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The Keio Journal of Medicine Sep 2001More than 20 years have passed since percutaneous transluminal coronary angioplasty (PTCA) was introduced for the treatment of coronary artery disease. During the first... (Review)
Review
More than 20 years have passed since percutaneous transluminal coronary angioplasty (PTCA) was introduced for the treatment of coronary artery disease. During the first decade, PTCA outcome had improved significantly. However, acute occlusive complications and restenosis remained as significant limitations of the procedure. During the second decade, new procedures, such as stents and atherectomy (directional coronary atherectomy, and Rotablator) had been introduced and had a significant impact on the outcome of percutaneous coronary intervention (PCI). In addition to the improvements in the equipment, the use of glycoprotein IIb/IIIa inhibitors to prevent platelet aggregation has reduced procedure-related complications. PCI continues to evolve with new developments such as distal protection devices to prevent distal embolism, brachytherapy and drug-eluting stents to prevent restenosis. These new technologies may play a significant role in expanding the applications of PCI in the future.
Topics: Angioplasty, Balloon, Coronary; Atherectomy, Coronary; Coronary Angiography; Coronary Disease; Humans; Recurrence; Stents
PubMed: 11594037
DOI: 10.2302/kjm.50.152 -
Journal of Vascular Surgery Jun 2014Percutaneous transluminal angioplasty (PTA) and primary stenting are commonly used endovascular therapeutic procedures for the treatment of infrapopliteal arterial... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Percutaneous transluminal angioplasty (PTA) and primary stenting are commonly used endovascular therapeutic procedures for the treatment of infrapopliteal arterial occlusive disease. However, which procedure is more beneficial for patients with infrapopliteal arterial occlusive disease is unknown.
METHODS AND RESULTS
We performed a meta-analysis, searching PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, ISI Web of Knowledge, and relevant websites without language or publication date restrictions for randomized trials that compared primary stenting with PTA in patients with infrapopliteal arterial occlusive disease. The keywords were "stents," "angioplasty," "infrapopliteal," "tibial arteries," and "below knee." We selected immediate technical success, primary and secondary patency, limb salvage, and patient survival as the outcomes of this meta-analysis. On the basis of the inclusion criteria, we identified six prospective randomized trials. One-year outcomes did not show any significant differences between the PTA and primary stenting groups, respectively: technical success (93.3% vs 96.2%; odds ratio [OR], 0.59; 95% confidence interval [CI], 0.24-1.47; P = .25), primary patency (57.1% vs 65.7%; OR, 0.95; 95% CI, 0.35-2.58; P = .92), secondary patency (73.5% vs 57.6%; OR, 2.08; 95% CI, 0.81-5.34; P = .13), limb salvage (82.2% vs 87.5%; OR, 0.64; 95% CI, 0.29-1.41; P = .27), and patient survival (84.0% vs 87.5%; OR, 0.79; 95% CI, 0.40-1.55; P = .49).
CONCLUSIONS
For infrapopliteal arterial occlusive disease, primary stenting has the same 1-year benefits as PTA. There is insufficient evidence to support the superiority of either method. Primary stenting is associated with a trend toward higher primary patency and lower secondary patency. Further large-scale prospective randomized trials should produce more reliable results.
Topics: Angioplasty; Arterial Occlusive Diseases; Endovascular Procedures; Humans; Popliteal Artery; Stents; Tibial Arteries; Vascular Patency
PubMed: 24836770
DOI: 10.1016/j.jvs.2014.03.012 -
Journal of Vascular Surgery Feb 2016
Topics: Adrenergic beta-Antagonists; Angioplasty; Carotid Artery Diseases; Female; Humans; Male; Stents; Stroke
PubMed: 26526053
DOI: 10.1016/j.jvs.2015.08.109 -
Journal of Vascular Surgery Apr 2016
Topics: Angioplasty; Carotid Arteries; Carotid Stenosis; Endarterectomy, Carotid; Female; Humans; Male; Radiography; Stents; Stroke
PubMed: 26610642
DOI: 10.1016/j.jvs.2015.08.120 -
Journal of Vascular Surgery Mar 2014
Topics: Angioplasty; Carotid Stenosis; Endarterectomy, Carotid; Female; Humans; Male; Stents
PubMed: 24246543
DOI: 10.1016/j.jvs.2013.09.062 -
European Journal of Vascular and... Jun 2008The importance of angioplasty and stenting in the treatment of carotid artery disease cannot be underestimated. Successful carotid stenting does not only depend of the... (Review)
Review
The importance of angioplasty and stenting in the treatment of carotid artery disease cannot be underestimated. Successful carotid stenting does not only depend of the operator's skills and experience, but also an adequate selection of cerebral protection devices and carotid stents can help avoiding neurological complications. A broad spectrum of carotid devices is currently on the market and since all have their assets and downsides, it is virtually impossible to acclaim one specific device as being the best. The individual characteristics of each specific protection system or stent may make it an attractive choice in one circumstance, but render it a less desirable option in others situations. The applicability depends primarily on the arterial anatomy and the specific details of the lesion being treated. But certainly, personal preferences and familiarity with a specific device may legitimately influence the decision to choose one over another.
