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1.
Cardiovasc Pathol ; 50: 107268, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32858206

RESUMO

We report the sudden unexpected death from exsanguination of a 60-year-old white female who underwent balloon angioplasty of her right popliteal artery via a right common femoral arteriotomy 3 weeks before death. This resulted in a mycotic pseudoaneurysm of the right femoral artery that ruptured, causing fatal exsanguination. A pseudoaneurysm is an arterial wall defect in which part of the wall consists of fibrin and fibrous tissue, lacking components of the normal arterial wall, that is intima, media, and adventitia. Pseudoaneurysms result from traumatic arterial injury, infection, rupture of a true aneurysm, or surgery. A literature search revealed no reports with the patient dying unexpectedly outside the hospital. Immediate surgical intervention and antibiotic therapy are preferred treatments.


Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Aneurisma Roto/etiologia , Angioplastia com Balão/efeitos adversos , Artéria Femoral/lesões , Lesões do Sistema Vascular/etiologia , Falso Aneurisma/patologia , Aneurisma Infectado/patologia , Aneurisma Roto/patologia , Autopsia , Evolução Fatal , Feminino , Artéria Femoral/patologia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Lesões do Sistema Vascular/patologia
2.
J Surg Res ; 257: 294-305, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32871430

RESUMO

BACKGROUND: Drug-eluting stents impair post-angioplasty re-endothelialization thus compromising restenosis prevention while heightening thrombotic risks. We recently found that inhibition of protein kinase RNA-like endoplasmic reticulum kinase (PERK) effectively mitigated both restenosis and thrombosis in rodent models. This motivated us to determine how PERK inhibition impacts re-endothelialization. METHODS: Re-endothelialization was evaluated in endothelial-denuded rat carotid arteries after balloon angioplasty and periadventitial administration of PERK inhibitor in a hydrogel. To study whether PERK in smooth muscle cells (SMCs) regulates re-endothelialization by paracrinally influencing endothelial cells (ECs), denuded arteries exposing SMCs were lentiviral-infected to silence PERK; in vitro, the extracellular vesicles isolated from the medium of PDGF-activated, PERK-upregulating human primary SMCs were transferred to human primary ECs. RESULTS: Treatment with PERK inhibitor versus vehicle control accelerated re-endothelialization in denuded arteries. PERK-specific silencing in the denuded arterial wall (mainly SMCs) also enhanced re-endothelialization compared to scrambled shRNA control. In vitro, while medium transfer from PDGF-activated SMCs impaired EC viability and increased the mRNA levels of dysfunctional EC markers, either PERK inhibition or silencing in donor SMCs mitigated these EC changes. Furthermore, CXCL10, a paracrine cytokine detrimental to ECs, was increased by PDGF activation and decreased after PERK inhibition or silencing in SMCs. CONCLUSIONS: Attenuating PERK activity pharmacologically or genetically provides an approach to accelerating post-angioplasty re-endothelialization in rats. The mechanism may involve paracrine factors regulated by PERK in SMCs that impact neighboring ECs. This study rationalizes future development of PERK-targeted endothelium-friendly vascular interventions.


Assuntos
Angioplastia com Balão/efeitos adversos , Reestenose Coronária/prevenção & controle , Miócitos de Músculo Liso/efeitos dos fármacos , Inibidores de Proteínas Quinases/administração & dosagem , Reepitelização/efeitos dos fármacos , eIF-2 Quinase/antagonistas & inibidores , Angioplastia com Balão/instrumentação , Animais , Artérias Carótidas/efeitos dos fármacos , Artérias Carótidas/patologia , Artérias Carótidas/cirurgia , Reestenose Coronária/etiologia , Modelos Animais de Doenças , Stents Farmacológicos/efeitos adversos , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/patologia , Endotélio Vascular/citologia , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/patologia , Humanos , Masculino , Músculo Liso Vascular/citologia , Músculo Liso Vascular/efeitos dos fármacos , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Comunicação Parácrina/efeitos dos fármacos , Comunicação Parácrina/genética , RNA Interferente Pequeno/metabolismo , Ratos , Reepitelização/genética , eIF-2 Quinase/genética
3.
J Stroke Cerebrovasc Dis ; 30(1): 105431, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33161353

