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Journal of the American College of... Nov 1993The purpose of this study was to determine whether residual stenoses after excimer laser angioplasty and atherectomy were due to inefficient tissue ablation/removal or... (Comparative Study)
Comparative Study
OBJECTIVES
The purpose of this study was to determine whether residual stenoses after excimer laser angioplasty and atherectomy were due to inefficient tissue ablation/removal or to undersized devices.
BACKGROUND
Significant residual stenoses are commonly observed after use of laser and atherectomy devices. It is not known whether these residual stenoses are due to inefficient or undersized devices.
METHODS
To determine the relative contribution of these factors, the minimal lumen diameter, percent diameter stenosis and normal reference diameter were measured immediately before and after coronary interventions in 696 lesions, including transluminal extraction atherectomy, high speed mechanical rotational atherectomy, excimer laser angioplasty and conventional balloon angioplasty. The ratio of the diameter of the device to the normal reference diameter (D/A, a measure of device sizing) and the ratio of the residual lumen diameter after use of the device to the device diameter (RLD/D, a measure of the efficiency of lumen enlargement) were calculated.
RESULTS
Baseline diameter stenoses were similar for all interventions. The percent diameter stenoses were greater immediately after extraction atherectomy (60 +/- 21%), rotational atherectomy (54 +/- 23%) and excimer laser angioplasty (61 +/- 18%) compared with balloon angioplasty (26 +/- 12%, p < 0.001). The D/A ratio was smaller after extraction atherectomy (0.63 +/- 0.14), rotational atherectomy (0.59 +/- 0.17) and excimer laser angioplasty (0.51 +/- 0.11) compared with balloon angioplasty (1.05 +/- 0.13, p < 0.001). The RLD/D ratio was similar after extraction atherectomy (0.73 +/- 0.24) and balloon angioplasty (0.71 +/- 0.11) but was greater after rotational atherectomy (0.92 +/- 0.16, p < 0.001) and excimer laser angioplasty (0.85 +/- 0.30, p < 0.01) compared with balloon angioplasty.
CONCLUSIONS
Residual stenoses after extraction atherectomy, rotational atherectomy and excimer laser angioplasty were more severe than after balloon angioplasty but were due to undersized devices (low D/A ratio), not to inefficient devices (low RLD/D ratio). Rotational atherectomy and excimer laser angioplasty were more efficient (higher RLD/D) than balloon angioplasty, whereas extraction atherectomy and balloon angioplasty were similar.
Topics: Aged; Analysis of Variance; Angioplasty, Balloon, Coronary; Angioplasty, Laser; Atherectomy, Coronary; Chi-Square Distribution; Coronary Angiography; Coronary Disease; Equipment Design; Humans; Middle Aged
PubMed: 8227830
DOI: 10.1016/0735-1097(93)90587-q -
The Journal of Cardiovascular Surgery Feb 2017Carotid artery stenting (CAS) is considered an alternative option to carotid endarterectomy (CEA) for significant carotid stenosis, in both symptomatic and asymptomatic... (Review)
Review
Carotid artery stenting (CAS) is considered an alternative option to carotid endarterectomy (CEA) for significant carotid stenosis, in both symptomatic and asymptomatic patients. Comparing to CEA, CAS offers significant advantages. The most important arise from the minimally invasive nature of the procedure, which reduces the surgical complications and adds significant comfort to the patient, without compromising the efficacy. Nowadays, CAS can achieve acute and long-term outcome results comparable to CEA, maintaining low rates of periprocedural embolic events. Evolution of the stent design and routine application of protection devices, played an important role to CAS performance. In this review, we aim to present all available new data on stent design and protection devices while we pose a set of unanswered questions that need to be addressed in the future.
Topics: Aged; Aged, 80 and over; Angioplasty; Carotid Artery Diseases; Embolic Protection Devices; Female; Humans; Male; Middle Aged; Prosthesis Design; Risk Factors; Stents; Stroke; Treatment Outcome
PubMed: 27922252
DOI: 10.23736/S0021-9509.16.09810-4 -
Journal of Vascular Surgery Jan 2023Bovine pericardial patch (BPP) is currently used in femoral angioplasty as an alternative for autologous vein patch (AVP), but studies comparing the results of the two...