Topics: Angioplasty; Carotid Artery Diseases; Choice Behavior; Clinical Competence; Evidence-Based Medicine; Filtration; Humans; Intracranial Embolism; Patient Selection; Practice Guidelines as Topic; Prosthesis Design; Stents; Treatment Outcome
PubMed: 18375153
DOI: 10.1016/j.ejvs.2008.02.005 -
Journal of Vascular Surgery Apr 2010
Topics: Angioplasty; Aptitude Tests; Clinical Competence; Computer Simulation; Curriculum; Education, Medical; Humans; Learning; Mental Recall; Motor Skills; Patient Simulation; Psychomotor Performance; Renal Artery Obstruction; Space Perception; Stents; Students, Medical; Task Performance and Analysis; Visual Perception
PubMed: 20347703
DOI: 10.1016/j.jvs.2009.11.058 -
The Cochrane Database of Systematic... Nov 2016In recent years subintimal angioplasty (SIA) has become an established percutaneous procedure for the treatment of symptomatic lower limb arterial chronic total... (Review)
Review
BACKGROUND
In recent years subintimal angioplasty (SIA) has become an established percutaneous procedure for the treatment of symptomatic lower limb arterial chronic total occlusions. However, the clinical benefits of this practice remain unclear. The aim of the review was to determine the effectiveness of SIA on clinical outcomes. This is an update of a review first published in 2013.
OBJECTIVES
To assess the effectiveness of SIA versus other treatment for people with lower limb arterial chronic total occlusions, determined by the effects on clinical improvement, technical success rate, patency rate, limb salvage rate, and morbidity rates.
SEARCH METHODS
The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register (last searched January 2016) and Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 12). We also searched clinical trials registries.
SELECTION CRITERIA
We included data from randomized controlled trials comparing the effectiveness of SIA and any other management method in the treatment of lower limb arterial chronic total occlusions. The primary intervention of interest was SIA, with or without a stent, for the restoration of vessel patency in people with occlusions of a lower limb artery. We compared SIA against alternative modalities used to restore vessel patency, including conventional percutaneous transluminal angioplasty, surgical bypass, or any other treatments. We compared different SIA devices and techniques against each other.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data. The third review author resolved disagreements.
MAIN RESULTS
Two studies, involving a total of 147 participants with TransAtlantic Inter-Society Consensus (TASC)-II D femoropopliteal lesions, met our inclusion criteria and were included in the review. Both studies were small but otherwise of high methodological quality. However, the treatment techniques and control groups of the two studies differed, precluding the combining of study results and resulting in the evidence being less applicable. We therefore considered the quality of the evidence to be low.In one study, participants with TASC-II D lesions were randomized to receive either SIA with stenting of the superficial femoral artery or remote endarterectomy (RE) with stenting of the superficial femoral artery. Three-year follow-up results showed a Rutherford classification improvement of 64% in the SIA group compared to 80% in the RE group (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.61 to 1.03; 95 participants; P = 0.079). Postexercise ankle brachial index improvements (defined as an increased value of 0.2) were reported in 70% of participants in the SIA group compared to 82% in the RE group (RR 0.86, 95% CI 0.68 to 1.08; 95 participants; P = 0.18). The study reported the technical success rate was 93% for the SIA group and 96% for the RE group (RR 0.97, 95% CI 0.88 to 1.07; 95 participants; P = 0.91). Primary patency at 12 months was 59.1% in the SIA group compared to 78.4% in the RE group (RR 0.75, 95% CI 0.57 to 1.00; 95 participants; P = 0.05). Primary patency at 24 months was 56.8% in the SIA group compared to 76.5% in the RE group (RR 0.74, 95% CI 0.55 to 1.00; 95 participants; P = 0.05) and 47.7% in the SIA group and 62.7% in the RE group at 36 months (RR 0.76, 95% CI 0.52 to 1.11; 95 participants; P = 0.15). Assisted primary patency was 52.3% in the SIA group compared to 70.6% in the RE group (P = 0.01) at 36 months. Secondary patency was better for the RE group (P = 0.03) at 36 months. Limb salvage at three years' follow-up was 95% in the SIA group and 98% in the