RESUMO

BACKGROUND: Symptomatic intracranial vertebro-basilar stenoses (SIVBS) are associated with high risk of recurrent ischemic stroke, even in patients receiving the best medical treatment. Although medical treatment is still the standard of care, non-responding patients may require endovascular treatment; balloon-mounted coronary stents (BMCS) could be successfully employed. This study aims to retrospectively analyze our high volume Interventional Neurovascular center ten-year experience in the off-label use of BMCS for the treatment of SIVBS, in order to assess its feasibility and safety. METHODS: We retrospectively analyzed all consecutive patients with SIVBS treated with BMCS in the last ten years in our center. Data collected included patient demographics, stenosis location and characteristics, early (<30 days) and late (>30 days) stroke and death rates, pre-symptomatic and post-treatment modified Rankin Scale (mRS) scores. RESULTS: 42 patients (35 males, average age 65,7 ± 10,7, range 37-85) with SIVBS were treated with BMCS. Thirty-four (80,9%) patients were symptomatic despite ongoing best medical therapy; eight (19,1%) patients were treated in emergency for large vessel occlusion, due to an underlying stenosis. BMCSs were successfully deployed in all cases. The incidence of stroke and death at one month was 7,1% (3/42). The incidence of TIA, stroke and death at long-term follow-up (average time of 3 years) was 14,3% (4,7 per 100 person-years). At long-term follow-up, mRS improved in 82% of patients who underwent elective treatment. CONCLUSIONS: In our experience, the off-label use of BMCS in the endovascular treatment of SIVBS resistant to medical treatment is feasible and safe.


Assuntos
Angioplastia com Balão/instrumentação , Stents , Insuficiência Vertebrobasilar/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/mortalidade , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/mortalidade , Insuficiência Vertebrobasilar/fisiopatologia
4.
Vasc Endovascular Surg ; 55(1): 77-80, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32869715

RESUMO

We report a case in which endovascular treatment (EVT) was performed for vertebral and basilar artery (VA and BA) tandem occlusion beyond 24 hours from onset of stroke. A 78-year-old man was admitted to our institution with dysarthria and disturbance of gait. MRI revealed occlusion of the BA with acute ischemic change in bilateral cerebellum and brain stem. At 36 hours after onset and 30 hours after administration, EVT was performed because of deteriorating neurological symptom. Successful revascularization was achieved with percutaneous transluminal angioplasty for VA and thrombectomy for BA occlusion. The neurological symptoms were improved in postoperative course.


Assuntos
Angioplastia com Balão , Acidente Vascular Cerebral/terapia , Trombectomia , Tempo para o Tratamento , Insuficiência Vertebrobasilar/cirurgia , Idoso , Humanos , Masculino , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia
5.
Vnitr Lek ; 66(6): 14-18, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33380148

RESUMO

Hemodialysed patients with end stage renal disease are reliant to proper function of vascular access - mostly arterio-venous fistula (AVF). AVF patency is jeopardized by stenosis formation, which needs to be treated before thrombosis. Angioplasty is primarily indicated and prolongs vascular access patency. High pressure balloons and cutting balloons aid to high technical success rate. Angioplasty needs to be repeated in order to maintain long term patency. Drug-eluting balloons prolong long term patency. Stents and stentgrafts are seldom used in inoperable patients and in selected locations. Technical advances allowed endovascular treatment in AVF thrombosis followed by angioplasty of culprit lesion. Vascular access endovascular occlusion is alternative for surgery in inoperable patients. In patients with residual renal function or iodine allergy, intervention could be ultrasound guided or carbon dioxide could be used without the need of iodine contrast.


