2.2%), and severe angle (<30°) between the subclavian artery and target vessel (1/90, 1.1%). Technical success was achieved in 98.9% of the cases (89/90), with six cases requiring a switch from radial to femoral (6.7%) and one case from femoral to radial (1.1%). There were no access site complications or complications related to the 0.081″ catheter. Two postprocedural complications occurred (2.2%), unrelated to the access catheter.
CONCLUSION
The BMX™ 81 large-bore access catheters was safe and effective in both radial and femoral access across a wide range of neurovascular procedures, achieving high technical success without any access site or device-related complications.
PubMed: 38899910
DOI: 10.1177/15910199241262848 -
Neurologia Medico-chirurgica Jun 2024There is a lack of data regarding the safety and effectiveness of implanting the Pipeline Embolization Device with Shield technology (PED-Shield) compared with the...
There is a lack of data regarding the safety and effectiveness of implanting the Pipeline Embolization Device with Shield technology (PED-Shield) compared with the previous generation of Pipeline (PED-Flex). This retrospective single-center study aimed to compare treatment outcomes between the PED-Shield and PED-Flex for treating unruptured internal carotid artery aneurysms. The PED-Flex was used in 62 procedures (67 aneurysms, 59 patients) and the PED-Shield in 53 procedures (59 aneurysms, 58 patients). The mean aneurysm diameter was significantly lower in the PED-Shield group than in the PED-Flex group (11.9 ± 7.0 mm vs. 15.2 ± 6.9 mm, p < 0.001). At the 12-month follow-up, the complete angiographic occlusion rate was 72.1% and 72.3% in the PED-Flex and PED-Shield groups, respectively (p = 0.9808). Limited to aneurysms larger than 10 mm, 70.6% and 68.0%, respectively (p = 0.8175). The incidence of more than three high signal intensity areas on diffusion-weighted imaging after treatment was significantly lower in the PED-Shield group than in the PED-Flex group (27.7% vs. 67.7%; p < 0.001). Limited to aneurysms larger than 10 mm, 41.1% and 69.6%, respectively (p < 0.0117). Symptomatic ischemic complications occurred within 30 days of four PED-Flex procedures (6.5%) and one PED-Shield procedure (2.0%) (p = 0.2315). Limited to aneurysms larger than 10 mm, 1.8% and 3.2%, respectively (p = 0.6677). The incidence of mRS score worsening at 6 months was 3.2% and 1.9% in the PED-Flex and PED-Shield groups, respectively (p = 0.6534). The PED-Shield can achieve outcomes equivalent to or better than the PED-Flex. Further large-scale studies are warranted to confirm our findings.
PubMed: 38897939
DOI: 10.2176/jns-nmc.2024-0034 -
Polish Archives of Internal Medicine Jun 2024Diagnosis of lead related infective endocarditis (LRIE) is often a real challenge. Current diagnostic criteria include LRIE definite and possible.
INTRODUCTION
Diagnosis of lead related infective endocarditis (LRIE) is often a real challenge. Current diagnostic criteria include LRIE definite and possible.
OBJECTIVES
Comparison of the outcomes of patients with definite and possible LRIE undergoing transvenous lead extraction (TLE) procedures.
PATIENTS AND METHODS
A retrospective analysis of data from 3782 patients undergoing TLE between 2006 and 2023 was performed. The study included 838 patients with definite and possible LRIE. The analysis of clinical data and short and long-term survival was performed.
RESULTS
The comparison of clinical data showed more frequent occurrence of vegetations (81.58% vs 37.21%; P <0.001), positive blood cultures (66.12 % vs 51.64%; P <0.001) and septic pulmonary embolism (40.14% vs 13.78%; P <0.001) in patients with definite LRIE. Long-term mortality of patients with definite and possible LRIE (median follow up 4.61 [1.04-9.40] and 5.06 [2.07-8.75] years respectively) was 61.14% vs 49.29%; P <0.001. Predictors of mortality in patients with marked LRIE include advanced age, low left ventricular ejection fraction (LVEF), comorbidities, septic pulmonary embolism, positive blood culture, and the presence of an abandoned lead. In possible LRIE, only the influence of advanced age, low LVEF and comorbidities was demonstrated. There has been no documented direct impact of delayed diagnosis on the long-term survival of patients after TLE Conclusions: The study documented better survival in patients with possible LRIE, which confirms the need to use extended diagnostic criteria for LRIE. Implementation of appropriate treatment at an early stage of infection allows for improved prognosis.
