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Sample records for acute stent thrombosis

  1. Acute stent thrombosis after primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Wiberg, Sebastian; Van't Hof, Arnoud;

    2015-01-01

    OBJECTIVES: This study sought to determine clinical, procedural, and treatment factors associated with acute stent thrombosis (AST) in the EUROMAX (European Ambulance Acute Coronary Syndrome Angiography) trial. BACKGROUND: Bivalirudin started during transport for primary percutaneous coronary int...

  2. Acute stent thrombosis after bifurcation stenting with the crush technique visualized with 64-slice computed tomography

    DEFF Research Database (Denmark)

    Kristensen, T.S.; Engstrom, T.; Kofoed, Klaus Fuglsang

    2008-01-01

    Acute stent thrombosis remains a potential complication after stent implantation. With the introduction of electrocardiographic gated multidetector row computed tomography (MDCT), a new nonnvasive imaging modality has become available that may contribute to the detection of complications after...

  3. Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance

    Energy Technology Data Exchange (ETDEWEB)

    Köklü, Erkan, E-mail: drerkankoklu@gmail.com; Arslan, Şakir; Yüksel, İsa Öner; Bayar, Nermin [Antalya Education and Research Hospital, Clinic of Cardiology (Turkey); Koç, Pınar [Antalya Education and Research Hospital, Clinic of Radiology (Turkey)

    2015-08-15

    Carotid artery stenting (CAS) is a revascularization modality that is an alternative to carotid endarterectomy. The efficacy of CAS in primary and secondary prevention from ischemic stroke has been demonstrated in various trials. Acute thrombosis of CAS is a rare complication that can lead to dramatic and catastrophic consequences. We discuss a case of acute CAS thrombosis in a patient who had previously undergone successful CAS. CAS was performed in a 73-year-old man who had had dysarthria lasting 2 weeks with 95 % stenosis in his left internal carotid artery. An acute cerebrovascular event resulting in right-sided hemiplegia developed 24 h after the procedure. Computed tomographic carotid angiography revealed complete occlusion of the stent with thrombus. The cause of stent thrombosis was thought to be antiaggregant resistance to both acetylsalicylic acid and clopidogrel. The most important cause of acute CAS thrombosis is inadequate or ineffective antiaggregant therapy. Evaluating patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may preclude this complication.

  4. Impact of rivaroxaban on stent thrombosis and secondary prevention of cardiovascular events in acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Krohn-Grimberghe M

    2014-05-01

    Full Text Available Marvin Krohn-Grimberghe, Christoph Bode, Constantin von zur MuhlenDepartment of Cardiology and Angiology I, Heart Center, University of Freiburg, GermanyAbstract: Angioplasty and stent implantation have greatly improved the outcome of patients with acute coronary syndrome. However, stents come with the risk of stent thrombosis, which is associated with a high rate of revascularization, myocardial infarction, and death. The inhibition of factor Xa due to rivaroxaban leads to an interruption of the intrinsic as well as the extrinsic coagulation pathway, which reduces thrombus formation as a potential mechanism to diminish the rate of stent thrombosis. In this review, we evaluate the role of rivaroxaban in the prevention of stent thrombosis and its general role in patients with acute coronary syndrome.Keywords: Rivaroxaban, stent thrombosis, acute coronary syndrome, secondary prevention

  5. ST-elevated acute myocardial infarction happening 1 month post stent implantation: late thrombosis in-stents or new lesions?

    Institute of Scientific and Technical Information of China (English)

    SONG Guang-yuan; YANG Yue-jin; XU Bo; LI Jian-jun; GAO Run-lin; QIAO Shu-bin; YUAN Jin-qing; TANG Yi-da; YOU Shi-jie; PEI Han-jun; ZHAO Zhen-yan; WANG Xi-mei; WU Yong-jian

    2009-01-01

    Background ST-elevated acute myocardial infarction (STEAMI) happening in the first month post percutaneous coronary intervention (PCI) is almost related to acute thrombosis or subacute thrombosis in-stents. This study aimed to investigate the possible causes of myocardial infarction one month later. Methods Patients who had a history of successful PCI, and received coronary angiography or re-PCI due to STEAMI were included in this study. The AMI-related lesions and previous angiographic findings such as the number of lesions, the degree of the stenosis, the type of stents and acute results of last PCI were recorded. If the AMI-related lesion was localized in-stents or at the edge of stents (distance apart from the edge <5 mm), it was defined to be late thrombosis; otherwise as a new-lesion induced AMI. Results One hundred and ninety-two patients aged 40-79 years were included in this study. New lesions, as the cause of STEAMI, were found in 144 patients (Group A, 75%), and late thrombosis in 48 patients (Group B, 25%). Almost all newly built thromboses were found at the sites of previous insignificant lesions (diameter stenosis <50%). There was a significant difference in the average time from previous PCI to AMI ((30.1+12.4) vs (20.3+11.9) months) between the two groups. Diabetes mellitus (DM) and drug-eluting stent (DES) utilization were associated with markedly higher morbidity of late thrombosis in adjusted Logistic regression (hazard ratio (HR) 3.4, 95% confidence interval (CI) 1.1-10.9 and 5.3, 95% CI 1.1-26.5). Conclusions STEAMIs happening 1 month after PCI are more likely to develop from previous insignificant lesion rupture than from late thrombosis in-stents. Moreover, DM and DES are associated with the high incidence of latethrombosis, which may indicate that intensive antiplatelet therapy should be considered in patients with diabetes.

  6. Acute and subacute stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction : incidence, predictors and clinical outcome

    NARCIS (Netherlands)

    Hesstermans, A. A. C. M.; van Werkum, J. W.; Zwart, B.; van der Heyden, J. A.; Kelder, J. C.; Breet, N. J.; van't Hof, A. W. J.; Koolen, J. J.; Brueren, B. R. G.; Zijlstra, F.; ten Berg, J. M.; Dambrink, Jan Hendrik Everwijn

    2010-01-01

    Background: Early coronary stent thrombosis occurs most frequent after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Objectives: To identify the specific predictors of, respectively, acute and subacute stent thrombosis in patients after prim

  7. Predictive value of antiplatelet resistance on early stent thrombosis in patients with acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    LI Lei; LI Hai-yan; QIAO Rui; YU Hai-yi; ZENG Hui; GAO Wei; ZHANG Jie

    2013-01-01

    Background Despite outstanding antiplatelet properties of aspirin and clopidogrel,some patients taking these drugs continue to suffer complications.Antiplatelet resistance appears to be a new prognostic factor in acute coronary syndrome patients for clinical events associated with stent thrombosis (ST).However,there is no optimal method to identify it and assess its correlation to clinical outcomes.This study sought to evaluate the predictive value of antiplatelet resistance assessed by whole blood impedance aggregometry for the risk of early ST in patients with acute coronary syndrome who underwent coronary stenting.Methods Platelet responses to aspirin and clopidogrel in 86 patients with acute coronary syndrome were measured by whole blood impedance aggregometry.Spontaneous platelet aggregation was defined as antiplatelet resistance identified by the increased electrical impedance.The clinical endpoint was early stent thrombosis during 30-day follow-up after coronary stenting.Results The prevalence of aspirin resistance,clopidogrel resistance and dual resistance of combined clopidogrel and aspirin resistance were 19.8%,12.8% and 5.8% respectively.Diabetes,female and higher platelet counts were more frequently detected in clopidogrel-resistant and dual-resistant patients.During 30-day follow-up,the patients with clopidogrel resistance and dual resistance had higher incidence of early stent thrombosis (18.2% vs.1.3%,40.0% vs.1.2%,P <0.05).Binary Logistic Regression analysis indicated that dual resistance remained an independent predicator for early stent thrombosis (odds ratio 34.064,95% CI 1.919-604.656,P=-0.016).Conclusions Antiplatelet resistance assessed by whole blood impedance aggregometry is paralleled to clinical events,and dual antiplatelet resistance is an independent predicator for early stent thrombosis in patients with acute coronary syndrome.As a physiological assessment of platelet reactivity,whole blood impedance aggregometry is a

  8. [Rescue treatment in acute thrombosis of intracranial stents].

    Science.gov (United States)

    Pumar, José M; Banguero, Alexandra; Arias-Rivas, Susana; Blanco, Miguel; Rodríguez-Yáñez, Manuel; Sucasas, Paula; Blanco, Miguel; Castiñeira-Mourenza, José A; Vázquez-Herrero, Fernando

    2014-02-01

    Introduccion. La trombosis aguda intrastent es una complicacion potencialmente grave en el stenting intracraneal. Es primordial determinar cual es la terapia mas adecuada en las trombosis intrastent. Caso clinico. Mujer de 58 años, el primer caso de trombosis aguda de un stent intracraneal, que fue tratada con exito mediante fibrinolisis tras la implantacion de un dispositivo diversificador de flujo (Silk) en un aneurisma basilar fusiforme. Conclusion. La administracion de abciximab como tratamiento de rescate parece segura en los casos de formaciones de trombos agudos intrastent.

  9. Very late bare-metal stent thrombosis, rare but stormy!

    LENUS (Irish Health Repository)

    Ali, Mohammed

    2011-08-01

    Recurrent in-stent thrombosis is rarely reported, with catastrophic clinical consequences of either acute coronary syndrome or death. We present a case of recurrent in-stent thrombosis with its outcome and a concise literature review.

  10. Disseminated Intravascular Coagulation as a Possible Cause of Acute Coronary Stent Thrombosis: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Syed Amer

    2012-01-01

    Full Text Available Disseminated intravascular coagulation (DIC, as a cause of acute coronary stent thrombosis, has not yet been reported to our knowledge. We report a case of 64-year-old male, who presented with non-ST-segment elevation myocardial infarction (NSTEMI. Coronary angiography revealed right coronary artery (RCA stenosis and a drug eluting stent was deployed. Fifteen hours following the intervention, the patient developed an inferior wall ST elevation myocardial infarction. Repeat cardiac catheterization showed an acute in-stent thrombosis. Following thrombectomy, another stent was placed. The patient noted to have an acute drop in platelet count following the second intervention. Two hours following repeat intervention, the patient again developed chest pain and EKG showed recurrent ST-segment elevations in leads II, III, and aVF. Prior to repeat cardiac catheterization, the patient became unresponsive and developed cardiogenic shock. The patient was resuscitated and intubated, and repeat catheterization showed complete stent thrombosis. Intracoronary tissue plasminogen activator (tPA was given. The platelet count further dropped. Additional studies confirmed the diagnosis of DIC. No further cardiac catheterization was done at this point. The patient then later had a cardiac arrest and unfortunately cardiopulmonary resuscitation could not revive him. Amongst the etiologies of acute stent thrombosis, DIC was deemed a possible cause.

  11. Reduction of stent thrombosis in patients with acute coronary syndromes treated with rivaroxaban in ATLAS-ACS 2 TIMI 51

    NARCIS (Netherlands)

    Gibson, C.M.; Chakrabarti, A.K.; Mega, J.; Bode, C.; Bassand, J.P.; Verheugt, F.W.A.; Bhatt, D.L.; Goto, S.; Cohen, M.; Mohanavelu, S.; Burton, P.; Stone, G.; Braunwald, E.

    2013-01-01

    OBJECTIVES: The aim of this study was to determine if rivaroxaban is associated with a reduction in stent thrombosis among patients with acute coronary syndromes (ACS) in the ATLAS-ACS 2 TIMI 51 (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects With Acute Co

  12. Circadian Variation in Coronary Stent Thrombosis

    NARCIS (Netherlands)

    Mahmoud, Karim D.; Lennon, Ryan J.; Ting, Henry H.; Rihal, Charanjit S.; Holmes, David R.

    2011-01-01

    Objectives We sought to determine the circadian, weekly, and seasonal variation of coronary stent thrombosis. Background Other adverse cardiovascular events such as acute myocardial infarction are known to have higher incidences during the early morning hours, Mondays, and winter months. Methods The

  13. Prevention of stent thrombosis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Reejhsinghani R

    2015-01-01

    Full Text Available Risheen Reejhsinghani, Amir S LotfiDivision of Cardiology, Baystate Medical Center, Springfield, MA, USAAbstract: Stent thrombosis is an uncommon but serious complication which carries with it significant mortality and morbidity. This review analyzes the entity of stent thrombosis from a historical and clinical perspective, and chronicles the evolution of this condition through the various generations of stent development, from bare metal to first-generation, second-generation, and third-generation drug-eluting stents. It also delineates the specific risk factors associated with stent thrombosis and comprehensively examines the literature related to each of these risks. Finally, it highlights the preventative strategies that can be garnered from the existing data, and concludes that a multifactorial approach is necessary to combat the occurrence of stent thrombosis, with higher risk groups, such as patients with ST segment elevation myocardial infarction, meriting further research.Keywords: stent thrombosis, preventative strategies, post-procedural myocardial infarction

  14. Incidence and predictors of coronary stent thrombosis

    DEFF Research Database (Denmark)

    D'Ascenzo, Fabrizio; Bollati, Mario; Clementi, Fabrizio;

    2013-01-01

    Stent thrombosis remains among the most feared complications of percutaneous coronary intervention (PCI) with stenting. However, data on its incidence and predictors are sparse and conflicting. We thus aimed to perform a collaborative systematic review on incidence and predictors of stent thrombo...

  15. A 2-step optical coherence tomography guided therapeutic approach to acute myocardial infarction secondary to stent thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Bogale, Nigussie, E-mail: nigussie.bogale@lyse.net [Vancouver General Hospital, Division of Cardiology University of British Columbia, Vancouver, BC (Canada); Stavanger University Hospital, Department of Cardiology, Stavanger (Norway); Lempereur, Mathieu; Fung, Anthony Y. [Vancouver General Hospital, Division of Cardiology University of British Columbia, Vancouver, BC (Canada)

    2016-07-15

    Myocardial infarction secondary to stent thrombosis has high mortality and recurrence rate. Emergency PCI has high risk of no-reflow. We used a 2-step approach of early recanalization with minimal mechanical intervention followed by delayed PCI 1–2 days later guided by Optical Coherence Tomography (OCT). From October 2011 to December 2013, we treated 5 patients with this approach. Time from early recanalization to the delayed definitive PCI was 1 day (median, range 1–3 days). All the OCT images were diagnostic with a clear view of the underlying structures. Summary: A 2-step approach to treat stent thrombosis appears beneficial with low incidence of peri-procedural thrombosis or no-reflow phenomena during the second step, and superb OCT imaging.

  16. Drug-eluting stents to prevent stent thrombosis and restenosis.

    Science.gov (United States)

    Im, Eui; Hong, Myeong-Ki

    2016-01-01

    Although first-generation drug-eluting stents (DES) have significantly reduced the risk of in-stent restenosis, they have also increased the long-term risk of stent thrombosis. This safety concern directly triggered the development of new generation DES, with innovations in stent platforms, polymers, and anti-proliferative drugs. Stent platform materials have evolved from stainless steel to cobalt or platinum-chromium alloys with an improved strut design. Drug-carrying polymers have become biocompatible or biodegradable and even polymer-free DES were introduced. New limus-family drugs (such as everolimus, zotarolimus or biolimus) were adopted to enhance stent performances. As a result, these new DES demonstrated superior vascular healing responses on intracoronary imaging studies and lower stent thrombotic events in actual patients. Recently, fully-bioresorbable stents (scaffolds) have been introduced, and expanding their applications. In this article, the important concepts and clinical results of new generation DES and bioresorbable scaffolds are described.

  17. Subacute coronary stent thrombosis in a patient with angina treated with double antiplatelet drugs for six days

    Institute of Scientific and Technical Information of China (English)

    XUE Feng; YANG Xiang-jun; CHENG Xu-jie; HUI Jie; JIANG Ting-bo; CHEN Tan; LIU Zhi-hua; SONG Jian-ping; JIANG Wen-ping

    2009-01-01

    @@ Stent implantation has been a great advance in percutaneous coronary intervention (PCI), decreasing the frequency of acute closure and restenosis. But stent thrombosis is a severe complication of this therapy regardless of the stent type: bare-metal stent (BMS) and drug-eluting stent (DES).

  18. Stent malapposition, as a potential mechanism of very late stent thrombosis after bare-metal stent implantation: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Higuma, Takumi, E-mail: higuma@cc.hirosaki-u.ac.jp; Abe, Naoki; Hanada, Kenji; Yokoyama, Hiroaki; Tomita, Hirofumi; Okumura, Ken

    2014-04-15

    A 90-year-old man was admitted to our hospital with acute ST-segment elevation myocardial infarction. He had a history of post-infarction angina pectoris 79 months ago and had a bare-metal stent (BMS) implanted in the proximal left anterior descending artery at our hospital. Emergent coronary angiography demonstrated thrombotic occlusion in the previously stented segment. After catheter thrombectomy, antegrade flow was restored, but 90% stenosis with haziness persisted in the proximal and distal portions of the previously stented segment. Intravascular ultrasound imaging showed interstrut cavities or stent malapposition at the proximal and distal sites of stented segment. In close proximity to the sites, residual thrombi were also observed. Optical coherence tomography (OCT) demonstrated neither lipid-laden neointimal tissue nor rupture but clearly demonstrated residual thrombus adjacent to the malapposed region in addition to the stent malapposition. PCI with balloon was successfully performed and stent apposition was confirmed by OCT. Stent malapposition is an unusual mechanism of very late stent thrombosis after BMS implantation. OCT can clearly reveal the etiology of stent thrombosis.

  19. Acute Portal Vein Thrombosis and Massive Necrosis of the Liver. An Unusual Complication After Stenting for Chronic Pancreatitis

    Directory of Open Access Journals (Sweden)

    Velayutham Vimalraj

    2006-11-01

    Full Text Available Context ERCP can provide information which is invaluable in managing chronic pancreatitis but it is associated withinfrequent, although significant, complications and rare mortality. The complications uniquely associated withdiagnostic ERCP include pancreatitis and sepsis (primary cholangitis. Case report A 32-year-old man presented with severe upper abdominal pain radiating to the back, associated with vomiting and abdominal distension. The patient was diagnosed as having had chronic calcific pancreatitis recently and had undergone ERCP with pancreatic duct stenting elsewhere. Two days after the procedure, the patient developed severe abdominal pain, vomiting and abdominal distention, and patient was referred to our hospital 7 days after the procedure. Investigation revealed massive liver necrosis and portal vein thrombosis. This patient had a life-threatening complication following pancreatic duct stenting for chronic pancreatitis and was managed medically.Conclusion Therapeutic pancreatic endoscopy procedures are technically demanding and should be restricted to highvolume centers. There is a continuing need for evaluation and comparison with alternative strategies. In a good surgical candidate, it is better to avoid stenting.

  20. Very late coronary aneurysm formation with subsequent stent thrombosis secondary to drug-eluting stent

    Institute of Scientific and Technical Information of China (English)

    Ibrahim Akin,; Stephan Kische; Tim C Rehders; Henrik Schneider; G(o)kmen R Turan; Tilo Kleinfeldt; Jasmin Ortak; Christoph A. Nienaber; Hüseyin Ince

    2011-01-01

    Drug-eluting stents have changed the practice in interventional cardiology.With the widespread use of these stents important safety concerns regarding stent thrombosis and formation of coronary artery aneurysm have been expressed.While the majority of attention was focused on stent thrombosis,the formation of coronary aneurysm was only described in anecdotal reports.We report on a patient who suffered from very late stent thrombosis in association with coronary artery aneurysm formation secondary to drug-eluting stent but not to bare-metal stent.

  1. Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS)

    DEFF Research Database (Denmark)

    Kosonen, Petteri; Vikman, Saila; Jensen, Lisette Okkels;

    2013-01-01

    This prospective multicenter registry used intravascular ultrasound (IVUS) in patients with definite stent thrombosis (ST) to compare rates of incomplete stent apposition (ISA), stent fracture and stent expansion in patients treated with drug-eluting (DES) versus bare metal (BMS) stents. ST...... is a rare, but potential life threatening event after coronary stent implantation. The etiology seems to be multifactorial....

  2. Coronary aneurysm and very late stent thrombosis formation associated with sirolimus-eluting stent implantation

    Institute of Scientific and Technical Information of China (English)

    XIE Hong-zhi; ZHANG Shu-yang; ZENG Yong; SHEN Zhu-jun; FANG Quan

    2009-01-01

    @@ Since drug-eluting stents (DES) can significantly reduce the risk of instant restenosis compared with bare-metal stents, they have been widely used in interventional therapy for coronary heart disease. With bare-metal stents being rapidly replaced by DES there is a great concern about the safety of DES due to stent thrombosis.~(1,2)

  3. Who is responsible for the consequences? A case of stent thrombosis subsequent to noncompliance with post angioplasty treatment regimen.

    Science.gov (United States)

    Sajwani, Salma Abdul Aziz; Allana, Saleema

    2014-01-01

    Coronary artery disease (CAD) is a major cause of mortality internationally and in Pakistan. Angioplasty has been proven to be an effective treatment for CAD. Stent thrombosis is a known but preventable complication of angioplasty. Several factors may lead to stent thrombosis with non-compliance with the prescribed drug regimen, being one of the most important factors. We report a case of stent thrombosis after four months of angioplasty. After exploring of patient's post angioplasty routines, it was found that the patient was non-compliant with the prescribed anti- platelets and other prescribed drugs. This time the patient presented with another acute myocardial infarction, and he went through angioplasty again.

  4. The risk and prognostic impact of definite stent thrombosis or in-stent restenosis after coronary stent implantation

    DEFF Research Database (Denmark)

    Thayssen, Per; Jensen, Lisette Okkels; Lassen, Jens Flensted;

    2012-01-01

    of death (HR=2.71 [95% CI: 1.72-4.27]) compared to cases without stent thrombosis. In-stent restenosis had no substantial impact (HR=1.17 [95% CI: 0.79-1.75]). However, in-stent restenosis presenting as non-ST-segment elevation myocardial infarction (NSTEMI) was associated with a greater mortality risk...

  5. Incidence of definite stent thrombosis or in-stent restenosis after drug-eluting stent implantation for treatment of coronary in-stent restenosis

    DEFF Research Database (Denmark)

    Jensen, Jesper Khedri; Jensen, Lisette Okkels; Terkelsen, Christian Juhl;

    2013-01-01

    There are limited data on the optimal management of in-stent restenosis after percutaneous coronary intervention (PCI) with bare metal stent (BMS) or drug-eluting stent (DES) implantations. We assessed the clinical presentation, the incidence, and prognosis of definite stent thrombosis...

  6. Stent Thrombosis Patients with Hyporesponsiveness to Clopidogrel, Prasugrel, and Ticagrelor: A Case Series Using Short Thromboelastography

    Directory of Open Access Journals (Sweden)

    Bartosz Olechowski

    2016-01-01

    Full Text Available Patients after percutaneous coronary intervention (PCI with stent implantation and functional hyporesponsiveness to P2Y12 inhibitors are at higher risk of ischaemic events, particularly stent thrombosis (ST. It is currently not routine practice to assess the functional response to these agents. However, concern over functional hyporesponsiveness to clopidogrel has led to widespread uptake of prasugrel and ticagrelor as the default P2Y12 inhibitor after stent implantation in patients with acute coronary syndrome. Here we report, for the first time, 3 cases in which patients who have had ST exhibit hyporesponsiveness to clopidogrel, prasugrel, and ticagrelor.

  7. Acute thrombosis during left main stenting using tap technique in a patient presenting with non-ST-segment elevation acute coronary syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Natarajan, Deepak, E-mail: deepaknatarajan@me.com

    2015-06-15

    This case reports the sudden development of large burden of thrombi in the left anterior descending coronary artery immediately following distal left main stenting using TAP technique in a middle aged man who presented with non ST-segment elevation acute coronary syndrome despite having been administered 7,500 units of unfractionated heparin and being given 325 mg of aspirin and 60 mg of prasugrel prior to the procedure. The thrombi were managed effectively by giving an intra-coronary high bolus dose of tirofiban (25 mcg/kg) without the need for catheter thrombus extraction. Tirofiban intra-venous infusion was maintained for 18 hours, and the patient was discharged in stable condition on the third day. Importantly there is no controlled study on upstream administration of glycoprotein IIb/IIIa inhibitors in addition to the newer more potent anti-platelet agents in patients with unprotected distal left main disease presenting with non ST-segment elevation acute coronary syndrome, nor is there any data on safety and efficacy of mandatory usage of injectable anti-platelet agents at the start of a procedure in a catheterization laboratory in such a setting.

  8. Effect of cause of iliac vein stenosis and extent of thrombus in the lower extremity on patency of iliac venous stent placed after catheter-directed thrombolysis of acute deep venous thrombosis in the lower extremity

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Sung Il; Choi, Young Ho; Yoon, Chang Jin; Lee, Min Woo; Chung, Jin Wook; Park, Jae Hyung [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    2003-10-01

    To assess the CT findings of acute deep venous thrombosis (DVT) in a lower extremity prior to catheter-directed thrombolysis, and to evaluate their relevance to the patency of an iliac venous stent placed with the help of CT after catheter-directed thrombolysis of DVT. Fourteen patients [M:F=3:11; age, 33-68 (mean, 50.1) years] with acute symptomatic DVD of a lower extremity underwent CT before and after catheter-directed thrombolysis using an iliac venous stent. The mean duration of clinical symptoms was 5.0 (range, 1-14 days. The CT findings prior to thrombolysis were evaluated in terms of their anatomic cause and the extent of the thrombus, and in all patients, the patency of the iliac venous stent was assessed at CT performed during a follow-up period lasting 6-31 (mean, 18.9) months. All patients were assigned to the patent stent group (n=9) or the occluded stent group (n=5). In the former, the anatomic cause of patency included typical iliac vein compression (May-Thurner syndrome) (n=9), and a relatively short segmental thrombus occurring between the common iliac and the popliteal vein (n=8). Thrombi occurred in the iliac vein (n=3), between the common iliac and the femoral vein (n=3), and between the common iliac and the popliteal vein (n=2). In one case, a relatively long segmental thrombus occurred between the common iliac vein and the calf vein. In the occluded stent group, anatomic causes included atypical iliac vein compression (n=3) and a relatively long segmental thrombus between the common iliac and the calf vein (n=4). Typical iliac vein compression (May-Thurner syndrome) occurred in two cases, and a relatively short segmental thrombus between the external iliac and the common femoral vein in one. Factors which can affect the patency of an iliac venous stent positioned after catheter-directed thrombolysis are the anatomic cause of the stenosis, and the extent of a thrombus revealed at CT of acute DVT and occurring in a lower extremity prior to

  9. Prior chronic clopidogrel therapy is associated with increased adverse events and early stent thrombosis.

    Science.gov (United States)

    Asher, Elad; Fefer, Paul; Sabbag, Avi; Herscovici, Romana; Regev, Ehud; Mazin, Israel; Shlomo, Nir; Zahger, Doron; Atar, Shaul; Hammerman, Haim; Polak, Arthur; Beigel, Roy; Matetzky, Shlomi

    2016-01-01

    Despite the growing use of clopidogrel, limited data exist regarding the prognostic significance of chronic clopidogrel therapy in patients sustaining acute coronary syndrome (ACS). Our aim was to determine whether patients sustaining ACS while on chronic clopidogrel therapy have a worse prognosis than clopidogrel-naïve patients. A total of 5,386 consecutive ACS patients were prospectively characterised and followed-up for 30 days. Of them, 680 (13%) were treated with clopidogrel prior to the index ACS. Major adverse cardiovascular events (MACE) were defined as death, recurrent ACS, stroke and/or stent thrombosis. Compared with clopidogrel-naïve, chronic clopidogrel-treated patients were older (66 ± 12 vs 63 ± 13, respectively; pclopidogrel therapy was associated with a two-fold increase in in-hospital (1.6% vs 0.6%, respectively; p =0.006) as well as 30-day stent thrombosis (2.2% vs 1.0%, respectively; p=0.007). MACE at 30 days was also higher among chronic clopidogrel-treated compared with clopidogrel-naïve patients [12.3% vs 9.4%, respectively; pclopidogrel treatment was an independent predictor of stent thrombosis [OR=2.6 (95%CI 1.2-5.6), p=0.001]. Patients sustaining ACS while on chronic clopidogrel treatment are at higher risk for in-hospital and 30-day adverse outcomes, including stent thrombosis.

  10. Relation of body mass index to risk of stent thrombosis after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Schmiegelow, Michelle; Torp-Pedersen, Christian; Gislason, Gunnar H;

    2012-01-01

    [CI] 0.86 to 0.97) for each increase in kilograms per square meter of BMI. There was no significant interaction between stent type and BMI (p = 0.48). Hazard ratios for probable stent thrombosis and possible stent thrombosis adjusted for numbers of stents at the index PCI were 1.01 (CI 0.99 to 1.......03) and 0.99 (CI 0.98 to 1.01) for each increase in kilograms per square meter of BMI, respectively. In conclusion, BMI was inversely correlated with risk of definite stent thrombosis after PCI irrespective of stent type....

  11. Computational simulation of platelet interactions in the initiation of stent thrombosis due to stent malapposition

    Science.gov (United States)

    Chesnutt, Jennifer K W; Han, Hai-Chao

    2016-01-01

    Coronary stenting is one of the most commonly used approaches to open coronary arteries blocked due to atherosclerosis. Stent malapposition can induce thrombosis but the microscopic process is poorly understood. The objective of this study was to determine the platelet-level process by which different extents of stent malapposition affect the initiation of stent thrombosis. We utilized a discrete element model to computationally simulate the transport, adhesion, and activation of thousands of individual platelets and red blood cells during thrombus initiation in stented coronary arteries. Simulated arteries contained a malapposed stent with a specified gap distance (0, 10, 25, 50, or 200 μm) between the struts and endothelium. Platelet-level details of thrombus formation near the proximal-most strut were measured during the simulations. The relationship between gap distance and amount of thrombus in the artery varied depending on different conditions (e.g., amount of dysfunctional endothelium, shear-induced activation of platelets, and thrombogenicity of the strut). Without considering shear-induced platelet activation, the largest gap distance (200 μm) produced no recirculation and less thrombus than the smallest two gap distances (0 and 10 μm) that created recirculation downstream of the strut. However, with the occurrence of shear-induced platelet activation, the largest gap distance produced more thrombus than the two smallest gap distances, but less thrombus than an intermediate gap distance (25 μm). A large gap distance was not necessarily the most thrombogenic, in contrast to implications of some computational fluid dynamics studies. The severity of stent malapposition affected initial stent thrombosis differently depending on various factors related to fluid recirculation, platelet trajectories, shear stress, and endothelial condition. PMID:26790093

  12. Computational simulation of platelet interactions in the initiation of stent thrombosis due to stent malapposition

    Science.gov (United States)

    Chesnutt, Jennifer K. W.; Han, Hai-Chao

    2016-02-01

    Coronary stenting is one of the most commonly used approaches to open coronary arteries blocked due to atherosclerosis. Stent malapposition can induce thrombosis but the microscopic process is poorly understood. The objective of this study was to determine the platelet-level process by which different extents of stent malapposition affect the initiation of stent thrombosis. We utilized a discrete element model to computationally simulate the transport, adhesion, and activation of thousands of individual platelets and red blood cells during thrombus initiation in stented coronary arteries. Simulated arteries contained a malapposed stent with a specified gap distance (0, 10, 25, 50, or 200 μm) between the struts and endothelium. Platelet-level details of thrombus formation near the proximal-most strut were measured during the simulations. The relationship between gap distance and amount of thrombus in the artery varied depending on different conditions (e.g., amount of dysfunctional endothelium, shear-induced activation of platelets, and thrombogenicity of the strut). Without considering shear-induced platelet activation, the largest gap distance (200 μm) produced no recirculation and less thrombus than the smallest two gap distances (0 and 10 μm) that created recirculation downstream of the strut. However, with the occurrence of shear-induced platelet activation, the largest gap distance produced more thrombus than the two smallest gap distances, but less thrombus than an intermediate gap distance (25 μm). A large gap distance was not necessarily the most thrombogenic, in contrast to implications of some computational fluid dynamics studies. The severity of stent malapposition affected initial stent thrombosis differently depending on various factors related to fluid recirculation, platelet trajectories, shear stress, and endothelial condition.

  13. Stent thrombosis, myocardial infarction, and death after drug-eluting and bare-metal stent coronary interventions

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Maeng, Michael; Kaltoft, Anne;

    2007-01-01

    OBJECTIVES: The aim of the study was to examine outcomes subsequent to implantation of drug-eluting stents (DES) and bare-metal stents (BMS). BACKGROUND: Use of DES might be associated with increased risk of stent thrombosis (ST), myocardial infarction (MI), and death. METHODS: From January 2002 ...

  14. Time course, predictors and clinical implications of stent thrombosis following primary angioplasty. Insights from the DESERT cooperation

    DEFF Research Database (Denmark)

    De Luca, Giuseppe; Dirksen, Maurits T; Spaulding, Christian;

    2013-01-01

    on the timing of stent thrombosis (ST) with both DES and bare metal stents (BMS) and its prognostic significance in patients undergoing pPCI. The Drug-Eluting Stent in Primary Angioplasty (DESERT) cooperation is based on a pooled database including individual data of randomised trials that evaluate the long...... angioplasty with BMS or DES. At 1201 ± 440 days, ST occurred in 267 patients (4.25%). Most of the events were acute or subacute (within 30 days) and very late (> 1 years), with different distribution between DES vs BMS. Patients with ST were more often diabetic (21.7% vs 15.1%, p=0.005), more frequently had...

  15. Late stent thrombosis: a not negligible issue after drug-eluting stent implantation

    Institute of Scientific and Technical Information of China (English)

    GAO Run-lin

    2007-01-01

    @@ Drug-eluting stent (DES) has markedly reduced restenosis and the need for target lesion revascularization (TLR). The safety profile of DES does not seem to differ from that of bare metal stent in the acute and subacute phases following coronary intervention.

  16. Sirolimus-eluting stent fractures associated with aneurysm and very late stent thrombosis in the right coronary artery

    Institute of Scientific and Technical Information of China (English)

    LIU Xuebo; Gary S.Mintz; Stéphane G.Carlier; Martin B.Leon

    2007-01-01

      Although the occurrence of coronary stent fracture is rare,recent reports showed that stent fracture after sirolimus-eluting stent(SES)implantation may be associated with neointimal hyperplasia and restenosis.We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery(RCA)that were related to the aneurysm,restenosis,thrombosis,and vessel occlusion.……

  17. Very late stent thrombosis following the placement of a crossing Y-stent with dual closed-cell stents for the coiling of a wide-necked aneurysm.

    Science.gov (United States)

    Lee, Chang-Young; Kim, Chang-Hyun

    2015-02-01

    The crossing Y-stent technique is a viable option for coiling of wide-necked bifurcation aneurysms. However, little is known about the long-term impact of this technique. Very late (>1 year) stent thrombosis following the placement of a crossing Y-stent with dual closed-cell stents for the coiling of a wide-necked basilar tip aneurysm, which has not been reported to date, is described.

  18. Meta-analysis of stent thrombosis after drug-eluting stent implantation: 4-year follow-up

    Institute of Scientific and Technical Information of China (English)

    Nata(s)a M Mili(c); Biljana J Parapid; Miodrag (C) Ostoji(c); Milan A Nedeljkovi(c); Jelena M Marinkovi(c)

    2010-01-01

    Background Drug-eluting stents (DES) are the most common device used in percutaneous treatment of coronary artery disease. Recently, there has been an increased concern regarding their safety profile, in particular the late and very late stent thrombosis rate compared to bare metal stents (BMS). The aim of the study was to compare the reported incidence of late and very late stent thrombosis of DES and BMS in patients from published clinical studies with an extended follow-up period to four years.Methods A search strategy was developed to identify publications reporting on late or very late thrombosis of BMS and DES available through MEDLINE and Cochrane Library databases. Two independent reviewers appraised eligible studies and extracted data. Odds ratios (OR) were calculated for each outcome and presented with 95% confidence intervals (CI).Results Fourteen randomized controlled trials, which were at least single blinded, were identified. There was no difference in the incidence of late and very late stent thrombosis in patients treated with DES compared with patients treated with BMS (late OR 0.55, 95%Cl 0.23-1.31 and late/very late OR=1.08, 95%CI 0.61-1.91).Conclusions The safety profile of DES was similar to BMS in terms of stent thrombosis. We found no evidence of increased risk of late and very late thrombosis for DES.

  19. Patients with previous definite stent thrombosis have a larger fraction of immature platelets and a reduced antiplatelet effect of aspirin

    DEFF Research Database (Denmark)

    Würtz, Morten; Grove, Erik; Wulff, Lise Nielsen;

    turnover. Key Words: aspirin; immature platelets; platelet aggregation; platelet function tests; stent thrombosis Abbreviations: ARU, aspirin reaction units; AU, aggregation units; BMS, bare-metal stent(s); DES, drug-eluting stent(s); IPF, immature platelet fraction; MEA, multiple electrode aggregometry...

  20. Should antiplatelet therapy be interrupted in drug eluting stent recipients throughout the periendoscopic period? A very late stent thrombosis case re-port and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Peng DONG; Xin-Chun YANG; Su-Yan BIAN

    2014-01-01

    In-stent thrombosis after cessation of antiplatelet medications in patients with drug-eluting stents (DES) is a significant problem in medical practice, particularly in the perioperative period. We report a case of an 87-year-old man with a medical history of hypertension, coronary artery disease and chronic atrophic gastritis. Very late thrombosis of a sirolimus-eluting stent occurred 1207 days after implantation, seven months after discontinuation of clopidogrel, and the interruption of aspirin 13 days in preparation of an elective endoscopic gastroin-testinal procedure presented with acute myocardial infarction. The patient was treated with thrombectomy and successfully revascularized with superimposition of two sirolimus-eluting stents. Medications administered in the catheterization laboratory included low molecular weight heparin and nitroglycerin. Flow was defined as grade 2 according to the thrombolysis in myocardial infarction scale. Electrocardio-gram after the procedure revealed persistent, but decreased, ST-segment elevation in the anterolateral leads. The patient recovered and was discharged on aspirin and clopidogrel indefinitely. There was no cardiac event during the two year follow-up period. This case underlines the importance of maintaining the balance of thrombosis and bleeding during perioperation of non-cardiac procedure and the possible need for continuation of aspirin therapy during periendoscopic procedures among patients with low bleeding risks who received DES.

  1. IVUS-Guided Implantation of Bioresorbable Vascular Scaffolds for Very Late Paclitaxel Stent Thrombosis

    Science.gov (United States)

    Lin, Zhe-Zhong; Chang, Wei-Ting; Chiang, Chun-Yen; Chen, Zhih-Cherng; Ku, Po-Ming

    2017-01-01

    Bioresorbable vascular scaffold (BVS) implantation has been shown to be safe in patients with stable coronary disease, and effective against the thrombotic lesion and the in-stent restenosis (ISR) of the drug-eluting stent (DES). BVSs have the advantages of a snow racket concept, positive vessel remodeling, and better conformability compared with DES in acute coronary syndrome (ACS). We report on a young patient with ST-elevation myocardial infarction (STEMI) who presented to our emergency department arising from very late stent thrombosis (VLST) of a 2.5 × 28 mm paclitaxel-eluting stent (Coroflex® Please) three years after its implantation. After the patient was treated with balloon dilation, intravascular ultrasound (IVUS) revealed a short segment of a guide wire outside the DES mesh. Two BVSs were implanted to prevent a DES recoil. Post-scaffold-implantation IVUS showed adequately expanded strut of BVSs. Six months later, optical coherence tomography (OCT) revealed that some segments of the scaffold had been absorbed and that there was no in-scaffold restenosis. The patient had not complained about angina during the out-patient clinic follow-up. This is the first report of successful BVS implantation for a STEMI patient attributable to DES VLST. PMID:28115812

  2. Acute Arterial Thrombosis of the Hand.

    Science.gov (United States)

    Iannuzzi, Nicholas P; Higgins, James P

    2015-10-01

    Arterial thrombosis of the hand occurs infrequently but may result in considerable morbidity and compromise of hand function. The hand surgeon may be called upon to direct management in cases of acute arterial thrombosis of the hand and should have an understanding of the available diagnostic tools and treatment modalities. This article discusses the vascular anatomy of the hand and clinical manifestations of arterial thrombosis. Differences between isolated thrombosis and diffuse intravascular injury are detailed, and treatment options for these conditions are described. Appropriate care often requires coordination with interventional radiologists or vascular surgeons. Outcomes after treatment of arterial thrombosis of the hand are variable, and prognosis may be related to whether isolated thrombosis or diffuse intravascular injury is present.

  3. Usefulness of Thrombus Aspiration for the Treatment of Coronary Stent Thrombosis

    NARCIS (Netherlands)

    Mahmoud, Karim D.; Vlaar, Pieter J.; van den Heuvel, Ad F. M.; Hillege, Hans L.; Zijlstra, Felix; de Smet, Bart J. G. L.

    2011-01-01

    Current treatment for coronary stent thrombosis (ST) often lacks satisfactory results and clinical outcome is poor. We investigated the impact of manual thrombus aspiration during percutaneous coronary intervention (PCI) on myocardial reperfusion and clinical outcome in patients with angiographicall

  4. Drug-Coated Balloon Treatment of Very Late Stent Thrombosis Due to Complicated Neoatherosclerosis

    Science.gov (United States)

    Alfonso, Fernando; Bastante, Teresa; Cuesta, Javier; Benedicto, Amparo; Rivero, Fernando

    2016-01-01

    We describe the treatment of a patient presenting with very-late stent thrombosis with the use of a drug-coated balloon. In this patient, optical coherence tomography disclosed that ruptured and complicated neoatherosclerosis was the underlying substrate responsible for the episode of very-late stent thrombosis. The potential use of drug-coated balloons in this unique scenario is discussed. PMID:27409130

  5. Novel nanostructured biomaterials: implications for coronary stent thrombosis

    Directory of Open Access Journals (Sweden)

    Karagkiozaki V

    2012-12-01

    Full Text Available Varvara Karagkiozaki,1,2 Panagiotis G Karagiannidis,1 Nikolaos Kalfagiannis,1 Paraskevi Kavatzikidou,1 Panagiotis Patsalas,3 Despoina Georgiou,1 Stergios Logothetidis11Lab for Thin Films – Nanosystems and Nanometrology (LTFN, Physics Department, Aristotle University of Thessaloniki, Thessaloniki, 2AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, 3Department of Materials Science and Engineering, University of Ioannina, Ioannina, Epirus, GreeceBackground: Nanomedicine has the potential to revolutionize medicine and help clinicians to treat cardiovascular disease through the improvement of stents. Advanced nanomaterials and tools for monitoring cell–material interactions will aid in inhibiting stent thrombosis. Although titanium boron nitride (TiBN, titanium diboride, and carbon nanotube (CNT thin films are emerging materials in the biomaterial field, the effect of their surface properties on platelet adhesion is relatively unexplored.Objective and methods: In this study, novel nanomaterials made of amorphous carbon, CNTs, titanium diboride, and TiBN were grown by vacuum deposition techniques to assess their role as potential stent coatings. Platelet response towards the nanostructured surfaces of the samples was analyzed in line with their physicochemical properties. As the stent skeleton is formed mainly of stainless steel, this material was used as reference material. Platelet adhesion studies were carried out by atomic force microscopy and scanning electron microscopy observations. A cell viability study was performed to assess the cytocompatibility of all thin film groups for 24 hours with a standard immortalized cell line.Results: The nanotopographic features of material surface, stoichiometry, and wetting properties were found to be significant factors in dictating platelet behavior and cell viability. The TiBN films with higher nitrogen contents were less thrombogenic compared with the biased carbon films and control

  6. Complete renal recovery from severe acute renal failure after thrombolysis of bilateral renal vein thrombosis.

    Science.gov (United States)

    Ramadoss, Suresh; Jones, Robert G; Foggensteiner, Lukas; Willis, Andrew P; Duddy, Martin J

    2012-10-01

    A previously healthy young man presented with acute renal failure due to extensive spontaneous deep vein thrombosis, including the inferior vena cava (IVC) and both renal veins. The patient was treated with selectively delivered thrombolytic therapy over a 7-day-period, which resulted in renal vein patency and complete recovery of renal function. A stent was placed over a segment stenosis of the IVC. No thrombophilic factors were identified. Bilateral renal vein thrombosis in young fit individuals is an unusual cause of acute renal failure. Thrombolytic therapy, even with delay, can completely restore renal function.