Assuntos
Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica , Angioplastia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Humanos , Diálise Renal , Estudos Retrospectivos , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
6.
Angiol Sosud Khir ; 26(4): 86-89, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332310

RESUMO

The article deals with the results of surgical treatment of a male patient presenting with bilateral restenosis of stents in the internal carotid arteries 11 years after carotid angioplasty with stenting. Described herein are literature reports reflecting the state of the art of the problem, scarcity of studies, as well as some important issues still unresolved. Defined are the main indications for and contraindications to performing this type of reconstruction. The main stages of the operation are demonstrated. This is followed by describing a method of intraoperative protection of the brain, including invasive measurement of retrograde pressure. Besides, the most optimal terms of carrying out the second stage of treatment were determined, eventually demonstrating efficacy and safety of carotid endarterectomy for correction of this condition.


Assuntos
Angioplastia com Balão , Estenose das Carótidas , Endarterectomia das Carótidas , Angioplastia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Humanos , Masculino , Recidiva , Stents , Resultado do Tratamento
7.
J Vasc Interv Radiol ; 31(12): 1969-1977.e1, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33139186

RESUMO

PURPOSE: To review outcomes of patients with critical limb ischemia (CLI) who underwent conventional percutaneous transluminal angioplasty (PTA) as first-line treatment for revascularization. MATERIALS AND METHODS: Retrospective review of 3,303 angioplasty procedures on 2,402 limbs in 1,968 patients with CLI was conducted. Mean patient age was 68 years ± 11, and 1,057 patients (54%) were male. Diabetes mellitus (DM) was present in 1,736 patients (88%), and end-stage renal disease (ESRD) in 579 (29%). A majority of patients (90%) had tissue loss. Limb salvage rates were generated by Kaplan-Meier plot. Univariate and multivariate Cox regression analysis was conducted to investigate associations between clinical predictors and time-to-event outcome. RESULTS: Limb salvage rates at 1, 3, 5, and 10 years were 75%, 73%, 72%, and 62%, respectively, and overall survival rates were 79%, 64%, 56%, and 34%, respectively. In multivariable Cox regression analysis with the outcome of major amputation, significant predictors included age < 69 years (P = .032), Malay race (P = .029), DM (P < .001), history of cerebral vascular disease (P = .003), ESRD (P < .001), Rutherford classification (P = .042), repeat intervention (P = .034), and number of straight-line flows (P < .001) and plantar arch integrity (P < .001) on completion angiography. Significant associations with mortality were age < 69 years (P < .001), male sex (P = .030), Malay race (P = .027), history of ischemic heart disease (P < .001), ESRD (P < .001), and repeat intervention (P < .001). CONCLUSIONS: PTA as first-line revascularization for patients with CLI is safe and effective. Further studies are suggested to validate the outcome predictive model.


Assuntos
Angioplastia com Balão , Isquemia/terapia , Salvamento de Membro , Doença Arterial Periférica/terapia , Idoso , Amputação , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Angioplastia com Balão/mortalidade , Comorbidade , Estado Terminal , Bases de Dados Factuais , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Salvamento de Membro/efeitos adversos , Salvamento de Membro/mortalidade , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Singapura , Stents , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
8.
Zhonghua Wai Ke Za Zhi ; 58(12): 904-908, 2020 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-33249807

RESUMO

Objective: To explore the safety and short-term efficacy of drug-coated balloon (DCB) angioplasty for patients with symptomatic intracranial vertebrobasilar artery stenosis. Methods: Sixteen patients with symptomatic intracranial vertebrobasilar artery stenosis who received DCB angioplasty from September 2018 to December 2019 at Department of Neurosurgery, Beijing Hospital were retrospectively reviewed. There were 15 males and 1 female, aged (63.1±9.2) years (range: 48 to 77 years). Patients' demographics, lesions characteristics, complications, clinical and imaging follow-up data were collected and analyzed. Results: A total of 19 symptomatic intracranial vertebrobasilar artery stenosis were successfully treated with DCB.The degree of stenosis of lesion was 75% (20%) (M(Q(R))) before operation and 0 (20%) after operation. One posterior circulation stroke due to perforator artery occlusion happened in peri-procedural period.With a mean imaging follow-up time of 5.5 months, there was no restenosis occurred. Within a mean clinical follow-up period of 6.3 months, no new symptoms happened. Conclusion: For patients with symptomatic intracranial vertebrobasilar artery stenosis, DCB angioplasty seems relatively high safety with satisfactory short-term clinical and imaging outcomes.


