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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 -
Journal of Vascular Surgery Sep 2011In 2008, the Society for Vascular Surgery published guidelines for the treatment of carotid bifurcation stenosis. Since that time, a number of prospective randomized... (Review)
Review
In 2008, the Society for Vascular Surgery published guidelines for the treatment of carotid bifurcation stenosis. Since that time, a number of prospective randomized trials have been completed and have shed additional light on the best treatment of extracranial carotid disease. This has prompted the Society for Vascular Surgery to form a committee to update and expand guidelines in this area. The review was done using the GRADE methodology.[corrected] The perioperative risk of stroke and death in asymptomatic patients must be below 3% to ensure benefit for the patient. Carotid artery stenting (CAS) should be reserved for symptomatic patients with stenosis 50% to 99% at high risk for CEA for anatomic or medical reasons. CAS is not recommended for asymptomatic patients at this time. Asymptomatic patients at high risk for intervention or with <3 years life expectancy should be considered for medical management as first line therapy. In this Executive Summary, we only outline the specifics of the recommendations made in the six areas evaluated. The full text of these guidelines can be found on the on-line version of the Journal of Vascular Surgery at http://journals.elsevierhealth.com/periodicals/ymva.
Topics: Angioplasty; Carotid Stenosis; Endarterectomy, Carotid; Evidence-Based Medicine; Humans; Patient Selection; Practice Guidelines as Topic; Risk Assessment; Risk Factors; Societies, Medical; Stents; Stroke; Treatment Outcome
PubMed: 21889705
DOI: 10.1016/j.jvs.2011.07.004 -
Annals of the Royal College of Surgeons... Jan 2002Peripheral angioplasty is increasingly the first choice intervention in patients with peripheral vascular disease. The aim of the current study was to audit...
BACKGROUND
Peripheral angioplasty is increasingly the first choice intervention in patients with peripheral vascular disease. The aim of the current study was to audit prospectively all major complications, especially the requirement for emergency surgical intervention.
PATIENTS AND METHODS
A prospective audit of outcome after peripheral angioplasty in 988 patients undergoing 1377 interventional procedures between 1 October 1995 and 30 September 1998 at which 1619 vessel segments were angioplastied.
RESULTS
Major medical morbidity (bronchopneumonia, stroke, renal failure, myocardial infarction) complicated 33/1377 procedures (2.4%). Emergency surgical intervention was required after 31/1377 procedures (2.3%) with the commonest aetiologies being acute limb ischaemia and haemorrhagic complications. The amputation rate following angioplasty was 0.6% and no patient presenting with claudication or graft complications underwent amputation. The amputation rate following angioplasty for critical limb ischaemia was 2.2%. Overall, the risk of death and/or major medical complication and/or requiring emergency surgical intervention was 3.5%. The rate of complications was no different for subintimal as opposed to transluminal angioplasties.
CONCLUSIONS
Peripheral angioplasty is associated with a low risk of major medical and surgical complications.
Topics: Amputation, Surgical; Angioplasty; Bronchopneumonia; Emergencies; Female; Hematoma; Hemorrhage; Humans; Intermittent Claudication; Ischemia; Leg; Male; Medical Audit; Middle Aged; Peripheral Vascular Diseases; Postoperative Complications; Prospective Studies; Reoperation; Salvage Therapy; Treatment Outcome
PubMed: 11892730
DOI: No ID Found -
Cardiovascular and Interventional... Oct 2023
Topics: Humans; Paclitaxel; Angioplasty, Balloon, Coronary; Angioplasty, Balloon; Treatment Outcome; Coated Materials, Biocompatible; Peripheral Arterial Disease; Popliteal Artery; Femoral Artery
PubMed: 37750920
DOI: 10.1007/s00270-023-03556-1 -
Journal of Vascular Surgery Mar 2011The purpose of this systematic review and meta-analysis was to synthesize the available evidence derived from randomized controlled trials (RCTs) regarding the relative... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The purpose of this systematic review and meta-analysis was to synthesize the available evidence derived from randomized controlled trials (RCTs) regarding the relative efficacy and safety of endarterectomy vs stenting in patients with carotid artery disease.