  7. Intravascular ultrasound assessment of very late bare-metal stent thrombosis: a case report

    Institute of Scientific and Technical Information of China (English)

    Ji Hyun Lee; Kyung Min Kim; Jun Won Lee; Sung Gyun Ahn; Young Jin Youn

    2012-01-01

    Very late stent thrombosis (VLST) is increasingly being regarded as a complication of drug-eluting stents (DES),and delayed endothelization,local hypersensitivity reactions,and late stent malapposition due to excessive positive remodeling have been postulated as mechanisms.Considering that stent endothelialization seems to be completed within 4 weeks following bare-metal stent (BMS) placement and that BMS do not possess antiproliferative coating,the mechanism of VLST may differ between patients with DES and those with BMS.We report a case of VLST 9 years after BMS implantation,in which thrombus from the ruptured neointima was confirmed by intravascular ultrasound.This finding suggests that de novo plaque rupture at the neointimal layer within the stent may be one of the explanations for VLST.

  8. Comparison of the incidence of late stent thrombosis after implantation of different drug-eluting stents in the real world coronary heart disease patients: three-year follow-up results

    Institute of Scientific and Technical Information of China (English)

    CHEN Ji-lin; LIU Hai-bo; WU Yong-jian; YUAN Jin-qing; CHEN Jue; YOU Shi-jie; DAI Jun; GAO Run-lin; GAO Li-jian; YANG Yue-jin; LI Jian-jun; QIAO Shu-bin; XU Bo; HUANG Jing-han; YAO Min; QIN Xue-wen

    2010-01-01

    Background Late stent thrombosis (LST) is still concerned by interventions cardiologists in daily clinical practice. This study aimed to compare the incidence of LST after implantation of different drug-eluting stents (DES) in coronary heart disease (CHD) patients in the real world.Methods From December 2001 to February 2009, a total of 11 875 consecutive CHD patients undergone DES implantation were enrolled in this single-center registery study. Patients with acute ST-segment elevation myocardial infarction, mixed DES implantation, restenosis lesions, and patients who could not take dual antiplatlet medication and those who were contraindicated for coronary interventional treatment were excluded. All patients were treated with completed dual antiplatelet medications for at least 9 months after DES deployment. The follow-up was completed by outpatient visits, letter correspondence, phone calls and coronary angiography. Definite LST was diagnosed auording to the Academic Research Consortium (ARC) definition.Results Cypher or Cypher Select stents were implanted in 4104 cases, Taxus or Taxus Liberty stents in 2271 cases and Firebird stents (Chinese rapamycin-eluting stents) in 5500 cases. One-year follow-up was completed in 9693 patients, including 3346 cases with Cypher or Cypher Select stents, 1529 cases with Taxus or Taxus Liberty stents and 4818 cases with Firebird stents. Two- and three-year follow-up results were obtained in 7133 and 4353 patients, respectively, including 2410 and 1760 cases with Cypher or Cypher Select stents, 1285 and 900 cases with Taxus or Taxus Liberty stents as well as 3438 and 1693 cases with Firebird stents. One-year follow-up results showed that the incidence of LST was 1.08% in patients with Cypher or Cypher Select stents, 1.24% in those with Taxus or Taxus Liberty stents and 0.71% in those with Firebird stents; there was no significant difference between those with Cypher or Cypher Select and Firebird stents, but there was significant

  9. Triple antithrombotic therapy in patients with atrial fibrillation undergoing coronary artery stenting: hovering among bleeding risk, thromboembolic events, and stent thrombosis

    Directory of Open Access Journals (Sweden)

    Menozzi Mila

    2012-10-01

    Full Text Available Abstract Dual antiplatelet treatment with aspirin and clopidogrel is the antithrombotic treatment recommended after an acute coronary syndrome and/or coronary artery stenting. The evidence for optimal antiplatelet therapy for patients, in whom long-term treatment oral anticoagulation is mandatory, is however scarce. To evaluate the safety and efficacy of the various antithrombotic strategies adopted in this population, we reviewed the available evidence on the management of patients receiving oral anticoagulation, such as a vitamin-k-antagonists, referred for coronary artery stenting. Atrial fibrillation is the most frequent indication for oral anticoagulation. The need of starting antiplatelet therapy in this clinical scenario raises concerns about the combination to choose: triple therapy with warfarin, aspirin, and a thienopyridine being the most frequent and advised. The safety of this regimen appeared suboptimal because of an increased risk in hemorrhagic complications. On the other hand, the combination of oral anticoagulation and an antiplatelet agent is suboptimal in preventing thromboembolic events and stent thrombosis; dual antiplatelet therapy may be considered only when a high hemorrhagic risk and low thromboembolic risk are perceived. Indeed, the need for prolonged multiple-drug antithrombotic therapy increases the bleeding risks when drug eluting stents are used. Since current evidence derives mainly from small, single-center and retrospective studies, large-scale prospective multicenter studies are urgently needed.

  10. Multiple coronary thrombosis and stent implantation to the subtotally occluded right renal artery in a patient with essential thrombocytosis: a case report with review.

    Science.gov (United States)

    Ozben, Beste; Ekmekci, Ahmet; Bugra, Zehra; Umman, Sabahattin; Meric, Mehmet

    2006-08-01

    Essential thrombocytosis is a myeloproliferative disorder of unknown etiology manifested clinically by the overproduction of platelets in the absence of a definable cause. Platelet dysfunction in essential thrombocytosis results in both hemorrhage and thrombosis. It is one of the rare causes of ischemic cardiovascular events. Fewer than 20 cases of essential thrombocytosis with involvement of coronary arteries leading to acute coronary syndromes or myocardial infarction have been reported. We report a case of multiple coronary thrombosis involving the left anterior descending artery and circumflex artery and stent implantation to the subtotally stenotic right renal artery in a women with unstable angina pectoris, essential thrombocytosis and previous history of renal artery trombosis.

  11. Simultaneous occlusion of left anterior descending and left circumflex arteries by very late stent thrombosis: vascular response to drug-eluting stents assessed by intravascular ultrasound.

    Science.gov (United States)

    Yamawaki, Masahiro; Onuma, Yoshinobu; Nakano, Masatsugu; Muramatsu, Takashi; Nakatani, Shimpei; Ishibashi, Yuki; Ishimori, Hiroshi; Hirano, Keisuke; Ito, Yoshiaki; Tsukahara, Reiko; Muramatsu, Toshiya

    2015-11-01

    Very late stent thrombosis (VLST) is a catastrophic complication after implantation of a drug-eluting stent (DES). It has been reported that VLST is associated with pathological changes, which often include late acquired incomplete stent apposition (LAISA) with thrombus formation. In addition, the vascular response to the stent (evaginations, neointimal growth, and thrombosis) and the incidence of LAISA are reported to vary among the different types of DES. We experienced a patient with cardiogenic shock induced by simultaneous VLST of both the left anterior descending artery (LAD) and the left circumflex artery (LCX) at 3 years after implantation of two sirolimus-eluting stents. Intravascular ultrasound (IVUS) showed LAISA of both arteries. A paclitaxel-eluting stent, which had been implanted in the right coronary artery 3 years earlier, did not show such a finding. IVUS revealed "different vascular reactions" to "different types of DES" in this patient.

  12. Hypersensitivity to drug-eluting stent and stent thrombosis: Kounis or not Kounis syndrome?

    Institute of Scientific and Technical Information of China (English)

    TAN Wei; CHENG Kang-lin; CHEN Qiu-xiong

    2009-01-01

    @@ With the utilization of coronary-stents, coronary remodeling and restenosis were reduced compared with balloon angioplasty alone.~1 However, the risk of restenosis is still in the range of 15% to 20%. Drug-eluting stents (DES), which could release antiproliferative pharmacological agents after deployment. were designed to inhibit the response to injury reaction after bare-metal stent (BMS) implantation.

  13. EFFICACY AND SAFETY OF GLYCOPROTEIN IIB/IIIA BLOCKER MONOFRAM IN CORONARY STENTING IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    E. I. Makhiyanova

    2011-01-01

    Full Text Available  Aim. To study of efficacy and safety of glycoprotein IIb/IIIa blocker monafram in acute ST-segment elevation myocardial infarction (STEMI patients, underwent coronary stenting. Material and methods. 220 STEMI patients were included in the trial; they were split into two groups. 109 patients of the first group were underwent coronary stenting with i/v monafram therapy. Coronary stenting without monafram therapy was performed in 111 patients of the second group. Bare metal stents were used in all patients. Deaths, stent thrombosis, individual intolerance, allergic reactions, bleeding were registered during hospitalization. Results. There were 3 (2.75% cases of stent thrombosis in monafram group and 4 (3.6% ones - in the control group. Good tolerance of monafram was observed in all patients. There were no allergic reactions, major and minor bleedings. Reinfarction rate was similar in both groups during 30 days observational period. Conclusions. Monafram therapy is effective and safe in acute STEMI patients underwent coronary stenting.  

  14. Acute celiac trunk thrombosis revealed by biliary peritonitis.

    Science.gov (United States)

    Jerraya, H; Sbaï, A; Khalfallah, M; Dziri, C

    2015-11-01

    Acute thrombosis of the celiac trunk is a very uncommon condition, which is a life-threatening emergency. The clinical presentation is highly variable depending on the extent of the ischemic territory. We report a case of biliary peritonitis related to an acute thrombosis of the celiac trunk. This case highlights the role of abdominal computed tomography in the diagnosis of acute upper abdominal pain.

  15. Acute scrotal pain: an uncommon manifestation of renal vein thrombosis.

    Science.gov (United States)

    Jou, Yeong-Chin; Jong, Ing-Chin; Hsieh, Ying-Chen; Kang, Chun-Hsiung

    2014-03-01

    The clinical manifestation of renal vein thrombosis varies with the speed and degree of venous occlusion. Such patients may be asymptomatic, have minor nonspecific symptoms such as nausea or weakness, or have more specific symptoms such as upper abdominal pain, flank pain, or hematuria. Acute scrotal pain is a very uncommon clinical expression of renal vein thrombosis. Here, we report a case of membranous glomerulonephritis-induced renal vein thrombosis presented with the symptom of acute scrotal pain caused by thrombosis-induced varicocele. This case report suggests that renal vein thrombosis should be considered in the diagnosis of acute scrotal pain; it also emphasizes that an investigation of retroperitoneum should be performed for adult patients with the sudden onset of varicocele.

  16. The late acute thrombosis in coronary drug-eluting stent-cases pooled analysis%冠状动脉药物洗脱支架晚发支架内急性血栓形成分析

    Institute of Scientific and Technical Information of China (English)

    王禹; 盖鲁粤; Sueselbeck T; Remppis A; 杨庭树; 陈练; 刘宏斌; 金琴花; 李丽

    2006-01-01

    目的分析近期临床应用冠脉药物洗脱支架(drug-eluting stent,DES)术后,晚发的支架内急性血栓形成病例的发生特点及可能影响因素.方法应用关键词:coronary artery、sirolimus、paclitaxil、drug-elutistent、thrombosis,anuervsm、malapposition等,应用美国国立医学图书馆的PubMed系统和德国海德堡大学的电子期刊系统对临床医学核心期刊进行系统检索.对检索出的12个病例及本中心3例冠状动脉内置入DES后晚发支架内急性血栓形成病例汇总分析.结果共有15例患者,在DES(sirolimus和paclitaxel支架)术后出现晚发的支架内急性血栓形成和(或)同时合并冠脉瘤样扩张、支架与血管壁贴合不良(malapposition).急性血栓发生时间:120~540天.9例患者在停用阿司匹林、氯吡格雷后4~15天发生;3例患者在DES置入部位出现明显冠脉瘤样扩张和(或)瘤腔内血栓形成;4例患者在DES发生急性血栓时、同时置入的6枚普通金属支架完全通畅.结论晚发的DES内急性血栓形成(≥6个月)、支架与血管壁贴合不良、明显的冠脉管壁瘤样扩张造成再次严重的心肌缺血或梗死.

  17. Microvascular Coronary Flow Comparison in Acute Myocardial Infarction Angioplasty treated with a mesh covered stent (MGUARD Stent) versus Bare Metal Stent

    Energy Technology Data Exchange (ETDEWEB)

    Lindefjeld, Dante S., E-mail: dslindef@puc.cl [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Guarda, Eduardo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Méndez, Manuel [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Martínez, Alejandro [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Pérez, Osvaldo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Fajuri, Alejandro; Marchant, Eugenio [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Aninat, Mauricio; Torres, Humberto [Hospital Dr. Gustavo Fricke, Viña del Mar-Chile (Chile); Dussaillant, Gastón [Hospital Clínico Universidad de Chile, Santiago-Chile (Chile)

    2013-01-15

    Background: Distal embolization of thrombus/platelet aggregates decreases myocardial reperfusion during primary percutaneous coronary intervention (PCI), and is associated with worse immediate and long-term prognosis of patients with ST-elevation myocardial infarction (STEMI). Objective: Assess the efficacy of a mesh covered stent (MGuard™ stent, MGS) in preventing distal embolization and microvascular reperfusion impairment during primary PCI, compared with a bare metal stent (BMS). Methods: Forty patients with STEMI referred for primary PCI were randomized for stenting the culprit lesion with the MGS (n = 20) or a BMS (n = 20). Blinded experts performed off-line measurements of angiographic epicardial and microvascular reperfusion criteria: TIMI flow grade, myocardial blush, corrected TIMI frame count (cTFC). Results: At baseline clinical, angiographic and procedural variables were not different between groups. Post PCI TIMI flow grade was similar in both groups. We observed better myocardial Blush grade in group MGS compared to BMS (median value 3.0 vs 2.5, 2p = 0.006) and cTFC (mean cTFC: MGS 19.65 ± 4.07 vs BMS 27.35 ± 7.15, 2p < 0.001, cTFC mean difference MGS-BMS: 7.7, CI 95%: 3.94 to 11.46). MGS stent group had a higher percentage of successful angioplasty (cTFC ≤ 23: MGS 85% vs BMS 30%, 2p < 0.001). We had two cases of acute stent thrombosis (one for each group) at 30 days follow up, but no clinical events at 6 months follow up. Conclusions: In this exploratory study, MGS significantly improved microvascular reperfusion criteria compared with a BMS in primary PCI. However its safety and impact on clinical outcomes should be verified in larger randomized clinical trials.

  18. [The fibrinolytic treatment with urokinase of acute arterial thrombosis].

    Science.gov (United States)

    Ballester, A; Donato di Paola, M; Saccà, A; Cappello, I; D'Addato, M

    1993-01-01

    We present our experiences on 86 patients with acute arterial thrombosis of the legs, undergoing a fibrinolytic treatment with urokinase. Results from the treatment are analyzed according to: the administration way (systemic, locoregional, intrathrombotic), the level of thrombosis (upper or lower legs), the associated morbidity and mortality.

  19. Acute abdominal aortic thrombosis following the Heimlich maneuver.

    Science.gov (United States)

    Ayerdi, Juan; Gupta, Sushil K; Sampson, Lawrence N; Deshmukh, Narayan

    2002-04-01

    Complications from the Heimlich maneuver are relatively infrequent. Two fatal cases of abdominal aortic thrombosis have been reported following this technique. We report on the first patient that suffered an acute thrombosis of the abdominal aorta and survived. Prompt recognition of this complication provides the only hope of survival from this rare and catastrophic complication.

  20. Stent Thrombosis is the Primary Cause of ST-Segment Elevation Myocardial Infarction following Coronary Stent Implantation: A Five Year Follow-Up of the SORT OUT II Study

    DEFF Research Database (Denmark)

    Kristensen, S. L.; Galloe, A. M.; Thuesen, L.;

    2014-01-01

    Background: The widespread use of coronary stents has exposed a growing population to the risk of stent thrombosis, but the importance in terms of risk of ST-segment elevation myocardial infarctions (STEMIs) remains unclear. Methods: We studied five years follow-up data for 2,098 all-comer patients...... treated with coronary stents in the randomized SORT OUT II trial (mean age 63.6 yrs. 74.8% men). Patients who following stent implantation were readmitted with STEMI were included and each patient was categorized ranging from definite-to ruled-out stent thrombosis according to the Academic Research...... Consortium definitions. Multivariate logistic regression was performed on selected covariates to assess odds ratios (ORs) for definite stent thrombosis. Results: 85 patients (4.1%), mean age 62.7 years, 77.1% men, were admitted with a total of 96 STEMIs, of whom 60 (62.5%) had definite stent thrombosis...

  1. Paraoxonase-1 is not a major determinant of stent thrombosis in a Taiwanese population.

    Directory of Open Access Journals (Sweden)

    Dong-Yi Chen

    Full Text Available BACKGROUND: Clopidogrel is a prodrug that undergoes in vivo bioactivation to show its antiplatelet effects. Recent studies have shown that cytochrome P450 (CYP, ATP-binding cassette transporters (ABCB1, and paraoxonase-1 (PON1 play crucial roles in clopidogrel bioactivation. Here, we aim to determine the effects of genetic polymorphisms of CYP (CYP 2C19*2, CYP 2C19*3, and CYP 2C19*17, ABCB1 (ABCB1 3435C>T, ABCB1 129T>C, and ABCB1 2677G>T/A, and PON1 (PON1 Q192R, PON1 L55M, and PON1 108C>T on the development of stent thrombosis (ST in patients receiving clopidogrel after percutaneous coronary intervention (PCI. METHODS AND RESULTS: We evaluated the incidence of ST (0.64% in 4964 patients who were recruited in the CAPTAIN registry (Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions. The presence of genetic polymorphisms was assessed in 20 subjects who developed ST after aspirin and clopidogrel therapy and in 40 age- and sex-matched control subjects who did not develop ST, which was documented after 9 months of angiographic follow-up. ST was acute in 5 subjects, subacute in 7, late in 7, and very late in 1. The presence of CYP 2C19*2 allele was significantly associated with ST (adjusted odds ratio [ORadj]: 4.20, 95% confidence interval [CI], 1.263-9.544; P = 0.031. However, genetic variations in PON1 and ABCB1 showed no significant association with ST. CONCLUSION: We conclude that in a Taiwanese population, PON1 Q192R genotype is not associated with ST development after PCI. However, the presence of CYP 2C19*2 allele is a risk factor for ST development after PCI.

  2. Chylous ascites caused by acute pancreatitis with portal vein thrombosis

    OpenAIRE

    Park, Dong Eun; Chae, Kwon Mook

    2011-01-01

    Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also rev...

  3. Paclitaxel and sirolimus eluting stents versus bare metal stents: long-term risk of stent thrombosis and other outcomes. From the Western Denmark Heart Registry

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Tilsted, Hans Henrik; Thayssen, Per;

    2010-01-01

    AND RESULTS: All patients who underwent PES, SES or BMS implantation from January 2002 to June 2005 were identified in the population-based Western Denmark Heart Registry. All were followed for 36 months. Cox regression analysis was used to estimate relative risk (RR), controlling for covariates. A total...... (adjusted RR: 0.71, 95% CI: 0.63-0.81). CONCLUSIONS: An increased risk of very late definite stent thrombosis was observed in DES-treated patients compared with BMS-treated patients, but a similar mortality was detected. TLR continued to be lower among patients receiving DES....

  4. 支架内血栓形成的原因及防治%Cause and prevention of stent thrombosis

    Institute of Scientific and Technical Information of China (English)

    冷利华; 黄文胜; 裴宜斌; 何小伍

    2015-01-01

    Objective Investigate the causes and prevention of stent thrombosis after percu-taneous coronary intervention ( PCI).Methods Retrospective analysis was made on the cases of stent thrombosis .Results In the last 5 years, there were 4 cases of stent thrombosis in 497 PCI ca-ses.Among them, one case of stent thrombosis happened within 30 min after PCI.After second PCI and anticoagulant and antiplatelet therapy , the patient safely discharged .Conclusion Stent throm-bosis is a serious postoperative complication of PCI in patients with coronary heart disease .Considering patient ’s specific conditions , personalized treatment can prevent stent thrombosis .%目的:探讨经皮冠状动脉介入治疗(percutaneous coronary intervention ,PCI)后支架内血栓发生的原因及防治策略。方法对支架内血栓形成的病例进行回顾性分析。结果近5年497例 PCI术后4例出现支架内血栓;其中,1例PCI术后30 min即出现支架内血栓,经再次PCI和调整抗凝、抗血小板药物治疗方案,患者症状缓解,安全出院。结论支架内血栓形成是严重影响冠心病患者预后的PCI术后并发症。结合患者具体病情,选择更具个性化的治疗,可避免支架内血栓形成。

  5. Drug-eluting stents for acute coronary syndrome: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Lishan Wang

    Full Text Available Drug-eluting stents (DES are increasingly used for treatment of acute coronary syndrome (ACS. However, clinical efficacy and safety of various types of DES is not well established in these subjects. We therefore evaluated clinical utility of second-generation and first-generation DES in patients with ACS by conducting a meta-analysis.A search of Medline, Embase, the Cochrane databases, and Web of Science was made. Randomized controlled trials (RCTs which compared second-generation DES (everolimus-eluting stents [EES] or zotarolimus-eluting stents [ZES] versus first-generation DES (sirolimus-eluting stents [SES] or paclitaxe-eluting stents [PES] in patients with ACS and provided data on clinical efficacy or safety endpoints were included. Pooled estimates were calculated using random-effects model.A total of 2,757 participants with ACS in 6 RCTs were included. Compared with first-generation one, second-generation DES trended to be associated with the decreased incidence of definite or probable stent thrombosis in ACS patients (risk ratio [RR]  = 0.60, 95% confidence intervals [CI] 0.33 to 1.07, p = 0.09. However, the rate of target lesion revascularization (TLR significantly increased in second-generation DES (RR = 2.08, 95%CI 1.25 to 3.47, p = 0.005. There were no significant differences in the incidence of major adverse cardiac events (MACEs, all-cause death, cardiac death, and recurrent myocardial infarction between the two arms (all p>0.10. The second-generation EES showed a tendency towards lower risk of MACEs (p = 0.06 and a beneficial effect on reducing stent thrombosis episodes (p = 0.009, while the second-generation ZES presented an increased occurrence of MACEs (p = 0.02 and TLR (p = 0.003.Second-generation DES, especially EES, appeared to present a lower risk of stent thrombosis, whereas second-generation ZES might increase the need for repeat revascularization in ACS patients. During coronary

  6. Management of late/very late stent thrombosis: Utility of ıntravenous ultrasonography (IVUS) in clinical practise

    OpenAIRE

    Emre Yalçınkaya; Barış Bugan; Yalçın Gökoğlan; Erkan Yıldırım

    2013-01-01

    To the editor We read with great interest the article by Aksu et al. [1] on the management of very late bare metal stent thrombosis. They performed intracoronary thrombus aspiration and inflated balloon in-stent for restenosis. During percutaneous coronary interventions, interventionalists have often to deal with thrombus-laden lesions in coronary vessels. Plaque characteristics and distribution, severity and extent of calcification, arterial remodeling and the presence of dissection or throm...

  7. Multiple Recurrent Stent Thrombosis in a Patient with Coexisting Clopidogrel Resistance and Increased Anticardiolipin Antibodies: A Case Report

    Directory of Open Access Journals (Sweden)

    Erik H. Middlebrooks

    2010-01-01

    Full Text Available The antiphospholipid syndrome (APS is a common cause of both arterial and venous thrombosis. While studies exist demonstrating the role of APS in coronary artery bypass graft failure, its role in stent thrombosis is less clearly documented. Also, a literature search of PubMed did not reveal any articles regarding the coexistence of clopidogrel resistance and APS despite increasing awareness of resistance to clopidogrel treatment. We present a case of a 59-year-old male having recurrent myocardial infarction after subacute restenosis of multiple drug-eluting stents despite anticoagulant therapy. The patient had in-stent thrombosis of seven drug-eluting stents in a course of eight days. He was subsequently found to have mild elevation of IgG anticardiolipin (aCL antibody titers and resistance to clopidogrel. Long-term anticoagulation with a combination of low-molecular-weight heparin, clopidogrel, and aspirin has been effective. While the patient's aCL titer level was not elevated above the level required by the current diagnostic criteria for APS, we believe that this patient suffers from the antiphospholipid syndrome. We will discuss some of the controversies surrounding the diagnosis of APS as well as appropriate treatment and recognition of the coexistence of APS and clopidogrel resistance in patients with stent thrombosis.

  8. Clinical safety of cardiac magnetic resonance imaging at 3 T early after stent placement for acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Jehl, Jerome; Comte, Alexandre; Aubry, Sebastien; Kastler, Bruno [Hopital Jean Minjoz, Service de Radiologie A and C, Centre Hospitalier Universitaire de Besancon, Besancon (France); Meneveau, Nicolas; Schiele, Francois [Hopital Jean Minjoz, Service de Cardiologie, Centre Hospitalier Universitaire de Besancon, Besancon (France)

    2009-12-15

    The purpose of this study was to prospectively evaluate the safety of cardiac magnetic resonance (CMR) imaging at 3 T performed early (less than 14 days) after bare metal or drug-eluting coronary stent implantation in patients with acute myocardial infarction (AMI). Seventy-two consecutive patients with AMI treated by percutaneous revascularisation with a stent underwent CMR examination with a median delay of 6 days. Patients were followed-up for major adverse cardiac events, during hospitalisation and at 6 months. After CMR imaging, no acute stent thrombosis, death or repeated AMI were recorded at 6-month follow-up. Two symptomatic in-stent restenoses and two silent in-stent restenoses were recorded, at a mean delay of 106 days. In our population, we found a target revascularisation rate of 5.6%. This is consistent with the 6-month event rates after coronary artery stent (CAS) placement for AMI, evaluated by several studies. This preliminary clinical study supports the safety of 3-T CMR imaging performed early after coronary stent placement. (orig.)

  9. Chylous ascites caused by acute pancreatitis with portal vein thrombosis.

    Science.gov (United States)

    Park, Dong Eun; Chae, Kwon Mook

    2011-12-01

    Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also review the relevant literature about chylous ascites with particular reference to the management of this rare disease.

  10. ST-segment Elevation Myocardial Infarction Resulting from Stent Thrombosis in Contemporary Real-World Practice.

    Science.gov (United States)

    Kanei, Yumiko; Nallu, Kishore; Makker, Parth; Behuria, Supreeti; Fox, John

    2017-03-01

    Stent thrombosis (ST) is a rare but devastating complication after percutaneous coronary intervention. Newer generation drug-eluting stents (DES) and newer antiplatelet therapies have been shown to decrease the incidence of ST, but we continue to observe ST-segment elevation myocardial infarction (STEMI) due to ST in contemporary practice. A retrospective analysis of 527 patients who presented with STEMI was performed; 57 patients (11%) with angiographically confirmed ST were compared with the patients with STEMI due to de novo lesion. The type of previous stent, the timing of ST, and the use of antiplatelet therapy were reviewed in patients with ST. Patients with ST had higher prevalence of comorbid conditions, such as hypertension, diabetes mellitus, and coronary artery disease, and had lower left ventricular ejection fraction (37 ± 5 vs. 44 ± 16%, p = 0.0011). There was no difference in in-hospital mortality (2 vs. 4%, p = 0.7082). ST was seen most commonly as "very late" (56%), and with previous second-generation DES (40%). Eighty-two percent of patients among early ST, compared with 22% of patients with very late ST were on dual antiplatelet therapy (DAPT). In 12% of patients, ST happened after DAPT was stopped by physician for procedures. ST is seen in a variety of clinical settings with the most common presentation being very late ST and in second-generation DES, which most likely represent the growing population with previous second-generation stents.

  11. Comparison of Acute Recoil between Bioabsorbable Poly-L-lactic Acid XINSORB Stent and Metallic Stent in Porcine Model

    Directory of Open Access Journals (Sweden)

    Yizhe Wu

    2012-01-01

    Full Text Available Objective. To investigate acute recoil of bioabsorbable poly-L-lactic acid (PLLA stent. Background. As newly developed coronary stent, bioabsorbable PLLA stent still encountered concern of acute stent recoil. Methods. Sixteen minipigs were enrolled in our study. Eight PLLA XINSORB stents (Weite Biotechnology Co., Ltd., China and eight metallic stents (EXCEL, Jiwei Co., Ltd. China were implanted into coronary arteries. Upon quantitative coronary angiography analysis, acute absolute recoil was defined as the difference between mean diameter of inflated balloon (X and mean lumen diameter of stent immediately after deployment (Y, while acute percent recoil was defined as (X−Y/X and expressed as a percentage. Intravascular ultrasound (IVUS was performed immediately after implantation and 24 hours later to compare cross-sectional area (CSA between two groups and detect stent malapposition or collapse. Results. Acute absolute recoil in XINSORB and EXCEL was 0.02±0.13 mm and −0.08±0.08 mm respectively (P=0.19. Acute percent recoil in XINSORB and EXCEL was 0.66±4.32% and −1.40±3.83%, respectively (P=0.45. CSA of XINSORB was similar to that of EXCEL immediately after implantation, so was CSA of XINSORB at 24-hours followup. Within XINSORB group, no difference existed between CSA after implantation and CSA at 24-hours followup. No sign of acute stent malapposition was detected by IVUS. Conclusions. The acute stent recoil of XINSORB is similar to that of EXCEL. No acute stent malapposition or collapse appeared in both kinds of stent. This preclinical study was designed to provide preliminary data for future studies of long-term efficacy and safety of XINSORB stent.

  12. Drug-eluting stents and acute myocardial infarction:A lethal combination or friends?

    Institute of Scientific and Technical Information of China (English)

    Shuji; Otsuki; Manel; Sabaté

    2014-01-01

    Primary percutaneous coronary intervention is the preferred reperfusion strategy for patients presenting with ST-segment elevation myocardial infarction(STEMI). First generation drug-eluting stents(DES),(sirolimus drug-eluting stents and paclitaxel drug-eluting stents), reduce the risk of restenosis and target vessel revascularization compared to bare metal stents. However, stent thrombosis emerged as a major safety concern with first generation DES. In response to these safety issues, second generation DES were developed with different drugs, improved stent platforms and more biocompatible durable or bioabsorbable polymeric coating. This article presents an overview of safety and efficacy of the first and second generation DES in STEMI.

  13. Stent-based mechanical thrombectomy in acute basilar artery occlusion.

    Science.gov (United States)

    Cohen, José E; Leker, Ronen R; Moscovici, Samuel; Attia, Moshe; Itshayek, Eyal

    2011-12-01

    Stent-based mechanical thrombectomy was recently proposed as an effective alternative to other mechanical techniques to achieve recanalization of large-vessel embolic occlusions in the anterior circulation. To our knowledge, there are no reports of the use of this technique in acute basilar artery occlusion (ABAO). We present a patient with complete endovascular recanalization of ABAO using a stent-based thrombectomy technique. Advantages and limitations of this technique in the management of ABAO are discussed. The stent-thrombectomy technique is promising, and will need further evaluation in posterior circulation stroke.

  14. Rescue coronary stenting in acute myocardial infarction

    Science.gov (United States)

    Barbieri, Enrico; Meneghetti, Paolo; Molinari, Gionata; Zardini, Piero

    1996-01-01

    Failed rescue coronary angioplasty is a high risk situation because of high mortality. Coronary stent has given us the chance of improving and maintaining the patency of the artery. We report our preliminary experience of rescue stenting after unsuccessful coronary angioplasty.

  15. Antithrombotic therapy in anticoagulated patients with atrial fibrillation presenting with acute coronary syndromes and/or undergoing percutaneous coronary intervention/stenting

    Directory of Open Access Journals (Sweden)

    Benjamin J. Wrigley

    2010-07-01

    Full Text Available The management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary inter vention/stenting cannot be done according to a regimented common protocol, and stroke and bleeding risk stratification schema should be employed to individualize treatment options. A delicate balance is needed between the prevention of thromboembolism, against recurrent cardiac ischemia or stent thrombosis, and bleeding risk. New guidance from a consensus document of the European Society of Cardiology Working Group on Thrombosis, endorsed by the European Heart Rhythm Association and the European Association ofPercutaneous Cardiovascular Interventions on the management of Antithrombotic Therapy in Atrial Fibrillation Patients Presenting with Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary Intervention/Stenting has sought to clarify some of the major issues and problems surrounding this practice, and will allow clinicians to make much more informed decisions when faced with treating such patients.

  16. FACTORES CLÍNICOS Y DEL PROCEDIMIENTO RELACIONADOS CON LA TROMBOSIS DE STENT / Clinical and procedural factors related to stent thrombosis

    Directory of Open Access Journals (Sweden)

    Ronald Aroche Aportela

    2012-03-01

    Full Text Available Resumen Introducción y objetivos: La trombosis del stent es una de las complicaciones posterior al intervencionismo coronario percutáneo, asociada a una elevada mortalidad y morbilidad. A pesar del uso de la doble terapia antiplaquetaria (aspirina y clopidogrel y la optimización de la técnica, su incidencia no ha desaparecido. El objetivo de esta investigación fue determinar los factores de riesgo de trombosis de los stent metálicos convencionales. Método: Se realizó un estudio descriptivo-retrospectivo. De las 2.014 arterias revascularizadas en el Centro de Investigaciones Médico-Quirúrgicas de La Habana, Cuba; entre agosto de 1997 y febrero de 2009, se seleccionaron las 289 reestudiadas. Resultados: La trombosis de los stent metálicos convencionales estuvo presente en 20 arterias, de las cuales 11 resultaron ser la descendente anterior, y su mayor incidencia se presentó en las primeras 24 horas y después de los 30 días. La diabetes mellitus se comportó como un factor de riesgo de trombosis (OR* = 3,06, así como la presión de liberación de menos de 10 atmósferas (OR = 3,70 y las lesiones complejas de los tipos B2 y C (OR = 8,80, todos con significación estadística (p < 0,05. Conclusiones: La mayor incidencia de trombosis de los stent metálicos convencionales fue en el primer día de la revascularización, después de la terminación de la doble terapia de antiagregación plaquetaria y en la arteria descendente anterior. La diabetes mellitus, las lesiones complejas y las bajas presiones de liberación del stent, se comportaron como factores de riesgo de trombosis con resultados estadísticamente significativos. Abstract Introduction and Objectives: Stent thrombosis is a complication after percutaneous coronary intervention associated with high mortality and morbidity. Despite the use of dual antiplatelet therapy (aspirin and clopidogrel and optimization of the technique, its incidence has not disappeared. The objective of

  17. [Acute arterial thrombosis of the extremity in pseudoxanthoma elasticum].

    Science.gov (United States)

    Rodríguez-Camarero, S J; Manchado, P; González, J A; Castro, M A; Rodero, J I; Mateo, A M

    1992-01-01

    We report a case of a patient with an elastic pseudoxanthoma (PXE) who presented an acute ischaemia at the left lower limb. The cause of such ischaemia was a thrombosis into the iliac and femoropopliteal arteries. Patient underwent a surgical procedure. The arteriopathy associated with a PXE rarely cause an arterial major occlusion. We did not found a case of acute arterial thrombotic ischaemia and PXE, treated with direct arterial revascularization in the reviewed literature.

  18. Towards Personalized Medicine Based on Platelet Function Testing for Stent Thrombosis Patients

    Directory of Open Access Journals (Sweden)

    Thea Cornelia Godschalk

    2012-01-01

    Full Text Available Stent thrombosis (ST is a severe and feared complication of coronary stenting. Patients who have suffered from ST are usually treated according to the “one-size-fits-all” dosing regimen of aspirin and clopidogrel. Many ST patients show high on-treatment platelet reactivity (HPR despite this antiplatelet therapy (APT. It has been shown that HPR is a risk factor for major adverse cardiac events. Therefore, ST patients with HPR are at a high risk for recurrent atherothrombotic events. New insights into the variable response to clopidogrel and the advent of stronger P2Y12 inhibitors prasugrel and ticagrelor have changed the attention from a fixed APT treatment strategy towards “personalized APT strategies.” Strategies can be based on platelet function testing, which gives insight into the overall response of a patient to APT. At our outpatient ST clinic, we practice personalized APT based on platelet function testing to guide the cardiologist to a presumed optimal antiplatelet treatment of ST patients. Beside results of platelet function testing, comedication, clinical characteristics, and genetics have to be considered to decide on personalized APT. Ongoing studies have yet to reveal the optimal personalized APT strategy for cardiologists to prevent their patients from atherothrombotic and bleeding events.

  19. Acute scrotum in a neonate caused by renal vein thrombosis.

    Science.gov (United States)

    Maas, C; Müller-Hansen, I; Flechsig, H; Poets, C F

    2011-03-01

    The authors report on a rare case of neonatal scrotal oedema occurring concurrently with pain upon palpation of the spermatic cord on the first day of life. An ultrasound examination showed poor perfusion of the left testicle and a thrombosis of the left renal vein; intraoperative exploration indicated necrosis of the left testicle without signs of torsion. Gorged vessels with paravasal bleeding were found in the spermatic cord. The authors hypothesise that necrosis of the testicle may result from haemorrhagic infarction caused by renal venous thrombosis. Acute scrotal discolouration with pain upon palpation in neonates is usually attributed to testicular torsion. The authors report a case where these symptoms had a different cause.

  20. Acute aortic thrombosis following incorrect application of the Heimlich maneuver.

    Science.gov (United States)

    Mack, Lloyd; Forbes, Thomas L; Harris, Kenneth A

    2002-01-01

    The Heimlich maneuver has been widely accepted as a safe and effective method of relieving life-threatening foreign-body upper airway obstruction. When applied incorrectly, however, it may result in direct trauma to the intraabdominal viscera. Only two cases of major aortic complications have been reported. Both have involved thrombosis of an abdominal aortic aneurysm. We report two further instances of aortic thrombotic complications due to the incorrect application of the Heimlich maneuver. The first case resulted in thrombosis of an abdominal aortic aneurysm. In the second case the abdominal thrusts caused dislodgement of thrombus from an atherosclerotic nonaneurysmal aorta, which resulted in thromboembolic occlusion of both lower extremities. In both cases, as with the two previously reported instances, massive reperfusion injury resulted, which eventually proved fatal. When applied incorrectly, the Heimlich maneuver may result in direct trauma to the abdominalaorta and is an unusual cause of acute aortic thrombosis.

  1. Primary stenting as emergency therapy in acute basilar artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Spreer, Joachim; Arnold, Sebastian; Klisch, Joachim; Schumacher, Martin [Section of Neuroradiology, University Hospital Freiburg, Breisacher Strasse 64, 79106 Freiburg (Germany); Els, Thomas; Hetzel, Andreas; Huppertz, Hans-Juergen; Oehm, Eckhardt [Department of Neurology, University Hospital Freiburg, Freiburg (Germany)

    2002-09-01

    In three patients with acute occlusion of the basilar artery intra-arterial fibrinolysis resulted in only partial recanalization and revealed severe stenosis as the underlying cause. Application of micro-stents without previous dilatation resulted in vessel re-opening. Two patients had an excellent clinical outcome. One patient died 10 days after the stroke due to brainstem infarction. Emergency primary stent application may improve the outcome in acute basilar artery occlusion, if intra-arterial thrombolysis fails to re-establish a sufficient flow. (orig.)

  2. Percutaneous aspiration thrombectomy for the treatment of acute lower extremity deep vein thrombosis: is thrombolysis needed?

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, S.H. [Department of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Oh, J.H. [Department of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of)], E-mail: radkwon@dreamwiz.com; Seo, T.-S. [Department of Radiology, Korea University Guro Hospital, Seoul (Korea, Republic of); Ahn, H.J.; Park, H.C. [Department of Surgery, Kyung Hee University Medical Center, Seoul (Korea, Republic of)

    2009-05-15

    Aim: To assess the technical feasibility and initial success of aspiration thrombectomy as a potential alternative to lytic therapy in initial endovascular management of acute lower extremity deep vein thrombosis (DVT). Materials and Methods: From July 2004 to October 2007, a retrospective analysis of 27 patients (male:female 5:22; mean age 59 years) with acute iliofemoral or femoropopliteal DVT of less than 2 weeks was performed. All patients underwent sonography of the lower extremities, and 13 patients underwent computed tomography (CT) venography. All patients received an inferior vena cava (IVC) filter and were initially treated with aspiration thrombectomy using the pullback technique with or without basket thrombus fragmentation. If persistent stenotic portions (>50% luminal narrowing) were noted, balloon angioplasty or stent placement was performed. Successful recanalization was defined as successful restoration of antegrade flow in the treated vein with elimination of any underlying obstructive lesion. Results: The mean procedure time was 65 min (range 40-100 min). Successful initial recanalization was achieved in 24 patients (88.9%) without complications. Urokinase was required for three patients (11.1%) due to a hard thrombus remaining in the iliac vein. Of the 27 patients, 23 had residual venous stenosis in the common iliac vein or external iliac vein. Therefore, balloon angioplasty (n = 23) and stent placement (n = 22) was performed. The remaining four patients were treated using only aspiration thrombectomy without angioplasty or stent placement. Conclusion: Aspiration thrombectomy without catheter-directed thrombolysis is a safe and effective treatment for acute DVT of the lower extremities, and minimizes the risk of haemorrhagic complications.

  3. One year clinical follow up of paclitaxel eluting stents for acute myocardial infarction compared with sirolimus eluting stents

    NARCIS (Netherlands)

    S.H. Hofma (Sjoerd); M. Valgimigli (Marco); C.A.G. van Mieghem (Carlos); P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); W.J. van der Giessen (Wim); P.P.T. de Jaegere (Peter); E.S. Regar (Eveline); G. Sianos (Georgios); J. Aoki (Jiro); G.A. Rodriguez-Granillo (Gaston); E.P. McFadden (Eugene); A.T.L. Ong (Andrew); R.T. van Domburg (Ron)

    2005-01-01

    textabstractOBJECTIVE: To compare clinical outcome of paclitaxel eluting stents (PES) versus sirolimus eluting stents (SES) for the treatment of acute ST elevation myocardial infarction. DESIGN AND PATIENTS: The first 136 consecutive patients treated exclusively with PES in the setting of primary pe

  4. Biocompatibility of Coronary Stents

    Directory of Open Access Journals (Sweden)

    Thamarasee M. Jeewandara

    2014-01-01

    Full Text Available Cardiovascular disease is the dominant cause of mortality in developed countries, with coronary artery disease (CAD a predominant contributor. The development of stents to treat CAD was a significant innovation, facilitating effective percutaneous coronary revascularization. Coronary stents have evolved from bare metal compositions, to incorporate advances in pharmacological therapy in what are now known as drug eluting stents (DES. Deployment of a stent overcomes some limitations of balloon angioplasty alone, but provides an acute stimulus for thrombus formation and promotes neointimal hyperplasia. First generation DES effectively reduced in-stent restenosis, but profoundly delay healing and are susceptible to late stent thrombosis, leading to significant clinical complications in the long term. This review characterizes the development of coronary stents, detailing the incremental improvements, which aim to attenuate the major clinical complications of thrombosis and restenosis. Despite these enhancements, coronary stents remain fundamentally incompatible with the vasculature, an issue which has largely gone unaddressed. We highlight the latest modifications and research directions that promise to more holistically design coronary implants that are truly biocompatible.

  5. Acute Pancreatitis and Splenic Vein Thrombosis due to Hypertriglyceridemia.

    Science.gov (United States)

    Gündüz, Ercan; Dursun, Recep; İçer, Mustafa; Zengin, Yılmaz; Güloğlu, Cahfer

    2015-01-01

    Acute pancreatitis (AP) is a condition characterised by the activation of the normally inactive digestive enzymes due to an etiological factor and digestion of the pancreatic tissues, resulting in extensive inflammation and leading to local, regional, and systemic complications in the organism. It may vary from the mild edematous to the hemorrhagic and severely necrotising form. The most common causes are biliary stones and alcohol abuse. In this case study, we would like to present a patient with AP due to hypertriglyceridemia (HPTG), which is a rare cause of pancreatitis, and splenic vein thrombosis, which is a rare complication of pancreatitis.

  6. Acute Pancreatitis and Splenic Vein Thrombosis due to Hypertriglyceridemia

    Directory of Open Access Journals (Sweden)

    Ercan Gündüz

    2015-01-01

    Full Text Available Acute pancreatitis (AP is a condition characterised by the activation of the normally inactive digestive enzymes due to an etiological factor and digestion of the pancreatic tissues, resulting in extensive inflammation and leading to local, regional, and systemic complications in the organism. It may vary from the mild edematous to the hemorrhagic and severely necrotising form. The most common causes are biliary stones and alcohol abuse. In this case study, we would like to present a patient with AP due to hypertriglyceridemia (HPTG, which is a rare cause of pancreatitis, and splenic vein thrombosis, which is a rare complication of pancreatitis.

  7. Acute clinical and angiographic results with the new AVE Micro coronary stent in bailout management.

    NARCIS (Netherlands)

    Y. Ozaki (Yukio); D.T.J. Keane (David); P.N. Ruygrok (Peter); S. Stertzer (Simon); P.W.J.C. Serruys (Patrick); P.J. de Feyter (Pim)

    1995-01-01

    textabstractTo determine the feasibility and safety of development of this new stent, we deployed 28 AVE Micro stents in 23 native coronary artery lesions in 20 patients who developed acute or threatened closure after balloon angioplasty (BA). Ten stents were deployed in the left anterior descending

  8. "Knot Stent": An Unusual Cause of Acute Renal Failure in Solitary Kidney

    Directory of Open Access Journals (Sweden)

    Kamal Moufid

    2012-01-01

    Full Text Available The insertion of indwelling ureteric stents is a routine procedure in urology practice. Complications secondary to the insertion of these stents have also increased, such as stent encrustation, stent fragmentation, stone formation, and recurrent urinary tract infections. Knot formation within the renal pelvis or in the coiled portion of the ureteral stent is an extremely rare condition, with less than 15 cases reported in literature. The authors report a rare case of knotted stent, complicated by an obstructive acute renal failure and urosepsis, in a patient with a solitary functioning kidney.