Assuntos
Angioplastia com Balão , Insuficiência Vertebrobasilar , Idoso , Angioplastia com Balão/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Insuficiência Vertebrobasilar/cirurgia
9.
J Cardiovasc Surg (Torino) ; 61(5): 626-631, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33231030

RESUMO

INTRODUCTION: Restenosis by myointimal hyperplasia after peripheral arterial angioplasty or stenting often limits long term patency. Drug-eluting balloons (DEBs) which inhibit the proliferation of neo-intimal growth of vascular smooth muscle cells may prevent restenosis. The aim of this paper was to examine the evidence in published literature on the use of DEBs in the treatment of peripheral arterial in-stent restenosis (ISR). EVIDENCE ACQUISITION: A systematic literature review was undertaken of all published literature on the treatment of peripheral ISR with drug eluting balloon using Medline and cross-referenced. All published papers on the use of DEBs in peripheral arterial disease (PAD) were used. Cochrane Central Register of Controlled Trials and electronic databases were also searched for on-going studies. EVIDENCE SYNTHESIS: There were no level 1 or 2 evidence published on this subject. The number of high-quality publications is few, and consequently a sufficient analysis is not possible. Recently data from non-randomized cohort studies showed encouraging results with DEB as treatment modality for ISR, whether used alone or as combined strategies. CONCLUSIONS: Evidence from the published literature suggests that DEBs are safe in preventing peripheral ISR. Despite strong corporate pressure for the use of DEBs, there is only circumstantial evidence that this is a useful modality for ISR. Results from on-going studies may allow further meta-analysis for efficiency and cost-effectiveness.


Assuntos
Angioplastia com Balão/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Stents , Dispositivos de Acesso Vascular , Angioplastia com Balão/efeitos adversos , Animais , Fármacos Cardiovasculares/efeitos adversos , Humanos , Hiperplasia , Neointima , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Recidiva , Retratamento , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
Semin Vasc Surg ; 33(1-2): 10-15, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33218611

RESUMO

Transcarotid artery revascularization is a relatively new technology made available to vascular interventionalists within the last several years for patients with carotid artery stenosis. However, the intraoperative techniques and perioperative management of these patients continues to evolve as more experience is gained. Herein, we consider some important principles of anesthesia for patients undergoing this procedure.


Assuntos
Anestesia por Condução , Anestesia Geral , Angioplastia com Balão , Estenose das Carótidas/terapia , Anestesia por Condução/efeitos adversos , Anestesia Geral/efeitos adversos , Anestesia Local , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Dispositivos de Proteção Embólica , Hemodinâmica , Humanos , Monitorização Neurofisiológica Intraoperatória , Fatores de Risco , Stents , Resultado do Tratamento
12.
Semin Vasc Surg ; 33(1-2): 16-23, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33218612

RESUMO

Both transfemoral carotid artery stenting (TF-CAS) and transcarotid artery revascularization (TCAR) are competing endovascular alternatives to carotid endarterectomy for the treatment of atherosclerotic carotid artery stenosis. TF-CAS is an endovascular procedure associated with a long learning curve and higher periprocedural stroke and death rates during an operator's early experience. Estimates suggest that more than 50 cases are required to achieve outcomes similar to carotid endarterectomy. TCAR is a novel hybrid procedure combining direct common carotid artery access and cerebral blood flow reversal with carotid stent placement. In distinction from TF-CAS, TCAR has a rather short learning curve. A multi-institutional analysis showed that operators achieved technical proficiency after approximately 10 to 15 cases. This was reinforced by a large Society for Vascular Surgery, Vascular Quality Initiative Transcarotid Artery Revascularization Surveillance Project analysis that demonstrated that expertise peaked after approximately 20 cases. Both studies found that TCAR was not associated with an increased rate of stroke or death during operator's early experience. These data suggest that TCAR is readily learned and patients are not at increased risk during a surgeon's early experience.