OBJECTIVE
Bovine pericardial patch (BPP) is currently used in femoral angioplasty as an alternative for autologous vein patch (AVP), but studies comparing the results of the two methods are scarce. In this retrospective study, we aimed to discover the differences between BPP and AVP closure in long-term durability.
METHODS
This study consisted of all femoral endarterectomies with BPP closure performed in Helsinki University Hospital from January 1, 2014, to December 31, 2017. For comparison, the same number of consecutive patients who underwent femoral endarterectomy with AVP closure from January 1, 2014, to October 16, 2016, were reviewed. Follow-up ended December 31, 2020. The mean follow-up was 19 months (range, 0-74 months) in the BPP group and 22 months (range, 0-79 months) in the AVP group. The primary endpoint was primary patency. Secondary endpoints were restenosis at patch site detected by imaging or perioperatively, patch rupture, and deep surgical wound infection. Propensity score analysis was performed for adjustment of differences between the AVP and BPP groups.
RESULTS
Overall primary patency was superior in the AVP group compared with the BPP group: at 1 year, 96.5% vs 85.0% and at 5 years, 83.0% vs 72.3% (P = .04). In propensity score-matched pairs (n = 92), no difference was found between the groups in primary patency: 95.7% and 95.7% at 1 year and 92.5% and 78.6% at 5 years (P = .861) or in freedom from restenosis: 100% and 100% at 1 year and 89.1% and 84.0% at 5 years (P = .057). Deep wound infections occurred slightly more often after BPP closure (8%) than after AVP closure (4%), but the difference was not statistically significant (P = .144). There were no patch ruptures in the BPP group, but in the AVP group, there were five ruptures (3.5%) (P = .024).
CONCLUSIONS
BPP is compatible to AVP in femoral endarterectomy in patency and can be regarded as the safer choice considering the risk of patch rupture.
Topics: Humans; Cattle; Animals; Endarterectomy, Carotid; Retrospective Studies; Treatment Outcome; Angioplasty; Carotid Stenosis
PubMed: 35987464
DOI: 10.1016/j.jvs.2022.08.010 -
The European Respiratory Journal Jun 2017
Topics: Angioplasty, Balloon; Stents
PubMed: 28596430
DOI: 10.1183/13993003.00718-2017 -
The International Journal of Artificial... Dec 2019To clarify the reasons and beneficial effects and duration of arteriovenous fistula patency after radiological interventions in arteriovenous fistula. The patients...
OBJECTIVE
To clarify the reasons and beneficial effects and duration of arteriovenous fistula patency after radiological interventions in arteriovenous fistula. The patients investigated were referred due to arteriovenous fistula access flow problems.
MATERIAL AND METHODS
In 174 patients, 522 radiological investigations and endovascular treatments such as percutaneous transluminal angioplasty were analyzed, retrospectively. All investigations were performed due to clinical suspicion of impaired arteriovenous fistula function.
RESULTS
Arterial stenosis was significantly more frequent among patients with diabetic nephropathy (p < 0.001) and interstitial nephritis (p < 0.001). According to the venous stenosis, the diagnosis did not affect the frequency (p = 0.22) or the degree (p = 0.39) of stenosis. The degree of stenosis prior to percutaneous transluminal angioplasty correlated significantly with the degree of remaining stenosis after intervention (p < 0.001). Of the 174 patients, 123 (71%) performed a total of 318 investigations including percutaneous transluminal angioplasty. Repeated percutaneous transluminal angioplasty was performed significantly more often in patients with diabetic nephropathy. The median times to the first percutaneous transluminal angioplasty and to the subsequent percutaneous transluminal angioplasties were 9.5 and 5 months, respectively. Arteriovenous fistula in patients with diabetic nephropathy performed similar to most other diagnoses, although performing more percutaneous transluminal angioplasty/patient than most other diagnoses.