PubMed: 38895973
DOI: 10.20452/pamw.16775 -
Journal of Clinical Medicine Jun 2024At present, the patent foramen ovale (PFO) does not receive the deserved medical attention. The PFO poses a serious threat to health and even the life of mankind. The... (Review)
Review
At present, the patent foramen ovale (PFO) does not receive the deserved medical attention. The PFO poses a serious threat to health and even the life of mankind. The first respective case report in the medical literature dates back to the 19th century. It led to death. The fact that a PFO is present in roughly 25% of people underscores its overall potential to cause harm. Yet at the same time, the sheer number discourages the medical community from screening for it and from treating it. About 5% of the population have particularly dangerous forms of PFOs. Such PFOs portray a high enough risk for clinical events, the likes of death, stroke, myocardial infarction, or ocular, visceral, and peripheral embolism, to justify screening for them. Highly significant health incidents being at stake, it appears obvious that PFO closure should be used for primary prevention. This is supported by the fact that closing a PFO is the simplest intervention in cardiology, with presumably the highest clinical yield. Being mainly a preventive measure, PFO closure represents a mechanical vaccination. When closing PFOs for one of the rarer therapeutic indications (migraine, platypnea orthodeoxia, etc.), patients automatically profit from the collateral benefit of getting, at the same time, mechanically vaccinated for life against paradoxical embolism. Vice versa, closing a PFO for the prevention of paradoxical embolism betters or cures migraine or exercise dyspnea not infrequently, thereby improving quality of life as a collateral benefit.
PubMed: 38893065
DOI: 10.3390/jcm13113355 -
Journal of Clinical Medicine May 2024Pulmonary embolism (PE) is a common acute cardiovascular condition. Within this review, we discuss the incidence, pathophysiology, and treatment options for patients... (Review)
Review
Pulmonary embolism (PE) is a common acute cardiovascular condition. Within this review, we discuss the incidence, pathophysiology, and treatment options for patients with high-risk and massive pulmonary embolisms. In particular, we focus on the role of mechanical circulatory support devices and their possible therapeutic benefits in patients who are unresponsive to standard therapeutic options. Moreover, attention is given to device selection criteria, weaning protocols, and complication mitigation strategies. Finally, we underscore the necessity for more comprehensive studies to corroborate the benefits and safety of MCS devices in PE management.
PubMed: 38892871
DOI: 10.3390/jcm13113161 -
Journal of Medical Case Reports Jun 2024The aim of this case report is to evaluate minimally invasive stabilization using screws and cement for acetabular metastatic tumor and summarize the indications and...
BACKGROUND
The aim of this case report is to evaluate minimally invasive stabilization using screws and cement for acetabular metastatic tumor and summarize the indications and contraindications for minimally invasive stabilization of acetabular metastatic tumors with screw and cement techniques.
CASE PRESENTATION
Under imaging guidance, a patient with acetabular metastatic tumor was treated with hollow screw combined with bone cement fixation. Ischial screw, ascending branch screw, and anterior and posterior screws were inserted to firmly fix the anterior and posterior column of the acetabulum. At the same time, the third screw connected the anterior and posterior columns together, combined with bone cement into the fracture site to further increase local stability and resist bone defects caused by local tumor osteolysis. The patient was a 52-year-old Uygur male. Herein, we summarize his clinical symptoms and operation. Differences in visual analog scale and walking function (Musculoskeletal Tumor Society) before operation and at 2 months, 6 months, and 12 months after operation were compared.
RESULTS
Postoperative complications and tumor progression were recorded. The patient was followed up for 16 months, and the operative time was 60 minutes. In total, 20 ml of bone cement was injected into the acetabular posterior column and the top of the acetabulum. VIsual analog scale score was 8 before operation, 3 at 2 months, 3 at 6 months, and 2 at 12 months after operation. Musculoskeletal Tumor Society function was 13 before operation, 23 at 2 months, 25 at 6 months, and 26 at 12 months after operation. During follow-up, no cement leakage, fever, hip nerve injury, pulmonary embolism, or imaging findings of further destruction of the acetabulum and surrounding bone were noted.
CONCLUSION
This case report shows that the treatment of acetabular metastatic cancer with minimally invasive stabilization using screws and cement under the C arm can effectively relieve pain and enhance the strength of the pelvis, and is innovative and feasible.
Topics: Humans; Male; Acetabulum; Middle Aged; Bone Cements; Bone Neoplasms; Bone Screws; Minimally Invasive Surgical Procedures; Treatment Outcome
PubMed: 38886832
DOI: 10.1186/s13256-024-04604-1