Assuntos
Angioplastia com Balão , Estenose das Carótidas/terapia , Cateterismo Periférico , Competência Clínica , Artéria Femoral , Curva de Aprendizado , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Cateterismo Periférico/efeitos adversos , Dispositivos de Proteção Embólica , Humanos , Punções , Fatores de Risco , Stents , Resultado do Tratamento
13.
Semin Vasc Surg ; 33(1-2): 24-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33218613

RESUMO

Carotid endarterectomy remains the reference standard procedure for carotid revascularization in patients with significant carotid artery stenosis. However, carotid artery stenting was established as a minimally invasive procedure for patients who are not candidates for open surgery due to medical or anatomic high-risk factors. However, despite years of technical refinement and significant improvement in proper patient selection and aggressive medical management, carotid artery stenting via the transfemoral approach has been scrutinized due to a higher risk of stroke or death in the perioperative period compared with carotid endarterectomy. The higher risk of stroke after carotid artery stenting was attributed to manipulation of the diseased aortic arch and the carotid lesion before placement of distal embolic protection devices, as well as failure of these devices to provide adequate neuroprotection. These limitations led to the development of transcarotid artery revascularization, which avoids the need to cross the aortic arch through direct access to the common carotid artery and utilizes a robust neuroprotection mechanism through clamping the proximal carotid artery and establishing active reversal of cerebral blood flow to clear embolic debris. Earlier studies have demonstrated favorable outcomes after transcarotid artery revascularization in high-risk patients. In this study, we aimed to compare the in-hospital outcomes of transcarotid artery revascularization with those of carotid endarterectomy in patients with symptomatic and asymptomatic carotid artery stenosis.


Assuntos
Angioplastia com Balão , Estenose das Carótidas/terapia , Endarterectomia das Carótidas , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Angioplastia com Balão/mortalidade , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Dispositivos de Proteção Embólica , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Feminino , Hemodinâmica , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Stents , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento
14.
Semin Vasc Surg ; 33(1-2): 4-9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33218614

RESUMO

Transcarotid artery revascularization is a minimally invasive technique performed by vascular surgeons for the management of carotid artery stenosis via direct access of the common carotid artery and stenting of the common and internal carotid artery atherosclerotic stenosis. Unlike the transfemoral approach for carotid artery stent angioplasty, the transcarotid artery revascularization procedure allows cerebral protection from embolization without manipulation of the internal carotid artery stenotic lesion via the ENROUTE Transcarotid Neuroprotection System (Silk Road Medical, Sunnyvale, CA). The ENROUTE reverse flow cerebral protection affords the opportunity to predilate carotid artery lesions with relative impunity before stent deployment. Our technique of transcarotid artery revascularization is detailed in this report of 70 patients (112 procedures) with <1% perioperative neurologic morbidity and documents clinical and hemodynamic (duplex ultrasound testing) success at more than 6 months' follow-up.


Assuntos
Angioplastia com Balão , Estenose das Carótidas/terapia , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Angioplastia com Balão/mortalidade , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Dispositivos de Proteção Embólica , Feminino , Hemodinâmica , Humanos , Masculino , Fatores de Risco , Stents , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento
15.
J Cardiovasc Surg (Torino) ; 61(5): 617-625, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33231029