  9. Hybrid Treatment of Acute Abdominal Aortic Thrombosis Presenting with Paraplegia.

    Science.gov (United States)

    Azzarone, Matteo; De Troia, Alessandro; Iazzolino, Luigi; Nabulsi, Bilal; Tecchio, Tiziano

    2016-05-01

    Acute thrombotic or embolic occlusion of the abdominal aorta is a rare vascular emergency associated with high morbidity and mortality rates. Classically, the clinical presentation is a severe peripheral ischemia with bilateral leg pain as the predominant feature. Aortic occlusion presenting as an isolated acute onset of paraplegia due to spinal cord ischemia is very rare and requires improved awareness to prevent adverse outcomes associated with delayed diagnosis. We report the case of a 54-year-old man who presented with sudden paraplegia due to the thrombotic occlusion of the infrarenal aorta involving the first segment of the common iliac arteries on both sides; emergent transperitoneal aorto iliac thrombectomy combined with the endovascular iliac kissing-stent technique were performed achieving perioperative complete regression of the symptoms.

  10. Early Stent Thrombosis and Mortality After Primary Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Dangas, George D; Schoos, Mikkel M.; Steg, Philippe Gabriel

    2016-01-01

    BACKGROUND: Early stent thrombosis (ST) within 30 days after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction is a serious event. We sought to determine the predictors of and risk of mortality after early ST according to procedural antithrombotic therapy. M...... with bivalirudin compared with heparin±GPI because of increased ST within 4 hours after primary percutaneous coronary intervention. However, the mortality attributable to early ST was significantly lower after bivalirudin than after heparin±GPI. CLINICAL TRIAL REGISTRATION: URL: http...

  11. Life-threatening Cerebral Edema Caused by Acute Occlusion of a Superior Vena Cava Stent

    Energy Technology Data Exchange (ETDEWEB)

    Sofue, Keitaro, E-mail: keitarosofue@yahoo.co.jp; Takeuchi, Yoshito, E-mail: yotake62@qg8.so-net.ne.jp; Arai, Yasuaki, E-mail: arai-y3111@mvh.biglobe.ne.jp [National Cancer Center Hospital, Department of Diagnostic Radiology (Japan); Sugimura, Kazuro, E-mail: sugimura@med.kobe-u.ac.jp [Kobe University, Department of Radiology, Graduate School of Medicine (Japan)

    2013-02-15

    A71-year-old man with advanced lung cancer developed a life-threatening cerebral edema caused by the acute occlusion of a superior vena cava (SVC) stent and was successfully treated by an additional stent placement. Although stent occlusion is a common early complication, no life-threatening situations have been reported until now. Our experience highlights the fact that acute stent occlusion can potentially lead to the complete venous shutdown of the SVC, resulting in life-threatening cerebral edema, after SVC stent placement. Immediate diagnosis and countermeasures are required.

  12. Successful treatment of post-exertion acute myocardial infarction by primary angioplasty and stenting in a patient with antiphospholipid antibody syndrome.

    Science.gov (United States)

    Musuraca, Gerardo; Imperadore, Ferdinando; Terraneo, Clotilde; De Girolamo, Piergiuseppe; Cemin, Claudio; Bonmassari, Roberto; Vergara, Giuseppe

    2004-01-01

    Antiphospholipid syndrome is a disorder characterized by arterial and venous thromboses, thrombocytopaenia and stroke. Acute myocardial infarction is rarely associated with this syndrome. The treatment of these patients is a clinical challenge. This report is about a patient with antiphospholipid syndrome presenting with an acute myocardial infarction after an exercise test. The infarct-related coronary artery was successfully revascularized by primary angioplasty and stenting without any major bleeding complications. We think that the physical exertion could have favoured acute coronary thrombosis in this particular setting.

  13. Endovascular rescue from arterial rupture and thrombosis during middle cerebral artery stenting

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, J.Y.; Chung, Y.S. [Department of Neurosurgery, College of Medicine, Pundang CHA Hospital, 351 Yatap-ding, Pundang-gu, 463-712, Sungnam (Korea); Lee, B.H. [Department of Interventional Neuroradiology, College of Medicine, Pundang CHA Hospital, 351 Yatap-dong, Pundang-gu, 463-712, Sungnam (Korea); Kim, O.J. [Department of Emergency Medicine, College of Medicine, Pundang CHA Hospital, 351 Yatap-dong, Pundang-gu, 463-712, Sungnam (Korea)

    2003-08-01

    Intravascular stents are being used with increasing frequency in interventional neuroradiology. Iatrogenic arterial rupture is an uncommon but serious complication. We present a case of arterial rupture and subarachnoid haemorrhage during middle cerebral artery stenting, treated by emergency additional, overlapping stenting and balloon tamponade of the dissected vessel. Thrombotic occlusion of the artery was managed by intra-arterial abciximab. Normal vessel patency was re-established within 20 min and the patient recovered with no neurological deficit. (orig.)

  14. Combined use of transmyocardial stents with gene therapy in the treatment of acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    王永武

    2006-01-01

    Objective To determine the efficacy of combined use of transmyocardial stent with gene therapy to treat acute myocardial infarction in porcine model. Methods 24 Chinese mini swines have been devided into 4 groups randomly: group myocardial infarction (group MI n1 = 6), group transmyocardial stent (group ST n2 = 6) , group vascular endothelial growth factor (group VEGF n3 = 6) , group transmyocardial stent and VEGF (group ST + VEGF n4 = 6). In group MI,acute myocardial infarc-

  15. Comparison of in vivo acute stent recoil between the bioabsorbable everolimus-eluting coronary stent and the everolimus-eluting cobalt chromium coronary stent: insights from the ABSORB and SPIRIT trials

    DEFF Research Database (Denmark)

    Tanimoto, Shuzou; Serruys, Patrick W; Thuesen, Leif

    2007-01-01

    the antiproliferative drug, everolimus, and expected to be totally metabolized and absorbed in the human body. Because the BVS is made from polymer, it may have more acute recoil than metallic stents in vivo. METHODS: A total of 54 patients, who underwent elective stent implantation for single de novo native coronary......OBJECTIVES: This study sought to evaluate and compare in vivo acute stent recoil of a novel bioabsorbable stent and a metallic stent. BACKGROUND: The bioabsorbable everolimus-eluting coronary stent (BVS) is composed of a poly-L-lactic acid backbone, coated with a bioabsorbable polymer containing...

  16. Histopathological evaluation of thrombus in patients presenting with stent thrombosis. A multicenter European study: a report of the prevention of late stent thrombosis by an interdisciplinary global European effort consortium†

    Science.gov (United States)

    Riegger, Julia; Byrne, Robert A.; Joner, Michael; Chandraratne, Sue; Gershlick, Anthony H.; ten Berg, Jurrien M.; Adriaenssens, Tom; Guagliumi, Giulio; Godschalk, Thea C.; Neumann, Franz-Josef; Trenk, Dietmar; Feldman, Laurent J.; Steg, Philippe Gabriel; Desmet, Walter; Alfonso, Fernando; Goodall, Alison H.; Wojdyla, Roman; Dudek, Dariusz; Philippi, Vanessa; Opinaldo, Sheryl; Titova, Anna; Malik, Nikesh; Cotton, James; Jhagroe, Darshni A.; Heestermans, Antonius A.C.M.; Sinnaeve, Peter; Vermeersch, Paul; Valina, Christian; Schulz, Christian; Kastrati, Adnan; Massberg, Steffen

    2016-01-01

    Background Stent thrombosis (ST) is a rare but serious complication following percutaneous coronary intervention. Analysis of thrombus composition from patients undergoing catheter thrombectomy may provide important insights into the pathological processes leading to thrombus formation. We performed a large-scale multicentre study to evaluate thrombus specimens in patients with ST across Europe. Methods Patients presenting with ST and undergoing thrombus aspiration were eligible for inclusion. Thrombus collection was performed according to a standardized protocol and specimens were analysed histologically at a core laboratory. Serial tissue cross sections were stained with haematoxylin–eosin (H&E), Carstairs and Luna. Immunohistochemistry was performed to identify leukocyte subsets, prothrombotic neutrophil extracellular traps (NETs), erythrocytes, platelets, and fibrinogen. Results Overall 253 thrombus specimens were analysed; 79 (31.2%) from patients presenting with early ST, 174 (68.8%) from late ST; 79 (31.2%) were from bare metal stents, 166 (65.6%) from drug-eluting stents, 8 (3.2%) were from stents of unknown type. Thrombus specimens displayed heterogeneous morphology with platelet-rich thrombus and fibrin/fibrinogen fragments most abundant; mean platelet coverage was 57% of thrombus area. Leukocyte infiltrations were hallmarks of both early and late ST (early: 2260 ± 1550 per mm2 vs. late: 2485 ± 1778 per mm2; P = 0.44); neutrophils represented the most prominent subset (early: 1364 ± 923 per mm2 vs. late: 1428 ± 1023 per mm2; P = 0.81). Leukocyte counts were significantly higher compared with a control group of patients with thrombus aspiration in spontaneous myocardial infarction. Neutrophil extracellular traps were observed in 23% of samples. Eosinophils were present in all stent types, with higher numbers in patients with late ST in sirolimus-and everolimus-eluting stents. Conclusion In a large-scale study of histological thrombus analysis from

  17. A history of late and very late stent thrombosis is not associated with increased activation of the contact system, a case control study

    Directory of Open Access Journals (Sweden)

    Brügger-Andersen Trygve

    2010-04-01

    Full Text Available Abstract Background The pathophysiological pathways resulting in Late Stent Thrombosis (LST remain uncertain. Findings from animal studies indicate a role of the intrinsic coagulation pathway in arterial thrombus formation, while clinical studies support an association with ischemic cardiovascular disease. It is currently unknown whether differences in the state of the contact system might contribute to the risk of LST or Very Late Stent Thrombosis (VLST. We assessed the relation between levels of several components involved in the contact system and a history of LST and VLST, termed (VLST in a cohort of 20 patients as compared to a matched control group treated with PCI. Methods and Results Activated factor XII (FXIIa, FXII zymogen (FXII, FXIIa-C1-esterase inhibitor (C1-inhibitor, Kallikrein-C1-inhibitor, FXIa-C1-inhibitor and FXIa-α1-antitrypsin (AT-inhibitor complexes were measured by Enzyme-linked immunosorbent assy (ELISA methodology. Cases and controls showed similar distributions in sex, age, baseline medications and stent type. Patients with a history of (VLST had a significantly greater stent burden and a higher number of previous myocardial infarctions than the control patients. There were no significant between-group differences in the plasma levels of the components of the contact system. Conclusion In a cohort of patients with a history of (VLST, we did not observe differences in the activation state of the intrinsic coagulation system as compared to patients with a history of percutaneous coronary intervention without stent thrombosis.

  18. Acute portal vein thrombosis due to chronic relapsing pancreatitis: a fistula between a pancreatic pseudocyst and the splenic vein.

    Science.gov (United States)

    Kikuchi, Masahiro; Nishizaki, Yasuhiro; Tsuruya, Kota; Hamada, Ikuko; Higashi, Toru; Sakuma, Keiko; Shiozawa, Hirokazu; Aoki, Jun; Nagashima, Rena; Koizumi, Jun; Arase, Yoshitaka; Shiraishi, Koichi; Matsushima, Masashi; Mine, Tetsuya

    2014-02-01

    Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but several other causes might play an important role in PVT pathogenesis. We present a case of alcoholic chronic pancreatitis complicated by acute extensive PVT. The patient was managed conservatively with danaparoid sodium at first, but the thrombosis gradually extended. We then tried radiological intervention using the direct transhepatic and transjugular intrahepatic postsystemic shunt approaches. Although we were able to successfully catheterize the percutaneous transhepatic portal vein (PTP), we could not achieve recanalization of the portal vein. Therefore, PTP catheterization and systemic intravenous infusion of urokinase and heparin was performed to prevent further progression of the thrombosis and cavernous transformation was finally achieved. Computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a pancreatic stone which had possibly induced dilatation of the tail duct and formation of a pancreatic pseudocyst and caused intractable pancreatitis. We performed endoscopic retrograde cholangiopancreatography and placed a stent in the pancreatic duct, which completely cured the pancreatitis. Retrospectively, the previous CT with curved multi-planar reconstruction was reviewed and a fistula was detected between the pancreatic pseudocyst and splenic vein. We concluded that the etiology of the PVT was not only inflammatory extension from pancreatitis but also a fistula between the pancreatic duct and the splenic vein.

  19. Stent-graft repair for acute traumatic thoracic aortic rupture.

    Science.gov (United States)

    Neuhauser, B; Czermak, B; Jaschke, W; Waldenberger, P; Fraedrich, G; Perkmann, R

    2004-12-01

    Traumatic rupture of the thoracic aorta is potentially life-threatening and leads to death in 75 to 90 per cent of cases at the time of injury. In high-risk patients, as traumatic injuries of the aorta combine with multiple associated injuries, endoluminal repair is now reported as a promising therapeutic strategy with encouraging results. This study determined the outcome of patients with traumatic thoracic aortic injury treated endovascularly during the past 7 years at our institution. Thirteen patients, 11 males and 2 females (mean age, 39 years; range, 19-82), with traumatic rupture of the otherwise unremarkable descending aorta (10 acute, 3 chronic), out of a series of 64 endovascular thoracic stent-graft procedures, were treated by implantation of Talent (n = 8), Vanguard (n = 5), and Excluder (n = 2) self-expanding devices between January 1996 and August 2003. The immediate technical success rate was 92 per cent (12/13). One patient showed a proximal endoleak type I, which was treated successfully by an additional stent-graft procedure. Secondary success rate was 100 per cent. The mortality rate was 0 per cent. Two additional stent-graft procedures were performed due to type I endoleaks after 18 and 28 months. There was no other intervention-related morbidity or mortality during the mean follow-up time of 26.4 months' (range, 6-86). Endovascular stent-graft repair of traumatic thoracic aortic injuries is a safe, effective, and low-morbidity alternative to open thoracic surgery and has promising midterm results.

  20. [Bilateral renal vein thrombosis and acute renal failure due to inferior vena cava filter thrombosis. Report of one case].

    Science.gov (United States)

    Vega, Jorge; Díaz, Rienzi

    2014-11-01

    Bilateral renal vein thrombosis is an unusual etiology of acute renal failure and usually is associated with nephrotic syndrome. We report a 77-year-old man, consulting in the emergency room for anuria that appeared 24 hours after a syncope. The patient was carrier of an inferior vena cava filter prophylactically installed 17 months earlier and was not receiving anticoagulation. Serum creatinine on admission was 5.45 mg/dl and blood urea nitrogen was 54 mg/dl. Computed tomography and Doppler ultrasonography showed an extensive thrombosis of inferior vena cava and both renal veins. Heparin therapy was started with a rapid recovery of renal function and diuresis.

  1. Warfarin therapy in a dog with acute arterial thrombosis and pyometra.

    Science.gov (United States)

    Arai, Shiori; Callan, Mary Beth

    2014-11-01

    This report describes the presentation of acute arterial thrombosis causing triparesis in a 6-year-old female Chihuahua with pyometra and its successful management in combination with warfarin therapy. This is the first case report of a dog with arterial thrombosis associated with pyometra.

  2. [Tactics of the patients management in continuing acute thrombosis of deep veins].

    Science.gov (United States)

    Prasol, V A; Mishenina, E V; Okley, D V

    2015-03-01

    Experience of active tactics of treatment application in 18 patients, suffering an acute thrombosis in system of lower vena cava, is presented. Possibilities were estimated and efficacy of active surgical tactics proved in continuing deep vein thrombosis on early stage were estimated. Active tactics, using catheter--governed thrombolysis, permits to escape pulmonary thromboembolism and to reduce a severity of further chronic venous insufficiency.

  3. Acute cytomegalovirus infection complicated by venous thrombosis: a case report

    Directory of Open Access Journals (Sweden)

    Parola Philippe

    2005-08-01

    Full Text Available Abstract Background CMV-induced vasculopathy and thrombosis have been reported, but they are rare conditions usually encountered in immunocompromised patients. However more and more complications of CMV infections are recognized in immunocompetent patients. Case presentation We present a case report of a previously healthy adult with cytomegalovirus infection that was complicated by tibiopopliteal deep venous thrombosis and in whom Factor V Leiden heterozygous mutation was found. Conclusion This new case report emphasizes the involvement of cytomegalovirus in induction of vascular thrombosis in patients with predisposing risk factors for thrombosis. It is necessary to screen for CMV infection in patients with spontaneous thrombosis and an history of fever.

  4. Atypical presentation of priapism in a patient with acute iliocaval deep venous thrombosis secondary to May-Thurner syndrome.

    Science.gov (United States)

    Alhalbouni, Saadi; Deem, Samuel; Abu-Halimah, Shadi; Sadek, Betro T; Mousa, Albeir

    2013-08-01

    We report on a 42-year-old male who presented with priapism, severe scrotal swelling, and left lower extremity pain and swelling. Initial management of priapism failed, and he was noted to have both cavernosal and glandular venous obstruction. Computed tomography (CT) was performed and identified extensive acute thrombosis involving the distal inferior vena cava and the left iliac veins. Pharmacomechanical thrombolysis (PMT) was started over the course of two days. At completion of thrombolysis, the culprit lesion in the left common iliac vein was treated with angioplasty and stenting. His postoperative course was uneventful, and his priapism as well as the scrotal and leg swelling improved. He was discharged home on full anticoagulation. To our knowledge, this is the first available description of this rare presentation along with a literature review of the underlying vascular etiology for priapism.

  5. Acute thrombosis of abdominal aortic aneurysm subsequent to Heimlich maneuver: a case report.

    Science.gov (United States)

    Kirshner, R L; Green, R M

    1985-07-01

    We report a case of acute thrombosis of an abdominal aortic aneurysm secondary to a correctly applied and successful Heimlich maneuver. Although the Heimlich maneuver is generally safe and effective, this possible catastrophic consequence needs to be recognized.

  6. Pregnancy after catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis

    DEFF Research Database (Denmark)

    Jørgensen, M; Broholm, R; Bækgaard, N

    2013-01-01

    To assess the safety and efficacy of low-molecular-weight heparin (LMWH) in pregnancy and puerperium in women with previous acute iliofemoral deep venous thrombosis (DVT) treated with catheter-directed thrombolysis (CDT).......To assess the safety and efficacy of low-molecular-weight heparin (LMWH) in pregnancy and puerperium in women with previous acute iliofemoral deep venous thrombosis (DVT) treated with catheter-directed thrombolysis (CDT)....

  7. Tissue factor pathway inhibitor relates to fibrin degradation in patients with acute deep venous thrombosis

    DEFF Research Database (Denmark)

    Sidelmann, Johannes J; Bladbjerg, Else-Marie; Gram, Jørgen

    2008-01-01

    Reduced concentration of tissue factor pathway inhibitor is a risk factor for development of deep venous thrombosis, whereas elevated concentrations of tissue factor pathway inhibitor are observed in patients with acute myocardial infarction and disseminated intravascular coagulation. Presently, we...... studied the association between inflammation, endothelial cell perturbation, fibrin degradation and the concentration of tissue factor pathway inhibitor in patients suspected for acute deep venous thrombosis. We determined the tissue factor pathway inhibitor -33T/C polymorphism, free and total tissue...... factor pathway inhibitor, C-reactive protein, von Willebrand factor and D-Dimer in 160 consecutive patients admitted to hospital with a tentative diagnosis of acute deep venous thrombosis. Deep venous thrombosis was identified in 57 patients (18 distal and 39 proximal). The distribution of the tissue...

  8. Heparin-Coated Coronary Stents.

    Science.gov (United States)

    van Der Giessen WJ; van Beusekom HM; Larsson; Serruys

    1999-09-01

    The development of the heparin-coated (HC)-stent should be viewed against the backdrop of the early unfavorable results with noncoated stents in the pre-intravascular ultrasound and pre-ticlopidine era. Notwithstanding, results of pilot and randomized trials show a surprisingly low incidence of (sub)acute stent thrombosis under challenging circumstances, such as acute coronary syndromes. Considering the quite low incidence of early complications with noncoated second-generation stents, it may require large trials to prove the clinical efficacy of the heparin- coating against noncoated devices. However, even if the "added value" of the heparin-coating will never be clinically proven, it has helped to enhance the penetration of stent therapy in interventional cardiology. Unlike the situation in 1992, very few cardiologists will now disagree with the statement that stents contribute to the state-of-the-art treatment of patients with angina pectoris or acute myocardial infarction. A preliminary comparison of available trials also suggests that the heparin-coated Palmaz-Schatz stent (Cordis Corp., Waterloo, Belgium) is as effective as the noncoated stent plus abciximab treatment.

  9. Acute deep vein thrombosis and endovascular techniques: It is time for a new aggiornamento!

    Science.gov (United States)

    Pernès, J-M; Auguste, M; Kovarski, S; Borie, H; Renaudin, J-M; Coppe, G

    2012-10-01

    The stated aims of treating acute deep vein thrombosis (DVT) are to prevent a pulmonary embolism, stop the clot from spreading, reduce the risk of a recurrence; they are less concerned with the late morbidity associated with post-thrombotic syndrome (PTS). In accordance with the French (Afssaps, 2009) and North American (ACCP, 2008) recommendations, anticoagulants (LMWH, heparin, AVK) form the cornerstone for treating DVT. These treatments appear to be far less effective in preventing post-thrombotic syndrome (PTS), associated with venous hypertension, residual occlusion, and with reflux caused by valve incompetence. Given that, the new aim is to optimise the prevention of PTS, the ACCP guidelines, unlike those of Afssaps, "suggest" for selected patients suffering from acute iliofemoral DVT, the use of both classic anticoagulants, and in situ percutaneous administration of thrombolytic drugs (recommendation grade 2B) and simultaneous correction of any underlying anatomical anomalies using angioplasty and stenting (recommendation 2C). Contemporary endovascular methods, referred to collectively as "facilitated" thrombolysis, combine low doses of rtPa or Urokinase administered locally, and the removal of the clot using various mechanical, rotating, rheolytic systems, or using ultrasound. The results of non-randomised, heterogeneous studies objectivised a lysis rate of 80%, a 50% lower risk of haemorrhage complications compared with systemic thrombolysis (<4%), and a clear reduction in treatment time (one-shot methods possible for procedures lasting less than 2 hours). This data ties in with the modern "open vein" concept which underpins the hope of an improvement in the late prognosis of acute DVT, through the removal of a clot, thereby improving permeability and valve integrity; this hypothesis is supported by the results at 24 months of a randomised CaVent objectifying absolute risk reduction of 15% in the thrombolysis in situ. The current randomised study (ATTRACT

  10. Hepatic artery stent-grafts for the emergency treatment of acute bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bellemann, Nadine, E-mail: nadine.bellemann@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Sommer, Christof-Matthias; Mokry, Theresa; Kortes, Nikolas; Gnutzmann, Daniel; Gockner, Theresa; Schmitz, Anne [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Weitz, Jürgen [Department of Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Department for Visceral, Thoracic and Vascular Surgery at the University Hospital, Technical University Dresden (Germany); Kauczor, Hans-Ulrich; Radeleff, Boris; Stampfl, Ulrike [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany)

    2014-10-15

    Highlights: • We report our experiences with stent-grafts for the treatment of acute hemorrhage from the hepatic artery or the stump of the gastroduodenal artery. • The technical success of stent-graft implantation was 88%. • The bleeding ceased immediately after stent-graft implantation in 88%. • The complication rate was 21%. - Abstract: Purpose: We evaluated the technical success and clinical efficacy of stent-graft implantation for the emergency management of acute hepatic artery bleeding. Methods: Between January 2010 and July 2013, 24 patients with hemorrhage from the hepatic artery were scheduled for emergency implantation of balloon expandable stent-grafts. The primary study endpoints were technical and clinical success, which were defined as successful stent-graft implantation with sealing of the bleeding site at the end of the procedure, and cessation of clinical signs of hemorrhage. The secondary study endpoints were complications during the procedure or at follow-up and 30-day mortality rate. Results: In 23 patients, hemorrhage occurred after surgery, and in one patient hemorrhage occurred after trauma. Eight patients had sentinel bleeding. In most patients (n = 16), one stent-graft was implanted. In six patients, two overlapping stent-grafts were implanted. The stent-grafts had a target diameter between 4 mm and 7 mm. Overall technical success was 88%. The bleeding ceased after stent-graft implantation in 21 patients (88%). The mean follow-up was 137 ± 383 days. In two patients, re-bleeding from the hepatic artery occurred during follow-up after 4 and 29 days, respectively, which could be successfully treated by endovascular therapy. The complication rate was 21% (minor complication rate 4%, major complication rate 17%). The 30-day mortality rate was 21%. Conclusions: Implantation of stent-grafts in the hepatic artery is an effective emergency therapy and has a good technical success rate for patients with acute arterial hemorrhage.

  11. Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip

    Energy Technology Data Exchange (ETDEWEB)

    Qanadli, S.D.; Mesurolle, B.; Sissakian, J.F.; Chagnon, S.; Lacombe, P. [Service de Radiologie, Hopital Ambroise Pare, 92 - Boulogne (France)

    2000-08-01

    We describe a case of a 49-year-old woman with stage-IIIB lung adenocarcinoma who experienced an acute superior vena cava syndrome related to an implanted central venous catheter without associated venous thrombosis. The catheter was surgically implanted for chemotherapy. Superior vena cava syndrome appeared after the procedure and was due to insertion of the catheter through a subclinical stenosis of the superior vena cava. Complete resolution of the patient's symptoms was obtained using stent placement and endovascular repositioning of the catheter tip. (orig.)

  12. Acute Mesenteric Venous Thrombosis with a Vaginal Contraceptive Ring

    Directory of Open Access Journals (Sweden)

    Wesley Eilbert

    2014-07-01

    Full Text Available Mesenteric venous thrombosis is a rare cause of abdominal pain, which if left untreated may result in bowel infarction, peritonitis and death. The majority of patients with this illness have a recognizable, predisposing prothrombotic condition. Oral contraceptives have been identified as a predisposing factor for mesenteric venous thrombosis in reproductive-aged women. In the last fifteen years new methods of hormonal birth control have been introduced, including a transdermal patch and an intravaginal ring. In this report, we describe a case of mesenteric venous thrombosis in a young woman caused by a vaginal contraceptive ring. [West J Emerg Med. 2014;15(4:395-397.

  13. Biolimus-eluting stents with biodegradable polymer versus bare-metal stents in acute myocardial infarction

    DEFF Research Database (Denmark)

    Räber, Lorenz; Kelbæk, Henning; Taniwaki, Masanori

    2014-01-01

    BACKGROUND: This study sought to determine whether the 1-year differences in major adverse cardiac event between a stent eluting biolimus from a biodegradable polymer and bare-metal stents (BMSs) in the COMFORTABLE trial (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Meta...... to improve cardiovascular events compared with BMS beyond 1 year. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NTC00962416....

  14. Acute Portomesenteric Venous Thrombosis following Laparoscopic Small Bowel Resection and Ventral Hernia Repair

    Directory of Open Access Journals (Sweden)

    Bhradeev Sivasambu

    2015-01-01

    Full Text Available Acute portomesenteric venous thrombosis is a rare but life-threatening complication of laparoscopic surgery that has been described in literature. Prompt diagnosis and early initiation of treatment are vital to prevent life-threatening complications such as mesenteric ischemia and infarction. A 51-year-old lady had laparoscopic small bowel resection and primary anastomosis with ventral hernia repair 4 weeks earlier for partial small bowel obstruction. Her postoperative period was uneventful and she was discharged home. Four weeks after surgery she developed watery diarrhea and generalized abdominal pain for four-day duration. A computed tomography of the abdomen revealed portomesenteric venous thrombosis although a computed tomography of abdomen before surgery 4 weeks back did not show any portomesenteric venous thrombosis. We are reporting a case of acute portomesenteric venous thrombosis as a complication of laparoscopic surgery.

  15. Asymptomatic superior mesenteric vein thrombosis as unusual complication of acute cytomegalovirus infection: a case report

    Directory of Open Access Journals (Sweden)

    Michele Bertoni

    2015-10-01

    Full Text Available We describe a 39-year-old male who presented with a fever of unknown origin, the diagnostic work-up of which disclosed an acute cytomegalovirus (CMV infection complicated by a partial superior mesenteric vein (SMV thrombosis. Further investigations revealed the presence of factor V Leiden mutation. Oral anticoagulant treatment with warfarin led to a complete recanalization of SMV two months after. A literature review on the association between CMV infection and portal system (PS thrombosis in immunocompetent patients was performed. We found that, in agreement with our case, in a minority of case reports patients did not complain of abdominal pain, but presented with a mononucleosis-like syndrome with malaise and prolonged fever and displayed a variable elevation of aminotransferase levels. Interestingly, most of them exhibited a limited extension of portal thrombosis. On the whole, these data suggest that PS thrombosis during acute CMV infection may be an underestimated complication.

  16. A rare case of acute renal infarction due to idiopathic renal arterial thrombosis

    Institute of Scientific and Technical Information of China (English)

    FU Zhi-fang; ZHANG Zhi-gang; LIU Xin-min

    2008-01-01

    @@ Because of the lack of specific clinical signs and symptoms,acute renal infarction is apt to be missed in diagnosis and hence has a"low"incidence.In this report,a case of acute renal infarction due to idiopathic renal arterial thrombosis is presented.

  17. Should anticoagulants be administered for portal vein thrombosis associated with acute pancreatitis?

    Institute of Scientific and Technical Information of China (English)

    Won-Seok Park; Hyeong-Il Kim; Byung-Jun Jeon; Seong-Hun Kim; Seung-Ok Lee

    2012-01-01

    Venous complications in patients with acute pancreatitis typically occur as a form of splenic,portal,or superior mesenteric vein thrombosis and have been detected more frequently in recent reports.Although a well-organized protocol for the treatment of venous thrombosis has not been established,anticoagulation therapy is commonly recommended.A 73-year-old man was diagnosed with acute progressive portal vein thrombosis associated with acute pancreatitis.After one month of anticoagulation therapy,the patient developed severe hematemesis.With endoscopy and an abdominal computed tomography scan,hemorrhages in the pancreatic pseudocyst,which was ruptured into the duodenal bulb,were confirmed.After conservative treatment,the patient was stabilized.While the rupture of a pseudocyst into the surrounding viscera is a well-known phenomenon,spontaneous rupture into the duodenum is rare.Moreover,no reports of upper gastrointestinal bleeding caused by pseudocyst rupture in patients under anticoagulation therapy for venous thrombosis associated with acute pancreatitis have been published.Herein,we report a unique case of massive upper gastrointestinal bleeding due to pancreatic pseudocyst rupture into the duodenum,which developed during anticoagulation therapy for portal vein thrombosis associated with acute pancreatitis.

  18. Drug-eluting stents: current issues

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); A.T.L. Ong (Andrew)

    2005-01-01

    textabstractEarly stent thrombosis occurs in about 1% to 1.5% of patients with drug-eluting stents, very similar to the rate with bare-metal stents. Late stent thrombosis is more of a concern with drug-eluting stents, with an incidence of at least 0.35%. I would urge caution if you feel you have to

  19. Use of Percutaneous Aspiration Thrombectomy vs. Anticoagulation Therapy to Treat Acute Iliofemoral Venous Thrombosis: 1-year Follow-up Results of a Randomised, Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Cakir, Volkan, E-mail: drvolkancakir@gmail.com [Katip Celebi University, Ataturk Training and Research Hospital, Department of Radiology, Division of İnterventional Radiology (Turkey); Gulcu, Aytac, E-mail: aytac.gulcu@deu.edu.tr [Dokuz Eylul University Hospital, Department of Radiology (Turkey); Akay, Emrah, E-mail: emrahakay@hotmail.com [Sakarya University Hospital, Department of Radiology (Turkey); Capar, Ahmet E., E-mail: ahmetergina@gmail.com [Dokuz Eylul University Hospital, Department of Radiology (Turkey); Gencpinar, Tugra, E-mail: tugra01@hotmail.com [Dokuz Eylul University Hospital, Department of Cardiovascular Surgery (Turkey); Kucuk, Banu, E-mail: banu.kucuk@deu.edu.tr [Dokuz Eylul University Hospital, Department of Radiology (Turkey); Karabay, Ozalp, E-mail: ozalp.karabay@deu.edu.tr [Dokuz Eylul University Hospital, Department of Cardiovascular Surgery (Turkey); Goktay, A. Yigit, E-mail: yigit.goktay@deu.edu.tr [Dokuz Eylul University Hospital, Department of Radiology (Turkey)

    2014-08-15

    PurposeThe purpose of this study was to compare the efficacy of percutaneous aspiration thrombectomy (PAT) followed by standard anticoagulant therapy, with anticoagulation therapy alone, for the treatment of acute proximal lower extremity deep vein thrombosis.MethodsIn this randomised, prospective study, 42 patients with acute proximal iliofemoral deep vein thrombosis documented via Doppler ultrasound examination, were separated into an interventional treatment group (16 males, 5 females, average age 51 years) and a medical treatment group (13 males, 8 females, average age 59 years). In the interventional group, PAT with large-lumen 9-F diameter catheterisation was applied, after initiation of standard anticoagulant therapy. Balloon angioplasty (n 19) and stent implementation (n: 14) were used to treat patients with residual stenosis (>50 %) after PAT. Prophylactic IVC filters were placed in two patients. The thrombus clearance status of the venous system was evaluated by venography. In both the medical and interventional groups, venous patency rates and clinical symptom scores were evaluated at months 1, 3, and 12 after treatment.ResultsDeep venous systems became totally cleared of thrombi in 12 patients treated with PAT. The venous patency rates in month 12 were 57.1 and 4.76 % in the interventional and medical treatment groups, respectively. A statistically significant improvement was observed in clinical symptom scores of the interventional group (PAT) with or without stenting (4.23 ± 0.51 before treatment; 0.81 ± 0.92 at month 12) compared with the medical treatment group (4.00 ± 0.63 before treatment; 2.43 ± 0.67 at month 12). During follow-up, four patients in the medical treatment and one in the interventional group developed pulmonary embolisms.ConclusionsFor treatment of acute deep vein thrombosis, PAT with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical

  20. Acute extensive portal and mesenteric venous thrombosis after splenectomy: Treated by interventional thrombolysis with transjugular approach

    Institute of Scientific and Technical Information of China (English)

    Mao-Qiang Wang; Han-Ying Lin; Li-Ping Guo; Feng-Yong Liu; Feng Duan; Zhi-Jun Wang

    2009-01-01

    AIM: To present a series of cases with symptomatic acute extensive portal vein (PV) and superior mesenteric vein (SMV) thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis. METHODS: A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis.The mean age of the patients was 41.2 years. After access to the portal system via the transjugular approach, pigtail catheter fragmentation of clots,local urokinase injection, and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis, followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV, which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization, and after discharge. RESULTS: Technical success was achieved in all 6 patients. Clinical improvement was seen in these patients within 12-24 h of the procedure. No complications were observed. The 6 patients were discharged 6-14 d (8 ± 2.5 d) after admission. The mean duration of follow-up after hospital discharge was 40 ± 16.5 mo. Ultrasound and contrast-enhanced computed tomography confirmed patency of the PV and SMV, and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period .CONCLUSION: Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.

  1. Catheter-Directed Thrombolysis with a Continuous Infusion of Low-Dose Urokinase for Non-Acute Deep Venous Thrombosis of the Lower Extremity

    Energy Technology Data Exchange (ETDEWEB)

    Gao, Binbin; Zhang, Jingyong; Wu, Xuejun; Han, Zonglin; Zhou, Hua; Dong, Dianning; Jin, Xing [Shandong Provincial Hospital, Shandong University, Ji' nan (China)

    2011-02-15

    We wanted to evaluate the feasibility of catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for treating non-acute (less than 14 days) deep venous thrombosis of the lower extremity. The clinical data of 110 patients who were treated by catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for lower extremity deep venous thrombosis was analysed. Adjunctive angioplasty or/and stenting was performed for the residual stenosis. Venous recanalization was graded by pre- and posttreatment venography. Follow-up was performed by clinical evaluation and Doppler ultrasound. A total of 112 limbs with deep venous thrombosis with a mean symptom duration of 22.7 days (range: 15-38 days) were treated with a urokinase infusion (mean: 3.5 million IU) for a mean of 196 hours. After thrombolysis, stent placement was performed in 25 iliac vein lesions and percutaneous angioplasty (PTA) alone was done in fi ve iliac veins. Clinically significant recanalization was achieved in 81% (90 of 112) of the treated limbs: complete recanalization was achieved in 28% (31 of 112) and partial recanalization was achieved in 53% (59 of 112). Minor bleeding occurred in 14 (13%) patients, but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. During followup (mean: 15.2 months, range: 3-24 months), the veins were patent in 74 (67%) limbs. Thirty seven limbs (32%) showed progression of the stenosis with luminal narrowing more than 50%, including three with rethrombosis, while one revealed an asymptomatic iliac vein occlusion: 25 limbs (22%) developed mild post-thrombotic syndrome, and none had severe post-thrombotic syndrome. Valvular reflux occurred in 24 (21%) limbs. Catheter-directed thrombolysis with a continuous infusion of low-dose urokinase combined with adjunctive iliac vein stenting is safe and effective for removal of the clot burden and for restoration of the venous flow in patients with non-acute lower

  2. Simultaneous acute deep vein thrombosis and acute brucellosis. A case report

    Science.gov (United States)

    Andaç, Şeyda; Kalender, Mehmet; Yıldırım, Onur; İmre, Ayfer

    2016-01-01

    Brucellosis is a zoonotic disease common in developing countries. Vascular complications, including arterial and venous, associated with Brucella infection have rarely been reported. A case of deep venous thrombosis (DVT) developing after a diagnosis of acute brucellosis in a young milkman is presented. A 26-year-old man presented with pain in the right leg. The patient's medical history included a diagnosis of brucellosis in our hospital where he had presented with complaints of weakness and fever. Peripheral venous Doppler ultrasound showed DVT, and the patient was treated with anticoagulants. The patient was discharged with warfarin therapy and anti-brucellosis treatment. Although rare, some infectious agents may cause vascular pathologies. Patients presenting with symptoms of DVT or similar vascular pathologies should be assessed for infectious agents, particularly in those coming from Brucella-endemic areas. PMID:27516795

  3. Artificial neural networks predict the incidence of portosplenomesenteric venous thrombosis in patients with acute pancreatitis.

    Science.gov (United States)

    Fei, Y; Hu, J; Li, W-Q; Wang, W; Zong, G-Q

    2017-03-01

    Essentials Predicting the occurrence of portosplenomesenteric vein thrombosis (PSMVT) is difficult. We studied 72 patients with acute pancreatitis. Artificial neural networks modeling was more accurate than logistic regression in predicting PSMVT. Additional predictive factors may be incorporated into artificial neural networks.

  4. Advanced management of acute iliofemoral deep venous thrombosis: emergency department and beyond.

    Science.gov (United States)

    Pollack, Charles V

    2011-06-01

    Recent attention to the increasing incidence of venous thromboembolism has included a call to action from the surgeon general and new guidelines from various specialty organizations. The standard of care for treatment of deep venous thrombosis in the emergency department (ED), supported by the 2008 American College of Chest Physicians (ACCP) guidelines, involves initiation of anticoagulation with low-molecular-weight heparin, pentasaccharide, or unfractionated heparin. For selected appropriate patients with extensive acute proximal deep venous thrombosis, the ACCP guidelines now recommend thrombolysis in addition to anticoagulation to reduce not only the risk of pulmonary embolism but also the risk of subsequent postthrombotic syndrome and recurrent deep venous thrombosis. Postthrombotic syndrome is a potentially debilitating chronic cluster of lower-extremity symptoms occurring in 20% to 50% of deep venous thrombosis patients subsequent to the acute insult, sometimes not until years later. A strategy of early thrombus burden reduction or frank removal might reduce the incidence of postthrombotic syndrome, as per natural history studies, venous thrombectomy data, observations after systemic and catheter-directed thrombolysis, and the still-limited number of randomized trials of catheter-directed thrombolysis (with anticoagulation) versus anticoagulation alone. Contemporary invasive (endovascular) treatments mitigate the drawbacks historically associated with thrombolytic approaches by means of intrathrombus delivery of drugs with greater fibrin specificity and lower allergenicity, followed by mechanical dispersion to accelerate lysis and then aspiration of remaining drug and clot debris. With a 2016 target completion date, the National Heart, Lung, and Blood Institute--sponsored Acute Venous Thrombosis: Thrombus Removal With Adjunctive Catheter-Directed Thrombolysis trial is comparing the safety and efficacy, in terms of both deep venous thrombosis and

  5. Successful Salvage of a Renal Allograft after Acute Renal Vein Thrombosis due to May-Thurner Syndrome

    Directory of Open Access Journals (Sweden)

    Omkar U. Vaidya

    2012-01-01

    Full Text Available A 68-year-old Caucasian female with a past medical history of a deceased donor kidney transplant four months prior was admitted with a two-day history of anuria and acute kidney injury. A renal ultrasound demonstrated thrombus in the transplanted kidney's renal vein that extended into the left iliac vein as well as into the left femoral venous system. Catheter-guided tissue thrombolytics were infused directly into the clot. Within twelve hours of initiating thrombolytic infusion, there was brisk urine output. Interval venography demonstrated decreasing clot burden. At the time of discharge her creatinine was 0.78 mg/dL, similar to her baseline value prior to presentation. The patient was noted to have May-Thurner syndrome on intravascular ultrasound (IVUS. Angioplasty followed by stent placement was done. Unique to our case report was the timing of the presentation of renal vein thrombosis (four months after transplant and the predisposing anatomy consistent with May-Thurner syndrome, which was diagnosed with IVUS and successfully treated with local thrombolytics.

  6. Impact of admission creatinine level on clinical outcomes of patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stent implantation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Qi; ZHANG Rui-yan; SHEN Jie; ZHANG Jian-sheng; HU Jian; YANG Zheng-kun; ZHANG Xian; ZHENG Ai-fang; SHEN Wei-feng

    2008-01-01

    Background Prognosis of patients with acute ST-elevation myocardial infarction (STEMI) and renal dysfunction (RD) who received primary percutaneous coronary intervention (PCI) has not been fully investigated in the drug-eluting stent (DES) era.This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI.Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset.Among them,86 patients had a serum creatinine level >115 μmol/L on admission (RD group),and the remaining 533 patients had normal renal function (non-RD group).The primary endpoint was 30-day major adverse cardiac events (MACE,including death,non-fatal reinfarction,and target vessel revascularization),and the secondary endpoint was subacute stent thrombosis.Results Patients in the RD group were older than those in the non-RD group.There are more female patients in the RD group and they had a history of hypertension,myocardial infarction and revascularization.The occurrence rates of Killip class ≥2 (29.1% vs 18.6%,P=0.02) and multi-vessel (62.8% vs 44.5%,P=0.001) and triple vessel disease (32.6% vs 18.2%,P=0.002),in-hospital mortality (9.3% vs 3.8%,P=0.03),and MACE rate during hospitalization (17.4% vs 7.7%,P=0.006) were higher in the RD group than those in the non-RD group.At a 30-day clinical follow-up,the MACE-free survival rate was significantly reduced in the RD group (76.7% vs 89.9%,P=0.0003).Angiographic stent thrombosis occurred in 3 (3.5%) and 7 (1.3%) of patients in the RD group and non-RD group,respectively (P=0.15).Multivariate analysis revealed that the serum creatinine level≥115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up (Hazard ratio (HR) 3.31,95% CI 1.19-9.18,P<0.001).Conclusion Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up,the short-term prognosis of

  7. Acute Iliac and Femoral Arterial Thrombosis Secondary to Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Nikola Fatic

    2014-12-01

    Full Text Available In the presented case report, we evaluated the mechanism of the external iliac, the common femoral and the superficial femoral arterial thrombosis secondary to total hip arthroplasty. A 75-year-old female sufferd from 5.5 cm shorter left lower limb and same sade coxarthritis. Next day after arthroplasty and eqalisation of the lower limbs, an acute ishemia of the treated leg was presented. Multyscan CT angiography revealed the presence of the external iliac, the common femoral and the superficial femoral arterial thrombosis. From the best of our knowledge, it seems to be the only case of this arterial segment thrombosis after total hip arthroplasty and equalistaion of the lower limbs reported.