CONCLUSION
Many patients could maintain long-term patency of arteriovenous fistula, including those with diabetic nephropathy, with repeated interventions; this motivates a closer follow-up for these patients. Clinically significant stenosis should be dilated as meticulously and as soon as possible. Occlusions of the arteriovenous fistula in most instances can be successfully thrombolyzed or dilated upon early diagnosis.
Topics: Aged; Angiography; Angioplasty; Arteriovenous Shunt, Surgical; Female; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Phlebography; Renal Dialysis; Retrospective Studies; Risk Assessment; Risk Factors; Sweden; Treatment Outcome; Vascular Patency
PubMed: 31303134
DOI: 10.1177/0391398819863429 -
JACC. Cardiovascular Interventions Jun 2012
Topics: Angioplasty; Asymptomatic Diseases; Carotid Artery Diseases; Centers for Medicare and Medicaid Services, U.S.; Cost-Benefit Analysis; Eligibility Determination; Evidence-Based Medicine; Health Care Costs; Health Care Rationing; Humans; Insurance, Health, Reimbursement; Outcome and Process Assessment, Health Care; Patient Safety; Patient Selection; Risk Assessment; Risk Factors; Stents; Treatment Outcome; United States; United States Food and Drug Administration
PubMed: 22721670
DOI: 10.1016/j.jcin.2012.05.001 -
Journal of Vascular Surgery Jun 2010Endovascular treatment for atherosclerotic renal artery stenosis (ARAS) was first performed >30 years ago and its use has increased rapidly since then. However, only... (Review)
Review
INTRODUCTION
Endovascular treatment for atherosclerotic renal artery stenosis (ARAS) was first performed >30 years ago and its use has increased rapidly since then. However, only recently have large randomized trials rigorously evaluated its clinical benefit.
METHODS
We systematically reviewed the controlled studies on primary stenting for atherosclerotic renal artery stenosis. Studies were included if they compared the outcome of stenting with other treatments, or the outcome associated with different stent characteristics or stenting methods.
RESULTS
Stenting is preferred over angioplasty alone and over surgery when revascularization is indicated for ostial ARAS, except in cases of coexistent aortic disease indicating surgery. Randomized controlled trials showed no significant benefit and substantial risk of renal artery stenting over medication alone in patients with atherosclerotic ARAS without a compelling indication. Improvements in the procedure, such as with distal embolic protection devices and coated stents, are not associated with better clinical outcomes after stent placement for ARAS.
CONCLUSION
Recent evidence shows that impaired renal function associated with ARAS is more stable over time than previously observed. Optimal medical treatment should be the preferred option for most patients with ARAS. Only low-level evidence supports compelling indications for revascularization in ARAS, including rapidly progressive hypertension or renal failure and flash pulmonary edema.
Topics: Angioplasty; Atherosclerosis; Cardiovascular Agents; Evidence-Based Medicine; Humans; Patient Selection; Renal Artery Obstruction; Risk Assessment; Severity of Illness Index; Stents; Treatment Outcome; Vascular Surgical Procedures
PubMed: 20488331
DOI: 10.1016/j.jvs.2010.02.011 -
PloS One 2020To evaluate the efficacy and long-term patency of endovascular treatment for non-maturing native arteriovenous fistulas according to the approach route (arterial vs....
OBJECTIVES
To evaluate the efficacy and long-term patency of endovascular treatment for non-maturing native arteriovenous fistulas according to the approach route (arterial vs. venous).
METHODS
Eighty-five patients underwent percutaneous transluminal angioplasty for non-maturing fistulas (63 radiocephalic and 22 brachiocephalic) between 2010 and 2019. Outcome variables such as procedural success, complications, and primary and secondary patency rates were analyzed from the patients' demographic, angiographic, clinical, and hemodialysis records according to the approach route (venous access group, n = 53 and arterial access group, n = 32). The Kaplan-Meier method was used to analyze the patency rates.