RESUMO

BACKGROUND: This clinical trial aims to evaluate the outcome (up to 24-months) of the treatment of in-stent restenotic or reoccluded lesions in the femoropopliteal arteries, by comparing the treatment of the GORE® VIABAHN® Endoprosthesis with PROPATEN Bioactive Surface (W. L. Gore & Associates, Flagstaff, AZ, USA) with a standard PTA treatment. The primary effectiveness endpoint of the study is the primary patency at 12 months, defined as no evidence of restenosis or occlusion within the originally treated lesion based on color-flow duplex ultrasound (PSVR≤2.5) and without target lesion revascularization (TLR) within 12 months. The primary safety endpoint is the proportion of subjects who experience serious device-related adverse events within 30 days postprocedure. METHODS: A total of 83 patients meeting inclusion and exclusion criteria have been enrolled in this prospective, randomized, multicenter, controlled study in 7 sites between June 2010 and February 2012. Patients with an in-stent restenosis lesion in the femoropopliteal region and a Rutherford classification from 2 to 5 could be enrolled. After screening, the patient was randomized to either treatment with the GORE® VIABAHN® Endoprosthesis with PROPATEN Bioactive Surface or treatment with a standard PTA balloon. After the index procedure, follow-up visits at 1 month, 6 months, 12 months and 24 months were required. A color flow Doppler ultrasound was performed on all follow-up visits and a quantitative vascular angiography at the 12-month follow-up visit. RESULTS: In the VIABAHN® group, 39 patients (74.4% male; mean age 67.69±9.77 years) were enrolled and in the PTA group, 44 patients (72.7% male; mean age 68.98±9.71 years) were enrolled, which is comparable for both treatment groups. In the VIABAHN® group, 34 (87.2%) patients presented with claudication (Rutherford 2 and 3) and 5 (12.8%) patients had critical limb ischemia (Rutherford 4 and 5). In the PTA group, 36 (81.8%) patients were claudicants (Rutherford 2 and 3) and 8 (18.2%) presented with critical limb ischemia (Rutherford 4 and 5). The 12-month primary patency rates were 74.8% for the VIABAHN® group and 28.0% for the PTA group (P<0.001). No patients were reported to have device-related serious adverse events within 30 days postprocedure. The primary patency rate for the 24-month follow-up was 58.40% in the Viabahn group and 11.60% in the PTA group (P<0.001). CONCLUSIONS: The treatment of femoropopliteal in-stent restenosis with a VIABAHN® Endoprosthesis shows significantly better results than the treatment with a standard PTA balloon. This demonstrates that the use of the VIABAHN® Endoprosthesis is a very promising tool for the treatment of complex in-stent restenosis.


Assuntos
Angioplastia com Balão/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Artéria Femoral/cirurgia , Doença Arterial Periférica/terapia , Stents , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Bélgica , Implante de Prótese Vascular/efeitos adversos , Constrição Patológica , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Recidiva , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
16.
J Vasc Interv Radiol ; 31(12): 2066-2072, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33127247

RESUMO

PURPOSE: To retrospectively evaluate the technical and clinical outcomes of superior vena cava (SVC) stent placement through upper-limb venous access in malignant SVC syndrome (SVCS) and compare the efficacy of different nitinol stent types. MATERIALS AND METHODS: Between 2006 and 2018, 156 patients (132 male; mean age, 62 y; age range, 33-81 y) underwent SVC stent placement for malignant obstructions through upper-limb venous access with 1 of 3 types of nitinol stent: 1 venous-dedicated (Sinus-XL stent) and 2 non-venous-dedicated (E-Luminexx Vascular Stent and Protégé GPS). Cases of common femoral vein access or non-nitinol stents were excluded from further analysis. The mean duration of follow-up was 8 mo. RESULTS: Technical success was achieved in 99.3% of cases. One patient died during the procedure as a result of cardiac tamponade. Balloon predilation was performed in 10 patients and postdilation in 126. Mean procedural time was 34.4 min (range, 18-80 min). Overall survival rates were 92.3%, 57.3%, and 26.8%, and overall primary patency rates were 94.5%, 84.8% and 79.6%, at 1, 6, and 12 mo, respectively. There were no statistically significant differences in primary patency rates between venous- and non-venous-dedicated stents or among different Stanford SVCS grading groups (P > .05). CONCLUSIONS: SVC stent placement through an upper-limb approach is a safe, fast, and effective technique. There is no evident benefit of venous-dedicated vs non-venous-dedicated stents in the treatment of malignant SVCS.