  8. Portal Vein Thrombosis

    OpenAIRE

    Hakan Demirci

    2016-01-01

    Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low...

  9. Firebird sirolimus eluting stent versus bare mental stent in patients with ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    GAO Hai; YAN Hong-bing; ZHU Xiao-ling; LI Nan; AI Hui; WANG Jian; LI Shi-ying; YANG Duo

    2007-01-01

    Background There are few evidences about the value of drug eluting stent in patients with ST-segment elevation myocardial infarction (STEMI). We prospectively designed a randomized controlled trial to compare the safety and efficacy of Firebird sirolimus eluting stent (Firebird stent) and bare metal stent (BMS).Methods Patients with STEMI enrolled during one year period were randomized to undergo implantation of Firebird stent or BMS, and clinical and angiographic follow-up. The primary endpoint of the present study was in-lesion late lumen loss (LLL) at 6 months, and secondary endpoint includes stent thrombosis and major adverse cardiac events (MACE) at 6 months.Results During one year period, 156 patients were randomized into the Firebird stent group (101 patients with an average age of 57.8 years) or the BMS group (55 patients with 59.7 years on average). Six-month angiographic follow-up was available in 66.3% and 63.7% of patients assigned to Firebird stent and BMS, respectively. At 6-month follow-up,mortality, target vessel revascularization (TVR) and MACE were 2.0%, 6.9% and 9.9% in the Firebird stent group, while 3.6%, 30.9% and 36.4% in the BMS group (P<0.05). Subacute thrombosis occurred in 1 patient in both groups,respectively. The mean LLL was 0.18 mm in the Firebird stent group versus 0.72 mm in the BMS group.Conclusion Implantation of Firebird sirolimus eluting stent for STEMI may greatly reduce TVR and MACE at 6 months with low incidence of acute/subacute stent thrombosis compared with BMS.

  10. Trombose arterial em leucemia promielocítica aguda Arterial thrombosis in acute promyelocytic leukemia

    Directory of Open Access Journals (Sweden)

    Sonia Regina Iantas

    2007-12-01

    Full Text Available Acute promyeloclocytic leukemia can present coagulopathies which are frequently very serious due to hemorrhagic conditions. Treatment using anthracyclines and retinoids provide a good response. The development of arterial thrombosis is uncommon. In this work a 56-year-old male patient with acute arterial insufficiency was evaluated. This patient was immediately submitted to thromboembolectomy with the removal of a white thrombus. Postoperative tests showed acute promyelocytic leukemia with transposition (15;17 Treatment with ATRA and Idarubicin chemotherapy was initiated with the patients's response being satisfactory. Currently, the patient is incomplete remission and a recent cytogenetics test does not show the t(15;17.

  11. Assessment of the safety and performance of the STENTYS self-expanding coronary stent in acute myocardial infarction: Results from the APPOSITION I study

    NARCIS (Netherlands)

    G. Amoroso (Giovanni); R.J.M. van Geuns (Robert Jan); C.M. Spaulding (Christian); S. Manzo-Silberman (Stephane); K. Hauptmann (Karl); R. Spaargaren (René); H.M. Garcia-Garcia (Hector); P.W.J.C. Serruys (Patrick); S. Verheye (Stefan)

    2011-01-01

    textabstractAims: In the setting of ST-elevation myocardial infarction (STEMI), epicardial vasoconstriction and throm- bus load may lead to stent undersizing and malapposition after primary percutaneous coronary intervention (PPCI), which can both be responsible for stent thrombosis or restenosis. A

  12. Post-partum transverse sinus thrombosis presenting as acute psychosis.

    Science.gov (United States)

    Dhasmana, Devesh Janardan; Brockington, Ian F; Roberts, Ann

    2010-08-01

    Whilst cerebral vascular disease and mental illness in the post-partum period are well recognised, their co-existence and the concept of organic psychoses in pregnancy, parturition and the puerperium remains poorly appreciated (Brockington 2006; Brockington Arch Women's Ment Health 10: 177-178, 2007a; Brockington Arch Women's Ment Health 10: 305-306, b). We report a woman who was referred to the Medical team on-call with a mixed presentation of euphoria, mutism and aggressive behaviour but ultimately demonstrated to have a transverse sinus thrombosis and recovered well with anti-coagulation. This serves an important reminder of the implications of a missed medical diagnosis in this high-risk and vulnerable group of patients.

  13. ”Missing clot” during mechanical thrombectomy in acute stroke using Solitaire stent retrieval system

    Directory of Open Access Journals (Sweden)

    Vikram Huded

    2016-01-01

    Full Text Available Stent retrieval system is an established treatment modality in acute ischemic stroke with large vessel occlusion. Here, we describe a complication which occurred during mechanical thrombectomy in three cases where the clot dislodged during retrieval. There was a possibility of the clot getting reinjected into the artery with possible dire consequences.

  14. Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

    Institute of Scientific and Technical Information of China (English)

    Feng-Yong Liu; Mao-Qiang Wang; Qing-Sheng Fan; Feng Duan; Zhi-Jun Wang; Peng Song

    2009-01-01

    AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-subacute portal vein and superior mesenteric vein thrombosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females,aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were accurately diagnosed with Doppler ultrasound scans, computed tomography and magnetic resonance imaging.They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutaneous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization).RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased significantly. Symptoms in these 45 patients were improved dramatically without severe operational complications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment.In 3 patients with interventional treatment, thrombi re-formed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful.CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

  15. Stent grafting of acute hepatic artery bleeding following pancreatic head resection

    Energy Technology Data Exchange (ETDEWEB)

    Stoupis, Christoforos [University of Berne, Inselspital, Department of Diagnostic, Interventional and Pediatric Radiology, Berne (Switzerland); Kreisspital, Radiology, Maennedorf (Switzerland); Ludwig, Karin; Triller, Juergen [University of Berne, Inselspital, Department of Diagnostic, Interventional and Pediatric Radiology, Berne (Switzerland); Inderbitzin, Daniel [University of Berne, Inselspital, Clinic for Visceral and Transplantation Surgery, Berne (Switzerland); Do, Dai-Do [University of Berne, Inselspital, Clinic for Angiology, Berne (Switzerland)

    2007-02-15

    The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed. Because of bleeding from the hepatic artery, a stent graft (with the over-the-wire or monorail technique) was implanted to control the hemmorhage by preserving patency of the artery. The outcome was evaluated. In all cases, the hepatic artery stent grafting was successfully performed, and the bleeding was immediately stopped. Clinically, immediately after the procedure, there was an obvious improvement in the general patient condition. There were no immediate procedure-related complications. Completion angiography (n=5) demonstrated control of the hemorrhage and patency of the hepatic artery and the stent graft. Although all patients recovered hemodynamically, three individuals died 2 to 10 days after the procedure. The remaining two patients survived, without the need for re-operation. Transluminal stent graft placement in the hepatic artery is a safe and technically feasible solution to control life-threatening bleeding of the gastroduodenal artery stump. (orig.)

  16. Prevalence, Pattern of Presentation, Risk Factors and Outcome of Acute Mesenteric Venous Thrombosis in Taif Province,

    Directory of Open Access Journals (Sweden)

    Mohamed Al Saeed*, Mohamed Hatem*Aseel Abu Duruk*Hala A Mohamed**,

    2013-07-01

    Full Text Available Background and aim of the study: Mesenteric venous thrombosis has a global incidence of 10-15% of all cases of mesenteric ischemia; however reports from high altitude provinces of Saudi Arabia as Taif and Aseer recorded an incidence above 60%. The aim of this study is to record the incidence, pattern of presentation, risk factors; diagnostic tools and outcome of treatment in a single center (King Abdul Aziz Specialist Hospital Taif, Saudi Arabia.Material and method: In this retrospective chart review study, we reviewed the records and data of all patients presented to King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January 2009 to January 2013 and their final diagnosis were proved to be acute mesenteric venous thrombosis. Traumatic, postoperative and non occlusive cases were excluded from the study.Results:Sixteen patients with final diagnosis of acute mesenteric venous thrombosis were included in this study, out of 26 patients (61.5% presented and diagnosed as acute occlusive mesenteric ischemia. Males were more affected than females. The mean age of the patients was 55±13.4 years. The mean duration of symptoms was 4.9±1.4 days.The most common presenting symptoms were; abdominal pain followed by nausea, vomiting, anorexia, bloody diarrhea and fever. The most prevalent physical findings was tachycardia followed by ileus, 5 patients presented by marked peritoneal signs 3 of them were shocked. Multiple risk factors were detected in all patients. Laboratory findings were not conclusive and diagnosis was established by CT angiography in most of the patients. During operation, all patients were found to have a segment of infarction of the small intestine and in one of them the cecum was involved. Resection of the gangrenous parts was done for all patients. Second look operation was performed in 25% of patients. The total mortality was 18.75%. Conclusion: Acute mesenteric venous thrombosis is the most common cause of acute occlusive

  17. Size of the thrombus in acute deep vein thrombosis and the significance of patients' age and sex.

    Science.gov (United States)

    Kierkegaard, A

    1981-01-01

    To determine the significance of patients' age and sex on the size of the thrombus in acute deep vein thrombosis, 420 consecutive phlebograms with acute deep vein thrombosis were studied. A significant correlation between the size of the thrombus and increasing age of the patient as well as the sex of male was noted. It is concluded that older patients and men often are at a high risk of pulmonary embolism at the time of diagnosis.

  18. Acute wiiitis representing as thrombosis of the inferior vena cava and left pelvic veins.

    Science.gov (United States)

    Brodmann, M; Gary, T; Hafner, F; Eller, P; Deutschmann, H; Pilger, E; Seinost, G

    2015-08-01

    Deep venous thrombosis as a result of venous wall injury provoked by trauma is a common finding. It often occurs in patients with sportive overstraining, caused by over fatigue of the body structures. In 2007, the entity of "acute wiiitis" was first described in a letter to the New England Journal of Medicine. Acute wiiitis sums up all affections, mainly skeletal and muscle affections, provoked by playing Nintendo Wii, a very common and loved video-game system. Deep venous thrombosis as a consequence of Nintendo Wii has not been described so far. We present a patient with a massive free floating thrombus of the left pelvic veins originating from the gluteal veins and reaching into the inferior vena cava after playing Nintendo Wii.

  19. Acute Brachial Artery Thrombosis in a Neonate Caused by a Peripheral Venous Catheter

    Directory of Open Access Journals (Sweden)

    Simon Berzel

    2014-01-01

    Full Text Available This case describes the diagnostic testing and management of an acute thrombosis of the brachial artery in a female neonate. On day seven of life, clinical signs of acutely decreased peripheral perfusion indicated an occlusion of the brachial artery, which was confirmed by high-resolution Doppler ultrasound. Imaging also showed early stages of collateralization so that surgical treatment options could be avoided. Unfractionated heparin was used initially and then replaced by low-molecular-weight heparin while coagulation parameters were monitored closely. Within several days, brachial artery perfusion was completely restored. Acetylsalicylic acid was given for additional six weeks to minimize the risk of recurring thrombosis. If inadequately fixated in a high-risk location, a peripheral venous catheter can damage adjacent structures and thus ultimately cause arterial complications.

  20. Outcomes after revascularisation with everolimus- and sirolimus-eluting stents in patients with acute coronary syndromes and stable angina pectoris

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Hansen, Henrik S

    2014-01-01

    Aims: The aim of this substudy of the SORT OUT IV trial was to compare clinical outcomes among patients with acute coronary syndromes (ACS) and stable angina pectoris (SAP) treated with everolimus-eluting stents (EES) or sirolimus-eluting stents (SES). Methods and results: We performed a post hoc...

  1. [Results of the surgical treatment of acute thrombosis of the major arteries of the limbs].

    Science.gov (United States)

    Ovchinnikov, V A; Vereshchagin, N A; Shavin, V V; Parakhoniak, N V

    1984-08-01

    An analysis of the surgical treatment of acute arterial trombosis of the extremities in 86 patients is presented. The causes of thrombosis were mainly obliterating atherosclerosis, artery trauma and postembolic occlusion. Best results of reconstructive operations were obtained in patients with postembolic occlusion of the arteries and their posttraumatic trombosis, worst results - in obliterating atherosclerosis. Thrombendarterectomy and autovenous shunts and prostheses were found to be the mos effective reconstructive operations.

  2. [Necrotizing tonsillitis and renal vein thrombosis due to acute myeloid leukaemia].

    Science.gov (United States)

    Akram, Javed; Josefsson, Pernilla; Rømeling, Frans

    2012-09-01

    A 37-year-old woman was admitted to hospital with severe tonsillitis with unilateral necrotizing tonsillitis. She suddenly got fever, malaise, difficulties swallowing, pain in the throat and deterioration despite four days of penicillin treatment. During hospitalisation, she experienced abdominal pain, and blood tests showed pancytopenia. She was transferred to a haematological department, where a bone marrow biopsy showed acute myeloid leukaemia. Subsequently, an abdominal computed tomography with intravenous contrast revealed bilateral renal vein thrombosis, probably because of coagulopathy due to leukaemia.

  3. Chemico-physical characterisation and in vivo biocompatibility assessment of DLC-coated coronary stents.

    Science.gov (United States)

    Castellino, Micaela; Stolojan, Vlad; Virga, Alessandro; Rovere, Massimo; Cabiale, Karine; Galloni, Marco R; Tagliaferro, Alberto

    2013-01-01

    The vast majority of stent thrombosis occurs in the acute and sub-acute phases and is more common in patients with acute coronary syndromes, due to the thrombotic milieu where stent struts are positioned. Stent thrombosis is likely due to incomplete tissue coverage of metallic stents as the contact between metallic stents and blood elements may lead to platelet adhesion and trigger vessel thrombosis. If a stent is covered after 7 days, the risk that it will be found uncovered at later stages is very low (<1%). In this article, we demonstrate that diamond-like carbon (DLC) coatings, deposited by physical vapour deposition, promote rapid endothelisation of coronary stent devices, with very low platelets activation, reducing thrombotic clots. We relate these behaviours to the surface and bulk material properties of the DLC films, subjected to a comprehensive chemico-physical characterisation using several techniques (X-ray photoelectron spectroscopy, atomic force microscopy, field-emission scanning electron microscope, transmission electron microscopy combined with electron energy loss spectroscopy, Raman and dispersive X-ray spectroscopy). In vivo studies, conducted on 24 pigs, have shown complete endothelisation after 7 days, with no fibrin mesh and with only rare monocytes scattered on the endothelial layer while 30 and 180 days tests have shown reduced inflammatory activation and a complete stabilisation of the vessel healing, with a minimal neointimal proliferation. The integral and permanent DLC film coating improves haemo- and bio-compatibility and leads to an excellent early vessel healing of the stent whilst the extremely thin strut thickness reduces the amount of late neointima and consequently the risk of late restenosis. These data should translate into a reduced acute and sub-acute stent thrombosis.

  4. Emergency coronary stenting with the Palmaz-Schatz stent for failed transluminal coronary angioplasty: results of a learning phase.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J; van der Wieken, R; Suwarganda, J

    1993-07-01

    This study describes initial results of Palmaz-Schatz stent implantation in our department to restore and maintain vessel patency in 52 patients with obstructive dissection, defined as an intraluminal filling defect with coronary flow impairment after percutaneous transluminal coronary angioplasty (PTCA). The majority of patients (62%) underwent PTCA for unstable angina (n = 28), defined as angina at rest with documented ST segment changes resistant to nitrates, or acute myocardial infarction (n = 4). In six patients (11%) the stent could not be delivered. Seven of the remaining 46 patients (15%) had coronary artery bypass surgery performed because of increased risk for subacute stent occlusion, residual thrombosis, residual obstruction near the stent, coronary artery diameter less than 3.0 mm, or multiple and overlapping stents. One patient (3%) died in hospital from intracranial bleeding. Nine patients (23%) had subacute stent occlusion, retrospectively unpredictable in four patients. Nine of 29 patients (29%) with an uncomplicated clinical course after stenting had angiographic restenosis at a mean follow-up of 6.0 +/- 1.4 months (range 12 days to 8.3 months). Two patients (7%) died 3 months after successful stenting: one patient because of stent thrombosis after stopping warfarin before an abdominal operation and one patient after acute vascular surgery for late traumatic groin bleeding. Of the 39 medically treated patients with a stent, three (8%) had major bleeding complications. It is concluded that stent implantation is feasible in most patients with obstructive dissection after PTCA. After successful stent delivery, coronary flow is temporarily restored.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Acute arterial thrombosis associated with inadvertent high dose of tranexamic acid

    Directory of Open Access Journals (Sweden)

    Surjya Prasad Upadhyay

    2013-01-01

    Full Text Available Tranexamic acid (TA act as anti-fibrinolytic agent and is widely used to limit bleeding in clinical practice. Tranexemic acid bind with plasminogen and prevent its conversion to plasmin, which limits the fibrinolytic pathway, so there is a theoretical risk of increasing thrombosis with high or prolonged therapy with TA. We encountered a case of acute arterial thrombosis following inadvertent administration of high dose of TA. A 27-years-old male with no other co-morbidity was ordered intravenous 1 gm TA to control excessive bleeding from previous bladder injury, but by mistake, he received 10 gm of TA. The patient developed signs and symptoms of acute ischemia in the right lower limb, which was diagnosed as acute iliac arterial thrombosis by computed tomography (CT angiography. The patient was managed with systemic heparinization, fasciotomy for impending gangrene and other supportive care following which he recovered fully within a few days. Caution should be exercised for all prophylactic use, especially with high dosage or prolonged therapy with TA.

  6. Catheter-Directed Thrombolysis via Small Saphenous Veins for Treating Acute Deep Venous Thrombosis.

    Science.gov (United States)

    Yang, Bin; Xu, Xiao-Dong; Gao, Peng; Yu, Ji-Xiang; Li, Yu; Zhu, Ai-Dong; Meng, Ran-Ran

    2016-08-23

    BACKGROUND There is little data comparing catheter-directed thrombolysis (CDT) via small saphenous veins vs. systematic thrombolysis on complications and efficacy in acute deep venous thrombosis patients. The aim of our study was to compare the efficacy and safety of CDT via the small saphenous veins with systematic thrombolysis for patients with acute deep venous thrombosis (DVT). MATERIAL AND METHODS Sixty-six patients with acute DVT admitted from June 2012 to December 2013 were divided into 2 groups: 27 patients received systemic thrombolysis (ST group) and 39 patients received CDT via the small saphenous veins (CDT group). The thrombolysis efficiency, limb circumference differences, and complications such as post-thrombotic syndrome (PTS) in the 2 groups were recorded. RESULTS The angiograms demonstrated that all or part of the fresh thrombus was dissolved. There was a significant difference regarding thrombolysis efficiency between the CDT group and ST group (71.26% vs. 48.26%, P=0.001). In both groups the postoperative limb circumference changes were higher compared to the preoperative values. The differences between postoperative limb circumferences on postoperative days 7 and 14 were significantly higher in the CDT group than in the ST group (all Pdeep venous thrombosis.

  7. Catheter-directed thrombolysis in the treatment of acute deep venous thrombosis: a meta-analysis.

    Science.gov (United States)

    Zheng, J J; Zhang, Z H; Shan, Z; Wang, W J; Li, X X; Wang, S M; Li, Y-X; Cheng, G-S

    2014-07-24

    We performed a meta-analysis for systematic evaluation of the status quo of catheter thrombolysis for the treatment of acute lower limb deep vein thrombosis in China. We searched the China Biomedical bibliographic database (CBM), China National Knowledge Infrastructure (CNKI), Weipu full-text electronic journals, Wanfang full-text database, and Medline (1990 through June 2011) for clinical randomized controlled trials of catheter-directed thrombolysis and superficial venous thrombolysis to compare their efficacies for the treatment of acute deep vein thrombosis. The results were analyzed by using the Cochrane-recommended RevMan 4.2 software package, and the odds ratio (OR) was used as the combined measure of efficacy. The search retrieved 8 randomized controlled trials, and meta-analysis using the total rate of effective treatment as the clinical observation index found that the combined OR for the catheter thrombolysis group versus the superficial venous thrombolysis group was significant (P venous thrombolysis for the treatment of acute deep vein thrombosis in the lower limb in Chinese individuals. However, the included trials were only of medium quality, so more rational and scientific clinical trials are needed to validate this conclusion.

  8. Stenting plus coiling: dangerous or helpful?; Stenting plus Coiling bei akut rupturierten intrakraniellen Aneurysmen

    Energy Technology Data Exchange (ETDEWEB)

    Wanke, I.; Gizewski, E.; Doerfler, A.; Stolke, D.; Forsting, M. [Essen Univ. (Germany). Inst. fuer Radiologie und Neuroradiologie

    2005-09-01

    Purpose: the purpose of this study was to evaluate the procedural risk of treating acute ruptured aneurysms with a stentcoil combination. Material and methods: between August 2001 and January 2004 we treated nine acute subarachnoid hemorrhage (SAH) patients with a combination of stents and platinum coils. Results: six aneurysms were 100% eliminated; the residual three aneurysms had a 95% to 99% occlusion. A transient thrombosis in the stent in one patient could be recanalized by intravenous application of ReoPro {sup registered}. In another patient an occlusive vasospasm at the distal end of the stent was successfully treated with intraarterial Nimotop {sup registered}. Neurological complications occurred in none of the patients. Conclusion: in broad-based aneurysms which cannot be clipped or in which any neurosurgical treatment presents an unacceptably high risk (posterior circulation and paraophthalmic aneurysms), treatment using a combination of stent and platinum coils might be an option even in the acute phase of an SAH. Platelet aggregation can be treated with Aspirin registered and Plavix {sup registered} after placement of the first coil, vasospasms with intraarterial Nimotop {sup registered}, and acute stent thrombosis with GP IIa/IIIb-antagonists. (orig.)

  9. Gradenigo’s syndrome and thrombosis of the cavernous sinus secundary to acute otitis media

    Directory of Open Access Journals (Sweden)

    Hellín-Meseguer D

    2012-05-01

    Full Text Available Gradenigo’s syndrome is characterized by facial pain in the area supplied by the trigeminal nerve and a unilateral external ophthalmoplegia (paralysis of VI cranial nerve secondary to acute apical petrositis for evolutionary complication of otitis media. This is a serious complication that requires immediate treatment to prevent permanent damage and may be associated with other intracranial complications such as thrombosis of the cavernous sinus. We report a 4 year old male who complains of fever, headache and external ocular paralysis in the course of acute otitis media.

  10. Transcatheter pharmacomechanical approach for acute renal vein thrombosis: a rational technique.

    Science.gov (United States)

    Srinivas, Budunur C; Singh, Bhupinder; Srinivasa, Sanjay; Reddy, Shashikumar S; Mahadevappa, Nagesh C; Reddy, Babu

    2014-07-01

    Acute renal vein thrombosis (RVT) causes rapid deterioration of renal function if it is not treated aggressively. Conventional anticoagulation therapy is the standard mode of treatment; however, the need for rapid and complete resolution has led to the development of newer modes of treatment such as percutaneous catheter-directed techniques. We describe a case of acute RVT with deteriorating renal functions that highlights the rational of percutaneous catheter-directed combined pharmacomechanical thrombolysis-thrombectomy approach to successfully restore the renal vein patency with improvement of the renal function.

  11. The risk factors for thrombosis in children with acute lymphoblastic leukemia.

    Science.gov (United States)

    Sivaslioglu, Selda; Gursel, Turkiz; Kocak, Ulker; Kaya, Zuhre

    2014-09-01

    We aimed to scrutinize the risk factors for thrombosis in children with acute lymphoblastic leukemia treated with the Berlin-Frankfurt-Münster 95 protocol. The study population was 82 children younger than 16 years of age. The children were followed up for 10 years until January 2007. Thrombosis occurred in 10 (12%) of 82 patients during the treatment course, mainly after the M protocol. The most common risk factor was factor V Leiden (FVL; 15.6%). This was followed by methyleneterahydrofolate reductase (MTHFR; 9.3%), elevated lipoprotein (1.5%), and prothrombin (PT) 20210A (1.5%) in descending order. The risk of thrombosis was found to be significantly high in patients with FVL mutation (odds ratio = 7.1, 95% confidence interval = 1.6-30.5). The risk of thrombosis was not significant in patients with MTHFR and PT20210A mutation (P = .2). Age, catheter usage, FVL mutation, and prednisolone treatment are significant risk factors for thromboemboli occurrence.

  12. [Surgical treatment of acute thrombosis of the leg and pelvic veins].

    Science.gov (United States)

    Denck, H

    1976-01-01

    Indications for thrombectomy in acute thrombosis of the deep veins of the pelvis and lower extremities are: 1. Phlegmasia coerulea dolens with imminent danger of venous gangrene. 2. All cases: a) with contraindications for a therapy with fibrinolysis, b) after therapy-failures with thrombolytic therapy, c) thrombosis of more than 3 days duration. 3. In cases associated with tumours or trauma. If a thrombectomy can only be partially achieved, or in cases with an old thrombosis, a temporary arteriovenous fistula is performed. In cases with phlegmasia alba and the inexistence of danger for an extremity treatment with fibrinolysis, this is preferable in the first three days after onset, if general conditions permit this treatment. Results of venous thrombectomies are particularly astonishingly good in phlegmasia coerulea and it is therefore mandatory to transfer all fresh cases of thrombosis of the deep veins of the peelvis and lower extremities to an angiologic center in order to differentiate cases for fibrinolytic therapy, from those which require surgical intervention.

  13. Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Hakan Demirci

    2016-01-01

    Full Text Available Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low molecular weight heparin achieves recanalization in more than half of acute cases.

  14. Endovascular stent graft treatment of acute thoracic aortic transections due to blunt force trauma.

    LENUS (Irish Health Repository)

    Bjurlin, Marc A

    2012-02-01

    Endovascular stent graft treatment of acute thoracic aortic transections is an encouraging minimally invasive alternative to open surgical repair. Between 2006 and 2008, 16 patients with acute thoracic aortic transections underwent evaluation at our institution. Seven patients who were treated with an endovascular stent graft were reviewed. The mean Glasgow Coma Score was 13.0, probability of survival was .89, and median injury severity score was 32. The mean number of intensive care unit days was 7.7, mean number of ventilator support days was 5.4, and hospital length of stay was 10 days. Mean blood loss was 285 mL, and operative time was 143 minutes. Overall mortality was 14%. Procedure complications were a bleeding arteriotomy site and an endoleak. Endovascular treatment of traumatic thoracic aortic transections appears to demonstrate superior results with respect to mortality, blood loss, operative time, paraplegia, and procedure-related complications when compared with open surgical repair literature.

  15. Efficacy of recombinant tissue-type plasminogen activator thrombolysis and primary coronary stenting after acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    陈步星; 王伟民; 赵红; 胡大一; 徐成斌; 赵明中; 卢明瑜; 刘健; 吴淳

    2003-01-01

    Objective To compare the efficacy of low dose recombinant tissue-type plasminogen activator (rt-PA) thrombolysis with primary coronary stenting after acute myocardial infarction.Methods Of 261 patients with first acute myocardial infarction, 131 were given low dose rt-PA intravenous thrombolysis, and 130 primary coronary stenting.Results The age, time from onset of chest pain to hospital presentation and infarct location between these two groups were comparable. The patency rate of the infarct-related artery (IRA) in patients in the thrombolysis group was significantly lower than that of patients in the primary stenting group (P0.05).Conclusion Comparing with low dose rt-PA thrombolytic therapy after acute myocardial infarction, primary coronary stenting has a higher patency rate of the IRA, better cardiac function and shorter hospitalization time.

  16. Outcomes after primary coronary intervention with drug eluting stent implantation in diabetic patients with acute ST elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    ZHANG Qi; HU Jian; YANG Zhen-kun; ZHENG Ai-fang; ZHANG Xian; SHEN Wei-feng; SHEN Jie; ZHANG Rui-yan; QIU Jian-ping; LU Ji-de; ZHANG Yu; CHEN Yue-hua; ZHANG Jun-feng; ZHANG Jian-sheng

    2007-01-01

    .03). The cumulative one-year MACE-free survival rate was significantly lower in diabetic than in non-diabetic group (78.6% vs 90.0%, P=0.02).Angiographic stent thrombosis occurred in 5.4% and 1.2% of the patients in diabetic and non-diabetic group, respectively (P=0.19). All of these patients experienced non-fatal myocardial infarction.Conclusions Although the early clinical outcomes were similar in diabetic and non-diabetic patients with acute STEMI treated with DES implantation, the cumulative MACE-free survival at one-year follow-up was worse in diabetic than in non-diabetic patients. More effective diabetes-related managements may further improve the clinical outcomes of diabetic cohort suffering STEMI.

  17. A vascular laboratory protocol for improving and managing after-hours suspected acute deep venous thrombosis.

    Science.gov (United States)

    Martin, Angela H; Eckert, George; Lemmon, Gary W; Sawchuk, Alan; Dalsing, Michael C

    2014-04-01

    This study reviews the clinical and workforce impact of a suggested protocol designed for the management of suspected acute deep venous thrombosis (DVT) in patients seen after standard vascular laboratory business hours. The protocol included the use of Wells score, D-dimer and a single dose of therapeutic anticoagulant to defer venous duplex ultrasound (VDU) testing until routine business hours unless contraindicated. Information was collected on medical history, physical exam and the timing of any diagnostic studies and treatment provided. Over 15% of studies done after-hours were deemed unnecessary by our protocol and in every individual the results were negative for an acute DVT. There were no adverse events from a one-time dose of anticoagulant. Limiting emergency VDU coverage to evaluate for acute DVT based on a management protocol can eliminate unnecessary after-hours VDU testing without having a negative impact on patient care.

  18. Thrombectomy assisted by carotid stenting in acute ischemic stroke management

    DEFF Research Database (Denmark)

    Steglich-Arnholm, Henrik; Holtmannspötter, Markus; Kondziella, Daniel;

    2015-01-01

    -term outcome (mRS ≤ 2). Harms included complications during and following EVT. Mean age was 64.3 years (standard deviation ±12.5), 40 (85%) patients received IVT initially. Median NIHSS was 16 (inter-quartile range 14-19). Mean time from stroke onset to recanalization was 311 min (standard deviation ±78......Extracranial carotid artery occlusion or high-grade stenosis with concomitant intracranial embolism causes severe ischemic stroke and shows poor response rates to intravenous thrombolysis (IVT). Endovascular therapy (EVT) utilizing thrombectomy assisted by carotid stenting was long considered risky......-center analysis of 47 consecutive stroke patients with carotid occlusion or high-grade stenosis and concomitant intracranial embolus treated between September 2011 and December 2014. Benefits included early improvement of stroke severity (NIHSS ≥ 10) or complete remission within 72 h and favorable long...

  19. Nanomaterial coatings applied on stent surfaces.

    Science.gov (United States)

    Bagheri, Mahsa; Mohammadi, Marzieh; Steele, Terry Wj; Ramezani, Mohammad

    2016-05-01

    The advent of percutaneous coronary intervention and intravascular stents has revolutionized the field of interventional cardiology. Nonetheless, in-stent restenosis, inflammation and late-stent thrombosis are the major obstacles with currently available stents. In order to enhance the hemocompatibility of stents, advances in the field of nanotechnology allow novel designs of nanoparticles and biomaterials toward localized drug/gene carriers or stent scaffolds. The current review focuses on promising polymers used in the fabrication of newer generations of stents with a short synopsis on atherosclerosis and current commercialized stents, nanotechnology's impact on stent development and recent advancements in stent biomaterials is discussed in context.

  20. [Lower limb vein thrombosis in dynamics of acute impairments of cerebral circulation].

    Science.gov (United States)

    Kuntsevich, G I; Maksimova, M Iu; Popova, L A; Riabinkina, Iu V; Gnedovskaia, E V; Piradov, M A

    2012-01-01

    The present work was aimed at studying the state of the inferior vena cava system according to the findings of duplex scanning in dynamics of acute cerebral circulation impairments (ACCI). Amongst 100 patients with ACCI, lower limb vein deep thrombosis (LLVDT) was revealed in 57% of cases. The incidence of LLVDT in patients with intracerebral haemorrhage was higher than in those with ischaemic stroke, however there were no statistically significant differences between the type of ACCI (p=0.06) and subtypes of ischaemic stroke (atherothrombotic, ceardioembolic) (p = 0.68). The main risk factors for LLVDT are the presence of pronounced motion deficit in the extremities, induced by the underlying disease (p=0.02) and immobilization. In the overwhelming majority of patients (81%) thrombosis localized isolatedly in the crural veins. Ascending thrombosis and the development of a floating thrombus were represented mainly on the side of motility deficit in the extremities. We have confirmed a strong association between positive dynamics in the neurological status of patients and frequency of recanalization of thrombi (p=0.043). Ultrasonographic examination of lower limb veins in dynamics of ACCI is an important component of preventive and therapeutic process.

  1. Lateral sinus thrombosis in setting of Acute otitis media: An atypical presentation

    Directory of Open Access Journals (Sweden)

    Rajeev Kumar

    2013-01-01

    Full Text Available Lateral sinus thrombosis (LST is a rare complication of Acute Otitis Media and associated mastoiditis. Although, in the era of antibiotics, the presentation may be variable and diagnosis is difficult. High index of suspicion is required to diagnose the atypical presentation. We report an atypical presentation of LST wherein a 12-year-old female presented with sudden onset severe occipital headache following ear syringing. Contrast enhanced computed tomography of temporal bone revealed LST without coalescent mastoiditis. Patient was managed conservatively with intravenous antibiotics and low-dose heparin. The management protocols in such cases are discussed and relevant literature reviewed.

  2. [Major intestinal resections and short-bowel syndrome in patients with the acute mesenterial thrombosis].

    Science.gov (United States)

    Khripun, A I; Shurygin, S N; Priamikov, A D; Mironkov, A B; Urvantseva, O M; Movsesiants, M Iu; Izvekov, A A; Abashin, M V

    2012-01-01

    The study represents the retrospective analysis of major intestinal resections (the length of the left in olace bowel less then 200 sm) and non-major resections in 52 patients operated on the acute mesenterial thrombosis. Major bowel resection was performed in 30 patients (57.7%). 66.7% of those patients (20 of 30) died soon after the operation. Whereas lethality rate among patients with non-major resections was 54.5% (12 of 22). All 10 survived patients demonstrated the short-bowel syndrome during the follow-up period (the median follow-up time was 25 months).

  3. The History of Primary Angioplasty and Stenting for Acute Myocardial Infarction.

    Science.gov (United States)

    Smilowitz, Nathaniel R; Feit, Frederick

    2016-01-01

    The evolution of the management of acute myocardial infarction (MI) has been one of the crowning achievements of modern medicine. At the turn of the twentieth century, MI was an often-fatal condition. Prolonged bed rest served as the principal treatment modality. Over the past century, insights into the pathophysiology of MI revolutionized approaches to management, with the sequential use of surgical coronary artery revascularization, thrombolytic therapy, and percutaneous coronary intervention (PCI) with primary coronary angioplasty, and placement of intracoronary stents. The benefits of prompt revascularization inspired systems of care to provide rapid access to PCI. This review provides a historical context for our current approach to primary PCI for acute MI.

  4. Acute partial Budd-Chiari syndrome and portal vein thrombosis in cytomegalovirus primary infection: a case report

    Directory of Open Access Journals (Sweden)

    Morard Isabelle

    2006-03-01

    Full Text Available Abstract Background Splanchnic vein thrombosis may complicate inherited thrombotic disorders. Acute cytomegalovirus infection is a rare cause of acquired venous thrombosis in the portal or mesenteric territory, but has never been described extending into a main hepatic vein. Case presentation A 36-year-old immunocompetent woman presented with acute primary cytomegalovirus infection in association with extensive thrombosis in the portal and splenic vein. In addition, a fresh thrombus was evident in the right hepatic vein. A thorough evaluation for a hypercoagulable state was negative. The clinical course, biological evolution, radiological and histological findings were consistent with cytomegalovirus hepatitis complicated by a partial acute Budd-Chiari syndrome and portal thrombosis. Therapeutic anticoagulation was associated with a slow clinical improvement and partial vascular recanalization. Conclusion We described in details a new association between cytomegalovirus infection and acute venous thrombosis both in the portal vein and in the right hepatic vein, realizing a partial Budd-Chiari syndrome. One should be aware that this rare thrombotic event may be complicated by partial venous outflow block.

  5. Acute iliofemoral venous thrombosis in patients with atresia of the inferior vena cava can be treated successfully with catheter-directed thrombolysis

    DEFF Research Database (Denmark)

    Broholm, Rikke; Jørgensen, Maja; Just, Sven;

    2011-01-01

    To assess the effectiveness and clinical outcomes of catheter-directed thrombolysis in patients with atresia of the inferior vena cava (IVC) and acute iliofemoral deep vein thrombosis (DVT).......To assess the effectiveness and clinical outcomes of catheter-directed thrombolysis in patients with atresia of the inferior vena cava (IVC) and acute iliofemoral deep vein thrombosis (DVT)....

  6. Analysis of clinical characteristics of 96 patients with acute superior mesenteric venous thrombosis

    Directory of Open Access Journals (Sweden)

    Wen-hui LIU

    2015-06-01

    Full Text Available Objective To investigate the clinical characteristics of patients suffering from acute superior mesenteric venous thrombosis (ASMVT. Methods Clinical data of 96 ASMVT patients admitted to the PLA General Hospital from January 2000 to December 2013 were retrospectively analyzed. Clinical characteristics and death-associated risk factors were studied, and the influence of treatment strategy and thrombosis location on patients' outcome were analyzed. Results The patients were divided into survival group (n=83 and death group (n=13 according to the outcome. The mean age was 46.9 years old, and the ratio of male/female was 3:1. Thirty-nine patients presented isolated superior mesenteric venous thrombosis (SMVT and fiftyseven patients presented combined SMVT. In the death group, higher incidence of severe acute pancreatitis and isolated SMVT were found than the survival group (P<0.01, P=0.004. The patients were again divided into laparotomy group, interventional thrombolysis group, and conservative treatment group according to treatment modality. The interval between symptom onset and treatment was shorter, the incidence of isolated SMVT and mortality rate were higher in the laparotomy group compared with those in interventional thrombolysis group and conservative treatment group. There was no death in the conservative treatment group. In comparison with the combined SMVT group, more patients in the isolated SMVT group presented peritoneal signs and less with history of splenectomy (P<0.001, P=0.002. The proportion of patients with laparotomy and bowel necrosis in the isolated SMVT group was higher than those in the combined SMVT group (P=0.023, P=0.012. Conclusions Patients with isolated SMVT are more likely to have peritoneal signs and bowel necrosis, surgical treatment is mandatory. Patients with combined SMVT often have a history of splenectomy. ASMVT patients with severe pancreatitis may present higher mortality rate. DOI: 10.11855/j

  7. Role of Self-Expandable Metal Stents in Acute Variceal Bleeding

    Directory of Open Access Journals (Sweden)

    Fuad Maufa

    2012-01-01

    Full Text Available Acute variceal bleeding continues to be associated with significant mortality. Current standard of care combines hemodynamic stabilization, antibiotic prophylaxis, pharmacological agents, and endoscopic treatment. Rescue therapies using balloon tamponade or transjugular intrahepatic portosystemic shunt are implemented when first-line therapy fails. Rescue therapies have many limitations and are contraindicated in some cases. Placement of fully covered self-expandable metallic stent is a promising therapeutic technique that can be used to control bleeding in cases of refractory esophageal bleeding as an alternative to balloon tamponade. These stents can be left in place for as long as two weeks, allowing for improvement in liver function and institution of a more definitive treatment.

  8. Acute posttraumatic pediatric cerebral venous thrombosis: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Al-Wala Awad

    2014-01-01

    Full Text Available Background : Pediatric cerebral venous thrombosis (CVT is a common sequelae of infection, coagulopathies, and dehydration in the pediatric population. Acute posttraumatic CVT is an uncommon etiology of pediatric CVT that presents a unique management challenge. There are no established guidelines outlining the treatment of this small subset of patients. Case Description: We present a case of a 12-year-old boy with posttraumatic CVT who was safely treated with anticoagulation therapy, and had resolution of his symptoms and radiographic improvement within 3 days of therapy. The relevant literature is reviewed. Conclusion : Anticoagulation therapy may be safely used in the treatment of acute posttraumatic CVT in pediatric patients, and may reduce the incidence of clot propagation, hospitalization time, and cost of treatment.

  9. Graduated compression stockings in the prevention of deep vein thrombosis in patients with acute myocardial infarction.

    Science.gov (United States)

    Kierkegaard, A; Norgren, L

    1993-10-01

    Venous volume (venous capacity) of the calf is low in patients with acute myocardial infarction, who also have a high risk of deep vein thrombosis (DVT). The effect of graduated compression stockings on the venous volume and on the incidence of DVT was therefore studied in 80 patients aged 70 years and above with acute myocardial infarction. Graduated compression stockings were randomly fitted to one leg, the other serving as a control, after which the venous volume was measured by strain gauge plethysmography. The incidence of DVT was measured by the 125I fibrinogen uptake test. Venous volume was significantly higher in legs treated with graduated compression stockings compared to control legs. DVT developed in eight control legs but not in any leg treated with graduated compression stockings (P = 0.003). DVT was also significantly more frequent in women compared to men and the majority of DVT developed in legs with very low venous volume values.

  10. Colonic stenting as bridge to surgery versus emergency surgery for management of acute left-sided malignant colonic obstruction: a multicenter randomized trial (Stent-in 2 study

    Directory of Open Access Journals (Sweden)

    Scholten Pieter

    2007-07-01

    Full Text Available Abstract Background Acute left-sided colonic obstruction is most often caused by malignancy and the surgical treatment is associated with a high mortality and morbidity rate. Moreover, these operated patients end up with a temporary or permanent stoma. Initial insertion of an enteral stent to decompress the obstructed colon, allowing for surgery to be performed electively, is gaining popularity. In uncontrolled studies stent placement before elective surgery has been suggested to decrease mortality, morbidity and number of colostomies. However stent perforation can lead to peritoneal tumor spill, changing a potentially curable disease in an incurable one. Therefore it is of paramount importance to compare the outcomes of colonic stenting followed by elective surgery with emergency surgery for the management of acute left-sided malignant colonic obstruction in a randomized multicenter fashion. Methods/design Patients with acute left-sided malignant colonic obstruction eligible for this study will be randomized to either emergency surgery (current standard treatment or colonic stenting as bridge to elective surgery. Outcome measurements are effectiveness and costs of both strategies. Effectiveness will be evaluated in terms of quality of life, morbidity and mortality. Quality of life will be measured with standardized questionnaires (EORTC QLQ-C30, EORTC QLQ-CR38, EQ-5D and EQ-VAS. Morbidity is defined as every event leading to hospital admission or prolonging hospital stay. Mortality will be analyzed as total mortality as well as procedure-related mortality. The total costs of treatment will be evaluated by counting volumes and calculating unit prices. Including 120 patients on a 1:1 basis will have 80% power to detect an effect size of 0.5 on the EORTC QLQ-C30 global health scale, using a two group t-test with a 0.05 two-sided significance level. Differences in quality of life and morbidity will be analyzed using mixed-models repeated measures

  11. The Impact of the Acute Results on the Long - Term Outcome after the Treatment of In- stent Restenosis: A Serial Intravascular Ultrasound Study

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Stenting reduces acute complications and restenosis compared to balloon angioplasty and other devices. However, in- stent restenosis (ISR) is an important clinical problem. The current serial intravascular ultrasound (IVUS)analysis was undertaken to determine whether the acute results obtained during the treatment of ISR influence the long term results and whether this is true for patients treated with and without adjunct brachytherapy.

  12. Massive Thrombosis of the Right Atrium Extended to the Superior Vena Cava at the Diagnosis of Acute Myeloid Leukemia

    Directory of Open Access Journals (Sweden)

    Bienvenu Houssou

    2016-01-01

    Full Text Available Introduction. Venous thromboembolic disease is a common complication found in 8% of patients with acute myeloid leukemia. The location at the right atrium is exceptional. These last fifty years, only 6 cases of thrombosis of the atrium in the diagnosis of acute myeloid leukemia were published on PubMed search engine. Case Presentation. 35-year-old farmer, who had been admitted by emergency department for superior vena cava syndrome and had a hyperleukocytic AML with complex karyotype associated with a significant thrombosis of the right atrium, extended all along the superior vena cava. He has been treated by the 2011 AML protocol using low molecular weight heparin and died from respiratory distress. Conclusions. If thrombosis is common in AML, the location in right atrium is rare. Its management requires surgery that is sometimes difficult to achieve.