METHODS
We searched MEDLINE, EMBASE, Current Contents, and Cochrane CENTRAL through July 2010 to update previous systematic reviews. Two reviewers determined trial eligibility and extracted descriptive, methodologic, and outcome data (death, nonfatal stroke, and nonfatal myocardial infarction). Random-effects meta-analysis was used to pool relative risks and the I(2) statistic was used to assess heterogeneity.
RESULTS
Thirteen RCTs proved eligible enrolling 7484 patients, of which 80% had symptomatic disease. Methodological quality was moderate to high, with better quality among RCTs published after 2008. Compared with carotid endarterectomy, stenting was associated with increased risk of any stroke (relative risk [RR], 1.45; 95% confidence interval [CI], 1.06-1.99; I(2) = 40%), decreased risk of periprocedural myocardial infarction (MI; RR, 0.43; 95% CI, 0.26- 0.71; I(2) = 0%), and nonsignificant increase in mortality (RR, 1.40; 95% CI, 0.85-2.33; I(2) = 5%). When analysis was restricted to the two most recent trials with the better methodology and more contemporary technique, we found stenting to be associated with a significant increase in the risk of any stroke (RR, 1.82; 95% CI, 1.35-2.45) and mortality (RR, 2.53; 95% CI, 1.27-5.08) and a nonsignificant reduction of the risk of MI (RR, 0.39; 95% CI, 0.12-1.23). For every 1000 patients opting for stenting rather than endarterectomy, 19 more patients would have strokes and 10 fewer would have MIs. Outcome data in asymptomatic patients were sparse and imprecise; hence, these conclusions apply primarily to symptomatic patients.
CONCLUSION
Compared with endarterectomy, carotid artery stenting (CAS) significantly increases the risk of any stroke and decreases the risk of MI.
Topics: Angioplasty; Carotid Artery Diseases; Endarterectomy, Carotid; Evidence-Based Medicine; Humans; Myocardial Infarction; Patient Selection; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Stents; Stroke; Treatment Outcome
PubMed: 21216556
DOI: 10.1016/j.jvs.2010.10.101 -
Journal of Neurointerventional Surgery May 2015High periprocedural complication rate is a key limitation of endovascular treatment of intracranial atherosclerotic disease (ICAD), despite potential risk reduction of...
BACKGROUND AND PURPOSE
High periprocedural complication rate is a key limitation of endovascular treatment of intracranial atherosclerotic disease (ICAD), despite potential risk reduction of recurrent stroke. Taking lessons from the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Arterial Stenosis (SAMMPRIS) trial, targeting a selected patient population, we prospectively evaluated the feasibility and safety of tailored angioplasty and/or stenting for patients with ICAD.
METHODS
From November 2011 to October 2012, 158 patients with symptomatic ICAD caused by hypoperfusion combined with poor collateral flow were consecutively recruited into a prospective single center study. Patients were divided into three groups based on arterial access and lesion morphology: balloon mounted stent group (group BS) for smooth access and Mori A lesion, angioplasty plus self-expanding stent group (group AS) for tortuous access and Mori B or C lesion, and angioplasty group (group AG) for tortuous access and Mori A lesion. The primary endpoints were successful procedure rate and any vascular event within 30 days.
RESULTS
Overall technical success rate was 96.3% (154/158). There were significant differences in the technical success rate: 89.7% (35/39) in group AG compared with 97.5% (79/81) in group BS and 100% (38/38) in group AS (p=0.042). The 30 day composite stroke, myocardial infarction, or death rate was 4.4% (7/158). Stroke within 30 days occurred in four patients in group BS and in three patients in group AS.
CONCLUSIONS
Individualized treatment of ICAD using tailored devices according to arterial access and lesion morphology was feasible and safe in symptomatic patients caused by hypoperfusion with poor collateral flow.
Topics: Adult; Aged; Angioplasty; Angioplasty, Balloon; Clinical Trials as Topic; Feasibility Studies; Female; Follow-Up Studies; Humans; Intracranial Arteriosclerosis; Male; Middle Aged; Outcome Assessment, Health Care; Postoperative Complications; Stents; Stroke
PubMed: 24759694
DOI: 10.1136/neurintsurg-2014-011109 -
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 -
Hong Kong Medical Journal = Xianggang... Apr 2006To assess the clinical applicability, efficacy, and safety of coronary angiography and angioplasty via a transradial approach in local Chinese patients. (Comparative Study)
Comparative Study
OBJECTIVE
To assess the clinical applicability, efficacy, and safety of coronary angiography and angioplasty via a transradial approach in local Chinese patients.