RESULTS
The mean duration from fistula creation to fistulography was 78.4±51.4 days (range, 1-180 days). The anatomical and clinical success rates were 98.8% and 83.5%, respectively. Lesions were most commonly located at the juxta-anastomosis (55.3%). Accessory cephalic veins were observed in 16 patients. The primary patency rates were 83.9%, 71.9%, and 66.3% and the secondary patency rates were 98.6%, 95.9%, and 94.2% at 3 months, 6 months, and 1 year, respectively. The degree of hypertension (P = 0.023), minimal preoperative vein size (P = 0.041), and increment in postoperative vein diameter were higher in the venous access group than in the arterial access group (P<0.01). The frequency of using cutting balloons (P = 0.026) and complication rate were higher in the arterial access group than in the venous access group (arterial access: 1 major, 8 minor; venous access: 4 minor; P = 0.015).
CONCLUSIONS
Aggressive evaluation and endovascular therapy can salvage most non-maturing fistulas. Transradial and distal radial approaches can be effective even for challenging lesions.
Topics: Aged; Angiography; Angioplasty; Angioplasty, Balloon; Arteriovenous Fistula; Female; Humans; Male; Middle Aged; Retrospective Studies; Salvage Therapy; Treatment Outcome; Veins
PubMed: 32991608
DOI: 10.1371/journal.pone.0238788 -
JACC. Cardiovascular Interventions Feb 2014
Topics: Angioplasty; Carotid Stenosis; Endarterectomy, Carotid; Hospitals, Community; Humans; Stents
PubMed: 24556096
DOI: 10.1016/j.jcin.2013.12.003 -
British Heart Journal Feb 1991To assess the value of emergency surgical standby for percutaneous transluminal coronary angioplasty. (Review)
Review
OBJECTIVE
To assess the value of emergency surgical standby for percutaneous transluminal coronary angioplasty.
DESIGN
Retrospective review of the major complications of coronary angioplasty in a regional cardiac centre.
SETTING
All angioplasties were performed in the cardiac catheterisation laboratory of Wythenshawe Hospital with surgical standby in an adjoining operating theatre.
PATIENTS
1262 vessels were dilated in 1032 patients (mean age 53 years) between 1984 and 1989.
MAIN OUTCOME MEASURES
In-hospital mortality from emergency surgical revascularisation after angioplasty; the rate of myocardial infarction and overall morbidity.
RESULTS
Coronary angioplasty achieved primary success in 90% of cases. Thirty eight (3.7%) patients (five women (mean age 55.8) and 33 men (mean age 53.0] were referred for urgent surgical revascularisation--36 direct to operation and two within 24 hours. All patients survived surgery. Five of the 38 had had a previous angioplasty to the same vessel and one had had previous coronary artery grafts. Four of the 38 had an angioplasty for unstable angina. Eighteen had single, 13 double, and seven triple vessel coronary artery disease. The target vessel was the left anterior descending in 25, right coronary artery in nine, circumflex in three, and the left anterior descending and circumflex coronary arteries in one. Five required external cardiac massage on the way to the operating theatre; two of them had a left main stem occlusion. Four internal mammary artery and 60 reversed saphenous vein grafts were implanted (1.6 per patient). Complete revascularisation was achieved in 36 (94.7%) patients. Q wave myocardial infarction occurred in six (15.8%). The final outcome was: none dead, three patients with angina, one late death, one cerebrovascular accident, one late operation for a new left anterior descending lesion, two patients on diuretics with or without an angiotensin converting enzyme inhibitor. One orthotopic transplant was performed in a patient in whom cardiogenic shock developed after the left anterior descending coronary artery became occluded 72 hours after angioplasty.
CONCLUSION
There was no surgical mortality and low morbidity among patients for whom immediate surgical cover was requested.
Topics: Angioplasty, Balloon, Coronary; Coronary Artery Bypass; Emergencies; Female; Humans; Male; Middle Aged; Prognosis; Retrospective Studies
PubMed: 1867949
DOI: 10.1136/hrt.65.2.68