  13. Point-of-care platelet function assays demonstrate reduced responsiveness to clopidogrel, but not aspirin, in patients with Drug-Eluting Stent Thrombosis whilst on dual antiplatelet therapy

    Directory of Open Access Journals (Sweden)

    Dawkins Keith D

    2008-02-01

    Full Text Available Abstract Background To test the hypothesis that point-of-care assays of platelet reactivity would demonstrate reduced response to antiplatelet therapy in patients who experienced Drug Eluting Stent (DES ST whilst on dual antiplatelet therapy compared to matched DES controls. Whilst the aetiology of stent thrombosis (ST is multifactorial there is increasing evidence from laboratory-based assays that hyporesponsiveness to antiplatelet therapy is a factor in some cases. Methods From 3004 PCI patients, seven survivors of DES ST whilst on dual antiplatelet therapy were identified and each matched with two patients without ST. Analysis was performed using (a short Thrombelastogram PlateletMapping™ (TEG and (b VerifyNow Aspirin and P2Y12 assays. TEG analysis was performed using the Area Under the Curve at 15 minutes (AUC15 as previously described. Results There were no differences in responses to aspirin. There was significantly greater platelet reactivity on clopidogrel in the ST group using the Accumetrics P2Y12 assay (183 ± 51 vs. 108 ± 31, p = 0.02 and a trend towards greater reactivity using TEG AUC15 (910 ± 328 vs. 618 ± 129, p = 0.07. 57% of the ST group by TEG and 43% of the ST cases by Accumetrics PRU had results > two standard deviations above the expected mean in the control group. Conclusion This study demonstrates reduced platelet response to clopidogrel in some patients with DES ST compared to matched controls. The availability of point-of-care assays that can detect these responses raises the possibility of prospectively identifying DES patients at risk of ST and manipulating their subsequent risk.

  14. Acute and long-term outcome after Palmaz-Schatz stenting: analysis from the New Approaches to Coronary Intervention (NACI) registry.

    Science.gov (United States)

    Carrozza, J P; Schatz, R A; George, C J; Leon, M B; King, S B; Hirshfeld, J W; Curry, R C; Ivanhoe, R J; Buchbinder, M; Cleman, M W; Goldberg, S; Ricci, D; Popma, J J; Safian, R D; Baim, D S

    1997-11-20

    The randomized Stent Restenosis Study (STRESS) and Belgium Netherlands Stent (Benestent) trials established that elective use of Palmaz-Schatz stents (PSSs) in native coronary arteries with de novo lesions is associated with increased procedural success and reduced restenosis. However there are other clinical indications for which stents are commonly used (unplanned use, vein grafts, restenosis lesions) that are not addressed in these studies. From 1990-1992, 688 lesions in 628 patients were treated with PSSs in the New Approaches to Coronary Intervention (NACI) registry. Angiographic core laboratory readings were available for 543 patients (595 lesions, of which 106 were stented for unplanned indications, 239 were in saphenous vein bypass grafts, and 296 were previously treated). The cohort of patients in whom stents were placed for unplanned indications had more women, current smokers, and had a higher incidence of recent myocardial infarction (MI). Patients who underwent stenting of saphenous vein grafts were older, had a higher incidence of diabetes mellitus, unstable angina, prior MI, and congestive heart failure. Lesion success was similar in all cohorts (98%), but procedural success was significantly higher for planned stenting (96% vs 87%; p < 0.01). Predictors of adverse events in-hospital were presence of a significant left main stenosis and stenting for unplanned indication. The incidence of target lesion revascularization by 30 days was significantly higher for patients undergoing unplanned stenting due to a higher risk for stent thrombosis. Recent MI, stenting in native lesion, and small postprocedural minimum lumen diameter independently predicted target lesion revascularization at 30 days. Independent predictors of death, Q-wave myocardial infarction, or target lesion revascularization at 1 year included severe concomitant disease, high risk for surgery, left main disease, stenting in the left main coronary artery, and low postprocedure minimum lumen

  15. Acute stenting and thromboaspiration in basilar artery occlusions due to embolism from the dominating vertebral artery

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    Nedeltchev, K.; Remonda, L.; Brekenfeld, C.; Ozdoba, C.; Schroth, G. [Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Freiburgstrasse 4, 3010, Bern (Switzerland); Do, D.D. [Institute of Angiology, University of Bern, Inselspital, Bern (Switzerland); Arnold, M.; Mattle, H.P. [Department of Neurology, University of Bern, Inselspital, Bern (Switzerland)

    2004-08-01

    Intra-arterial thrombolysis (IAT) is the only treatment that has demonstrated benefit in patients with acute basilar artery occlusions (ABAO). IAT may be difficult to perform when access to the occluded basilar artery (BA) is prevented by pathology of the vertebral arteries (VA). We report on two patients with ABAO due to embolism from the dominating VA. Catheter navigation through the occluded VA and thromboaspiration enabled access to the BA. Thromboaspiration alone or in addition to IAT resulted in a complete recanalization of the BA and a favorable clinical outcome. A stent was deployed at the site of the stenosis in the VA either prior to or immediately after BA recanalization. (orig.)

  16. [Effectiveness of locoregional rt-PA lysis in acute leg and arm vein thrombosis].

    Science.gov (United States)

    Perkmann, R; Neuhauser, B; Bodner, G; Tauscher, T; Fraedrich, G

    2001-06-01

    39 patients suffering from a thrombosis of the peripheral venous system were treated with a loco-regional lysis, using rt-PA. Two cycles of 40 mg rt-PA a day were applicated by means of a special drainage-management, using perforans veins. During lytic therapy, 20,000 to 30,000 IE of unfractionized heparin were additionally administered. Laboratory work including aPTT and fibrinogen measurement was performed every 8 hours. Additionally a phlebography was performed after 24 hours. Patients received an anticoagulative therapy using sintrom or marcumar the following 3 months. We obtained a successful thrombolysis without any major complications in 90%. Minor complications included 3 peripheral pulmonary embolisms. Duplex sonographic and plethysmographic follow up was performed in 25 patients one year after operation. In two patients with ankle edema insufficient valves at the popliteal vein were found with both diagnostic modalities. 23 patients showed no signs of insufficient valves neither clinically nor at duplex sonography and plethysmography. The locoregional lysis appears to be an effective method for the treatment of acute peripheral vein thrombosis.

  17. Acute venous thrombosis as complication and clue to diagnose a SAPHO syndrome case. A case report.

    Science.gov (United States)

    Rosero, A; Ruano, R; Martin, M; Hidalgo, C; Garcia-Talavera, J

    2013-01-01

    This report concerns a male adult admitted for sternal and left arm pain, who was diagnosed and treated for acute deep venous thrombosis in the left subclavian and axillary veins. X-ray and a hybrid single photon emission tomography and computed tomography (SPECT-CT) scintigraphy scan revealed high intensity uptake in both sternoclavicular joints, which corresponded to hyperostosis, thereby suggesting a SAPHO syndrome. Upon reviewing the patient's medical history, we found dermatological pustulosis disease and an intermittent sternal chest pain untreated since 10 years ago. In the biochemical study we found erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) elevation, hyperglobulinemia, and mild anaemia. Initial treatment included nonsteroidal anti-inflammatory drugs (NSAIDs) with low response, which then changed to methotrexate, sulfasalazine, and prednisone. The patient's pain was controlled almost completely in 10 months. A control bone scan revealed a marked decrease in intensity of bone deposits according to clinical response. To our knowledge, there are only a few cases of SAPHO and thrombosis and none are followed up with a bone SPECT-CT scan.

  18. Acute kidney injury as the first sign of spontaneous renal vein thrombosis: report of 2 cases.

    Science.gov (United States)

    Shumei, Shi; Ling, Xu; Yanxia, Wang; Lei, Zhang; Yuanyuan, Sun

    2012-01-01

    Spontaneous renal vein thrombosis (RVT) is very rare in the absence of nephrotic syndrome. It is more common in newborns and infants. RVT should always be included in the differential diagnosis of flank pain and hematuria, and because RVT can induce acute renal injury. A 19-year-old man was admitted to our hospital because he complained of right flank pain and oliguria for 3 days. Another patient, a 24-year-old man, complained of a severe and sudden onset of bilateral flank pain and anuria for a day. They were both healthy before they developed the described symptoms and had different levels of decrease in renal function when they visited the hospital. Color Doppler ultrasonography revealed RVT in both the patients. The patients received therapy, including anticoagulation and thrombolysis, following their diagnoses, and they recovered in a few days.

  19. Association of deep venous thrombosis with calf vein diameter in acute hemorrhagic stroke.

    Science.gov (United States)

    Ogata, Toshiyasu; Yasaka, Masahiro; Wakugawa, Yoshiyuki; Kitazono, Takanari; Okada, Yasushi

    2013-10-01

    We investigated the association between the development of deep venous thrombosis (DVT) and calf vein diameter in patients with acute hemorrhagic stroke. We measured the maximum diameter of paralytic side posttibial veins (PTVs) and peroneal veins (PVs) in 49 patients with intracerebral hemorrhage on admission and at 2 weeks after stroke onset by ultrasonography. We also examined for the presence or absence of DVT, and then analyzed the association of DVT with the maximum vein diameter. At 2 weeks after stroke, DVTs were detected in PTVs in 7 patients and in PVs in 6 patients. The maximum calf vein diameters at 2 weeks were significantly greater in patients with DVT compared with those without DVT (PTV, P = .033; PV, P = .015). Although calf vein diameter at admission did not influence the future incidence of DVT in patients with intracerebral hemorrhage, the presence of DVT was associated with calf vein dilatation.

  20. Resolution of Acute Inflammation and the Role of Resolvins in Immunity, Thrombosis, and Vascular Biology.

    Science.gov (United States)

    Sansbury, Brian E; Spite, Matthew

    2016-06-24

    Acute inflammation is a host-protective response that is mounted in response to tissue injury and infection. Initiated and perpetuated by exogenous and endogenous mediators, acute inflammation must be resolved for tissue repair to proceed and for homeostasis to be restored. Resolution of inflammation is an actively regulated process governed by an array of mediators as diverse as those that initiate inflammation. Among these, resolvins have emerged as a genus of evolutionarily conserved proresolving mediators that act on specific cellular receptors to regulate leukocyte trafficking and blunt production of inflammatory mediators, while also promoting clearance of dead cells and tissue repair. Given that chronic unresolved inflammation is emerging as a central causative factor in the development of cardiovascular diseases, an understanding of the endogenous processes that govern normal resolution of acute inflammation is critical for determining why sterile maladaptive cardiovascular inflammation perpetuates. Here, we provide an overview of the process of resolution with a focus on the enzymatic biosynthesis and receptor-dependent actions of resolvins and related proresolving mediators in immunity, thrombosis, and vascular biology. We discuss how nutritional and current therapeutic approaches modulate resolution and propose that harnessing resolution concepts could potentially lead to the development of new approaches for treating chronic cardiovascular inflammation in a manner that is not host disruptive.

  1. Everolimus-eluting coronary stents

    Directory of Open Access Journals (Sweden)

    Alejandro Saez

    2010-09-01

    Full Text Available Alejandro Saez, Raul MorenoDivision of Interventional Cardiology, University Hospital La Paz, Madrid, SpainAbstract: Bare metal stents enabled a reduction in the risk of early procedural complications and restenosis in comparison with balloon angioplasty alone, but introduced a new and device-specific iatrogenic condition, ie, in-stent restenosis due to increased neointimal hyperplasia. Sirolimus- and paclitaxel-eluting stents reduce restenosis and the need for new revascularizations in comparison with bare metal stents, although at the cost of a slight increase in the risk of late stent thrombosis and a need for prolonged dual antiplatelet therapy. Everolimus is an analog of sirolimus with an increased solubility. In this review, the currently available evidence for everolimus-eluting stents is revised, including randomized trials against bare metal stents, and head-to-head trials comparing this stent with other drug-eluting stents.Keywords: coronary stents, restenosis, everolimus, review

  2. Influence of clopidogrel combined with proton pump inhibitors on subacute stent thrombosis%氯吡格雷与质子泵抑制剂合用对亚急性支架内血栓形成的影响

    Institute of Scientific and Technical Information of China (English)

    刘雪; 马淑梅

    2015-01-01

    Objective To explore the effect of clopidogrel combined with PPIs on subacute stent thrombosis after PCI. Methods 6 209 patients received aspirin and clopidogrel treatment after PCI operation were divided into two groups: PPIs group ( patients used PPIs, n =1 182 ) and non PPIs group ( n =5 027 ) . The status of subacute stent thrombosis between the two groups at a month after PCI was observed and compared. The effects of clopidogrel com-bined with PPIs on the formation of subacute stent thrombosis was analyzed. Results There was no significant differ-ence between the two groups in general information,related assays and examinations,concomitant medications as well as coronary artery lesion (P>0. 05). 34 cases (0. 68%) in non PPIs group were diagnosed with subacute stent throm-bosis,and 4 cases were found in PPIs group (0. 37%),there was no significant difference (χ2 =1. 797,P=0. 18). Conclusion The risk of using clopidogrel with PPIs increases subacute stent thrombosis was not discovered during the observation.%目的:探讨氯吡格雷与质子泵抑制剂( PPIs)合用对PCI术后1个月内亚急性支架内血栓形成的影响。方法观察6209例PCI术后接受氯吡格雷治疗的患者,分为使用PPIs组(1182例)及未使用PPIs组(5027例)。比较两组PCI术后1个月内亚急性支架内血栓发生情况,分析氯吡格雷与PPIs合用对亚急性支架内血栓形成的影响。结果两组患者的一般资料、相关检查化验、合并用药及冠脉病变等比较差异无统计学意义(P>0.05)。发生亚急性支架内血栓形成情况:未使用PPIs组34例(0.68%),使用PPIs组4例(0.37%),两组比较差异无统计学意义(χ2=1.797,P=0.18)。结论 PCI术后1个月内接受氯吡格雷联合PPIs治疗,未观察到有增加亚急性支架内血栓形成的风险。

  3. Neoatherosclerosis in the stent

    Directory of Open Access Journals (Sweden)

    A. A. Komkov

    2015-01-01

    Full Text Available Achievements of interventional cardiology in the treatment of coronary artery disease are based on coronary balloon angioplasty with implanting bare metal stents and drug eluting stents. Questions of complications such as early stent thrombosis and restenosis of stent were solved in a considerable degree. However, with the lengthening of the followup period, the problem of late complications became obvious. Except endothelization and fibromuscular proliferation in stented coronary arteries the process of plaque formation has an important influence on later complications in follow-up period more than one year. This process was defined as neoatherosclerosis. This is verified by clinical manifestations of the disease, histological studies, angioscopy, intravascular ultrasound and optical-coherence tomography in stented patients. Dynamic observation of the condition in stentedcoronary arteries showed multistep proliferation with restenosis, its regression, and neoatherosclerosis development. Evidences of neoatherosclerosis formation in stented coronary arteries are considered in this review.

  4. Persistent high levels of plasma oxidized low-density lipoprotein after acute myocardial infarction predict stent restenosis

    NARCIS (Netherlands)

    T. Naruko; M. Ueda; S. Ehara; A. Itoh; K. Haze; N. Shirai; Y. Ikura; M. Ohsawa; H. Itabe; Y. Kobayashi; H. Yamagishi; M. Yoshiyama; J. Yoshikawa; A.E. Becker

    2006-01-01

    Objective-Recently, elevated levels of plasma oxidized low-density lipoprotein (LDL) have been shown to relate to plaque instability in human atherosclerotic lesions. We investigated prospectively patients admitted with acute myocardial infarction (AMI) who underwent primary coronary stenting to eva

  5. Prevalence of deep venous thrombosis in patients with acute exacerbation of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    DUAN Sheng-chen; YANG Yuan-hua; LI Xu-yan; LIANG Xiao-ning; GUO Rui-jun; XIE Wan-mu; KUANG Tu-guang; DAI Hua-ping; WANG Chen

    2010-01-01

    Background Acute exacerbation of chronic obstructive pulmonary disease (COPD) is always associated with a high incidence and mortality. Because of the presence of some concomitant risk factors such as immobilization, bronchial superinfection, patients who are admitted for acute exacerbations of COPD are generally considered to be at moderate risk for the development of venous thromboembolism. In this study, we investigated the prevalence and the clinical manifestations of deep venous thrombosis (DVT) in patients with acute exacerbation of COPD.Methods From March 2007 to March 2009, 520 consecutive patients were included in this study. On admission, color Doppler ultrasound of lower extremities in all cases was performed for diagnosing DVT. Patients with DVT were compared with those without DVT from such aspects as demographics, symptoms, physical signs and risk factors.Results Among the 520 patients, DVT was found in 46 cases (9.7%). In patients with DVT, the duration of hospitalization was longer (P=0.01), and the mechanical ventilation requirement increased (P <0.001). Other indicators for patients with more possibility of DVT were immobility exceeding 3 days (P <0.001); pneumonia as concomitance (P=0.01); respiratory failure type Ⅱ (P=0.013); current smoking (P=0.001). Lower extremity pain was more common in DVT cases in comparison to those without DVT (34.8% vs. 15.2%, P=0.01 ).Conclusions The acute exacerbation of COPD patients, who were immobilized for over 3 days, complicated by pneumonia and had respiratory failure type Ⅱ, had a higher risk of DVT. In addition, DVT detection awareness should be increased in cases that had a lower extremity pain.

  6. Catheter-directed therapy for acute renal vein thrombosis in systemic lupus erythematosus: A case report.

    Science.gov (United States)

    Jong, Chien-Boon; Lo, Wei-Yung; Hsieh, Mu-Yang

    2017-02-15

    We report our experience using catheter-directed thrombectomy/thrombolysis (CDT) to treat a patient with acute renal vein thrombosis (RVT) associated with systemic lupus erythematosus (SLE). A 34-year-old woman presented with persistent left flank pain, and a renal ultrasonography examination revealed an enlarged left kidney. Contrast-enhanced computed tomography confirmed the presence of acute left RVT. Because medical treatment failed to relieve her pain and the renal function was deteriorating, we attempted to salvage the occluded left renal vein using an endovascular approach. The pain was completely relieved after a CDT and an overnight urokinase infusion. A follow-up computed tomography examination revealed the complete resolution of the thrombus. The creatinine level returned to normal (1.7-0.4 mg/dL), along with contrast enhancement in the left kidney, and this suggested the preservation of renal function. To our knowledge, this is the first report utilizing CDT to treat SLE-associated RVT. When the renal function is deteriorating, CDT is worth considering for RVT if conventional medical treatment has failed. © 2016 Wiley Periodicals, Inc.

  7. Endovascular therapy of acute tumour-related obstruction of the superior vena cava using a self-expanding Nitinol stent

    Directory of Open Access Journals (Sweden)

    Peter Kamusella

    2013-11-01

    Full Text Available Objective: To evaluate, in a retrospective study, the clinical efficacy and safety of the self-expanding Nitinol stent in the superior vena cava to alleviate upper venous congestion.Method: In 22 patients (15 men, 7 women, a tumour-related compression of the superior vena cava was diagnosed by spiral CT after intravenous application of contrast medium. Clinically, acute superior vena cava syndrome was found in all patients. Histologically, a bronchial carcinoma was present in 14/22, a lymphoma in 6/22, and mediastinal lymphnode metastases (1 breast carcinoma, 1 malignant melanoma in 2/22. After a transfemoral approach, cavography was initially performed. The degree of stenosis was classified according to the Stanford classification. In accordance with the degree of stenosis, a self-expanding Nitinol stent was placed.Results: Endovascular stent implantation was conducted without complications in all patients. A marked improvement in acute symptoms was observed clinically within 24 hours in all patients. In the follow-up period of up to 2 years, there were no cases of stent migration. In 7/22 patients, the CT follow-ups revealed tumour progression (3/7 after 3 months, 2/7 after 6 months, and 2/7 after 12 months with evidence of residual stenosis caused by tumour growth through the stent mesh. During the follow-up period, 15/22 patients died (mean survival 6.4 months.Conclusion: Self-expanding Nitinol stents provide endovascular therapy for superior vena cava syndrome, having a high radial expansive force and the facility to be placed precisely, and alleviating acute, life-threatening symptoms in the palliative situation.

  8. Ovarian vein thrombosis mimicking acute abdomen: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Arkadopoulos Nikolaos

    2011-12-01

    Full Text Available Abstract Background Ovarian vein thrombosis (OVT is a rare, but serious condition that affects mostly postpartum women. A high index of suspicion is required in order to diagnose this unusual cause of abdominal pain. Case presentation A 19-year-old woman at three days postpartum was admitted to our hospital because of severe right lower quandrant abdominal pain and fever 38.5'C. Physical examination revealed an acutely ill patient and right lower quadrant tenderness with positive rebound and Giordano signs. The patient underwent appendectomy which proved to be negative for acute appendicitis. Postoperatively fever and pain persisted and abdominal CT-scan with intravenous contrast agent demonstrated a thrombosed right ovarian vein. The patient was initiated on low-molecular weight heparin (LMWH and antibiotic treatment and a month later a new abdominal CT-scan showed a patent right ovarian vein. Discussion Pathophysiologically, OVT is explained by Virchow's triad, because pregnancy is associated with a hypercoagulable state, venous stasis due to compression of the inferior vena cava by the uterus and endothelial trauma during delivery or from local inflammation. Common symptoms and signs of OVT include lower abdomen or flank pain, fever and leukocytosis usually within the first ten days after delivery. The reported incidence of OVT ranges 0,05-0,18% of pregnancies and in most cases the right ovarian vein is the one affected. Anticoagulation and antibiotics is the mainstay of treatment of OVT. Complications of OVT include sepsis, extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main source of mortality due to OVT. Conclusions OVT is a rare condition, usually in the postpartum period. A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen.

  9. High versus low-pressure balloon inflation during multilinktrade mark stent implantation: acute and long-term angiographic results.

    Science.gov (United States)

    Caixeta, A M; Brito, F S; Rati, M; Perin, M A; da Luz, P L; Ramires, J A; Ambrose, J A; Martinez, E E

    2000-08-01

    We compared the impact of low and high-pressure balloon inflation on acute and late angiographic results of Multilink stent. Low-pressure balloon inflation (9.5 +/- 1.9 atm) was used in 43 stents and high pressure (17.1 +/- 1.5 atm) in 44. A larger immediate luminal gain was achieved in stents with high-pressure balloon inflation (1.80 +/- 0.26 vs. 1.47 +/- 0.62; P = 0.002), resulting in a larger mean diameter in this group (2.71 +/- 0.37 vs. 2.48 +/- 0.47; P = 0.017). At follow-up, a larger luminal diameter was achieved in the high pressure group (1.93 +/- 0.72 vs. 1.45 +/- 0.66; P = 0.002) and a trend to a lower rate of angiographic restenosis (15% vs. 38%, P = 0.08).

  10. Acute traumatic subclavian artery thrombosis and its successful repair via resection and end-to-end anastomosis

    Institute of Scientific and Technical Information of China (English)

    Saulat H Fatimi; Amna Anees; Marium Muzaffar; Hashim M Hanif

    2010-01-01

    Subclavian artery thrombosis is a rare complication of clavicle fractures. We reported a 20-year-old man who was admitted to the emergency room after a road traffic accident. He was a pedestrian who was initially hit by a bus and after he fell down on the road, he was run over by a car. On evaluation, he was found to have multiple facial and rib fractures, distal right humerus and right clavicle fracture. Significantly, right radial pulse was absent. After further evaluation including Doppler studies and an angiography which revealed complete obstruction of right subclavian artery just distal to its 1st portion, the patient was urgently taken to the operation room. A midclavicular fracture was adjacent to the injured vessel. We established proximal and distal control, removed damaged part. After mobilizing the subclavian artery, an end-to-end anastomosis was made. Then open reduction and internal fixation of right distal humerus was performed. The rest of the postoperative course was unremarkable. To prevent complications of subclavian artery thrombosis, different treatment modalities can be used, including anticoagulation therapy,angioplasty, stenting and bypass procedures.

  11. Patency of paclitaxel-eluting versus bare metal stents long term after implantation in acute ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Vink, Maarten A; Van Nooijen, Ferdinand C; Laarman, Gerrit J; Suttorp, Maarten J; Tijssen, Jan G; Slagboom, Ton; Patterson, Mark S; Van Der Schaaf, Rene J; Kiemeneij, Ferdinand; Amoroso, Giovanni; Dirksen, Maurits T

    2011-11-01

    Drug-eluting stents effectively inhibit neointimal hyperplasia within the first year, thereby reducing the need for repeat revascularization. However, a delayed pattern of restenosis might be more prominent in drug-eluting stents compared to bare metal stents (BMSs). The extent of restenosis of paclitaxel-eluting stents (PESs) long term after implantation in acute ST-segment elevation myocardial infarction is currently unknown. The present study was designed to evaluate very late luminal loss (VLLL) of PESs used in ST-segment elevation myocardial infarction compared to BMSs. A total of 116 patients (61 with PESs and 55 with BMSs) initially included in the Paclitaxel Eluting Stent Versus Conventional Stent in ST-segment Elevation Myocardial Infarction (PASSION) trial and who were free from previous lesion failure underwent angiographic follow-up. Off-line quantitative coronary analysis of the angiogram immediately after stent implantation and at follow-up was performed. The primary end point was VLLL within the stent. The presence of binary restenosis was defined as diameter stenosis >50% as a secondary end point. The mean interval between stent implantation and follow-up was 4.1 ± 0.5 years in both stent groups. In-stent VLLL was 0.12 mm (interquartile range -0.03 to 0.42) in the PES group versus 0.30 mm (interquartile range 0.08 to 0.69) in the BMS group (p = 0.011). In-segment binary restenosis was found in 4 patients (6.6%) with a PES and 6 patients (10.9%) with a BMS (p = 0.40). In conclusion, angiographic follow-up 4 years after implantation in ST-segment elevation myocardial infarction showed that in patients prospectively randomized to PESs or BMSs, VLLL was low in both stent groups. PESs were associated with lower VLLL than BMSs, and the observed rate of binary restenosis was not significantly different between the 2 stent groups.

  12. Association between low serum magnesium level and major adverse cardiac events in patients treated with drug-eluting stents for acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Guipeng An

    Full Text Available OBJECTIVES: We investigated the association of serum magnesium (Mg levels and major adverse cardiac events (MACEs after drug-eluting stent (DES implantation. BACKGROUND: Mg depletion plays a key role in the pathphysiologic features of diabetes mellitus, hypertension, thrombosis, arrhythmias and coronary artery disease. Whether the depletion is related to the long-term prognosis of DES implantation is not known. METHODS: From 2008 to 2011, we enrolled 414 consecutive patients <50 years old who underwent DES implantation for acute coronary syndrome. Serum Mg level was analyzed and patients were followed up for a median of 24 months (interquartile range 14-32 months for the occurrence of MACEs defined as death, myocardial infarction, stroke, and any revascularization. RESULTS: For patients with unstable angina, no significant association between serum Mg level and MACEs was found in the multivariate model. For patients with myocardial infarction, after adjusting for age, positive family history, smoking status, hypertension, hypercholesterolemia, and diabetes at baseline, the risk was 8.11-fold higher for patients with quartile 1 than 4 Mg level (95% confidence interval 1.7-38.75; P<0.01. In addition, when tested as a continuous variable, serum magnesium was a significant predictor for MACEs of acute myocardial infarction (HR [per 0.1 mM increase], 0.35 [95% CI, 0.19-0.63], p< 0.01, after adjustment for other confounders. CONCLUSIONS: Low serum level of Mg may be an important predictor of MACEs with DES implantation for acute myocardial infarction. Further research into the effectiveness of Mg supplementation for these patients is warranted.

  13. Clinical application of self-expanding metallic stent in the management of acute left-sided colorectal malignant obstruction

    Institute of Scientific and Technical Information of China (English)

    You-Ben Fan; Ying-Sheng Cheng; Ni-Wei Chen; Hui-Min Xu; Zhe Yang; Yue Wang; Yu-Yao Huang; Qi Zheng

    2006-01-01

    AIM: To summarize our experience with the application of self-expanding metallic stent (SEMS) in the management of acute left-sided colorectal malignant obstruction.METHODS: A retrospective chart review of all patients undergoing placement of SEMS between April 2000 and January 2004 was performed.RESULTS: Insertion of SEMS was attempted in 26patients under fluoroscopic guidance with occasional endoscopic assistance. The sites of lesions were located in splenic flexure of two patients, left colon of seven patients, sigmoid colon of eight patients and rectum of nine patients. The intended uses of SEMS were for palliation in 7 patients and as a bridge to elective surgery in 19 patients. In the latter group, placement of SEMS allowed for preoperative systemic and bowel preparation and the following one-stage anastomosis. Successful stent placement was achieved in 22 (85%) of the 26patients. The clinical bowel obstruction resolved 24 hours after successful stent placement in 21 (95%) patients.Three SEMS-related minor complications occurred, two stents migrated and one caused anal pain.CONCLUSION: SEMS represents an effective and safe tool in the management of acute malignant colorectal obstruction. As a bridge to surgery, SEMS can provide time for systematic support and bowel preparation and obviate the need for fecal diversion or on-table lavage.As a palliative measure, SEMS can eliminate the need for emergent colostomy.

  14. The use of primary stenting or balloon percutaneous transluminal coronary angioplasty for the treatment of acutely occluded saphenous vein grafts. Results from the Brazilian National Registry - CENIC

    Directory of Open Access Journals (Sweden)

    Luiz Alberto Mattos

    2001-06-01

    Full Text Available OBJECTIVE: We conducted a comparative analysis of the in-hospital outcomes of patients who underwent primary percutaneous transluminal angioplasty (PTCA or stent implantation because of an acute myocardial infarction (AMI related to an acute vein graft occlusion. METHODS: Since 1991 the Brazilian Society of Hemodynamic and Interventional Cardiology has maintained a large database (CENIC. From these, we selected all consecutive patients, who underwent primary PTCA or stenting in the first 24 hours of AMI, with the target vessel being an occluded vein graft. Immediate results and major coronary events occurring up until hospital discharge were analyzed. RESULTS: During this period, 5,932 patients underwent primary PTCA or stenting; 158 (3% of the procedures were performed because of an acute vein graft occlusion. Stenting was performed in 74 (47% patients. Patients treated with stents had a higher success rate and lower mean residual stenosis compared with those who underwent primary balloon PTCA. The incidence of reinfarction and death were similar for stenting and balloon PTCA. CONCLUSION: Primary percutaneous treatment of AMI related to acute vein graft occlusion is still an uncommon practice. Primary stenting improved luminal diameter and offered higher rates of success; however, this strategy did not reduce the in-hospital reinfarction and death rate, compared with that occurring with PTCA treatment.

  15. Acute deep venous thrombosis of the upper extremity as demonstrated by scintigraphy with {sup 99m}Tc-apcitide

    Energy Technology Data Exchange (ETDEWEB)

    Dunzinger, A.; Piswanger-Soelkner, J.; Lipp, R. [Medical Univ. Graz (Austria). Div. of Nuclear Medicine; Hafner, F.; Brodmann, M. [Medical Univ. Graz (Austria). Div. of Angiology

    2008-07-01

    With an incidence of 0.7% inhabitants per year, acute deep venous thrombosis (DVT) is a common occurrence (20). Its incidence in the upper extremities, however, is not as precisely known; the literature reports that 1% to 10% of all DVT cases involve the upper limbs. Acute DVT of upper limb is mainly iatro-genic following interventions like implantation of pacemakers or central venous catheters, and is more likely to occur in obese patients or those with malignant diseases. Life-threatening pulmonary embolism (PE) may occur if acute DVT remains undetected. The presented case report demonstrates the feasibility of {sup 9}9mTc-apcitide scintigraphy for diagnosis of acute DVT of the upper limb and exclusion of PE in a single examination.

  16. Fully biodegradable coronary stents : progress to date.

    Science.gov (United States)

    Ramcharitar, Steve; Serruys, Patrick W

    2008-01-01

    Biotronik absorbable magnesium stent, which showed a MACE of 26.7% at 12 months without deaths, stent thrombosis, or acute myocardial infarction in the PROGRESS-AMS trial. Unlike magnesium stents, there has been little progress with iron stents, which remain in the pre-clinical phase, and this may be partly due to the longer degradation times needed and potential issues related with iron clearance.

  17. Association between Low Serum Magnesium Level and Major Adverse Cardiac Events in Patients Treated with Drug-Eluting Stents for Acute Myocardial Infarction

    OpenAIRE

    Guipeng An; Zhongqi Du; Xiao Meng; Tao Guo; Rui Shang; Jifu Li; Fengshuang An; Wenjing Li; Cheng Zhang

    2014-01-01

    OBJECTIVES: We investigated the association of serum magnesium (Mg) levels and major adverse cardiac events (MACEs) after drug-eluting stent (DES) implantation. BACKGROUND: Mg depletion plays a key role in the pathphysiologic features of diabetes mellitus, hypertension, thrombosis, arrhythmias and coronary artery disease. Whether the depletion is related to the long-term prognosis of DES implantation is not known. METHODS: From 2008 to 2011, we enrolled 414 consecutive patients

  18. Drug eluting stents: Current status and new developments

    NARCIS (Netherlands)

    G. Ertaş; H.M.M. van Beusekom (Heleen)

    2012-01-01

    textabstractDespite the favorable impact of drug eluting stents on stent restenosis, their long-term reliability is considered worrisome by some because of stent thrombosis. Often attributed to adverse reactions to the stent platform, both the drugs and polymer characteristics have been further adva

  19. Endothelial cell recovery, acute thrombogenicity, and monocyte adhesion and activation on fluorinated copolymer and phosphorylcholine polymer stent coatings.

    Science.gov (United States)

    Chin-Quee, Shawn L; Hsu, Steve H; Nguyen-Ehrenreich, Kim L; Tai, Julie T; Abraham, George M; Pacetti, Stephen D; Chan, Yen F; Nakazawa, Gaku; Kolodgie, Frank D; Virmani, Renu; Ding, Nadine N; Coleman, Leslie A

    2010-02-01

    This study compares the effects of two polymers currently being marketed on commercially available drug-eluting stents, PVDF-HFP fluorinated copolymer (FP) and phosphorylcholine polymer (PC), on re-endothelialization, acute thrombogenicity, and monocyte adhesion and activity. Rabbit iliac arteries were implanted with cobalt-chromium stents coated with FP or PC polymer (without drug) and assessed for endothelialization at 14 days by confocal and scanning electron microscopy (SEM). Endothelialization was equivalent and near complete for FP and PC polymer-coated stents (>80% by SEM). Acute thrombogenicity was assessed in a Chandler loop model using porcine blood. Thrombus adherence was similar for both polymers as assessed by clot weight, thrombin-antithrombin III complex, and lactate dehydrogenase expression. In vitro cell adhesion assays were performed on FP and PC polymer-coated glass coupon surfaces using HUVECs, HCAECs, and THP-1 monocytes. The number of ECs adhered to FP and control surfaces were equivalent and significantly greater than on PC surfaces (p<0.05). There were no differences in THP-1 monocyte adhesion and cytokine (MCP-1, RANTES, IL-6, MIP-1alpha, MIP-1beta, G-CSF) expression. The data suggests that biological responses to both FP and PC polymer are similar, with no mechanistic indication that these polymers would be causative factors for delayed vessel healing in an acute timeframe.

  20. Cerebral venous thrombosis in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma during induction chemotherapy with l-asparaginase: The GRAALL experience.

    Science.gov (United States)

    Couturier, Marie-Anne; Huguet, Françoise; Chevallier, Patrice; Suarez, Felipe; Thomas, Xavier; Escoffre-Barbe, Martine; Cacheux, Victoria; Pignon, Jean-Michel; Bonmati, Caroline; Sanhes, Laurence; Bories, Pierre; Daguindau, Etienne; Dorvaux, Véronique; Reman, Oumedaly; Frayfer, Jamile; Orvain, Corentin; Lhéritier, Véronique; Ifrah, Norbert; Dombret, Hervé; Hunault-Berger, Mathilde; Tanguy-Schmidt, Aline

    2015-11-01

    Central nervous system (CNS) thrombotic events are a well-known complication of acute lymphoblastic leukemia (ALL) induction therapy, especially with treatments including l-asparaginase (l-ASP). Data on risk factors and clinical evolution is still lacking in adult patients. We report on the clinical evolution of 22 CNS venous thrombosis cases occurring in 708 adults treated for ALL or lymphoblastic lymphoma (LL) with the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)-induction protocol, which included eight L-ASP (6,000 IU/m(2) ) infusions. The prevalence of CNS thrombosis was 3.1%. CNS thrombosis occurred after a median of 18 days (range: 11-31) when patients had received a median of three l-ASP injections (range: 2-7). Patients with CNS thrombosis exhibited a median antithrombin (AT) nadir of 47.5% (range: 36-67%) at Day 17 (range: D3-D28), and 95% of them exhibited AT levels lower than 60%. There were no evident increase in hereditary thrombotic risk factors prevalence, and thrombosis occurred despite heparin prophylaxis which was performed in 90% of patients. Acquired AT deficiency was frequently detected in patients with l-ASP-based therapy, and patients with CNS thrombosis received AT prophylaxis (45%) less frequently than patients without CNS thrombosis (83%), P = 0.0002). CNS thrombosis was lethal in 5% of patients, while 20% had persistent sequelae. One patient received all planned l-ASP infusions without recurrence of CNS thrombotic whereas l-ASP injections were discontinued in 20 patients during the management of thrombosis without a significant impact on overall survival (P = 0.4).

  1. Long-term outcome of patients of over 85 years old with acute coronary syndrome undergoing percutaneous coronary stenting: a comparison of bare metal stent and drug eluting stent

    Institute of Scientific and Technical Information of China (English)

    MA Han-ying; ZHOU Yu-jie; Ronald J Dick; SHI Dong-mei; LIU Yu-yang; CHENG Wan-jun; GUO Yong-he; WANG Jian-long; GE Hai-long

    2008-01-01

    Background Patients aged over 85 years have been under-represented in percutaneous coronary intervention (PCI)trials despite an increase in referrals for PCI. The long-term safety and efficacy of percutaneous coronary stenting in patients aged over 85 years with acute coronary syndrome (ACS) remain unclear. Moreover it is unknown whether there are differences between bare metal stent (BMS) and drug eluting stent (DES) in this special population.Methods A total of 80 patients with ACS aged over 85 years undergoing stenting (BMS group n=21 vs DES group n=59)were retrospectively studied. In-hospital, one year and overall clinical follow-up (12-36 months) of major adverse cardiac events (MACEs) including cardiac deaths, myocardial infarction, target lesion revascularization (TLR) and target vessel revascularization (TVR) as well as stroke and other major bleeding were compared between the two groups.Results In the entire cohort, the procedure success rate was 93.8% with TIMI-3 coronary flow post-PCI in 93.8% of the vessels and the procedure related complication was 17.5%. The incidence of in-hospital MACEs in BMS group was higher (14.3% vs 6.8%, P=0.30). The 1-year incidence of MACEs in DES group was 7.0% while there was no MACE in the BMS group. Clinical follow-up for 12-36 months showed that the overall survival free from MACE was 82.9% and the incidence of MACE in the BMS group was lower (5.3% vs 21.1%, P=0.20). Multivariate regression analysis showed that the creatinine level (OR:1.013; 95%C1: 1.006-1.020; P=0.004) and hypertension (OR:3.201; 95%C1: 1.000-10.663;P=0.04) are two major factors affecting the long-term MACE.Conclusions Percutaneous coronary stenting in patients aged over 85 years is safe and provides good short and long-term efficacy. Patients with renal dysfunction and hypertension may have a relatively high incidence of MACE.

  2. Effect of biolimus-eluting stents with biodegradable polymer vs bare-metal stents on cardiovascular events among patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Räber, Lorenz; Kelbæk, Henning; Ostojic, Miodrag

    2012-01-01

    The efficacy and safety of drug-eluting stents compared with bare-metal stents remains controversial in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI)....

  3. Mechanical Thrombectomy using a solitaire stent in acute ischemic stroke; The relationship between the visible antegrade flow on first device deployment and final success in revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Ho; Lee, Byung Hon; Hwang, Yoon Joon; Kim, Su Young; Lee, Ji Young; Hong, Keun Sik; Cho, Yong Jin [Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of)

    2015-05-15

    The purpose of the study was to evaluate the relationship between the successful revascularization on the first Solitaire stent deployment and the successful revascularization on the final angiography in acute ischemic stroke. From February 2012 to April 2014, 24 patients who underwent Solitaire stent thrombectomy as the first thrombectomy method for treatment of acute ischemic strokes were retrospectively reviewed. When the first Solitaire stent was deployed, 9 patients showed revascularization (Group 1) and 15 patients did not show revascularization (Group 2). Revascularization immediately after the first Solitaire stent removal and on the final angiography were comparatively assessed between the 2 groups. Statistical analysis was performed by the Fisher exact test and Student's t-test. The rates of revascularization maintenance immediately after the first Solitaire stent removal were 89% in Group 1 and 27% in Group 2, respectively (p = 0.009), and the rates of final successful revascularization were 100% in Group 1 and 47% in Group 2, respectively (p = 0.009). There was a statistically significant difference between the 2 groups. Revascularization on the first Solitaire stent deployment can be a useful predictor in evaluating the success of final revascularization in the treatment of acute ischemic stroke.

  4. Research about the relevant factors of late thrombosis in drug-eluting stents ZHANG Hai-jun, CHEN Huixiao,%药物涂层支架晚期血栓形成相关因素的分析

    Institute of Scientific and Technical Information of China (English)

    张海军; 杨静; 李曦; 陈会校; 张强; 李俊峡; 齐书英; 李鑫平; 崔俊玉; 孔令海; 石勇

    2013-01-01

    Objective To investigate the relevant factors of late thrombosis in drug-eluting stents (DES). Methods The patients ( n=30 ) with late thrombosis in stent after DES implantation ( thrombosis group ) and patients ( n=30 ) without thrombosis instent for at least 1 year ( control group ) were chosen from Jan. 2008 to Jan. 2013. and the adherent situation and stent position as well as the length and diameter were all conculated by 64 SCT, meanwhile the history of all the patients were collcted for further analysis. Results Compared with control group, the incidence of DES malapposition ( 60.0% vs. 10.0% ) , ratio of applying squeezing bracket technique ( 36.7% vs. 13.3% ) , incidence of bifurcation lesion ( 43.3% vs. 16.7% ) , and implantation ratio of multiple DES ( >4, 33.3% vs. 0 ) were all higher in thrombosis group, and at the same time, the average stent length was longer [ ( 39.2 ± 20 ) mm vs. ( 21.7 ± 7 ) mm] and average stent diameter was larger [ ( 3.0 ± 0.5 ) mm vs. ( 2.5 ± 0.5 ) mm, P<0.05], The incidences of complicated decrease of left ventricular ejection fraction ( LVEF ) , diabetes, renal insufficiency and premature discontinuation of dual antiplatelet treatment were all higher in thrombosis group than those in control group. Conclusion There're many factors for the thrombosis in DES, including complex lesions, stenting too much or too long, as well as the history of diabetes, renal insufficiency, also lack of anticoagulation.%目的 探讨药物涂层支架(DES)晚期血栓形成的相关因素.方法 分别纳入我院2008年1月~2013年1月DES置入术后发生晚期血栓患者30例(血栓组)和置入DES 1年以上未发生支架内血栓患者30例(对照组),通过64SCT冠状动脉成像观测支架贴壁情况、支架置入部位个数及长度与直径,采集病史分析晚期血栓的危险因素.结果 与对照组相比,血栓组支架贴壁不良发生率(60.0%vs.10.0%)、采用挤压支架技术(crush技术)比例(36.7% vs.13.3%)

  5. Bioresorbable microporous stents deliver recombinant adenovirus gene transfer vectors to the arterial wall.

    Science.gov (United States)

    Ye, Y W; Landau, C; Willard, J E; Rajasubramanian, G; Moskowitz, A; Aziz, S; Meidell, R S; Eberhart, R C

    1998-01-01

    The use of intravascular stents as an adjunct for percutaneous transluminal revascularization is limited by two principal factors, acute thrombosis and neointimal proliferation, resulting in restenosis. To overcome these limitations, we have investigated the potential of microporous bioresorbable polymer stents formed from poly(L-lactic acid) (PLLA)/poly(epsilon-caprolactone) (PCL) blends to function both to provide mechanical support and as reservoirs for local delivery of therapeutic molecules and particles to the vessel wall. Tubular PLLA/PCL stents were fabricated by the flotation-precipitation method, and helical stents were produced by a casting/winding technique. Hybrid structures in which a tubular sheath is deposited on a helical skeleton were also generated. Using a two-stage solvent swelling technique, polyethylene oxide has been incorporated into these stents to improve hydrophilicity and water uptake, and to facilitate the ability of these devices to function as drug carriers. Stents modified in this manner retain axial and radial mechanical strength sufficient to stabilize the vessel wall against elastic recoil caused by vasoconstrictive and mechanical forces. Because of the potential of direct gene transfer into the vessel wall to ameliorate thrombosis and neointimal proliferation, we have investigated the capacity of these polymer stents to function in the delivery of recombinant adenovirus vectors to the vessel wall. In vitro, virus stock was observed to readily absorb into, and elute from these devices in an infectious form, with suitable kinetics. Successful gene transfer and expression has been demonstrated following implantation of polymer stents impregnated with a recombinant adenovirus carrying a nuclear-localizing betaGal reporter gene into rabbit carotid arteries. These studies suggest that surface-modified polymer stents may ultimately be useful adjunctive devices for both mechanical support and gene transfer during percutaneous

  6. Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

    Directory of Open Access Journals (Sweden)

    Luiz Alberto Mattos

    1999-07-01

    Full Text Available PURPOSE: The authors analyzed the 30-day and 6-month outcomes of 1,126 consecutive patients who underwent coronary stent implantation in 1996 and 1997. METHODS: The 30-day results and 6-month angiographic follow-up were analyzed in patients treated with coronary stents in 1996 and 1997. All patients underwent coronary stenting with high-pressure implantation (>12 atm and antiplatelet drug regimen (aspirin plus ticlopidine. RESULTS: During the study period, 1,390 coronary stents were implanted in 1,200 vessels of 1,126 patients; 477 patients were treated in the year 1996 and 649 in 1997. The number of percutaneous procedures performed using stents increased significantly in 1997 compared to 1996 (64 % vs 48%, p=0.0001. The 30-day results were similar in both years; the success and stent thrombosis rates were equal (97% and 0.8%, respectively. The occurrence of new Q wave MI (1.3% vs 1.1%, 1996 vs 1997, p=NS, emergency coronary bypass surgery (1% vs 0.6%, 1996 vs 1997, p=NS and 30-day death rates (0.2% vs 0.5%, 1996 vs 1997, p=NS were similar. The 6-month restenosis rate was 25% in 1996 and 27% in 1997 (p= NS; the target vessel revascularization rate was 15% in 1996 and 16% in 1997 (p = NS. CONCLUSIONS: Intracoronary stenting showed a high success rate and a low incidence of 30-day occurrence of new major coronary events in both periods, despite the greater angiographic complexity of the patients treated with in 1997. These adverse variables did not have a negative influence at the 6-month clinical and angiographic follow-up, with similar rates of restenosis and ischemia-driven target lesion revascularization rates.