DESIGN
Prospective case series.
SETTING
Regional hospital, Hong Kong.
PATIENTS
All patients undergoing coronary angiography and coronary angioplasty between 1 January and 30 June 2004.
INTERVENTIONS
Transradial coronary angiography and coronary angioplasty.
MAIN OUTCOME MEASURES
Feasibility, success rate, and complications.
RESULTS
A total of 268 coronary angiographies (62% of all coronary angiographies) and 118 coronary angioplasties (48% of all coronary angioplasties) were performed via a transradial approach. The procedural success rate for coronary angiography was 93.7% with a mean duration of 21.8 (standard deviation, 13.5) minutes compared with 17.9 (10.0) minutes for angiography via a femoral approach. Most (99%) patients were free from any complications. Of those patients who underwent elective transradial coronary angiography in the morning, 64% were discharged on the same day. Comparison of data in the first half of the study period with those in the second half revealed a significant increase in the percentage of coronary angiographies performed via a transradial approach (from 52% to 73%, P<0.0001), and an improved procedural success rate (from 91.5% to 95.3%, P=0.1). For transradial coronary angioplasty, the procedural success rate was 98%. A total of 246 lesions (2.08 lesions per patient) were treated with no procedure-related complications.
CONCLUSIONS
Transradial coronary angiography and angioplasty are feasible in a significant proportion of local Chinese patients and achieve a high success rate and low complication rate. It tends to prolong procedural duration, but improves patients' comfort and permits earlier ambulation and discharge. The procedural success rate improves with accumulating experience.
Topics: Aged; Angioplasty, Balloon, Coronary; Coronary Angiography; Feasibility Studies; Female; Humans; Male; Middle Aged; Prospective Studies; Radial Artery; Safety; Treatment Outcome
PubMed: 16603777
DOI: No ID Found -
Journal of Interventional Cardiology Feb 2016We aim to perform a systematic literature review on all studies reporting the clinical outcomes of the use of bioresorbable scaffolds (BRS) in different settings of... (Review)
Review
OBJECTIVES
We aim to perform a systematic literature review on all studies reporting the clinical outcomes of the use of bioresorbable scaffolds (BRS) in different settings of coronary artery disease (CAD).
BACKGROUND
BRS are designed to provide early support of the vessel wall postangioplasty, deliver antiproliferative agents to prevent excessive hyperplastic healing responses and finally "disappear" when no longer required. Emerging data have provided evidence of their use in specific clinical scenarios.
METHODS
A comprehensive literature search was performed by 2 independent reviewers utilizing MEDLINE, EMBASE, and Cochrane Library databases. The only 2 CE marked BRS: everolimus-eluting Bioresorbable vascular scaffold ABSORB BVS and the myolimus-eluting DESolve Bioresorbable Coronary Scaffold (BCS) System were included.
RESULTS
The studies were categorized into: ST elevation myocardial infarction (STEMI), stable CAD, and "all-comers" group. Thirty-one studies were included; 8 in STEMI patients (all ABSORB), 15 in stable CAD patients. In the STEMI group (n = 606), acute procedural success ranged from 96% to 100%, cardiac mortality 0-9.1%, recurrent MI and stent thrombosis rates were 0-4.3%. In the stable CAD group, the 13 ABSORB studies (n = 3259) demonstrated cardiac mortality rate of 0-0.6%, recurrent MI rate 0-4.5%, and stent thrombosis rate 0-4.3%
CONCLUSIONS
Current clinical data suggest the BRS, especially the ABSORB BVS, may represent a reasonable alternative to DES in uncomplicated coronary anatomy.
Topics: Absorbable Implants; Aged; Angioplasty; Antineoplastic Agents; Coronary Artery Disease; Everolimus; Female; Humans; Male; Middle Aged; Sirolimus; Tissue Scaffolds; Treatment Outcome
PubMed: 26728234
DOI: 10.1111/joic.12260 -
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