Assuntos
Angioplastia com Balão/instrumentação , Cateterismo Periférico , Neoplasias/complicações , Stents , Síndrome da Veia Cava Superior/terapia , Extremidade Superior/irrigação sanguínea , Veia Cava Superior , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligas , Angioplastia com Balão/efeitos adversos , Cateterismo Periférico/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Desenho de Prótese , Sistema de Registros , Estudos Retrospectivos , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/fisiopatologia
17.
Vascular ; 28(6): 747-755, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33045944

RESUMO

OBJECTIVES: To compare perioperative outcomes related to atherectomy with percutaneous transluminal angioplasty versus percutaneous transluminal angioplasty alone for the treatment of lower extremity chronic limb threatening ischemia using a national patient database. METHODS: Patients with chronic limb threatening ischemia treated with atherectomy and percutaneous transluminal angioplasty or percutaneous transluminal angioplasty alone from 2011 to 2016 in the National Surgical Quality Improvement Program database were identified. Primary outcomes were major adverse limb events (30-day untreated loss of patency, major reintervention, major amputation) and major adverse cardiac events (cardiac arrest, composite outcome of myocardial infarction or stroke). Secondary outcomes included 30-day mortality, length of stay, and any unplanned readmission within 30 days. Multivariate regression analyses were performed to determine independent predictors of outcome. Propensity score matched cohort analysis was performed. A p-value <0.05 was considered statistically significant. Subgroup analyses of femoropopliteal and infrapopliteal interventions were performed. RESULTS: In total, 2636 (77.2%) patients were treated with percutaneous transluminal angioplasty and 778 (22.8%) were treated with atherectomy and percutaneous transluminal angioplasty. Multivariate analyses of the unadjusted cohort revealed no significant differences in major adverse cardiac events or major adverse limb events between the two groups (p-value >0.05). Subgroup analysis of femoropopliteal interventions demonstrated a significantly decreased likelihood of untreated loss of patency in 30 days in the atherectomy group compared to the percutaneous transluminal angioplasty group (1.1% vs. 2.7%, respectively; p-value = 0.034), which persisted on propensity score matched analysis (1.1% vs. 3.1%, respectively; p-value = 0.026). CONCLUSION: Atherectomy with balloon angioplasty of femoropopliteal disease provides a significant decrease in untreated loss of patency compared to balloon angioplasty alone.


Assuntos
Angioplastia com Balão , Aterectomia , Isquemia/terapia , Doença Arterial Periférica/terapia , Idoso , Amputação , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/mortalidade , Aterectomia/efeitos adversos , Aterectomia/mortalidade , Doença Crônica , Bases de Dados Factuais , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
18.
Int Heart J ; 61(5): 999-1004, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32999197

RESUMO

This study aimed to clarify the usefulness of the Ikari-curve left (IL) guiding catheter for balloon pulmonary angioplasty (BPA).The current BPA strategy for chronic thromboembolic pulmonary hypertension is dilation of as many branches as possible to normalize hemodynamics and oxygenation. The shape of the guiding catheter is a major factor in achieving this. However, conventional guiding catheters are difficult to introduce into particular branches. The IL guiding catheter may be suitable; however, its utility remains unclear.We retrospectively analyzed 202 consecutive BPA sessions of 40 patients from November 2016 to October 2019 and divided these sessions into two groups: the IL group where the IL guiding catheter was used and the non-IL group where other catheters were utilized. The occurrence of lung injury was determined by the presence of bloody sputum. We compared the rates of successful introduction into target vessels and assessed for the occurrence of lung injury.The average age of enrolled patients was 60.3 ± 14.4 years, with females comprising 65%. There were 99 sessions in the IL group. The median treated branches per session differed between the 2 groups (IL group: 15 versus non-IL group: 10, P < 0.05). The occurrence of lung injury was lower in the IL group (4.0% versus 11.7%, P = 0.07). The IL group had more successful vessel insertions than the non-IL group (78.8% versus 42.7%, P < 0.01).The IL guiding catheter may be introduced into branches that cannot be accessed by conventional guiding catheters.