  7. A high maintenance dose of clopidogrel improves short-term clinical outcomes in patients with acute coronary syndrome undergoing drug-eluting stent implantation

    Institute of Scientific and Technical Information of China (English)

    HAN Ya-ling; WANG Bin; LI Yi; XU Kai; WANG Shou-li; JING Quan-min; WANG Zu-lu; WANG Dong-mei; MA Ying-yan; WANG Geng

    2009-01-01

    Background Recurrent ischemic events occurred even during routine use of 75 mg clopidogrel in addition to aspirin,that indicated a potentially insufficient maintenance dosage of clopidogrel.The aim of the present study was to evaluate the short-term efficacy and safety of a 150 mg maintenance dose of clopidogrel following a 600 mg loading dose in patients with an acute coronary syndrome (ACS) undergoing drug eluting stent (DES) implantation.Methods Between November 2005 and November 2006,a total of 813 consecutive ACS patients undergoing DES implantation were enrolled.A 600 mg loading dose was administered before percutaneous coronary intervention (PCI) nd patients were randomized to receive clopidogrel 75 mg or 150 mg for 30 days in addition to 300 mg aspidn daily.Primary end points were the composite of cardiac death,non-fatal myocardial infarction (MI) and urgent target vessel revascularization (UTVR).Secondary end points included stent thrombosis (ST),major and minor bleeding events at 30days.Results At a follow-up period of 30 days,4 (1.0%) patients in the 150 mg group and 9 (2.2%) patients in the 75 mg group (P >0.05) reached the primary end points.There was no significant difference in the incidences of MI (0.5% vs1.2%,P >0.05),UTVR (0.7% vs 2.0%,P >0.05),and cardiac death (0.2% vs 0.2%,P >0.05) between the two groups.The incidence of ST (0 vs 1.5%,P <0.05) was significantly lower in the 150 mg group than that in the 75 mg group.There were no significant differences between both groups regarding the risk of major (0.2% vs 0,P >0.05) or minor (0.5% vs 0.2%,P >0.05) bleedings.Conclusion A high clopidogrel maintenance dose of 150 mg daily following a 600 mg loading dose for the first month after PCI procedure reduces the risk of ST and appears to be safe in patients with ACS undergoing DES implantation.

  8. Mesenteric vein thrombosis: CT identification

    Energy Technology Data Exchange (ETDEWEB)

    Rosen, A.; Korobkin, M.; Silverman, P.M.; Dunnick, N.R.; Kelvin, F.M.

    1984-07-01

    Superior mesenteric vein thrombosis was identified on computed tomographic scans in six patients. In each case, contrast-enhanced scans showed a high-density superior mesenteric vein wall surrounding a central filling defect. Four fo the six patients had isolated superior mesenteric vein thrombosis. A fifth patient had associated portal vein and splenic vein thrombosis, and the sixth patient had associated portal vein and inferior vena cava thrombosis. One of the six patients had acute ischemic bowel disease. The other five patients did not have acute ischemic bowel symptoms associated with their venous occlusion. This study defines the computed tomographic appearance of mesenteric vein thrombosis.

  9. Application of a new-type sutureless anastomosis stent to the primary reconstruction of the bilioenteric continuity after acute bile duct injury in dogs

    Institute of Scientific and Technical Information of China (English)

    Jianhui Li; Yi Lü; Bo Qu; Zhiyong Zhang; Chang Liu; Yuan Shi; Bo Wang; Xuewen Ji; Liang Yu

    2007-01-01

    Objective: To evaluate the effect of a new-type sutureless magnetic bilioenteric anastomosis stent that was used to reconstruct the bilioenteric continuity (primarily under the circumstances of severe inflammation after acute bile duct injury in dogs).Methods: Establishing an animal model of acute bile duct injury with severe inflammation and bile peritonitis in dogs. The newtype sutureless magnetic bilioenteric anastomosis stent was used to reconstruct the bilioenteric continuity primarily. Results: The experiment group anastomosis healed well with a mild local inflammation reaction, and the collagen lined up in order without the occurrence of observable bile leakage and infection. Conclusion: It was safe and feasible to use the new-type anastomosis stent to reconstruct the bilioenteric continuity primarily under the circumstances of severe inflammation after acute bile duct injury in dogs.

  10. Coronary stenting with cardiogenic shock due to acute ascending aortic dissection

    Institute of Scientific and Technical Information of China (English)

    Yuichi; Hanaki; Kazuhiko; Yumoto; Seigen; I; Hajime; Aoki; Tomoyuki; Fukuzawa; Takahiro; Watanabe; Kenichi; Kato

    2015-01-01

    A 65-year-old man developed chest pain under cardiogenic shock. Coronary angiography revealed severe stenosis from the ostium of the left main coronary artery(LMCA) to the left anterior descending artery(LAD). Intravascular ultrasound(IVUS) identified a large hematoma that originated from the aorta and extended into the LAD, thereby compressing the true lumen. Type A aortic dissection(TAAD) that involved the LMCA was diagnosed by IVUS. Coronary stenting was performed via the LMCA to the proximal LAD, which resulted in coronary blood flow restoration and no further propagation of dissection. Elective surgical aortic repair was performed 2 wk after the stenting. LMCA stenting under IVUS guidance is effective for prompt diagnosis and precise stent deployment in patients with cardiogenic shock due to TAAD with LMCA dissection.

  11. Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Knežević Božidarka

    2008-01-01

    Full Text Available Introduction. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization. Case report. We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest x-ray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition. Conclusion. Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non- ST segment elevation acute coronary syndromes may be a life saving procedure.

  12. Gender difference in patients with acute myocardial infarction treated by primary percutaneous coronary intervention in drug-eluting stent era

    Institute of Scientific and Technical Information of China (English)

    GE Jun-bo

    2010-01-01

    @@ Primary percutaneous coronary intervention (PCI) has been the standard of care for patients with acuteST-elevation myocardial infarction (STEMI) within 12 hours of symptom onset in modern era.~(1,2) The advances and applications of robust anti-platelet and anti-coagulation medicines further improve the outcome of STEMI patients undergoing primary PCI,~3 and drug-eluting stent (DES) has also been proven to be effective and safe when applying in primary PCI.~4 Historical data indicated that women undergoing PCI exerted worse outcomes than male patients, and the gender differences in outcome after PCI are still topical and of interest, especially the outcome after primary PCI.

  13. Long-term outcomes of palliative colonic stenting versus emergency surgery for acute proximal malignant colonic obstruction: a multicenter trial

    Science.gov (United States)

    Siddiqui, Ali; Cosgrove, Natalie; Yan, Linda H.; Brandt, Daniel; Janowski, Raymond; Kalra, Ankush; Zhan, Tingting; Baron, Todd H.; Repici, Allesandro; Taylor, Linda Jo; Adler, Douglas. G.

    2017-01-01

    Background and study aims Long-term data are limited regarding clinical outcomes of self-expanding metal stents as an alternative for surgery in the treatment of acute proximal MBO. The aim of this study was to compare the long-term outcomes of stenting to surgery for palliation in patients with incurable obstructive CRC for lesions proximal to the splenic flexure. Patients and methods Retrospective multicenter cohort study of obstructing proximal CRC patients with who underwent insertion of a SEMS (n = 69) or surgery (n = 36) from 1999 to 2014. The primary endpoint was relief of obstruction. Secondary endpoints included technical success, duration of hospital stay, early and late adverse events (AEs) and survival. Results Technical success was achieved in 62/69 (89.8 %) patients in the SEMS group and in 36 /36 (100 %) patients who underwent surgery (P = 0.09). In the SEMS group, 10 patients underwent stenting as a bridge to surgery and 59 underwent stent placement for palliation. Clinical relief was achieved in 78 % of patients with stenting and in 100 % of patients who underwent surgery (P group (7.2 % vs. 30.5 %, P = 0.003). Hospital mortality for the SEMS group was 0 % compared to 5.6 % in the surgery group (P = 0.11). Patients in the SEMS group had a significantly shorter median hospital stay (4 days) as compared to the surgery group (8 days) (P group (73.9 %) than the surgery group (97.3 %; P = 0.003). SEMS placement was associated with higher long-term complication rates compared to surgery (21 % and 11 % P = 0.27). Late SEMS AEs included occlusion (10 %), migration (5 %), and colonic ulcer (6 %). At 120 weeks, survival in the SEMS group was 5.6 % vs. 0 % in the surgery group (P = 0.8). Conclusions Technical and clinical success associated with proximal colonic obstruction are higher with surgery when compared to SEMS, but surgery is associated with longer hospital stays and more

  14. Aspirin desensitization in patients undergoing planned or urgent coronary stent implantation. A single-center experience

    NARCIS (Netherlands)

    Luca, G. De; Verdoia, M.; Binda, G.; Schaffer, A.; Suryapranata, H.; Marino, P.

    2013-01-01

    INTRODUCTION: Dual antiplatelet therapy (aspirin and ADP-antagonists) is mandatory after stent implantation in order to avoid stent thrombosis, especially in the era of DES. In fact, a delayed re-endothelization process may enlarge the window of occurrence of stent thrombosis beyond 1-year after imp

  15. A randomized, prospective, two-center comparison of sirolimus-eluting stent and zotarolimus-eluting stent in acute ST-elevation myocardial infarction: The SEZE trial

    Institute of Scientific and Technical Information of China (English)

    Woo-Young Chung; Sang-Hyun Kim; In-Ho Chae; Joo-Hee Zo; Myung-A Kim; Dong-Ju Choi; Jeehoon Kang; Young-Seok Cho; Hae-Jun Park; Han-Mo Yang; Jae-Bin Seo; Jung-Won Suh; Kwang-Il Kim; Tae-Jin Youn

    2012-01-01

    Background The zotarolimus-eluting stent has shown larger in-stent late lumen loss compared to sirolimus-eluting stents in previous studies.However,this has not been thoroughly evaluated in ST elevation myocardial infarction.Methods This was a prospective,randomized,controlled trial evaluating angiographic outcomes in patients presenting with ST elevation myocardial infarction,treated with zotarolimus-eluting stents or sirolimus-eluting stents.From March 2007 to February 2009,122 patients were randomized to zotarolimus-eluting stents or sirolimus-eluting stents in a 1:1 fashion.The primary endpoint was 9-month in-stent late lumen loss confirmed by coronary angiography,and secondary endpoints were percent diameter stenosis,binary restenosis rate,major adverse cardiac events (a composite of cardiac death,non-fatal myocardial infarction,and target vessel revascularization),and late-acquired incomplete stent apposition.Results Angiographic in-stent late lumen loss was significantly higher in the zotarolimus-eluting stent group compared to the sirolimus-eluting stent group ((0.49±0.65) mm vs.(0.10±0.46) mm,P=0.001).Percent diameter stenosis at 9-month follow-up was also larger in the zotarolimus-eluting stent group ((30.0±17.9)% vs.(17.6±14.0)%,P <0.001).In-segment analysis showed similar findings.There were no significant differences in binary restenosis rate,major adverse cardiac events,and late-acquired incomplete stent apposition.Conclusions Compared to sirolimus-eluting stents,the zotarolimus-eluting stent is associated with significantly higher in-stent late lumen loss at 9-month angiographic follow-up in the treatment of ST elevation myocardial infarction.Although there was no significant difference in 1-year clinical outcomes,the clinical implication of increased late lumen loss should be further studied.

  16. Multiobjective design optimisation of coronary stents.

    Science.gov (United States)

    Pant, Sanjay; Limbert, Georges; Curzen, Nick P; Bressloff, Neil W

    2011-11-01

    We present here a multi-objective and multi-disciplinary coronary stent design optimization paradigm. Coronary stents are tubular, often mesh-like, structures which are deployed in diseased (stenosed) artery segments to provide a scaffolding feature that compresses atheromatus plaque, hence restoring luminal area and maintaining vessel patency. A three variable geometry parameterisation of a CYPHER (Cordis Corporation, Johnson & Johnson co.) type stent is proposed to explore the functionality of a sequence of circumferential rings connected by 'n' shaped links. The performance of each design is measured by six figures of merit (objectives/metrics) representing (i) acute recoil, (ii) tissue stresses, (iii) haemodynamic disturbance, (iv) drug delivery, (v) uniformity of drug distribution, and (vi) flexibility. These metrics are obtained from computational simulations of (i) structural deformation through balloon inflated expansion of a stent into contact with a stenosed vessel, (ii) pulsatile flow over the deformed stent embedded in the vessel wall, (iii) steady-state drug distribution into the tissue, and (iv) flexibility of a stent in response to an applied moment. Design improvement is obtained by a multi-objective surrogate modelling approach using a non-dominated sorting genetic algorithm (NSGA-II) to search for an optimal family of designs. A number of trade-offs between the different objectives are identified. In particular a conflict between pairs of the following objectives are shown -- (a) volume average stress vs. recoil, (b) volume average drug vs. volume average stress, (c) flexibility vs. volume average stress, (d) flexibility vs. haemodynamic disturbance, (e) volume average drug vs. haemodynamic disturbance, and (f) uniformity of drug vs. volume average stress. Different paradigms to choose the optimal designs from the obtained Pareto fronts are presented and under each such paradigm, the optimal designs and there relative positions with respect to a

  17. Acute torsion of a retroperitoneal renal transplant mimicking renal vein thrombosis.

    Science.gov (United States)

    Winter, Thomas C; Clarke, Andrea Lynn; Campsen, Jeffrey

    2013-09-01

    When imaging a renal transplant, the combination of absent flow in the main renal vein and reversed diastolic flow in the intrarenal arteries is considered highly suggestive of renal vein thrombosis. We present a case of torsion of a transplant kidney presenting with identical findings. Renal transplant torsion in general is a rare entity, previously described only in intraperitoneally placed organs; this case is the first that we are aware of with torsion occurring in a retroperitoneally placed graft.

  18. Endovascular Mechanical Recanalisation After Intravenous Thrombolysis in Acute Anterior Circulation Stroke: The Impact of a New Temporary Stent

    Energy Technology Data Exchange (ETDEWEB)

    Fesl, Gunther, E-mail: gunther.fesl@med.uni-muenchen.de; Patzig, Maximilian; Holtmannspoetter, Markus [University of Munich, Department of Neuroradiology (Germany); Mayer, Thomas E. [University of Jena, Department of Neuroradiology (Germany); Pfefferkorn, Thomas; Opherk, Christian [University of Munich, Department of Neurology (Germany); Brueckmann, Hartmut [University of Munich, Department of Neuroradiology (Germany); Wiesmann, Martin [University Hospital, Department of Diagnostic and Interventional Neuroradiology (Germany)

    2012-12-15

    Purpose: Treatment of acute stroke by endovascular mechanical recanalisation (EMR) has shown promising results and continues to be further refined. We evaluated the impact of a temporary stent compared with our results using other mechanical devices. Materials and Methods: We analysed clinical and radiological data of all patients who were treated by EMR after intravenous thrombolysis for acute carotid T- and middle-cerebral artery (M1) occlusions at our centre between 2007 and 2011. A comparison was performed between those patients in whom solely the stent-retriever was applied (group S) and those treated with other devices (group C). Results: We identified 14 patients for group S and 16 patients for group C. Mean age, National Institute of Health Stroke Scale score, and time to treatment were 67.1 years and 16.5 and 4.0 h for group S and 61.1 years and 17.6 and 4.5 h for group C, respectively. Successful recanalisation (thrombolysis in cerebral infarction scores {>=}IIb) was achieved in 93% of patients in group S and 56% of patients in group C (P < 0.05). Mean recanalisation times for M1 occlusions were 23 min (group S) and 29 min (group C) and for carotid-T occlusions were 39 min (group S) and 50 min (group C), and 45% of the patients in group S and 33% in group C had a favourable outcome (Modified Rankin Scale score {<=}2). Conclusion: The findings suggest an improvement in recanalisation success by the application of a temporary stent compared with previously used devices. These results are to be confirmed by larger studies.

  19. Biolimus-eluting biodegradable polymer-coated stent versus durable polymer-coated sirolimus-eluting stent in unselected patients receiving percutaneous coronary intervention (SORT OUT V)

    DEFF Research Database (Denmark)

    Christiansen, Evald Høj; Jensen, Lisette Okkels; Thayssen, Per

    2013-01-01

    Third-generation biodegradable polymer drug-eluting stents might reduce the risk of stent thrombosis compared with first-generation permanent polymer drug-eluting stents. We aimed to further investigate the effects of a biodegradable polymer biolimus-eluting stent compared with a durable polymer...

  20. Incidence of acute deep vein thrombosis in two districts. A phlebographic study.

    Science.gov (United States)

    Kierkegaard, A

    1980-01-01

    The incidence of deep vein thrombosis (DVT), diagnosed by ascending phlebography, was calculated in two Swedish districts. The average incidence per thousand population and year was 0.85 in males and 0.68 in females. Before the age of 50 the incidence was very low and almost the same in both sexes. After age 50 the incidence in men markedly increased with age. A similar increase was found in women, but not before age 60. DVT occurring after age 50 was significantly more common in men than in women. The study strongly suggests male sex as a risk factor for DVT.

  1. Importance of thrombosis and thrombolysis in silent ischaemia: comparison of patients with acute myocardial infarction and unstable angina.

    Science.gov (United States)

    Gurfinkel, E.; Altman, R.; Scazziota, A.; Rouvier, J.; Mautner, B.

    1994-01-01

    OBJECTIVE--To investigate whether plaque rupture and thrombosis have a role in silent ischaemia as well as in unstable angina. DESIGN--Prospective analysis of the results of haemostatic diagnostic tests at the moment of developing silent ischaemia at rest. SETTING--Coronary care unit. PATIENTS--22 patients with acute myocardial infarction, 12 patients with symptomatic angina (unstable angina), and 10 normal volunteers (control group). INTERVENTIONS--Continuous cardiac monitoring detected 15 asymptomatic episodes (silent ischaemia) in 6 patients with unstable angina. Blood samples were obtained at admission and when an asymptomatic alteration was detected and 10 minutes later. MAIN OUTCOME MEASURES--Comparisons of concentrations of tissue plasminogen activator, urokinase type plasminogen activator, tissue plasminogen activator inhibitor-1, cross-linked fibrin degradation products, von Willebrand factor, and thrombin-antithrombin III complexes in patients and controls at admission; same comparisons in patients with silent ischaemia at the start of an episode and 10 minutes later. RESULTS--Tissue plasminogen activator concentrations were raised at admission in patients with acute myocardial infarction (mean (SD) 14.2 (6) ng/ml) and in patients with unstable angina (10.1 (2.5) ng/ml) in comparison with controls (5.1 (2.7) ng/ml, p < 0.01 and < 0.05 respectively). There was no differences between the two groups of patients, however. Similar results were observed at the start of a silent ischaemic episode (9.8 (1.9) ng/ml) and 10 minutes later (10.5 (2.9) ng/ml) compared with controls (p < 0.05). Tissue plasminogen activator inhibitor-1 concentrations were raised in patients with acute myocardial infarction (45.1 (15) ng/ml) compared with volunteers (20.6 (16) ng/ml, p < 0.01). In patients with silent ischaemia tissue plasminogen activator inhibitor-1 concentrations were slightly but not significantly increased. Concentrations of cross-linked fibrin degradation products

  2. Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database

    DEFF Research Database (Denmark)

    Kamman, Arnoud V; Brunkwall, Jan; Verhoeven, Eric L

    2017-01-01

    BACKGROUND: The high-risk patient cohort of uncomplicated type B aortic dissections (uTBADs) needs to be clarified. We compared uTBAD patients treated with best medical treatment (BMT), with and without aortic growth, from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) trial...

  3. Outcome of endoscopic self-expandable metal stents in acute malignant colorectal obstruction at a tertiary center

    Directory of Open Access Journals (Sweden)

    Eduardo Rodrigues-Pinto

    2015-09-01

    Full Text Available Background: Malignant colorectal obstruction (MCRO by advanced colonic cancer occurs in 8-13% of colonic cancer patients. Emergent surgery carries a high mortality and morbidity risk. Endoscopic self-expanding metal stents (SEMS may be used in acute MCRO. Aim: Evaluate clinical outcome of SEMS in acute MCRO and efficacy of SEMS placement considering fluoroscopy guidance. Methods: Retrospective study of patients with acute MCRO that placed SEMS in a 3 years period. Results: SEMS were placed in 47 patients, followed-up for a median time of 150 days. The intent of stenting was bridge to definitive surgery in 40% of the patients (n = 19 and palliation in the remaining 60% (n = 28. The location of the tumor did not influence the presence of lymph node involvement (p = 0.764 nor metastasis (p = 0.885. Mortality rate at year 1 was 61%. Survival was significantly higher in patients submitted later to combination therapy compared to chemotherapy, surgery or symptomatic treatment (p < 0.001. Fluoroscopy was used in 57% of the procedures. Clinical success was 79%. A second SEMS was needed during the procedure in 6% of the patients. Rate of early and late complications was 11% and 5%, respectively. Fluoroscopy guidance did not influence the occurrence of immediate (p = 0.385, early (p = 0.950 or late complications (p = 0.057. Thirty-three percent of patients underwent surgery at a later stage, with neo-adjuvant therapy in 18%. Conclusions: SEMS provide a relative safe and successful treatment in a palliative or bridge-to-surgery indication. No significant differences were found in SEMS placement success, early complications or late complications considering fluoroscopy guidance.

  4. Safety and efficacy of everolimus-eluting stents compared with first-generation drug-eluting stents in patients undergoing primary percutaneous coronary intervention

    Energy Technology Data Exchange (ETDEWEB)

    Escárcega, Ricardo O.; Baker, Nevin C.; Magalhaes, Marco A.; Lipinski, Michael J.; Minha, Sa’ar; Torguson, Rebecca; Satler, Lowell F.; Pichard, Augusto D.; Suddath, William O.; Waksman, Ron, E-mail: ron.waksman@medstar.net

    2014-09-15

    Objective: To assess the safety and efficacy everolimus-eluting stents (EES) compared with first-generation drug-eluting stents (DES) in patients with acute myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI). Background: EES have been associated with improved clinical outcomes compared to paclitaxel-eluting stents (PES) and with similar outcomes compared to sirolimus-eluting stents (SES). Methods: A total of 520 patients who presented with ST-elevation myocardial infarction (STEMI) from 2003 to 2013, who underwent primary PCI with DES, were retrospectively analyzed. Of these, 247 received SES, 136 PES, and 137 EES. Patients were followed up to 2 years for major adverse cardiac events (MACE). Univariate and multivariate models detected correlates to outcome. Results: EES implantation, compared with PES and SES, resulted in comparable rates of MACE (8.8% vs. 16.2%, p = 0.06 and 8.8% vs. 12.6%, respectively, p = 0.26), stent thrombosis, MI, and target lesion revascularization. Patients who received EES had lower rates of all-cause mortality (3.7% vs. 12.6% vs. 9.4%, p = 0.03) at 1-year follow up. However, in the univariate and multivariate analyses, stent type was not independently associated with the primary outcome or with all-cause mortality. Diabetes mellitus and number of stents implanted were independently associated with the primary outcome. Conclusion: While EES seem to be associated with better outcome when compared to PES, the main correlates of STEMI patients are the presence of diabetes and number of stents implanted, and not the type of stent used for intervention.

  5. Recanalization and Mortality Rates of Thrombectomy With Stent-Retrievers in Octogenarian Patients with Acute Ischemic Stroke

    Energy Technology Data Exchange (ETDEWEB)

    Parrilla, G., E-mail: gpr1972@gmail.com [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain); Carreón, E. [Service of Neurology Hospital Clínico Universitario Virgen de la Arrixaca (Spain); Zamarro, J.; Espinosa de Rueda, M.; García-Villalba, B. [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain); Marín, F. [Hospital Clínico Universitario Virgen de la Arrixaca, Department of Cardiology (Spain); Hernández-Fernández, F. [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain); Morales, A. [Service of Neurology Hospital Clínico Universitario Virgen de la Arrixaca (Spain); Fernández-Vivas, M.; Núñez, R. [Hospital Clínico Universitario Virgen de la Arrixaca, Intensive Care Unit (Spain); Moreno, A. [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain)

    2015-04-15

    BackgroundOur objective was to evaluate the effect of treatment with stent-retrievers in octogenarians suffering an acute ischemic stroke.MethodsA total of 150 consecutive patients with acute stroke who were treated with stent-retrievers between April 2010 and June 2012 were retrospectively reviewed. Patients were divided into those <80 years old (n = 116) and those ≥80 (n = 34). Baseline characteristics, procedure data, and endpoints (postprocedural NIHSS, death, and mRS at 3 months) were compared.ResultsHigh blood pressure, atrial fibrillation, and anticoagulation were more frequent in octogenarians (p = 0.01, 0.003, and 0.04 respectively). There were no differences between both groups regarding previous intravenous thrombolysis (32.4 vs. 48.3 %, p = 0.1), preprocedural NIHSS (18.1 vs. 16.8, p = 0.3), procedure time (74.5 (40–114) min vs. 63 (38–92) min, p = 0.2), revascularization time (380.5 (298–526.3) min vs. 350 (296.3–452.8), p = 0.3), TICI ≥ 2B (88.2 vs. 93.9 %, p = 0.1), and symptomatic haemorrhage (5.9 vs. 2.6 %, p = 0.3). Discharge NIHSS was higher in octogenarians (9.7 vs. 6.5, p = 0.03). Death and 3-month mRS ≥3 were more frequent in octogenarians (35.3 vs. 17.2 %, p = 0.02 and 73.5 vs. 37.1 %, p = 0.02). ICA-involvement and prolonged revascularization involved higher mortality (66.7 vs. 27.6 %, p = 0.03) and worse mRS (50 vs. 24.4 %, p = 0.06) in octogenarians.ConclusionsIn our series, treatment with stent-retrievers in octogenarians with acute ischemic stroke achieved good rates of recanalization but with a high mortality rate. ICA involvement and revascularization times beyond 6 hours associated to a worse prognosis. These data might be of value in the design of prospective studies evaluating the clinical efficacy of the endovascular treatments in octogenarians.

  6. Three-dimensional reconstruction of coronary stents in vivo based on motion compensated X-ray angiography

    Science.gov (United States)

    Schäfer, Dirk; Movassaghi, Babak; Grass, Michael; Schoonenberg, Gert; Florent, Raoul; Wink, Onno; Klein, Andrew J. P.; Chen, James Y.; Garcia, Joel; Messenger, John C.; Carroll, John D.

    2007-03-01

    The complete expansion of the stent during a percutaneous transluminal coronary angioplasty (PTCA) procedure is essential for treatment of a stenotic segment of a coronary artery. Inadequate expansion of the stent is a major predisposing factor to in-stent restenosis and acute thrombosis. Stents are positioned and deployed by fluoroscopic guidance. Although the current generation of stents are made of materials with some degree of radio-opacity to detect their location after deployment, proper stent expansion is hard to asses. In this work, we introduce a new method for the three-dimensional (3D) reconstruction of the coronary stents in-vivo utilizing two-dimensional projection images acquired during rotational angiography (RA). The acquisition protocol consist of a propeller rotation of the X-ray C-arm system of 180°, which ensures sufficient angular coverage for volume reconstruction. The angiographic projections were acquired at 30 frames per second resulting in 180 projections during a 7 second rotational run. The motion of the stent is estimated from the automatically tracked 2D coordinates of the markers on the balloon catheter. This information is used within a motion-compensated reconstruction algorithm. Therefore, projections from different cardiac phases and motion states can be used, resulting in improved signal-to-noise ratio of the stent. Results of 3D reconstructed coronary stents in vivo, with high spatial resolution are presented. The proposed method allows for a comprehensive and unique quantitative 3D assessment of stent expansion that rivals current X-ray and intravascular ultrasound techniques.

  7. Successful Endovascular Repair of an Iatrogenic Perforation of the Superficial Femoral Artery Using Self-Expanding Nitinol Supera Stents in a Patient with Acute Thromboembolic Limb Ischemia

    Directory of Open Access Journals (Sweden)

    Tom Eisele

    2016-01-01

    Full Text Available The treatment of acute thromboembolic limb ischemia includes well-established surgical thrombectomy procedures and, in recent times, also percutaneous rotational thrombectomy using Straub Rotarex® system. This modality not only enables efficient treatment of such thrombotic occlusion but also in rare cases may imply the risk of perforation of the occluded artery. Herein, we report the case of a perforation of the superficial femoral artery (SFA in an elderly female patient with thromboembolic limb ischemia. The perforation was successfully treated by implantation of self-expanding nitinol Supera stents and without the need for implantation of a stent graft.

  8. Drug-eluting or bare-metal stents for large coronary vessel stenting? The BASKET-PROVE (PROspective Validation Examination) trial: Study protocol and design

    DEFF Research Database (Denmark)

    Pfisterer, M.; Bertel, O.; Bonetti, P.O.;

    2008-01-01

    Background Based on a subgroup analysis of 18-month BAsel Stent Kosten Effektivitats Trial (BASKET) outcome data, we hypothesized that very late (>12 months) stent thrombosis occurs predominantly after drug-eluting stent implantation in large native coronary vessel stenting. Methods To prove...... stent use in patients with large native vessel stenting. The 2-year death/myocardial infarction-as well as target vessel revascularization-and bleeding rates in these patients with a first-versus second-generation drug-eluting stent should demonstrate the benefit or harm of these stents compared...

  9. Delayed cerebral infarction due to stent folding deformation following carotid artery stenting

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Kwon Duk; Lee, Kyung Yul; Suh, Sang Hyun [Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Byung Moon [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-12-15

    We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.

  10. Emergency and elective implantation of covered stent systems in iatrogenic arterial injuries

    Energy Technology Data Exchange (ETDEWEB)

    Goltz, J.P.; Kickuth, R. [Universitaetsklinikum Wuerzburg (Germany). Inst. fuer Roentgendiagnostik; Bastuerk, P.; Hoppe, H.; Triller, J. [Universitaetsspital Bern (Switzerland). Inst. fuer Diagnostische, Interventionelle und Paediatrische Radiologie

    2011-07-15

    Purpose: To evaluate the effectiveness and safety of covered stents for the management of iatrogenic arterial injury. Materials and Methods: Between 03/1998 and 12/2009, 31 patients underwent selective covered stent implantation after iatrogenic arterial injury. 12/31 of these patients (38.7 %) were hemodynamically unstable. Six different endovascular covered stent types were utilized. The primary endpoints of this study were technical and clinical success and rates of minor and major complications. Results: Initial angiograms demonstrated active extravasation in 19 (61.3 %) patients and pseudoaneurysms in 12 (38.7 %) patients. The following sites of bleeding origin were detected: axillary artery, subclavian artery, common iliac artery, external iliac artery, internal iliac artery, common femoral artery, superficial femoral artery, popliteal and fibular artery, femoro-popliteal and popliteo-crural bypasses, common hepatic artery, aberrant hepatic artery, cystic and gastroduodenal artery. In all patients bleeding was effectively controlled by covered stent implantation resulting in an immediate technical success of 100 %. Clinical success attributed to covered stent implantation was documented in 30 of the 31 patients (96.8 %). Major complications included death in four patients (11.1 %), acute thrombosis with arm ischemia in one patient (2.8 %) and stent fracture with associated pseudoaneurysm in another patient (2.8 %). In 2/31 patients (6.5 %) covered stent failure was detected and successfully treated by implantation of a second covered stent. Conclusion: Emergency and elective implantation of covered stents may be used for minimally invasive and effective management of iatrogenic arterial injury. (orig.)

  11. [Acute extremity ischemia based on the popliteal artery aneurysm thrombosis--combined thrombolytic and surgical management].

    Science.gov (United States)

    Danek, T; Janousek, R; Havlícek, K

    2006-03-01

    Authors present their experience with combined trombolytic-surgical treatment of acute ischaemia of low extremity based on trombosis of popliteal artery aneurysm. This treatment was performed in three patients. Authors compare results of intraarterial catheter pharmacological trombolysis of infrapopliteal arteries with indirect surgical trombolysis.

  12. Cross-sectional imaging for diagnosis and clinical outcome prediction of acute basilar artery thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Mortimer, A.M., E-mail: alex_mortimer@hotmail.co [Severn School of Radiology, Bristol (United Kingdom); Department of Radiology, Great Western Hospital, Swindon (United Kingdom); Saunders, T.; Cook, J.-L. [Department of Radiology, Great Western Hospital, Swindon (United Kingdom)

    2011-06-15

    Basilar artery occlusion is a potentially fatal condition and imaging findings can be subtle. Prompt diagnosis is vital, as recognition may lead to therapeutic recanalization that may improve functional outcome and survival. Furthermore, cross-sectional imaging signs may help predict eventual outcome and, therefore, guide which patients should be subjected to aggressive treatment. Computed tomography (CT) signs include a hyperdense basilar artery that has a high specificity, accuracy, positive and negative predictive value. Evidence regarding the prognostic significance of the hyperdense basilar artery sign is conflicting. Early magnetic resonance imaging (MRI) features include loss of flow void, seen as increased signal intensity within the basilar artery on T2-weigted images and identification of acute thrombus, seen as intermediate signal on T1-weighted images. MRI sequences are more sensitive for early detection of acute ischaemia or infarction, ideally with diffusion-weighted imaging (DWI). Both CT and MR angiography are sensitive for detection of acute thrombus, seen as a filling defect or occlusion. These are the non-invasive imaging techniques of choice to confirm diagnosis, with perhaps the speed and accessibility of CT angiography resulting in this technique being valuable in the acute setting. Several new scoring systems based on arterial segmentation rather than global volume assessment using CT angiography source images and DWI have shown early promise in the prediction of eventual clinical outcome in order to isolate those patients who may benefit from therapeutic recanalization.

  13. Impact of baseline characteristics on outcomes of carotid artery stenting in acute ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Yu CS

    2016-03-01

    Full Text Available Cheng-Sheng Yu,1,* Chih-Ming Lin,2,3,* Chi-Kuang Liu,4 Henry Horng-Shing Lu1 1Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, 2Stroke Centre and Department of Neurology, Chunghua Christian Hospital, Chunghua, 3Graduate Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, 4Department of Medical Imaging, Chunghua Christian Hospital, Chunghua, Taiwan, Republic of China *These authors contributed equally to this work Abstract: Carotid artery stenting is an effective treatment for ischemic stroke patients with moderate-to-severe carotid artery stenosis. However, the midterm outcome for patients undergoing this procedure varies considerably with baseline characteristics. To determine the impact of baseline characteristics on outcomes following carotid artery stenting, data from 107 eligible patients with a first episode of ischemic stroke were collected by retrospective chart review. A modified Rankin Scale (mRS was used to divide patients into two baseline groups, mRS ≤2 and mRS >2. A three-step decision-tree statistical analysis was conducted. After weighting the decision-tree parameters, the following impact hierarchy was obtained: admission low-density lipoprotein, gouty arthritis, chronic kidney disease, ipsilateral common carotid artery resistance index, contralateral ophthalmic artery resistance index, sex, and dyslipidemia. The finite-state machine model demonstrated that, in patients with baseline mRS ≤2, 46% had an improved mRS score at follow-up, whereas 54% had a stable mRS score. In patients with baseline mRS >2, a stable mRS score was observed in 75%, improved score in 23%, and a poorer score in 2%. Admission low-density lipoprotein was the strongest predictive factor influencing poststenting outcome. In addition, our study provides further evidence that carotid artery stenting can be of benefit in first-time ischemic stroke patients with baseline m

  14. Endovascular stent-graft management of thoracic aortic diseases

    Energy Technology Data Exchange (ETDEWEB)

    Dake, Michael D. E-mail: mddake@stanford.edu

    2001-07-01

    The traditional standard therapy for descending thoracic aortic aneurysm (TAA) is open operative repair with graft replacement of the diseased aortic segment. Despite important advances in surgical techniques, anesthetic management, and post-operative care over the last 30 years, the mortality and morbidity of surgery remains considerable, especially in patients at high risk for thoracotomy because of coexisting severe cardiopulmonary abnormalities or other medical diseases. The advent of endovascular stent-graft technology provides an alternative to open surgery for selected patients with TAA. The initial experience suggests that stent-graft therapy potentially may reduce the operative risk, hospital stay and procedural expenses of TAA repair. These potential benefits are especially attractive for patients at high risk for open TAA repair. Current results of endovascular TAA therapy document operative mortalities of between 0 and 4%, aneurysm thrombosis in 90 and 100% of cases, and paraplegia as a complication in 0 and 1.6% of patients. The early success of stent-graft repair of TAA has fostered the application of these devices for the management of a wide variety of thoracic aortic pathologies, including acute and chronic dissection, intramural hematoma, penetrating ulcer, traumatic injuries, and other diseases. The results of prospective controlled trials that compare the outcomes of stent-graft therapy with those of surgical treatment in patients with specific types of aortic disease are anxiously awaited before recommendations regarding the general use of these new devices can be made with confidence.

  15. Acute thrombosis of the superior mesenteric artery in a 39-year-old woman with protein-S deficiency: a case report

    Directory of Open Access Journals (Sweden)

    Luceretti Remo

    2011-01-01

    Full Text Available Abstract Introduction Acute thromboembolic occlusion of the superior mesenteric artery is a condition with an unfavorable prognosis. Treatment of this condition is focused on early diagnosis, surgical or intravascular restoration of blood flow to the ischemic intestine, surgical resection of the necrotic bowel and supportive intensive care. In this report, we describe a case of a 39-year-old woman who developed a small bowel infarct because of an acute thrombotic occlusion of the superior mesenteric artery, also involving the splenic artery. Case presentation A 39-year-old Caucasian woman presented with acute abdominal pain and signs of intestinal occlusion. The patient was given an abdominal computed tomography scan and ultrasonography in association with Doppler ultrasonography, highlighting a thrombosis of the celiac trunk, of the superior mesenteric artery, and of the splenic artery. She immediately underwent an explorative laparotomy, and revascularization was performed by thromboendarterectomy with a Fogarty catheter. In the following postoperative days, she was given a scheduled second and third look, evidencing necrotic jejunal and ileal handles. During all the surgical procedures, we performed intraoperative Doppler ultrasound of the superior mesenteric artery and celiac trunk to control the arterial flow without evidence of a new thrombosis. Conclusion Acute mesenteric ischemia is a rare abdominal emergency that is characterized by a high mortality rate. Generally, acute mesenteric ischemia is due to an impaired blood supply to the intestine caused by thromboembolic phenomena. These phenomena may be associated with a variety of congenital prothrombotic disorders. A prompt diagnosis is a prerequisite for successful treatment. The treatment of choice remains laparotomy and thromboendarterectomy, although some prefer an endovascular approach. A second-look laparotomy could be required to evaluate viable intestinal handles. Some authors

  16. Endovascular repair of arterial iliac vessel wall lesions with a self-expandable nitinol stent graft system.

    Directory of Open Access Journals (Sweden)

    Birger Mensel

    Full Text Available OBJECTIVE: To assess the therapeutic outcome after endovascular repair of iliac arterial lesions (IALs using a self-expandable Nitinol stent graft system. METHODS: Between July 2006 and March 2013, 16 patients (13 males, mean age: 68 years with a self-expandable Nitinol stent graft. A total of 19 lesions were treated: nine true aneurysms, two anastomotic aneurysms, two dissections, one arteriovenous fistula, two type 1B endoleaks after endovascular aneurysm repair, one pseudoaneurysm, and two perforations after angioplasty. Pre-, intra-, and postinterventional imaging studies and the medical records were analyzed for technical and clinical success and postinterventional complications. RESULTS: The primary technical and clinical success rate was 81.3% (13/16 patients and 75.0% (12/16, respectively. Two patients had technical failure due to persistent type 1A endoleak and another patient due to acute stent graft thrombosis. One patient showed severe stent graft kinking on the first postinterventional day. In two patients, a second intervention was performed. The secondary technical and clinical success rate was 87.5% (14/16 and 93.8% (15/16. The minor complication rate was 6.3% (patient with painful hematoma at the access site. The major complication rate was 6.3% (patient with ipsilateral deep vein thrombosis. During median follow-up of 22.4 months, an infection of the aneurysm sac in one patient and a stent graft thrombosis in another patient were observed. CONCLUSION: Endovascular repair of various IALs with a self-expandable Nitinol stent graft is safe and effective.

  17. Novel stents for the prevention of restenosis.

    Science.gov (United States)

    McKenna, C J; Holmes, D R; Schwartz, R S

    1997-10-01

    Since the introduction of Interventional Cardiology in 1976, there has been rapid expansion both in its clinical application and the tools of the trade. This growth was accelerated with the introduction of the intra-coronary stent in 1987. The demonstration that stents may reduce the incidence of restenosis after percutaneous coronary revascularization has further stimulated the search for the perfect endovascular prosthesis. By creating a hybrid stent, incorporating natural coatings and local drug delivery in the design, it is hoped that the complications associated with stent thrombosis and restenosis can be eradicated. (Trends Cardiovasc Med 1997;7:245-249). © 1997, Elsevier Science Inc.

