ABSTRACT
PURPOSE: Paclitaxel-coated balloons (PCB) inhibit neointimal proliferation in arteries. The purpose of this retrospective analysis was to investigate the effect of PCB in in-stent restenosis after transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhotic liver disease. MATERIALS AND METHODS: Six patients (mean age: 65â±â10 years) with recurrent in-stent restenoses in TIPS (5 bare stents, 1 covered stent) underwent a single percutaneous transluminal angioplasty (PTA) with PCB (3âµg paclitaxel/mm(2)). Post-interventional outcome and patency were compared with those of prior plain optimal balloon angioplasty (POBA) in the same patients. During a two-year follow-up period, all patients underwent angiographic examinations at 6-month intervals. In-stent minimal lumen diameter (MLD) and late lumen loss (LLL) were assessed. Paclitaxel residues on balloon and sheath surfaces as well as venous plasma concentrations (0â-â24 hours) were analyzed. RESULTS: PCB decreased the need for clinically driven repeat PTA (POBA: 53â% of angiographic examinations; paclitaxel PTA: 19â%; Pâ=â0.014). LLL/diameter stenosis was higher after POBA (2.4â±â1.5âmm/28â±â18â%) than after PCB (0.5â±â0.8âmm/7â±â11â%, Pâ=â0.029). Residual paclitaxel on balloons was 28â±â9â% of dose and 0.2â±â0.1â% on sheath surfaces. Paclitaxel plasma concentrations were below detectable levels throughout the first 24 hours after the interventions in all patients. The procedure was well tolerated and no clinical side effects attributable to paclitaxel were observed. CONCLUSION: In patients with recurrent in-stent stenoses, a single PTA with PCB resulted in a prolonged secondary patency due to pseudointimahyperplasia without a systemic effect of paclitaxel. KEY POINTS: â¢Intimahyperplasia is a common reason for long-time TIPS dysfunction. â¢First-in-man local paclitaxel application in TIPS patients with recurrent in-stent stenoses. â¢PTA with PCB resulted in a prolonged secondary patency compared to POBA. â¢No systemic effects of Paclitaxel were detected.
Subject(s)
Angioplasty, Balloon/methods , Drug-Eluting Stents , Fibrosis/therapy , Graft Occlusion, Vascular/therapy , Paclitaxel/administration & dosage , Portasystemic Shunt, Transjugular Intrahepatic/adverse effects , Aged , Angioplasty, Balloon/instrumentation , Combined Modality Therapy/methods , Female , Fibrosis/complications , Fibrosis/diagnosis , Graft Occlusion, Vascular/diagnosis , Humans , Male , Middle Aged , Treatment Outcome , Tubulin Modulators/administration & dosageABSTRACT
Uveal melanoma is very rare in children, and in both adults and children it can in rare cases develop intralesional cavities resembling an intraocular cyst. The presence of a solid mass at the base and a thick wall surrounding the cavity can assist in differentiating cavitary melanoma from a benign cyst. We report the case of a 5-year-old girl who presented with a large intraocular pigmented mass in the left eye, showing multiple hollow cavities on ocular ultrasonography, CT scan, and MRI. The patient was treated by enucleation and the pathology confirmed the diagnosis of choroidal melanoma. FISH revealed no aberration in chromosome 3.