RE group (RR 0.97, 95% CI 0.90 to 1.05; 95 participants; P = 0.4). There were no perioperative deaths, but complications occurred in two SIA participants (femoral pseudoaneurysm and pulmonary edema) and in three RE participants (seroma, femoral pseudoaneurysm, superficial femoral artery acute occlusion).In the second study, the effects of the SIA OUTBACK re-entry catheter device in people affected by TASC-II D superficial femoral artery chronic total occlusion were compared with the SIA manual re-entry technique. This study did not report clinical improvement and limb salvage. Technical success was achieved in all cases in both the OUTBACK device and manual groups. The primary 6-month patency rate was 100% in the OUTBACK group (26 of 26 participants) compared to 96.2% in the manual group (25 of 26 participants) (RR 1.04, 95% CI 0.94 to 1.15). The primary 12-month patency rate was 92.3% in the OUTBACK group (24 of 26 participants) compared to 84.6% in the manual group (22 of 26 participants) (RR 1.09, 95% CI 0.90 to 1.33). Patency rates at 24 and 36 months were not reported. The study reported that there were no complications.
AUTHORS' CONCLUSIONS
Using the GRADE approach, we classified the quality of the evidence presented by both studies in this review as low due to small study size and the small number of studies. In addition, the two included trials differed from each other in the techniques and control used, and we were therefore unable to combine the data. Consequently there is currently insufficient evidence to support SIA over other techniques. Evidence from more randomized controlled trials is needed to assess the role of SIA in people with chronic lower limb arterial total occlusions.
Topics: Angioplasty; Arterial Occlusive Diseases; Chronic Disease; Endarterectomy; Femoral Artery; Humans; Lower Extremity; Peripheral Arterial Disease; Randomized Controlled Trials as Topic; Stents; Tunica Intima
PubMed: 27858952
DOI: 10.1002/14651858.CD009418.pub3 -
BMC Neurology Jul 2020Cerebral vasospasm still results in high morbidity and mortality rates in patients after aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to establish...
BACKGROUND
Cerebral vasospasm still results in high morbidity and mortality rates in patients after aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to establish a protocol for the management of vasospasm and demonstrate our experience of angioplasty using the Scepter XC balloon catheter.
METHODS
In this retrospective study, a computed tomography angiography and perfusion image was arranged if early symptoms occurred or on the 7th day following aneurysmal SAH. In patients with clear consciousness, balloon angioplasties were performed for symptomatic vasospasms, which were not improved within 6-12 h after maximal medical treatments. In unconscious patients, balloon angioplasties were performed for all patients with angiographic vasospasms.
RESULTS
Fifty patients underwent Scepter XC balloon angioplasty among 396 consecutive patients who accepted endovascular or surgical treatments for ruptured aneurysms. All angioplasty procedures were successful without complications. 100% angiographic improvement and 94% clinical improvement were reached immediately after the angioplasties. A favorable functional outcome (modified Rankin Score of ≤2) could be achieved in 82% of patients. Even in patients with poor clinical grading (Hunt-Hess grade 4-5), a clinical improvement rate of 87.5% and favorable outcome rate was 70.8% could be achieved.
CONCLUSION
Balloon angioplasty with Scepter XC balloon catheter is safe and effective for post-SAH vasospasm. This device's extra-compliant characteristics could considerably improve the quality of angioplasty procedures. For all patients, even those with poor neurological status, early treatment with combined protocol of nimodipine and angioplasty can have good clinical outcomes.
Topics: Adult; Aged; Aneurysm, Ruptured; Angioplasty, Balloon; Computed Tomography Angiography; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Nimodipine; Retrospective Studies; Subarachnoid Hemorrhage; Treatment Outcome; Vasospasm, Intracranial
PubMed: 32635892
DOI: 10.1186/s12883-020-01856-4 -
European Journal of Vascular and... Dec 2022
Topics: Humans; Atherectomy, Coronary; Constriction, Pathologic; Angioplasty, Balloon; Atherectomy; Stents; Treatment Outcome; Femoral Artery; Peripheral Arterial Disease; Popliteal Artery; Vascular Patency; Coated Materials, Biocompatible
PubMed: 36216236
DOI: 10.1016/j.ejvs.2022.10.014