  18. Comparison of short- and mid-term outcomes between CYPHER and TAXUS stents in patients with complex lesions of the coronary arteries

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background Drug-eluting stent (DES) could obviously reduce in-stent restenosis, which has been proved by international multi-center clinical trials. However, the types of the lesions for stenting were highly selected in these trials. Up to now, there has been no large scale study on the effect of DES in treating complex lesions in real world. Although REALITY trial was just reported during American College of Cardiology Congress 2005, the entry criteria for lesions were limited to one or two de novo lesions. This study was conducted to compare the short- and mid-term clinical outcomes between sirolimus-eluting stent (CYPHER stent) and paclitaxel-eluting stent (TAXUS stent) in patients with complex lesion. Methods This is a retrospective study. From April 2002 to June 2004, a total of 1061 patients were treated with DES in Fu Wai Hospital, of which, 611 patients (642 lesions with 698 CYPHER stents) were in CYPHER group,and 450 patients (534 lesions with 600 TAXUS stents) were in TAXUS group. There was no significant difference in clinical data and lesion types between CYPHER group and TAXUS group. Results Success rates of stent implantation were 99.2% and 98.8% in CYPHER and TAXUS stent groups respectively. The major adverse cardiac events (MACE) during in-hospital and 6-8-month follow-up were 0.7% and 2.3% in CYPHER stent group versus 1.3% and 3.2% in TAXUS stent group. There was no significant difference in MACE rate between these two groups. Restenosis rate was a little higher in TAXUS stent group than that in CYPHER stent group (14.0% vs 7.3%), but there was no significant difference. The incidence of acute occlusion of side branch after implanting DES in main vessel was 6.9% in CYPHER group and 11.9% in TAXUS group(P<0.05).Conclusions CYPHER and TAXUS DES were safe and effective in patients with complex lesion. Clinical outcomes of CYPHER stent were better than TAXUS stent in bifurcation lesions. There was an increasing tendency in restenosis rate and late

  19. Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ota, Hideaki [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Mahmoudi, Michael [University of Surrey, Guildford Road, Surrey, GU2-7XH (United Kingdom); Kitabata, Hironori; Torguson, Rebecca; Chen, Fang; Satler, Lowell F.; Suddath, William O.; Pichard, Augusto D. [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Waksman, Ron, E-mail: ron.waksman@medstar.net [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States)

    2015-03-15

    Objectives: The aim of this study was to compare the safety and efficacy of everolimus-eluting stent (EES), sirolimus-eluting stent (SES), and plain old balloon angioplasty (POBA) for the treatment of SES in-stent restenosis (S-ISR). Background: The optimal treatment for drug-eluting in-stent restenosis remains controversial. Methods: The study cohort comprised 310 consecutive patients (444 lesions) who presented with S-ISR to our institution and underwent treatment with EES (43 patients), SES (102), or POBA (165). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac event (MACE) defined as the composite of death, MI, or TLR at 1-year. Results: The three groups were well matched for the conventional risk factors for coronary artery disease except for smoking. The 1-year analyzed clinical parameters were similar in the three groups: MACE (EES = 14%, SES = 18%, POBA = 20%; p = 0.65), death (EES = 2.3%, SES = 6.2%, POBA = 6.1%; p = 0.61), MI (EES = 4.8%, SES = 2.1%, POBA = 2.5%; p = 0.69), TLR (EES = 11.9%, SES = 12.1%, POBA = 24%; p = 0.78), and TVR (EES = 11.9%, SES = 24.8%, POBA = 22.2%; p = 0.23). There were no cases of definite ST. MACE-free rate was significantly lower in patients with recurrent in-stent restenosis (log-rank p = 0.006). Presentation with acute MI, number of treated lesions and a previous history of MI were found to be independent predictors of MACE. Conclusions: In patients presenting with S-ISR, treatment with implantation of an EES, SES, or POBA is associated with similar clinical outcomes. Patients presenting with recurrent ISR may have a poorer clinical outcome.

  20. "I Can't Walk!" Acute Thrombosis of Descending Aorta Causing Paraplegia

    Directory of Open Access Journals (Sweden)

    Matthew L Mitchell

    2013-09-01

    Full Text Available A 50-year-old man presented to the emergency department (ED with acute, bilateral lower extremity weakness and loss of sensation, as well as absent pulses bilaterally. Computed tomography angiography showed complete occlusion of the aorta below the inferior mesenteric artery, extending to the iliac bifurcations. Echocardiographic findings showed severe systolic dysfunction (ejection fraction of 15% and cryptic cardiogenic shock in spite of stable vital signs. Prior to early operative intervention, an early goal-oriented hemodynamic strategy of shock management resulted in the resolution of motor and sensory deficits. After definitive surgical intervention, the patient was discharged neurologically intact. Acute aortic occlusion is frequently accompanied by myocardial dysfunction, which can be from mild to severe. The most severe form can even occur with normalvital signs or occult cardiogenic shock. Early detection and goal-directed preoperative hemodynamic optimization, along with surgical intervention in the ED, is required to optimize outcomes. [West JEmerg Med. 2013;14(5:424–427.

  1. Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

    Science.gov (United States)

    Kamata, Ken; Takenaka, Mamoru; Kitano, Masayuki; Omoto, Shunsuke; Miyata, Takeshi; Minaga, Kosuke; Yamao, Kentaro; Imai, Hajime; Sakurai, Toshiharu; Watanabe, Tomohiro; Nishida, Naoshi; Kudo, Masatoshi

    2017-01-01

    AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed. METHODS Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured. RESULTS The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492). CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction. PMID:28216973

  2. The significance of patient's age and sex in the interpretation of signs and symptoms in clinically suspected acute deep vein thrombosis.

    Science.gov (United States)

    Kierkegaard, A

    1982-01-01

    876 consecutive patients with clinically suspected acute deep vein thrombosis (DVR) in the leg were studied with an ascending phlebography, and the patient's age and sex were correlated to the phlebographic diagnosis. In unoperated patients a thrombus was demonstrated significantly more often in males and in older patients than in females and in younger patients. In operated patients no correlation could be noted between the phlebographic diagnosis and patients's age and sex, but a thrombus was demonstrated significantly more often in operated than in unoperated patients. The results suggest that signs and symptoms of thrombosis are less reliable in females and younger patients than in males and older patients, when a DVT is suspected clinically in unoperated patients.

  3. Usefulness of preprocedure high-sensitivity C-reactive protein to predict death, recurrent myocardial infarction, and stent thrombosis according to stent type in patients with ST-segment elevation myocardial infarction randomized to bare metal or drug-eluting stenting during primary percutaneous

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Kelbæk, Henning; Kofoed, Klaus F;

    2011-01-01

    It is unknown whether high-sensitivity C-reactive protein (hs-CRP) predicts outcome depending on implanted stent type. We investigated the prognostic value of hs-CRP in relation to type of stent implanted in patients with ST-segment elevation myocardial infarction (STEMI). Immediately before...... primary percutaneous coronary intervention (pPCI), 301 patients had blood drawn. Patients were categorized according to hs-CRP levels and combination of hs-CRP (≤2 vs >2 mg/L) and stent type (bare metal stent [BMS] vs drug-eluting stent [DES]). Hs-CRP >2 mg/L (median, hazard ratio 2.7, 95% confidence...... type. Survival analysis demonstrated significant differences for occurrence of death and MI: 4.8% in BMS + CRP ≤2 mg/L, 11.9% in DES + CRP ≤2 mg/L, 17.6% in DES + CRP >2 mg/L, and 27.9% in BMS + CRP >2 mg/L. None of the 14 stent thromboses occurred in patients with BMS + CRP ≤2 mg/L. In conclusion...

  4. Minimally invasive direct coronary artery bypass plus coronary stent for acute coronary syndrome: a case report

    Institute of Scientific and Technical Information of China (English)

    Caiyi Lu; Gang Wang; Qi Zhou; Jinwen Tian; Lei Gao; Shenhua Zhou; Jinyue Zhai; Rui Chen; Zhongren Zhao; Cangqing Gao; Shiwen Wang; Yuxiao Zhang; Ming Yang; Qiao Xue; Cangsong Xiao; Wei Gao; Yang Wu

    2008-01-01

    A 69-year old female patient was admitted because of 3 days of worsened chest pain.Coronary angiography showed60% stenosis of distal left main stem,chronic total occlusion of left anterior descending (LAD),70% stenosis at the ostium of a smallleft circumflex,70-90%stenosis at the paroxysmal and middle part of a dominant fight coronary artery (RCA),and a normal left internalmammary artery (LIMA) with normal origination and orientation.Percutaneous intervention was attempted but failed on the occludedlesion of LAD.The patient received minimally invasive direct coronary artery bypass (MIDCAB) with left LIMA isolation by Davincirobot.Eleven days later,the RCA lesion was treated by Sirolimus Rapamicin eluting stents implantation percutaneously.Then thepatient was discharged uneventfully after 3 days hospitalization.Our experience suggests that two stop shops of hybrid technique befeasible and safe in the treatment of elderly patient with multiple coronary diseases.

  5. Aspiration Thrombectomy Using a Guiding Catheter in Acute Lower Extremity Deep Vein Thrombosis: Usefulness of the Calf-Squeeze Technique

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae A; Kwak, Hyo Sung; Han, Young Min; Yu, Hee Chul [Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2011-05-15

    The effectiveness of the calf-squeeze technique during aspiration thrombectomy using guiding catheter in the treatment of an acute lower extremity deep vein thrombosis (DVT) was evaluated by the use of imaging and the clinical follow-up of patients. A prospective analysis of ten patients (seven women, three men; median age, 56.9 years) with common iliac vein (CIV) obstruction and ipsilateral DVT was performed for this study. All patients presented with leg edema or pain and were treated with catheter-directed thrombolysis via an ipsilateral popliteal vein approach after insertion of a temporary inferior vena cava (IVC) filter. Subsequently, the patients were treated with by aspiration thrombectomy using a guiding catheter to remove the residual thrombus. The calf-squeeze technique during aspiration thrombectomy can be used to induce the proximal migration of thrombi in the popliteal, tibial, and muscular veins were used to increase venous flow. The calf-squeeze technique was employed at mean of 1.3 times (range, 1-3 times). All patients showed proximal migration of a popliteal and muscular vein thrombus during the execution of the calf-squeeze technique. Successful recanalization was achieved in all patients (100%) without any complications. On duplex ultrasonography, which was performed immediately after the aspiration thrombectomy, four patients had a residual thrombus in the soleal muscular veins. However, none of the patients had a thrombus in the popliteal and tibial veins; and, during follow-up, no DVT recurred in any patient. The use of the calf-squeeze technique during aspiration thrombectomy after catheter-directed thrombolysis can induce the proximal migration of thrombi in the popliotibial and muscular veins and is an effective method that can remove a thrombus in calf veins.

  6. Aspiration Thrombectomy and Drug-Eluting Stent Implantation Decrease the Occurrence of Angina Pectoris One Year After Acute Myocardial Infarction.

    Science.gov (United States)

    Lee, Wei-Chieh; Fang, Chih-Yuan; Chen, Huang-Chung; Hsueh, Shu-Kai; Chen, Chien-Jen; Yang, Cheng-Hsu; Yip, Hon-Kan; Hang, Chi-Ling; Wu, Chiung-Jen; Fang, Hsiu-Yu

    2016-04-01

    Angina pectoris is a treatable symptom that is associated with mortality and decreased quality of life. Angina eradication is a primary care goal of care after an acute myocardial infarction (AMI). Our aim was to evaluate factors influencing angina pectoris 1 year after an AMI.From January 2005 to December 2013, 1547 patient received primary percutaneous intervention in our hospital for an acute ST-segment elevation myocardial infarction (MI). Of these patients, 1336 patients did not experience post-MI angina during a 1-year follow-up, and 211 patients did. Univariate and multivariate logistic regression analyses were performed to identify the factors influencing angina pectoris 1 year after an AMI. Propensity score matched analyses were performed for subgroups analyses.The average age of the patients was 61.08 ± 12.77 years, with a range of 25 to 97 years, and 82.9% of the patients were male. During 1-year follow-up, 13.6% of the patients experienced post-MI angina. There was a longer chest pain-to-reperfusion time in the post-MI angina group (P = 0.01), as well as a higher fasting sugar level, glycohemoglobin (HbA1C), serum creatinine, troponin-I and creatine kinase MB (CK-MB). The post-MI angina group also had a higher prevalence of multiple-vessel disease. Manual thrombectomy, and distal protective device and intracoronary glycoprotein IIb/IIIa inhibitor injection were used frequently in the no post-MI angina group. Antiplatelet agents and post-MI medication usage were similar between the 2 groups. Multivariate logistic regression analyses demonstrated that prior MI was a positive independent predictor of occurrence of post-MI angina. Manual thrombectomy use and drug-eluting stent implantation were negative independent predictors of post-MI angina. Higher troponin-I and longer chest pain-to-reperfusion time exhibited a trend toward predicting post-MI angina.Prior MIs were strong, independent predictors of post-MI angina. Manual thrombectomy and drug

  7. Effects of coexisting polymorphisms of CYP2C19 and P2Y12 on clopidogrel responsiveness and clinical outcome in patients with acute coronary syndromes undergoing stent-based coronary intervention

    Institute of Scientific and Technical Information of China (English)

    TANG Xiao-fang; ZHANG Jia-hui; WANG Jing; HAN Ya-ling; XU Bo; QIAO Shu-bin; WU Yong-jian

    2013-01-01

    Background The CYP2C19 G681A single polymorphism has been proven to affect clopidogrel responsiveness.However,the effect of coexisting polymorphisms of other genes has not yet been reported in the Chinese population.This study investigated the effect of coexisting polymorphisms of CYP2C19 and P2Y12 on clopidogrel responsiveness and adverse clinical events in Chinese patients.Methods In 577 Han Chinese patients undergoing stent placement because of acute coronary syndrome had platelet reactivity assessed by thromboelastography,and the CYP2C19 G681A and P2Y12 C34T polymorphisms were detected by the ligase detection reaction.Primary clinical endpoints included cardiovascular death,nonfatal myocardial infarction,target vessel revascularization,and stent thrombosis.The secondary clinical endpoints were thrombolysis in myocardial infarction bleeding.The follow-up period was 12 months.Results Genotyping revealed 194 carriers of the wild type GG genotype of CYP2C19 and the wild type CC genotype of P2Y12 (group 1),102 carriers of the wild type GG genotype of CYP2C 19 and the mutational T allele of P2Y12 (group 2),163 carriers of the mutational A allele of CYP2C19 and the wild type CC genotype of P2Y12 (group 3),and 118 carriers of the mutational A allele of CYP2C19 and the mutational T allele of P2Y12 (group 4).Group 4 had the lowest ADP-inhibition (49.74±32.61) and the highest prevalence of clopidogrel low response (29.7%) of the four groups.The rate of the composite of primary clinical endpoints increased more in group 4 (8.5%) than in the other three groups; the rate of composite primary endpoints in group 2 (2.9%) and group 3 (3.7%) were not significantly different than that of group 1 (1.5%).Conclusion Coexisting polymorphisms of different genes affected clopidogrel responsiveness and clinical outcome more than single polymorphism in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention.

  8. Primary intracoronary stenting in 39 patients with acute myocardial infarction%冠状动脉支架植入术治疗急性心肌梗塞39例

    Institute of Scientific and Technical Information of China (English)

    颜红兵; 马长生; 王勇; 周玉杰; 李宪伦; 郑知刚; 柯元南

    2001-01-01

    目的:小结采用直接冠状动脉支架植入术治疗39例急性心肌梗塞患者的中期效果。方法:接受介入治疗距胸痛发作的平均时间为4.2 h。经股动脉采用Judkins技术完成冠状动脉造影及支架植入术。在38例患者42支血管共植入55个支架,1例患者仅行右冠状动脉球囊成形术。结果:术后即刻TIMI血流3级者36例(92.3%),TIMI血流2级者3例(7.7%)。术中6例(15.4%)在梗塞相关动脉开通后出现心室颤动,1例(2.6%)死于继发性心室颤动。术后平均随访8.1个月,除1例死于术后2周非梗塞相关动脉择期支架植入术外,无心肌梗塞、做外科冠状动脉搭桥术和再次做梗塞相关动脉介入治疗的病例。结论:直接冠状动脉支架术可以迅速获得梗塞相关动脉TIMI 3级血流,中期效果良好。%Objective:To describe the mid-term result of primary intracoronary stenting in 39 patients with acute myocardial infarction.Methods:Coronary stenting was applied within an average 4.2 hours after onset of chest pain by using Judkins technique via femoral artery.Fifty-five stents were implanted into 42 infarct related coronary arteries with a full procedural success rate.Results:Thrombolysis in myocardial infarction(TIMI)grade 3 flow was archived in 36 patients (92.3%), and TIMI grade 2 flow in three patients (7.7%).In the procedure, reperfusional arrhythmia-ventricle fibrillation occurred in six patients (15.4%) while a patent infarct-related artery was established,and another patient (2.6%) died of secondary ventricle fibrillation.Except one patient who died of acute coronary thrombosis secondary to elective coronary angioplasty for another non-infarct related artery after two weeks,no myocardial infarction, coronary artery bypass grafting or repeat percutaneous transluminal coronary angioplasty of the infarct-related vessel occurred during an average 8.1 months clinical follow-up.Conclusion:Primary coronary stenting

  9. Primary renal graft thrombosis

    NARCIS (Netherlands)

    Bakir, N; Sluiter, WJ; Ploeg, RJ; van Son, WJ; Tegzess, Adam

    1996-01-01

    Background. Renal allograft thrombosis is a serious complication of kidney transplantation that ultimately leads to graft loss. Its association with acute and hyperacute rejection is well documented; however, in a large proportion of patients the precise cause remains obscure. The exact incidence an

  10. Impact of diabetes on the benefits from everolimus-eluting stent as compared to first-generation drug-eluting stent in patients with ST elevation myocardial infarction

    NARCIS (Netherlands)

    Luca, G. De; Sauro, R.; Capasso, M.; Lanzillo, T.; Manganelli, F.; Carbone, G.; Lanni, F.; Pagliuca, M.R.; Palmieri, V.; Serino, V.; Rosato, G.; Suryapranata, H.; Lorenzo, E. Di

    2015-01-01

    BACKGROUND: Drug-eluting stent has been shown to reduce the risk of repeated revascularization. However, as shown for first-generation drug-eluting stent, they may be counterbalanced by a potential higher risk of stent thrombosis, especially among ST-segment elevation myocardial infarction patients.

  11. The clinical value of color Doppler ultrasound diagnosis of acute lower extremity deep venous thrombosis%彩色多普勒超声诊断下肢深静脉急性血栓的临床价值

    Institute of Scientific and Technical Information of China (English)

    雷声鸣; 童燕燕; 林继平

    2011-01-01

    Objective To evaluate the clinical value of color Doppler ultrasound in acute deep vein thrombosis diagnosis. Methods 38 patients acute deep venous thrombosis were treatment with color Doppler ultrasound then observed the, imaging features and the flow characteristics. Results The data in the diagnosis of acute thrombosis in 38 cases, 1 case of misdiagnosis, diagnosis rate of 97.44%, In which 37 patients with unilateral thrombosis, I case of thrombosis of both lower extremities; left lower extremity venous thrombosis in 27 cases, 10 cases of right lower limb thrombosis. Conclusion Color Doppler ultrasound examination for acute lower extremity deep venous thrombosis diagnosis has important clinical value, the preferred and reliable disease- based inspection methods.%目的 探讨彩色多普勒超声在下肢深静脉急性血栓诊断的价值.方法 应用彩色多普勒超声诊断39例下肢深静脉急性血栓,观察声像图特征及血流特点.结果 本组资料中诊断急性血栓38例,误诊1例,诊断符合率97.44%,其中单侧血栓37例,双下肢血栓1例;左下肢静脉血栓27例,右下肢血栓10例.结论 彩色多普勒超声检查对下肢深静脉急性血栓的诊断有重要的临床价值,为本病的首选和可靠的检查方法.

  12. Interventional Treatment by Popliteal Vein Puncture and Transcatheter Aspiration for Acute Lower Extremity Deep Venous Thrombosis%经腘静脉穿刺导管抽吸介入治疗急性下肢深静脉血栓

    Institute of Scientific and Technical Information of China (English)

    申刚; 陈德基; 何明基; 练辉

    2012-01-01

    目的 探讨经腘静脉穿刺导管抽吸治疗急性下肢深静脉血栓(lower extremity deep venous thrombosis,LEDVT)的临床应用价值.方法 对32例LEDVT患者行经腘静脉穿刺导管抽取栓术为主的综合介入治疗,其中行导管血栓抽吸术32例,导管接触溶栓术32例,球囊扩张术18例,支架植入术12例.结果 32例介入治疗有效率100%,患者平均住院时间为8.4d.患肢肿胀、疼痛均于介入治疗后1~2d内开始消退.术后下肢静脉造影复查,静脉通畅率100%.出院时健、患肢膝关节上、下15 cm处周径差及患肢膝关节上、下15 cm处周径与入院时比较,差异有统计学意义(P<0.01).治疗过程中无严重并发症发生.结论 经腘静脉穿刺导管抽吸治疗LEDVT是一种快捷、有效的方法,值得临床推广使用.%Objective To discuss the clinical value of popliteal vein puncture and transcatheter aspiration in the interventional treatment for acute lower extremity deep venous thrombosis(LEDVT). Methods Popliteal vein puncture and synthetic interventional treatment were performed in 32 cases,including catheter-directed thrombolysis in 32 cases,transcatheter aspiration in 32 cases,angioplasty 18 cases,and stenting in 12 cases. Results Total achievement ratio by interventional therapy was 100% ,the average days in hospital was ?.4 days. Swelling and pain in affected limb disappeared or relieved after interventional therapy for 1 ~2 days. Vein patency rate was 100% when 32 patients received lower venography after treatment. Knee joint upper and down IS cm perimeter of uninjured and injured side had statistical difference. Knee joint upper and down 15cm perimeter o f before and after therapy had statistical difference. The cause of treatment does not appear serious complications. Conclusion Popliteal vein puncture and transcatheter aspiration for acute deep venous thrombosis of lower limb is a quick and effective method, with better prognosis, which is worthy to be

  13. Usefulness of preprocedure high-sensitivity C-reactive protein to predict death, recurrent myocardial infarction, and stent thrombosis according to stent type in patients with ST-segment elevation myocardial infarction randomized to bare metal or drug-eluting stenting during primary percutaneous

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Kelbæk, Henning; Kofoed, Klaus F;

    2011-01-01

    It is unknown whether high-sensitivity C-reactive protein (hs-CRP) predicts outcome depending on implanted stent type. We investigated the prognostic value of hs-CRP in relation to type of stent implanted in patients with ST-segment elevation myocardial infarction (STEMI). Immediately before...... interval 1.3 to 5.6, p = 0.007) and the combined variable of hs-CRP >2 mg/L and BMS (hazard ratio 2.4, 95% confidence interval 1.2 to 4.5, p = 0.006) independently predicted the composite end point of death and MI at 36-month follow-up. There was a significant interaction (p = 0.006) for hs-CRP and stent...

  14. A rare case of renal vein thrombosis due to urinary obstruction.

    Science.gov (United States)

    Jana, Tanima; Orlander, Philip R; Molony, Donald A

    2015-08-01

    Renal vein thrombosis (RVT) is an uncommon condition in adults and may be caused by endothelial damage, stasis, or hypercoagulable states. RVT is commonly identified in patients with nephrotic syndrome or malignancy. We present the case of a 57-yearold man with no past medical history who presented with a 1-month history of abdominal pain, dysuria, and hematuria. Initial laboratory studies were consistent with acute kidney injury (AKI). Imaging revealed bladder distension, enlargement of the prostate, bilateral hydronephrosis, and left renal vein thrombosis extending into the inferior vena cava. His renal failure and presenting symptoms resolved with placement of a Foley catheter and ureteral stent. The patient was discharged on anticoagulation. Here, we report a rare case of RVT that appears to have occurred as a consequence of obstructive uropathy causing massive bladder distention resulting in compression of the renal vein.

  15. A prospective randomized antiplatelet trial of cilostazol versus clopidogrel in patients with bare metal stent

    Institute of Scientific and Technical Information of China (English)

    CHEN Yun-dai; LU Yan-ling; JIN Ze-ning; YUAN Fei; L(U) Shu-zheng

    2006-01-01

    Background Cilostazol is a newly developed antiplatelet drug that has been widely applied for clinical use. Its antiplatelet action appears to be mainly related to inhibition of intracellular phosphodiesterase activity. Recently,cilostazol has been used for antiplatelet therapy after coronary bare metal stent implantation for thrombosis and restenosis prevention. This prospective randomized and double blind trial was designed to investigate the safety and efficacy of cilostazol for the prevention of late restenosis and acute or subacute stent thrombosis.Methods One hundred and twenty patients who underwent elective stent were randomly assigned to treatment group with cilostazol 200 mg/d (n = 60), clopidogrel 75 mg/d and aspirin 100 mg/d or to control group with clopidogrel treatment 75 mg/d (n = 60) and aspirin 100 mg/d. Follow-up coronary angiography was performed 6-9 months later.Results Nine months major adverse cardio-cerebral event (MACCE) were lower in treatment groups (P<0.05).The quantitative coronary angiography (QCA) at 6 months follow-up showed that minimum lumen diameter(MLD) was higher in treatment group than that of control group [(2.14±0.52)mm vs (1.82 ±0.36)mm, P<0.05].Late lumen loss (LL) [(0.82 ± 0.42)mm vs (1.31 ± 0.58)mm; P<0.01 ], restenosis rate (RR) (14% vs 32%; P<0.05)and target lesion revascularizaion (TLR) rate (5% vs 17%; P<0.05) were lower in treatment group than in control group.Conclusion Cilostazol therapy is an effective regimen for prevention not only stent thrombosis but also RR and TLR through reducing MLD without the risk of increasing bleeding.

  16. Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Ronny Cohen

    2015-01-01

    Full Text Available Portal vein thrombosis (PVT is the blockage or narrowing of the portal vein by a thrombus. It is relatively rare and has been linked with the presence of an underlying liver disease or prothrombotic disorders. We present a case of a young male who presented with vague abdominal symptoms for approximately one week. Imaging revealed the presence of multiple nonocclusive thrombi involving the right portal vein, the splenic vein, and the left renal vein, as well as complete occlusion of the left portal vein and the superior mesenteric vein. We discuss pathogenesis, clinical presentation, and management of both acute and chronic thrombosis. The presence of PVT should be considered as a clue for prothrombotic disorders, liver disease, and other local and general factors that must be carefully investigated. It is hoped that this case report will help increase awareness of the complexity associated with portal vein thrombosis among the medical community.

  17. Massive splenic infarction and splenic venous thrombosis observed in a patient with acute splenic syndrome of sickle cell traits on contrast-enhanced thin-slice computed tomography.

    Science.gov (United States)

    Hayashi, Takana Yamakawa; Matsuda, Izuru; Hagiwara, Kazuchika; Takayanagi, Tomoko; Hagiwara, Akifumi

    2016-09-01

    We report a case of splenic infarction in a patient with sickle cell traits (SCT), focusing on the computed tomography (CT) findings. The patient was an African-American man in his twenties with no past medical history who experienced sudden left upper quadrant pain while climbing a mountain (over 3000 m above sea level). Dynamic contrast-enhanced CT revealed massive non-segmental splenic infarction accompanied with nodule-like preserved splenic tissue. The region of splenic infarction did not coincide with the arterial vascular territory and differed from the features of infarction caused by large arterial embolism. In addition, thrombotic occlusion of the distal splenic vein was depicted on plain and contrast-enhanced thin-slice CT images. Early-phase contrast-enhanced images also showed inhomogeneous enhancement of the hepatic parenchyma. The patient's symptoms improved with conservative therapy. A hemoglobin electrophoresis test confirmed the diagnosis of SCT. SCT is usually asymptomatic, but hypoxic environments may induce acute splenic syndrome, which is commonly manifested as splenic infarction. We observed splenic venous thrombosis and inhomogeneous hepatic parenchymal enhancement in addition to a huge splenic infarction in our patient. To the best of our knowledge, this is the first report describing the specific imaging findings, particularly splenic venous thrombosis and inhomogeneous hepatic parenchymal enhancement, of acute splenic syndrome in a patient with previously undiagnosed SCT. These findings demonstrate the pathophysiology of SCT, and may help with the diagnosis of this disease.

  18. Retrievable Guenther Tulip Vena Cava Filter in the prevention of pulmonary embolism in patients with acute deep venous thrombosis in perinatal period

    Energy Technology Data Exchange (ETDEWEB)

    Koecher, Martin [Department of Radiology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic)], E-mail: martin.kocher@seznam.cz; Krcova, Vera [Department of Hematooncology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic); Cerna, Marie [Department of Radiology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic); Prochazka, Martin [Department of Obstetrics and Gynaecology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic)

    2009-04-15

    Objectives: To evaluate the feasibility and efficacy of the retrievable Guenther Tulip Vena Cava Filter in the prevention of pulmonary embolism in patients with acute deep vein thrombosis in the perinatal period and to discuss the technical demands associated with the filter's implantation and retrieval. Methods: Between 1996 until 2007, eight women (mean age 27.4 years, range 20-42 years) with acute deep iliofemoral venous thrombosis in the perinatal period of pregnancy and increased risk of pulmonary embolism during delivery were indicated for retrievable Guenther Tulip Vena Cava Filter implantation. All filters were inserted and removed under local anesthesia from the jugular approach. Results: The Guenther Tulip Vena Cava Filter was implanted suprarenally in all patients on the day of caesarean delivery. In follow-up cavograms performed just before planned filter removal, no embolus was seen in the filter in any patient. In all patients the filter was retrieved without complications on the 12th day after implantation. Conclusions: Retrievable Guenther Tulip Vena Cava Filters can be inserted and removed in patients during the perinatal period without major complications.

  19. Acute intraventricular thrombosis of an impella LP 5.0 device in an ST-elevated myocardial infarction complicated by cardiogenic shock.

    Science.gov (United States)

    Ranc, Sylvain; Sibellas, Franck; Green, Lisa

    2013-01-01

    A 58-year-old male patient, suffering from an acute anterior ST-elevated myocardial infarction, developed cardiogenic shock, despite an optimal revascularization and hemodynamic support through the use of an intra-aortic balloon pump and inotropic pharmacological agents. Additional support was provided by a left ventricular assistance device Impella LP 5.0 (Abiomed, Europe GmbH). Device failure occurred 27 hours after implantation due to an acute thrombosis of the Impella inflow portion. This major adverse event might have occurred due to an inflammatory status in the cardiogenic shock context, a pre-existing intraventricular thrombus that could have been sucked up inside the Impella, and/or a subtherapeutic anticoagulation. There are very few data regarding this type of complication. Further studies are therefore needed to assess the frequency of such a complication and the means to avoid it.

  20. Safety and efficacy of hybrid platform design sirolimus eluting stent system in percutaneous coronary intervention in ST elevation myocardial infarction patients at 1 year after treatment

    Directory of Open Access Journals (Sweden)

    Louie Fisher

    2016-10-01

    Conclusions: In contemporary practice of percutaneous coronary intervention in ST Elevation Myocardial Infarction, Genxsync stent was associated with low risks of stent thrombosis and MACE. [Int J Res Med Sci 2016; 4(10.000: 4458-4464

  1. Efficacy and safety of zotarolimus-eluting and sirolimus-eluting coronary stents in routine clinical care (SORT OUT III): a randomised controlled superiority trial

    DEFF Research Database (Denmark)

    Rasmussen, Klaus; Maeng, Michael; Kaltoft, Anne

    2010-01-01

    In low-risk patients, the zotarolimus-eluting stent has been shown to reduce rates of restenosis without increasing the risk of stent thrombosis. We compared the efficacy and safety of the zotarolimus-eluting stent versus the sirolimus-eluting stent in patients with coronary artery disease who we...

  2. Balloon-guided navigation technique to perform stenting in an acutely angled anterior cerebral artery.

    Science.gov (United States)

    Cohen, José E; Gomori, John M; Moscovici, Samuel; Itshayek, Eyal

    2012-03-01

    The complex anatomic features of wide-necked anterior communicating artery aneurysms represent an endovascular challenge. Compliant balloons and microstents are frequently required to achieve aneurysm occlusion. When the angle between the A1 and A2 segments is acute, microcatheter navigation is hazardous, and may be difficult or sometimes impossible with standard techniques. We present our technique using a support balloon to facilitate guidewire engagement and navigation of A2, and to assist with microcatheterization in this unfavorable vascular anatomy.

  3. Cerebral venous thrombosis in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Huisman, T.A.G.M.; Martin, E.; Willi, U.V. [Dept. of Diagnostic Imaging and Radiology, University Children' s Hospital Zurich (Switzerland); Holzmann, D. [Dept. of Otorhinolaryngology, University Children' s Hospital Zurich, Zurich (Switzerland)

    2001-09-01

    This was a retrospective study to determine different etiologies of cerebral venous thrombosis (CVT) in childhood and to correlate extent and location of thrombosis with the etiology and the age of the child as well as the final outcome. In addition, the radiologic approach is discussed. This was a retrospective analysis of 19 children with CVT. The children were examined by contrast-enhanced dynamic CT. Radiologic findings were correlated with the etiology of CVT. Cerebral venous thrombosis is not as infrequent in children as has been thought. Cerebral venous thrombosis in children can occur due to trauma (n=9), infections (n=7), or coagulation disorders (n=3). Extent and location of thrombosis, as well as complications, final outcome, and therapy, depend on the etiology. Computed tomography remains a valuable primary imaging modality in the diagnosis of CVT in the acutely injured or diseased child. (orig.)

  4. Stent, drug, polymer——enefits, risks, and opportunities

    Institute of Scientific and Technical Information of China (English)

    Samuel J. Shubrooks

    2006-01-01

    @@ It has been well established that use of drug-eluting stents has resulted in marked reduction in neointimal proliferation following stenting and that this is reflected clinically in a very significant decrease in late lumen loss, instent restenosis, and target lesion revascularization. This benefit occurs, however, in the setting of delayed endothelial and vascular wall healing with its potential for continuing thrombogenicity requiring more prolonged use of dual antiplatelet therapy to prevent stent thrombosis.

  5. A Case Report of Arterial Thrombosis in Wegener’s Granulomatosis Presenting with Acute Lower Limb Ischemia

    Directory of Open Access Journals (Sweden)

    Z. Basiri

    2012-04-01

    Full Text Available Introduction: Wegener’s Granolomatosis (WG is a systemic, necrotizing, small-vessel vasculitis. Vascular inflammation and occlusion leading to tissue ischemia is a hallmark of WG. WG has a clinical predilection for the upper airways, lungs, and kidneys. Thromboembolic events do not usually occur and arterial thrombosis is extremely rare.Case Report: Here we reported 2 rare cases of arterial thrombosis that caused lower limb ischemia. There were not any risk factors such as deficiency of protein C, protein S or anti-thrombin 3, Factor V Leiden mutation, and anti-phospholipids syndrome. Limb perfusion returned as a result of emergency treatment and ischemia did not occur. High doses of prednisolone and endoxan were administrated for them. Conclusion: The thrombosis seemed to happen due to the inflammation process of the disease itself. Because of possible morbidity of limb gangrene we suggest special notice to limb pain, evaluation by paraclinics such as color doppler sonography or angiography to rule out or rule in thromboembolism, determining whether there are risk factors for thrombosis such as (deficiency of protein C and protein S or anti-thrombin III, Leiden 5 factor mutation and anti-phospholipid antibody syndrome, and treatment or removal of them. If no risk factor is found, high doses of immunosuppressive therapy like steroid and cytotoxic agents like Endoxan will be the choice.(Sci J Hamadan Univ Med Sci 2012;19(1:75-78

  6. Bronchial stents

    Directory of Open Access Journals (Sweden)

    Ibrahim Emad

    2006-01-01

    Full Text Available Bronchial stents are mostly used as a Palliative relief of symptoms often caused by airway obstruction, It is also used for sealing of stump fistulas after pneumonectomy and dehiscence after bronchoplastic operations. Advances in airway prosthetics have provided a variety of silicone stents, expandable metal stents, and pneumatic dilators, enabling the correction of increasingly complex anatomical problems. Several series have been published describing the application and results of these techniques. This manuscript reviews the historical development of stents, types, indication, outcome, and complications. Alternative therapies for tracheobronchial stenting were also reviewed

  7. Spontaneous rupture of the left common iliac vein: management with surgical repair and endovascular stent

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan; Lee, Sang Kwon; Ko, Sung Min; Choi, Jin Soo; Koo, Ja Hyun; Kim, Hyung Tae; Cho, Won Hyun [Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2006-06-15

    We report here on a case of spontaneous rupture of the left common iliac vein that was diagnosed preoperatively with computed tomography (CT), and the patient was successfully treated with surgery and stent placement. A 60-year-old woman was referred to our emergency room because of sudden left lower abdominal pain and swelling of the left lower extremity. CT revealed a huge retroperitoneal hematoma and extrinsic compression of the left common iliac vein with acute thrombosis of the deep veins of the left lower extremity. Venous patch angioplasty was performed at the site of spontaneous rupture. After performing thrombectomy with using a Forgaty catheter, a stent was placed at the occluded segment of the left common iliac vein under C-arm fluoroscopic guidance. The follow-up CT scans taken at 10 days and 8 months after the initial examination demonstrated a venous stent with preserved luminal patency and the striking resolution of the deep vein thrombosis of the left lower extremity.

  8. Transient ST-segment elevation in precordial leads by acute marginal branch occlusion during stent implantation.

    Science.gov (United States)

    Arzola, Leidimar Carballo; Esteban, Marcos T Rodríguez; Niebla, Javier García

    2016-01-01

    The isolated right ventricular infarction is a rare entity. Our case presented a selective occlusion of an acute marginal branch that supplies the right ventricular free wall with isolated ST elevation in precordial leads simulating an occlusion of the left anterior descending artery and without pseudonormalization in inferior due to the non-involvement of the main branch in the ischemic process. Our case clearly illustrates a rare differential diagnosis when a new ST segment elevation appears in earlier precordial leads in patients with symptoms of myocardial ischemia.

  9. Morphologic characteristics of late stent malapposition after drug-eluting stents implantation by optical coherence tomography follow-up

    Institute of Scientific and Technical Information of China (English)

    HOU Jing-bo; LIU Hui-min; MA Li-jia; YANG Shuang; MENG Ling-bo; HAN Zhi-gang; ZHANG Shuo; YU Bo

    2010-01-01

    Background Late stent malapposition was frequently observed after DES implantation, which has been associated with the occurrence of late stent thrombosis due to poor neointimal coverage. This study was designed to evaluate the frequency of late stent malapposition at least 1 year after different DESs implantation by optical coherence tomography (OCT). Methods Angiographic and OCT examinations were given to 68 patients who had received total 126 various DESs implantation for at least 1 year to detect late stent malapposition. Malapposed strut distance (MSD), malapposed strut area (MSA), reference lumen area (RLA) and reference stent area (RSA) were checked with off-line OCT analysis. Results Totally 26 Cypher Select stents, 15 Taxus Liberte stents, 51 Partner stents and 34 Firebird I stents were examined. Among 68 patients who underwent DES implantation, 7 patients (10.3%) had late malapposition. Average RSA, MSA and MSD were (7.9±2.8)mm~2,(2.0±1.6)mm~2 and (590±270)μm respectively.According to the MSA/RSA ratio,4 patients had slight malapposition,2 patients had moderate malapposition and 1 patient had severe malapposition.Conclusions Late stent malapposition is detected frequently after implantation of DES,but if this predisposes to late stent thrombosis and requires any specific therapy needs to be further elucidated.

  10. Modified culotte stenting for treatment of complex coronary bifurcation lesions: immediate and 9-month outcomes in a pilot study

    Institute of Scientific and Technical Information of China (English)

    CHEN Liang-long; FAN Lin; CHEN Zhao-yang; ZHEN Xing-chun; LUO Yu-kun; LIN Chao-gui; PENG Ya-fei

    2011-01-01

    Background The optimal stenting strategy for the treatment of coronary bifurcation lesions (CBLs) remains uncertain. The present study observed technical feasibility and reliability, 9-month clinical and angiographic outcomes of the modified culotte stenting (MCS) in the treatment of CBLs with drug-eluting stents.Methods A total of 34 consecutive patients with CBLs that required stenting the parent vessel (PV), the main branch (MB) and the side branch (SB) were included. All patients were first assigned to receive MCS for CBL interventions (per MCS), and might be switched to receive the double-kissing-crush stenting (DKS) in case of temporally acute branch occlusion (per protocol).Results The immediate angiographic or procedural success was achieved in 33/34 (97%) lesions (patients) per MCS, 34/34 (100%) lesions (patients) per protocol with 100% successful final balloon kissing. The long-term clinical success at 9 months was 94% per MCS and 94% per protocol, only 2 patients had reoccurrence of angina but none of them needed target lesion revascularization. There were no procedure-related biomarker elevation, no in-stent thrombosis peri-procedurally and at 9-month follow-up. Quantitative coronary angiography data at 9 months showed that in-stent (6%) or in-segment (6%) binary stenosis was infrequent, and minimal lumen diameter was significantly reduced but late lumen loss was acceptable with only (0.10±0.14) mm for PV, (0.21 ±0.23) mm for MB and (0.27±0.32) mm for SB.Conclusions MCS for treatment of CBLs that required dual-stent implantation was technically easier and safer, readily to complete final balloon kissing, and was associated with high immediate success and optimal 9-month outcomes.

  11. The current status of stenting pathobiology.

    Science.gov (United States)

    Fleser, A; Leclerc, G

    1997-01-01

    Stents permanently maximize the arterial lumen following percutaneous transluminal coronary angioplasty (PTCA) at the cost of a vascular injury caused by the deployment of the prosthesis. Even though clinical trials show progressive reduction of restenosis and thrombosis rates in implanted coronary stents, these two events continue to represent a potential limitation to their clinical use. This review is focused on the arterial pathobiology related to the use of permanent and temporary stents. © 1997, Elsevier Science Inc. (Trends Cardiovasc Med 1997;7:24-28).

  12. Foreign body contamination during stent implantation.

    Science.gov (United States)

    Whelan, D M; van Beusekom, H M; van der Giessen, W J

    1997-03-01

    The treatment of coronary artery disease using stents has become a widely accepted technique. However, the inadvertent co-implantation of contaminating factors with the stent has received little attention. We studied histological cross-sections of stented porcine coronary arteries and observed contamination of some vessels with surgical glove powder and textile fibres. The contaminating particles were associated with a foreign body reaction. Such a reaction could delay the wound-healing response of a stented vessel and thereby prolong the period in which subacute thrombosis could occur. It is also proposed that air contamination could affect the thrombogenicity of the stent. Appropriate measures should be followed to reduce the chance of contamination occurring.

  13. [Sequence of venous blood flow alterations in patients after recently endured acute thrombosis of lower-limb deep veins based on the findings of ultrasonographic duplex scanning].

    Science.gov (United States)

    Tarkovskiĭ, A A; Zudin, A M; Aleksandrova, E S

    2009-01-01

    This study was undertaken to investigate the sequence of alterations in the venous blood flow to have occurred within the time frame of one year after sustained acute thrombosis of the lower-limb deep veins, which was carried out using the standard technique of ultrasonographic duplex scanning. A total of thirty-two 24-to-62-year-old patients presenting with newly onset acute phlebothrombosis were followed up. All the patients were sequentially examined at 2 days, 3 weeks, 3 months, 6 months and 12 months after the manifestation of the initial clinical signs of the disease. Amongst the parameters to determine were the patency of the deep veins and the condition of the valvular apparatus of the deep, superficial and communicant veins. According to the obtained findings, it was as early as at the first stage of the phlebohaemodynamic alterations after the endured thrombosis, i. e., during the acute period of the disease, that seven (21.9%) patients were found to have developed valvular insufficiency of the communicant veins of the cms, manifesting itself in the formation of a horizontal veno-venous reflux, and 6 months later, these events were observed to have occurred in all the patients examined (100%). Afterwards, the second stage of the phlebohaemodynamic alterations was, simultaneously with the process of recanalization of the thrombotic masses in the deep veins, specifically characterized by the formation of valvular insufficiency of the latter, manifesting itself in the form of the development of a deep vertical veno-venous reflux, which was revealed at month six after the onset of the disease in 56.3% of the examined subjects, to be then observed after 12 months in 93.8% of the patients involved. Recanalization of thrombotic masses was noted to commence 3 months after the onset of thrombosis in twelve (37.5%) patients, and after 12 months it was seen to ensue in all the patients (100%), eventually ending in complete restoration of the patency of the affected

  14. Six-month clinical outcomes of Firebird 2TM sirolimus-eluting stent implantation in real-world patients with coronary artery diseases

    Institute of Scientific and Technical Information of China (English)

    GE Jun-bo; ZHANG Feng; QIAN Ju-ying; GE Lei; LIU Xue-bo; ZHOU Jun

    2011-01-01

    Background The Firebird 2TM sirolimus-eluting stent (Firebird 2 stent) is a second-generation sirolimus-eluting stent which has a cobalt-chromium alloy stent platform, a brand new bracket structure, and two layers of styrene-butylenes-styrene polymer coatings with better biocompatibility. The Firebird 2TM cObalt-Chromium alloy sirolimus-elUting Stent registry (FOCUS registry) aimed to evaluate the safety and efficacy of the Firebird 2 stent in patients with coronary artery disease in daily practice.Methods The FOCUS registry is a prospective, non-randomized, international multi-center, single-arm clinical registry.Between March 2009 and February 2010, 5084 patients receiving at least 1 Firebird 2 stent during daily clinical practice at 83 medical centers were enrolled.Results Of the 5084 patients enrolled in the registry, 5077 and 5058 were respectively available for 30 days and 6 months follow-up. The 30-day rate of major adverse cardiac events (MACE) was 1.20%, including 13 cardiac deaths, 46 non-fatal myocardial infarction (MI), and 6 target vessel revascularization (TVR). At 6 months follow-up, the rate of MACE was 1.80%. There were 32 cardiac deaths, 48 non-fatal MI, and 15 TVR. According to the Academic Research Consortium definition, definite/probable stent thrombosis (ST) occurred in 0.43% (22/5058) of patients, including 8 cases of acute ST, 11 subacute ST, and 3 late ST.Conclusion The Firebird 2 stent showed the promising efficacy and safety at 30 days and 6 months in a real-world population of patients with coronary artery diseases.