Assuntos
Angioplastia com Balão/métodos , Hipertensão Pulmonar/terapia , Embolia Pulmonar/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/estatística & dados numéricos , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2536-2539, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018523

RESUMO

Atherosclerosis is one of the most common vascular pathologies in the world. Among the most commonly performed endovascular treatments, percutaneous transluminal angioplasty (PTA) has been showing significantly positive clinical outcomes. Due to the complex geometries, material properties and interactions that characterize PTA procedures, finite element analyses of acute angioplasty balloon deployment are limited. In this work, finite element method (FEM) was used to simulate the inflation and deflation of a semi-compliant balloon within the 3D model of a stenosed artery with two different plaque types (lipid and calcified). Self-defined constitutive models for the balloon and the plaque were developed based on experimental and literature data respectively. Balloon deployment was simulated at three different inflation pressures (10, 12 and 14 atm) within the two plaque types. Balloon sizing influence on the arterial elastic recoil obtained immediately after PTA was then investigated. The simulated results show that calcified plaques may lead to higher elastic recoil ratios compared to lipid stenosis, when the same balloon inflation pressures are applied. Also, elastic recoil increases for higher balloon inflation pressure independent of the plaque type. These findings open the way for a data-driven assessment of angioplasty balloon sizing selection and clinical procedures optimization.Clinical Relevance- The FE model developed in this work aims at providing quantitative evaluation of recoil after balloon angioplasty. It may be useful for both manufacturers and clinicians to improve efficiency of angioplasty balloon device design and sizing selection with respect to plaque geometry and constitution, consequently enhancing clinical outcomes.


Assuntos
Angioplastia com Balão , Técnica para Retentor Intrarradicular , Angioplastia , Animais , Constrição Patológica , Análise de Elementos Finitos
20.
PLoS One ; 15(10): e0241321, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33108398

RESUMO

BACKGROUND: The aim of this pilot study was to evaluate the safety and efficacy of the MagicTouch™ sirolimus-coated balloon (SCB) catheter (Concept Medical Inc., Tampa, FL, US) on improving the patency of failing arterio-venous fistulas (AVF) with de novo and recurrent stenoses. MATILDA reports early outcomes at 3- and 6 months post intervention. METHODS: Single-centre, single-arm prospective pilot study of 33 (18 males; mean age 64.7±11.6 years) end-stage renal failure Asian patients with a dysfunctional AVF, who underwent SCB angioplasty between May 2019-January 2020. All procedures were performed under local anaesthetic without sedation and as day surgery. All patients were prescribed dual antiplatelet therapy for 3 months and followed up with Duplex ultrasound at 3 and 6 months. RESULTS: 47 stenotic target lesions treated and 24/33 (72.7%) patients were for restenosis. Main indications for intervention was low/dropping access flow (21/33; 63.6%) and most common target lesion was in the juxta-anastomosis (19/47; 40.4%). There was 100% technical and procedural success. There were no peri-procedural complications related to the SCB. The target lesion primary patency rates at 3 and 6 months were 46/47 (97.9%) and 29/35 (82.9%) respectively. Circuit access patency rates at 3 and 6 months were 31/33 (93.9%) and 17/25 (68%) respectively. There was one (2.9%) death at 6 months and 4/33 (12.1%) overall to date, all from patients' underlying co-morbidities. CONCLUSIONS: SCB angioplasty for dysfunctional AVF circuits is a safe and efficacious modality in Asian haemodialysis patients at six months comparable if not better than the paclitaxel data reported to date in the literature.


Assuntos
Angioplastia com Balão , Fístula Arteriovenosa/fisiopatologia , Fístula Arteriovenosa/terapia , Materiais Revestidos Biocompatíveis/química , Diálise Renal , Sirolimo/farmacologia , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento
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