  15. A Patient with Recurrent Arteriovenous Graft Thrombosis.

    Science.gov (United States)

    Allon, Michael

    2015-12-01

    Arteriovenous grafts (AVGs) are prone to frequent thrombosis that is superimposed on underlying hemodynamically significant stenosis, most commonly at the graft-vein anastomosis. There has been great interest in detecting AVG stenosis in a timely fashion and performing preemptive angioplasty, in the belief that this will prevent AVG thrombosis. Three surveillance methods (static dialysis venous pressure, flow monitoring, and duplex ultrasound) can detect AVG stenosis. Whereas observational studies have reported that surveillance with preemptive angioplasty substantially reduces AVG thrombosis, randomized clinical trials have failed to confirm such a benefit. There is a high frequency of early AVG restenosis after angioplasty caused by aggressive neointimal hyperplasia resulting from vascular injury. Stent grafts prevent AVG restenosis better than balloon angioplasty, but they do not prevent AVG thrombosis. Several pharmacologic interventions to prevent AVG failure have been evaluated in randomized clinical trials. Anticoagulation or aspirin plus clopidogrel do not prevent AVG thrombosis, but increase hemorrhagic events. Treatment of hyperhomocysteinemia does not prevent AVG thrombosis. Dipyridamole plus aspirin modestly decreases AVG stenosis or thrombosis. Fish oil substantially decreases the frequency of AVG stenosis and thrombosis. In patients who have exhausted all options for vascular access in the upper extremities, thigh AVGs are a superior option to tunneled internal jugular vein central vein catheters (CVCs). An immediate-use AVG is a reasonable option in patients with recurrent CVC dysfunction or infection. Tunneled femoral CVCs have much worse survival than internal jugular CVCs.

  16. Therapeutic effect and safety of Firebird stent combined tirofiban on acute myocardial infarction%Firebird 支架联合替罗非班用于急性心肌梗死中的疗效及安全性

    Institute of Scientific and Technical Information of China (English)

    刘远萍; 郝亚荣

    2015-01-01

    .0% ) and corrected TIMI frame [ (29.2 ± 4.4) vs .(21.4 ± 5.1)] ,significant rise in percentage of TIMI class 3~4 (86.1% vs .96.0% ) in combined treatment group , P<0.05 all;on six months after PCI ,compared with routine treatment group ,there were significant reductions in inci‐dence rates of subacute thrombosis (2.8% vs .0% ) and myocardial infarction (2.8% vs . 0% ) in combined treat‐ment group (P<0.05 both);on 12 months after operation ,compared with routine treatment group ,there were sig‐nificant reductions in incidence rates of angina pectoris (16.7% vs .6.0% ) ,subacute thrombosis rate (11.1% vs . 0% ) ,myocardial infarction (8.3% vs .0% ) ,heart failure (2.8% vs .0% ) and rehospitalization rate (11.1% vs . 0% ) in combined treatment group , P<0.05 or <0.01 .Conclusion:Firebird stent combined tirofiban possesses sig‐nificant therapeutic effect on acute myocardial infarction ,and it's safe and reliable ,which is worth extending .

  17. Inconsistencies in the planning of the duration of anticoagulation among outpatients with acute deep-vein thrombosis. Results from the OTIS-DVT Registry.

    Science.gov (United States)

    Spirk, David; Husmann, Marc; Willenberg, Torsten; Banyai, Martin; Frank, Ulrich; Baldi, Thomas; Amann-Vesti, Beatrice; Baumgartner, Iris; Kucher, Nils

    2011-02-01

    Three-month anticoagulation is recommended to treat provoked or first distal deep-vein thrombosis (DVT), and indefinite-duration anticoagulation should be considered for patients with unprovoked proximal, unprovoked recurrent, or cancer-associated DVT. In the prospective Outpatient Treatment of Deep Vein Thrombosis in Switzerland (OTIS-DVT) Registry of 502 patients with acute objectively confirmed lower extremity DVT (59% provoked or first distal DVT; 41% unprovoked proximal, unprovoked recurrent, or cancer-associated DVT) from 53 private practices and 11 hospitals, we investigated the planned duration of anticoagulation at the time of treatment initiation. The decision to administer limited-duration anticoagulation therapy was made in 343 (68%) patients with a median duration of 107 (interquartile range 91-182) days for provoked or first distal DVT, and 182 (interquartile range 111-184) days for unprovoked proximal, unprovoked recurrent, or cancer-associated DVT. Among patients with provoked or first distal DVT, anticoagulation was recommended for DVT, anticoagulation was recommended for DVT.

  18. Appraisal of the Prognosis in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

    Institute of Scientific and Technical Information of China (English)

    马晓娟; 殷惠军; 陈可冀

    2009-01-01

    Acute myocardial infarction(AMI) is still the leading factor causing crippling and death in cardiovascular disease.Percutaneous coronary intervention(PCI) can significantly reduce inpatient mortality and incidence of complication.But owing to the existence of restenosis,in-stent thrombosis,etc.,recurrent post-PCI cardiovascular events and high repeatability of hospitalization,as well as its crippling rate and mortality, remain a serious threat to the society and the patients' family.Therefore,the apprais...

  19. Computational Analysis on Stent Geometries in Carotid Artery: A Review

    Science.gov (United States)

    Paisal, Muhammad Sufyan Amir; Taib, Ishkrizat; Ismail, Al Emran

    2017-01-01

    This paper reviews the work done by previous researchers in order to gather the information for the current study which about the computational analysis on stent geometry in carotid artery. The implantation of stent in carotid artery has become popular treatment for arterial diseases of hypertension such as stenosis, thrombosis, atherosclerosis and embolization, in reducing the rate of mortality and morbidity. For the stenting of an artery, the previous researchers did many type of mathematical models in which, the physiological variables of artery is analogized to electrical variables. Thus, the computational fluid dynamics (CFD) of artery could be done, which this method is also did by previous researchers. It lead to the current study in finding the hemodynamic characteristics due to artery stenting such as wall shear stress (WSS) and wall shear stress gradient (WSSG). Another objective of this study is to evaluate the nowadays stent configuration for full optimization in reducing the arterial side effect such as restenosis rate after a few weeks of stenting. The evaluation of stent is based on the decrease of strut-strut intersection, decrease of strut width and increase of the strut-strut spacing. The existing configuration of stents are actually good enough in widening the narrowed arterial wall but the disease such as thrombosis still occurs in early and late stage after the stent implantation. Thus, the outcome of this study is the prediction for the reduction of restenosis rate and the WSS distribution is predicted to be able in classifying which stent configuration is the best.

  20. Spontaneous Solitaire™ AB Thrombectomy Stent Detachment During Stroke Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Akpinar, Suha, E-mail: akpinarsuha@hotmail.com; Yilmaz, Guliz, E-mail: glz.yilmaz@hotmail.com [Near East University Hospital, Department of Radiology, Faculty of Medicine (Turkey)

    2015-04-15

    Spontaneous Solitaire™ stent retriever detachment is a rarely defined entity seen during stroke treatment, which can result in a disastrous clinical outcome if it cannot be solved within a critical stroke treatment time window. Two solutions to this problem are presented in the literature. The first is to leave the stent in place and apply angioplasty to the detached stent, while the second involves surgically removing the stent from the location at which it detached. Here, we present a case of inadvertent stent detachment during stroke treatment for a middle cerebral artery M1 occlusion resulting in progressive thrombosis. The detached stent was removed endovascularly by another Solitaire stent, resulting in the recanalization of the occluded middle cerebral artery.

  1. Comparison of the sirolimus-eluting versus paclitaxel-eluting coronary stent in patients with diabetes mellitus: the diabetes and drug-eluting stent (DiabeDES) randomized angiography trial

    DEFF Research Database (Denmark)

    Maeng, Michael; Jensen, Lisette Okkels; Galloe, Anders Michael;

    2008-01-01

    The aim of the present study was to evaluate angiographic late luminal loss after the implantation of sirolimus-eluting Cypher stents and paclitaxel-eluting Taxus stents in patients with diabetes. The study was a Danish multicenter, open-label, randomized trial. One hundred fifty-three patients...... with diabetes with coronary artery disease were randomized to Cypher (n = 76) or Taxus (n = 77) stent implantation. All patients were followed for 8 months. The primary end point was 8-month angiographic in-stent late luminal loss. This primary end point was reduced in the Cypher group compared with the Taxus.......8%) in the Cypher and Taxus groups, respectively (p = 0.25). Definite stent thrombosis was observed in 2 patients (in the Taxus group), no patients had probable stent thrombosis, and 1 patient in each group had possible stent thrombosis. Major adverse cardiac events (cardiac death, myocardial infarction, definite...

  2. Buflomedil Treat Diabetes Combined with Acute Cerebral Thrombosis Effect Observation%丁咯地尔治疗糖尿病合并急性脑血栓形成效果探讨

    Institute of Scientific and Technical Information of China (English)

    李玉博

    2016-01-01

    目的:探究丁咯地尔治疗糖尿病合并急性脑血栓形成的临床价值。方法选取糖尿病合并急性脑血栓形成患者40例(2013年6月-2015年6月)作为该次研究对象,按照患者治疗方法的不同将患者分为2组,对照组患者接受复方丹参治疗,实验组则接受丁咯地尔治疗,对比2组糖尿病合并急性脑血栓形成患者治疗效果的差异性。结果实验组糖尿病合并急性脑血栓形成患者治疗效果(95.00%)优于对照组(70.00%),(P<0.05)。结论丁咯地尔治疗糖尿病合并急性脑血栓形成,可以有效改善患者功能缺损评分,减少患者脑血栓的致残率,对糖尿病合并急性脑血栓形成患者预后的改善十分有益。%Objective To explore the buflomedil clinical value for the treatment of diabetes combined with acute cerebral thrombosis. Methods Select 40 patients with diabetes mellitus complicating acute cerebral thrombosis (June 2013 - June 2015) as the research object, according to the treatment of patients with different divided the patients into two groups, con-trol group patients treated with compound salvia miltiorrhiza, the experimental group received butyl luo to treatment, com-pared two groups of diabetic patients with acute cerebral thrombosis treatment effect. Results In experimental diabetic pa-tients with acute cerebral thrombosis treatment effect (95.00%) than the control group (70.00%),(P< 0.05). Conclusion Bu-flomedil treatment diabetes complicating acute cerebral thrombosis, can effectively improve the function defect scale, reduce the disability, in patients with cerebral thrombosis, to improve the prognosis of diabetic patients with acute cerebral throm-bosis is very good.

  3. A new removable airway stent

    Directory of Open Access Journals (Sweden)

    Tore Amundsen

    2016-09-01

    Full Text Available Background: Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway stent for improved individualised treatment. Methods: To our knowledge, the new airway stent is the world's first knitted and uncovered self-expanding metal stent, which can unravel and be completely removed. In an in vivo model using two anaesthetised and spontaneously breathing pigs, we deployed and subsequently removed the stents by unravelling the device. The procedures were executed by flexible bronchoscopy in an acute and a chronic setting – a ‘proof-of-principle’ study. Results: The new stent was easily and accurately deployed in the central airways, and it remained fixed in its original position. It was easy to unravel and completely remove from the airways without clinically significant complications. During the presence of the stent in the chronic study, granulation tissue was induced. This tissue disappeared spontaneously with the removal. Conclusions: The new removable stent functioned according to its purpose and unravelled easily, and it was completely removed without significant technical or medical complications. Induced granulation tissue disappeared spontaneously. Further studies on animals and humans are needed to define its optimal indications and future use.

  4. PORTAL VEIN THROMBOSIS-ULTRASOUND IMAGING

    Directory of Open Access Journals (Sweden)

    Trajkovska Meri

    2016-07-01

    Full Text Available Portal venous system, apart from the main portal vein, includes its tributaries: superior and inferior mesenteric vein, as well as splenic vein, so the term portal venous thrombosis encompasses a broad spectrum of pathological conditions. Usually, one or more causative factors can be recognized, either local endothelial/ flow disturbances, or systemic inherited /acquired conditions. Portal vein thrombosis can be associated with benign or malignant disorders. Weather we are speaking about acute or chronic thrombosis, the clinical presentation is different. Acute thrombosis can be presented in a wide range, from mild abdominal discomfort to a state of intestinal ischemia and life-threatening infarction. Chronic thrombosis is usually recognized when variceal bleeding or other symptoms of portal hypertension express. Fast and accurate diagnosis sometimes is a life-saving procedure, especially in acute vascular alterations. Recently, due to the improvement of imaging procedures the number of patients with diagnosed portal vein thrombosis is increasingly growing. With a negative predictive value of 98% color Doppler ultrasound is considered as imaging modality of choice in detecting portal vein thrombosis. Based on large studies it is presumed that overall risk of getting portal vein thrombosis during lifetime is 1% in general population, but much bigger 5%-15% in cirrhotic patients. Existence of specific ultrasound criteria, if fulfilled, has ensured that diagnosis of portal vein thrombosis is fast and non-invasive. Procedure is convenient for the patient and healthcare providers, and above all, allows prompt treatment preventing further deterioration.

  5. Non-traumatic thoracic emergencies: CT venography in an integrated diagnostic strategy of acute pulmonary embolism and venous thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Ghaye, Benoit; Dondelinger, Robert F. [Department of Medical Imaging, University Hospital Sart Tilman, Domaine Universitaire du Sart Tilman B35, 4000 Liege (Belgium)

    2002-08-01

    Deep venous thrombosis and pulmonary embolism are the two aspects of venous thrombo-embolism. Investigation of lower limb veins has been part of various diagnostic algorithms in the past 15 years. Recently, the combination of CT venography (CTV) of lower limbs and abdominal veins together with CT angiography of the pulmonary arteries has allowed a complete examination of venous thrombo-embolism in one session. The technical aspects, imaging findings, venous anatomy on CT, interpretative pitfalls, results and advantages of CT venography are reviewed. (orig.)

  6. Neonatal renal vein thrombosis.

    Science.gov (United States)

    Brandão, Leonardo R; Simpson, Ewurabena A; Lau, Keith K

    2011-12-01

    Neonatal renal vein thrombosis (RVT) continues to pose significant challenges for pediatric hematologists and nephrologists. The precise mechanism for the onset and propagation of renal thrombosis within the neonatal population is unclear, but there is suggestion that acquired and/or inherited thrombophilia traits may increase the risk for renal thromboembolic disease during the newborn period. This review summarizes the most recent studies of neonatal RVT, examining its most common features, the prevalence of acquired and inherited prothrombotic risk factors among these patients, and evaluates their short and long term renal and thrombotic outcomes as they may relate to these risk factors. Although there is some consensus regarding the management of neonatal RVT, the most recent antithrombotic therapy guidelines for the management of childhood thrombosis do not provide a risk-based algorithm for the acute management of RVT among newborns with hereditary prothrombotic disorders. Whereas neonatal RVT is not a condition associated with a high mortality rate, it is associated with significant morbidity due to renal impairment. Recent evidence to evaluate the effects of heparin-based anticoagulation and thrombolytic therapy on the long term renal function of these patients has yielded conflicting results. Long term cohort studies and randomized trials may be helpful to clarify the impact of acute versus prolonged antithrombotic therapy for reducing the morbidity that is associated with neonatal RVT.

  7. Microfabrication and nanotechnology in stent design.

    Science.gov (United States)

    Martinez, Adam W; Chaikof, Elliot L

    2011-01-01

    Intravascular stents were first introduced in the 1980s as an adjunct to primary angioplasty for management of early complications, including arterial dissection, or treatment of an inadequate technical outcome due to early elastic recoil of the atherosclerotic lesion. Despite the beneficial effects of stenting, persistent high rates of restenosis motivated the design of drug-eluting stents for delivery of agents to limit the proliferative and other inflammatory responses within the vascular wall that contribute to the development of a restenotic lesion. These strategies have yielded a significant reduction in the incidence of restenosis, but challenges remain, including incomplete repair of the endothelium at the site of vascular wall injury that may be associated with a late risk of thrombosis. A failure of vessel wall healing has been attributed primarily to the use of polymeric stent coatings, but the effects of the eluted drug and other material properties or design features of the stent cannot be excluded. Improvements in stent microfabrication, as well as the introduction of alternative materials may help to address those limitations that inhibit stent performance. This review describes the application of novel microfabrication processes and the evolution of new nanotechnologies that hold significant promise in eliminating existing shortcomings of current stent platforms.

  8. Effect of external stents on prevention of intimal hyperplasia in a canine vein graft model

    Institute of Scientific and Technical Information of China (English)

    ZOU Rong-jiang; ZOU Liang-jian; HUANG Sheng-dong; WANG Yin; HAN Lin; JI Guang-yu; XU Zhi-yun

    2007-01-01

    Background External stents have been used to reduce intimal hyperplasia of vein grafts.The aim of the present study was to define the size of an external stent appropriate for a particular graft by comparing vein grafts with different sizes of external stents.Methods A series of paired trials was performed to compare femoral vein grafts with different sizes of external stents,where 30 modeled canines were equally divided into three groups:6-mm external stent vs non-stent control,4-mm vs 6-mm external stent,and 4-mm vs 8-mm external stent.At day 3 after operation,color Doppler flow imaging(CDFI)was done to observe blood flow in the lumen.Four weeks later,CDFI was re-checked and the veins were harvested,stained and measured.Results All grafts were patent without formation of thrombosis.External stents significantly reduced intimal thickness of the vein grafts with a 6-mm external stent compared with the vein grafts without external stents(P<0.05).The vein grafts with the 4-mm external stent had similar intimal, medial and adventitial thicknesses compared with those with the 6-mm external stent and the 8-mm external stent.Conclusions External stents can reduce intimal hyperplasia of vein grafts.Stents of different diameters exert the similar effect on prevention of intimal hyperplasia.

  9. 急性下肢深静脉血栓形成的微创治疗%Minimally Invasive Therapy in Acute Deep Venous Thrombosis of Lower Extremities

    Institute of Scientific and Technical Information of China (English)

    张希全; 王义平; 潘晶晶; 朱伟; 李长海; 郭锋; 董戈; 张清

    2012-01-01

    Objective To discuss the clinical effect and value of minimally invasive therapy on lower extremity deep venous thrombosis (DVT). Methods The clinical data of 911 patients with acute lower extremity DVT from April 1998 to December 2011 were analyzed retrospectively. There were 489 males, 422 females; the age ranged from 23-86 years old with (58. 72±11. 95) years old. Five hundred and sixty-eight patients occurred on the left leg, 343 patients on the right leg. There were 487 cases of central type, 166 cases of peripheral type,258 cases of mixed type. All the patients were implanted inferior vena cava filter under local anesthesia, then inserted an 8-14 F catheter via the femoral vein of the affected limbs to suck mechanically thrombus. Five hundred and twenty-seven cases of iliofemoral vein thrombus were inserted into sheathing canal with the help of technique of guide wire griped. The guide wire could be plugged into femoral vein, even more far, with the help of sheathing canal. Following the guide wire, a diameter-10 mm balloon catheter was used to pull the thrombus to iliac vein, with the watching of DSA, so it could be sucked from iliac vein. Before sucking thrombus, a diameter-12 mm balloon was put into the confluence of inferior vena cava and iliac vein, in case of thrombus fall off with blood flow to block inferior vena cava. Results Among 911 patients, 423 cases were only treated by sucking thrombus, 275 cases sucking thrombus plus endovascular thrombolysis, 91 cases sucking thrombus plus endovascular thrombolysis plus percutaneous transluminal angioplasty (PTA) , 122 cases sucking thrombus plus endovascular thrombolysis plus PTA plus stenting.the average hospital stay was 7. 5 d.①Discharge success rate: 907 (99. 56%) cases were successful by interventional therapy, 4 (0. 44%) cases were failed. Nine hundred and eleven patients were performed mechanical thrombus suction, which was 556 cases of grade Ⅲ, 142 cases of grade Ⅱ , 213 cases of grade

  10. The Supralimus sirolimus-eluting stent.

    Science.gov (United States)

    Lemos, Pedro A; Bienert, Igor

    2013-05-01

    The use of biodegradable polymeric coatings has emerged as a potential bioengineering target to improve the vascular compatibility of coronary drug-eluting stents (DESs). This review summarizes the main features and scientific facts about the Supralimus sirolimus-eluting stent (Sahajanand Medical Technologies Ltd, Surat, India), which is a biodegradable polymer-based, sirolimus-eluting metallic stent that was recently introduced for routine use in Europe. The novel stent is built on a stainless steel platform, coated with a blend of biodegradable polymers (poly-l-lactide, poly-dl-lactide-co-glycolide and polyvinyl pyrrolidone; coating thickness is 4-5 µm). The active agent is the antiproliferative sirolimus in a dose load of 1.4 µg/mm(2), which is released within 48 days. The Supralimus stent was initially evaluated in the single-arm SERIES-I study, which showed binary angiographic restenosis rates of 0% (in-stent) and 1.7% (in-segment) and an in-stent late lumen loss of 0.09 ± 0.28 mm. The multicenter randomized PAINT trial compared two DESs with identical metallic platforms and biodegradable polymer carriers, but different agents (Infinnium [Sahajanand Medical Technologies Pvt Ltd] paclitaxel-eluting stent or Supralimus sirolimus-eluting stent) against bare stents. After 3 years, the pooled DES population had similar rates of cardiac death or myocardial infarction (9 vs 7.1%; p = 0.6), but a lower risk of repeat interventions (10 vs 29.9%; p < 0.01) than controls with bare stents. The incidence of definite or probable stent thrombosis in the pooled DES group was 2.3% (1st year: 1.8%; 2nd year: 0.4% and 3rd year: 0%). These results demonstrate that the novel Supralimus stents are effective in reducing reintervention, while potentially improving the safety profile by decreasing the risk of late-term thrombosis, even though further studies would be necessary to confirm these findings.

  11. Arterial healing following primary PCI using the Absorb everolimus-eluting bioresorbable vascular scaffold (Absorb BVS) versus the durable polymer everolimus-eluting metallic stent (XIENCE) in patients with acute ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Räber, Lorenz; Onuma, Yoshinobu; Brugaletta, Salvatore

    2015-01-01

    Aims: The Absorb bioresorbable vascular scaffold (Absorb BVS) provides similar clinical outcomes compared with a durable polymer-based everolimus-eluting metallic stent (EES) in stable coronary artery disease patients. ST-elevation myocardial infarction (STEMI) lesions have been associated...... with delayed arterial healing and impaired stent-related outcomes. The purpose of the present study is to compare directly the arterial healing response, angiographic efficacy and clinical outcomes between the Absorb BVS and metallic EES. Methods and results: A total of 191 patients with acute STEMI were...... randomly allocated to treatment with the Absorb BVS or a metallic EES 1:1. The primary endpoint is the neointimal healing (NIH) score, which is calculated based on a score taking into consideration the presence of uncovered and malapposed stent struts, intraluminal filling defects and excessive neointimal...

  12. Ballon angioplasty and stenting for acute ischemic stroke%急性缺血性卒中患者的球囊血管成形和支架置入术治疗

    Institute of Scientific and Technical Information of China (English)

    石明超; 王守春

    2009-01-01

    药物溶栓治疗急性缺血性卒中存在一定的局限性,球囊血管成形和支架置入术已成为急性缺血性卒中治疗的研究热点.文章综述了球囊血管成形和支架置入术治疗急性缺血性卒中的有效性和安全性.%Thrombolytic agents for the treatment of acute ischemic stroke have some limitations. Balloon angioplasty and stenting have become the research hotspot in the treatment of acute ischemic stroke. 1his article reviews the effectiveness and safety of balloon angioplasty and stenting in the treatment of acute ischemic stroke.

  13. Recent developments in drug-eluting coronary stents.

    Science.gov (United States)

    Yildiz, Mustafa; Yildiz, Banu Sahin; Gursoy, Mustafa Ozan; Akin, Ibrahim

    2014-01-01

    The interventional treatment of coronary artery disease was introduced in 1970`s by Andreas Grüntzig. The initial treatment strategy with plain old balloon angioplasty (POBA) was associated with high restenosis rates. The introduction of coronary stents, especially drug-eluting stents (DES) in 2002 has improved the results by lowering the rate of in-stent restenosis from 20-40% in the era of bare-metal stent (BMS) to 6-8%. However, in 2006 with the observation of late stent thrombosis the reputations of DES have decreased. However, improvements in stent design especially antiproliferative agents, polymeric agents as well as stent platforms improved newer generation DES. In controlled trials as well as registries the use of second-generation DES as compared to bare-metal stents (BMS) was associated with better clinical and angiographic results. A further development of these stents with use of biodegradable polymers, polymer-free stents, and biodegradable stents on the basis of poly L-lactide (PLLA) or magnesium resulted in third-generation DES and has been evaluated in preclinical and first clinical trials. However, to date, there is a lack of data comparing these third-generation DES with first- and second-generatrion DES in a large scale.

  14. A Nano-Inspired Multifunctional POSS-PCU Covered Stent: Endothelial Progenitor Cell Capture with Stealth Liposomal Drug Release

    OpenAIRE

    Tan, A. J. K.

    2014-01-01

    The 2 main unresolved issues inherent in coronary stents are in-stent restenosis (ISR) and late stent thrombosis (ST). ISR is largely due to vascular smooth muscle cell (VSMC) proliferation, and ST is attributed to a lack of re-endothelialization. This thesis describes the conceptualization and development of a biofunctionalized polyhedral oligomeric silsesquioxane poly(carbonate-urea) urethane (POSS-PCU) platform, for the express purpose of circumventing ISR and ST. A bare-metal stent is emb...

  15. Endovascular Treatment of Left Iliofemoral Deep Vein Thrombosis Using Urokinase Thrombolysis and Adjunctive Aspiration Thrombectomy

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Sang Hyun; Lee, Do Yun; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    To evaluate the efficacy of adjunctive aspiration thrombectomy for the treatment of iliofemoral deep vein thrombosis (DVT). 24 patients (9 males and 15 females; mean age, 53 years), treated by aspiration thrombectomy were enrolled in this study. The day after undergoing urokinase (UK) thrombolysis, any residual thrombus over a long segment was treated by aspiration thrombectomy using a 12 Fr long sheath. Residual short-segment (< 10 cm) iliac vein thrombus and/or stenosis were treated with a stent. The evaluation of venous patency was conducted by color Doppler ultrasonography, venography and/or computed tomography. The technical and clinical success rates were 100% and 92%, respectively. Twenty-three patients were treated by UK thrombolysis and iliac stent. The overall patency rate at 1, 2 and 3 years was 85%, 82% and 81%, respectively. Over the course of the follow-up period, occlusion was observed in 4 cases (1 acute and 3 chronic cases). Periprocedural complication occurred in 4 cases (17%) in the form of a minimal hematoma or pain on the puncture site as well as a case of pulmonary embolism at one month after treatment. The adjunctive aspiration thrombectomy with conventional thrombolysis and stent placement can be an effective and safe method in the treatment of left iliofemoral DVT

  16. Second- and third-generation drug-eluting coronary stents: progress and safety.

    Science.gov (United States)

    Akin, I; Schneider, H; Ince, H; Kische, S; Rehders, T C; Chatterjee, T; Nienaber, C A

    2011-05-01

    Drug-eluting stents (DES) have revolutionized the treatment of coronary artery disease by reducing the rate of in-stent restenosis from 20-40% with bare-metal stent (BMS) to 6-8% with DES. However, with widespread use of DES, safety concerns have risen due to the observation of late stent thrombosis. With this in mind and better understanding of mechanism and pathophysiology of stent thrombosis, the technological platform, especially innovative anti-restenotic agents, polymeric coatings, and stent platforms, improved with newer DES. Two second-generation DES, the Endeavor zotarolimus-eluting stent (ZES) and the Xience-V everolimus-eluting stent (EES), have provided promising results in both randomized controlled trials (SPIRIT and ENDEAVOR) and registries (E-Five, COMPARE) compared with bare-metal stents (BMS) and first-generation DES. Newer third-generation stent technology, especially biodegradable polymers, polymer-free stents, and biodegradable stents on the basis of poly-L-lactide (PLLA) or magnesium, has been evaluated in preclinical and initial clinical trials. However, despite encouraging initial results, long-term data of large-scale randomized trials as well as registries comparing them to currently approved first- and second-generation DES are still lacking.

  17. Management of a subclavian artery thrombosis causing acute anterior wall infarction and concurrent left arm ischemia in a patient with prior coronary bypass.

    Science.gov (United States)

    Akgüllü, Çağdaş; Eryılmaz, Ufuk; Zencir, Cemil; Güngör, Hasan

    2014-12-01

    We report a 57-year-old patient with acute anterior wall infarction with a history of a coronary baypass graft operation in 2007. He also had concurrent left arm cyanosis and severe pain. He had received diagnosis of pancreatic adenocarcinoma one month previously and had had his first chemotherapy in the previous week with gemcitabine and 5-fluorouracil. After the angiography, a giant thrombus was detected in the proximal left subclavian artery, deteriorating the flows of both left internal mammarian artery (LIMA) to left anterior descending (LAD) coronary artery graft, as well as the left brachial artery. The proximal subclavian artery was stented and good flow was achieved. Through the LIMA, the distal part of LAD, which was totally obstructed with probable distal thrombus embolization, was reached and a percutaneous balloon angioplasty performed. However, the no-reflow phenomenon was observed in distal LAD. A Fogarty traction of thrombus was performed successfully for the revascularization of the left arm. Approximately 30 minutes after the procedure, both angina and ST segment elevation in ECG were resolved under unfractioned heparin and nitroglycerin infusion. However, the patient died due to sepsis seven days after admission to hospital. In the literature, there are only a few previous reports on this rare clinical entity. The eitology, presentation, and the possible management strategies of this clinical entity is presented in this report.

  18. [Absorbable coronary stents. New promising technology].

    Science.gov (United States)

    Erbel, Raimund; Böse, Dirk; Haude, Michael; Kordish, Igor; Churzidze, Sofia; Malyar, Nasser; Konorza, Thomas; Sack, Stefan

    2007-06-01

    Coronary stent implantation started in Germany 20 years ago. In the beginning, the progress was very slow and accelerated 10 years later. Meanwhile, coronary stent implantation is a standard procedure in interventional cardiology. From the beginning of permanent stent implantation, research started to provide temporary stenting of coronary arteries, first with catheter-based systems, later with stent-alone technology. Stents were produced from polymers or metal. The first polymer stent implantation failed except the Igaki-Tamai stent in Japan. Newly developed absorbable polymer stents seem to be very promising, as intravascular ultrasound (IVUS) and optical coherence tomography have demonstrated. Temporary metal stents were developed based on iron and magnesium. Currently, the iron stent is tested in peripheral arteries. The absorbable magnesium stent (Biotronik, Berlin, Germany) was tested in peripheral arteries below the knee and meanwhile in the multicenter international PROGRESS-AMS (Clinical Performance and Angiographic Results of Coronary Stenting with Absorbable Metal Stents) study. The first magnesium stent implantation was performed on July 30, 2004 after extended experimental testing in Essen. The magnesium stent behaved like a bare-metal stent with low recoil of 5-7%. The stent struts were absorbed when tested with IVUS. Stent struts were not visible by fluoroscopy or computed tomography (CT) as well as magnetic resonance imaging (MRI). That means, that the magnesium stent is invisible and therefore CT and MRI can be used for imaging of interventions. Only using micro-CT the stent struts were visible. The absorption process could be demonstrated in a patient 18 days after implantation due to suspected acute coronary syndrome, which was excluded. IVUS showed a nice open lumen. Stent struts were no longer visible, but replaced by tissue indicating the previous stent location. Coronary angiography after 4 months showed an ischemia-driven target lesion

  19. Open triple-branched stent graft applied to patient of acute type a aortic dissection with Aberrant Right Subclavian Artery

    OpenAIRE

    Guo, Changfa; Zhu, Kai; Xu, Demin; Wang, Chunsheng

    2013-01-01

    A 57-year-old Chinese male patient presented with Standford type A aortic dissection with an aberrant right subclavian artery (ARSA). At operation, the ascending aorta was replaced by a mono–branch vascular prosthesis with the branch bypassing to the ARSA; the triple-branched stent graft was inserted into the true lumen of the arch and proximal descending aorta (covering the origin of the ARSA) with each sidearm graft being positioned into the aortic branches; and then its proximal end was su...

  20. Early local intracoronary platelet activation after drug-eluting stent placement

    Institute of Scientific and Technical Information of China (English)

    Ailiman Mahemuti; Nicolas Meneveau; Marie-France Seronde; Francois Schiele; Mariette Mercier; Evelyne Racadot; Jean-Pierre Bassand

    2007-01-01

    Background Early local platelet activation after coronary intervention identifies patients at increased risk of acute stent thrombosis (AST). However, early changes in platelet activation in coronary circulation following drug-eluting stent (DES) implantation have never been reported.Methods In a prospective study of 26 consecutive elective stable angina patients, platelet activation was analyzed by measuring soluble glycoprotein V (sGPV) and P-selectin (CD62P) before and after implantation of either DES or bare metal stent (BMS). All patients were pretreated with clopidogrel (300 mg loading dose) and aspirin (75 mg orally) the day before the procedure. Blood samples were drawn from the coronary ostium and 10 - 20 mm distal to the lesion site.Results Consistent with the lower baseline clinical risk, the levels of CD62P and sGPV were within normal reference range, both in the coronary ostium and distal to the lesion before percutaneous coronary intervention (PCl) procedure.The levels of CD62P and sGPV did not change significantly (CD62P: (31.1 ± 9.86) ng/ml vs (29.5 ± 9.02) ng/ml, P=0.319and sGPV: (52.4 ± 13.5) ng/ml vs (51.8 ± 11.7) ng/ml, P=0.674, respectively) after stent implantation when compared with baseline. Changes in these platelet activation markers did not differ between stent types.Conclusions Intracoronary local platelet activation does not occur in stable angina patients before and immediately following DES implantation when dual anti-platelet is administered.

  1. Thrombosis is reduced by inhibition of COX-1, but unaffected by inhibition of COX-2, in an acute model of platelet activation in the mouse.

    Directory of Open Access Journals (Sweden)

    Paul C Armstrong

    Full Text Available BACKGROUND: Clinical use of selective inhibitors of cyclooxygenase (COX-2 appears associated with increased risk of thrombotic events. This is often hypothesised to reflect reduction in anti-thrombotic prostanoids, notably PGI(2, formed by COX-2 present within endothelial cells. However, whether COX-2 is actually expressed to any significant extent within endothelial cells is controversial. Here we have tested the effects of acute inhibition of COX on platelet reactivity using a functional in vivo approach in mice. METHODOLOGY/PRINCIPAL FINDINGS: A non-lethal model of platelet-driven thromboembolism in the mouse was used to assess the effects of aspirin (7 days orally as control diclofenac (1 mg.kg(-1, i.v. and parecoxib (0.5 mg.kg(-1, i.v. on thrombus formation induced by collagen or the thromboxane (TX A(2-mimetic, U46619. The COX inhibitory profiles of the drugs were confirmed in mouse tissues ex vivo. Collagen and U46619 caused in vivo thrombus formation with the former, but not latter, sensitive to oral dosing with aspirin. Diclofenac inhibited COX-1 and COX-2 ex vivo and reduced thrombus formation in response to collagen, but not U46619. Parecoxib inhibited only COX-2 and had no effect upon thrombus formation caused by either agonist. CONCLUSIONS/SIGNIFICANCE: Inhibition of COX-1 by diclofenac or aspirin reduced thrombus formation induced by collagen, which is partly dependent upon platelet-derived TXA(2, but not that induced by U46619, which is independent of platelet TXA(2. These results are consistent with the model demonstrating the effects of COX-1 inhibition in platelets, but provide no support for the hypothesis that acute inhibition of COX-2 in the circulation increases thrombosis.

  2. Prospective, multi-center evaluation of a silicon carbide coated cobalt chromium bare metal stent for percutaneous coronary interventions: Two-year results of the ENERGY Registry

    Energy Technology Data Exchange (ETDEWEB)

    Erbel, Raimund, E-mail: erbel@uk-essen.de [Department of Cardiology, University of Duisburg-Essen, Essen (Germany); Eggebrecht, Holger [Cardioangiological Center Bethanien (CCB), Frankfurt (Germany); Roguin, Ariel [Department of Cardiology, Rambam Medical Center, Haifa (Israel); Schroeder, Erwin [Division of Cardiovascular Medicine, Cliniques Universitaires de Mont-Godinne, Yvoir (Belgium); Philipp, Sebastian [Department Internal Medicine/Cardiology, Elbe Klinikum Stade, Stade (Germany); Heitzer, Thomas [Department of Cardiology, Heart Center Dortmund, Dortmund (Germany); Schwacke, Harald [Department of Internal Medicine, Diakonissen-Stiftungs- Krankenhaus Speyer (Germany); Ayzenberg, Oded [The Heart Institute, Kaplan Medical Center, Rehovot (Israel); Serra, Antonio [Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España (Spain); Delarche, Nicolas [Cardiology unit, Pau General Hospital, Pau (France); Luchner, Andreas [Department of Internal Medicine/Cardiology, Universitätsklinikum Regensburg (Germany); Slagboom, Ton [Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam (Netherlands)

    2014-11-15

    Background: Novel bare metal stents with improved stent design may become a viable alternative to drug-eluting stents in certain patient groups, particularly, when long-term dual antiplatelet therapy should be avoided. Purpose: The ENERGY registry aimed to assess the safety and benefits of a cobalt–chromium thin strut bare metal stent with a passive coating in a large series of patients under real-world conditions. Methods and materials: This prospective registry recruited 1016 patients with 1074 lesions in 48 centers from April to November 2010. The primary endpoint was the rate of major adverse cardiac events (MACEs), a composite of cardiac death, myocardial infarction and clinically driven target lesion revascularization. Results: More than half of the lesions (61.0%) were type A/B1 lesions, mean lesion length was 14.5 ± 6.5 mm and mean reference vessel diameter 3.2 ± 0.5 mm. MACE rates at 6, 12 and 24 months were 4.9%, 8.1% and 9.4%, target lesion revascularization rates 2.8%, 4.9% and 5.4% and definite stent thrombosis rates 0.5%, 0.6% and 0.6%. Subgroups showed significant differences in baseline and procedural characteristics which did not translate into significantly different clinical outcomes. Specifically, MACE rates at 24 months were 13.5% in diabetics, 8.6% in small stents and 9.6% in acute coronary syndrome patients. Conclusion: The population of ENERGY reflects real-world conditions with bare metal stents being mainly used in simple lesions. In this setting, percutaneous coronary intervention using a cobalt–chromium thin strut bare metal stent with a passive coating showed very good results up to 24 months. (ClinicalTrials.gov:NCT01056120) Summary for annotated table of contents: The ENERGY international registry evaluated the safety and benefits of a cobalt–chromium thin strut bare metal stent with passive coating in 1016 patients under real-world conditions until 2 years. Results were encouraging with a low composite rate of cardiac death

  3. The clinical analysis for 43 cases of acute superior mesenteric artery thrombosis confirmed by angiography and surgery

    Institute of Scientific and Technical Information of China (English)

    刘文徽

    2014-01-01

    Objective To investigate the clinical manifestations and mortality related risk factors in patients with acute superior mesenteric artery embolism(ASMAE).Methods Clinical data of forty-three confirmed ASMAE patients in the PLA General Hospital from June 2002 to June 2012were retrospectively analyzed.All patients were classified into a survival group(28 cases)and a death group(15 cases)according to the prognosis.The prognosis associated factors were further analyzed.Results The study

  4. Acute Unilateral Blindness from Superior Ophthalmic Vein Thrombosis: A Rare Presentation of Nephrotic Syndrome from Class IV Lupus Nephritis in the Absence of Antiphospholipid or Anticardiolipin Syndrome

    Science.gov (United States)

    Baidoun, Firas; Issa, Rommy; Al-Turk, Bashar

    2015-01-01

    Patients with systemic lupus erythematosus (SLE) are at high risk of arterial and venous thrombosis secondary to anti-phospholipid antibodies. Herein, we are presenting an interesting case of venous thrombosis in a patient with SLE in the absence of anti-phospholipid antibodies. PMID:26858847

  5. Comparison of neointimal morphology of in-stent restenosis with sirolimus-eluting stents versus bare metal stents: virtual histology-intravascular ultrasound analysis.

    Science.gov (United States)

    Yamamoto, Yoshihiro; Otani, Hajime; Iwasaka, Junji; Park, Haengnam; Sakuma, Takao; Kamihata, Hiroshi; Iwasaka, Toshiji

    2011-09-01

    Sirolimus-eluting stents (SES) have reduced the incidence of restenosis and target lesion revascularization compared to bare metal stents (BMS). However, inhibition of endothelialization and neointimal formation after SES implantation may produce vulnerable plaques. The present study compared the neointimal morphology of in-stent restenosis (ISR) between SES and BMS using virtual histology-intravascular ultrasound (VH-IVUS). Thirty ISR lesions (SES n = 15, BMS n = 15) demonstrated by coronary angiography in 30 patients with stable angina pectoris were analyzed with VH-IVUS between 6 months to 3 years after stent implantation. Tissue maps were reconstructed from radiofrequency data using VH-IVUS software. ISR lesions after SES implantation consisted of a significantly increased necrotic core (NC) compared to BMS (12.9 vs. 5.6% of neointimal volume, p stent thrombosis after SES implantation.

  6. Long-term effectiveness and safety of sirolimus drug-eluting stents

    Directory of Open Access Journals (Sweden)

    Bikkina M

    2011-08-01

    Full Text Available Mahesh Bikkina, Jayanth KoneruSt Joseph Regional Medical Center, Paterson, Seton Hall University, NJ, USAAbstract: The root cause of coronary artery disease is atherosclerosis, ie, intraluminal narrowing (stenosis of the arteries that supply blood to tissues of the heart. The introduction of the drug-eluting stent over the past decade has revolutionized the field of interventional cardiology. It is used extensively in clinical practice for the treatment of coronary artery disease. The first drug-eluting stent to receive US Food and Drug Administration approval was the sirolimus-eluting stent. Recently, two other stent analogs of sirolimus were approved, ie, the zotarolimus-eluting stent and the everolimus-eluting stent. However, concern has arisen in recent years about the long-term safety and efficacy of drug-eluting stents, due to the occurrence of late adverse clinical events, such as stent thrombosis. This review focuses on clinical studies that have been performed with the sirolimus-eluting stent or its analogs. We discuss the pharmacology, safety, and various therapeutic options that exist when choosing stents for coronary artery disease. Our aim is to provide a thorough review of the long-term efficacy and safety of sirolimus drug-eluting stents, and also to discuss currently approved and promising investigational drug-eluting stents, in an effort to provide insight into how these stents are currently evolving and generate further investigation in this area.Keywords: drug-eluting stent, long-term safety, sirolimus 

  7. [Recanalization of lower-limb deep veins as an index of efficacy of treatment for acute venous thrombosis].

    Science.gov (United States)

    Kuznetsov, M R; Sapelkin, S V; Boldin, B V; Leont'ev, S G; Neskhodimov, L A

    2016-01-01

    The authors analysed the results of examination and treatment of a total of 102 patients presenting with iliofemoral venous thrombosis. During treatment, ultrasonographic duplex scanning was used to determine the localization of the proximal margin of thrombotic masses, the time of appearing of the first signs of recanalization, its degree at various levels of the deep venous system, as well as alteration in velocity of the venous blood flow in the deep veins of the lower limbs. The dynamics of clinical symptoms was assessed by the visual analogue scale. Clinical and instrumental examination was performed on day 10, and then 1, 3, 6 and 12 months after the beginning of treatment. The patients were subdivided into three groups. Group One comprised 38 patients receiving therapy with low-molecular-weight heparin (enoxaprin) followed by switching to indirect anticoagulants (warfarin) combined with venotonics (original highly-purified diosmin 600 mg once daily). Group Two was composed of 33 patients receiving rivaroxaban at a dose of 15 mg twice daily for 3 weeks, followed by 20 mg once daily. Group Tree patients (n=31) were also given rivaroxaban according to the above-described standard regimen but in combination with venotonics (original highly-purified diosmin 600 mg once daily). The obtained findings showed that prescribing rivaroxaban to patients from the first day of the disease made it possible to considerably improve and accelerate the processes of restoration of patency of deep veins of lower extremities as compared with the patients taking vitamin K antagonists (warfarin). In patients receiving rivaroxaban, there were no cases of residual thrombotic occlusions of the major veins, and recanalization in three fourths of patients was assessed as good and in the remaining third as moderate. In the warfarin group, occlusion in the iliac veins was noted to persist persisted in 13% of patients, with good recanalization observed only in half of the patients. Addition

  8. Magnetizable stent-grafts enable endothelial cell capture

    Science.gov (United States)

    Tefft, Brandon J.; Uthamaraj, Susheil; Harburn, J. Jonathan; Hlinomaz, Ota; Lerman, Amir; Dragomir-Daescu, Dan; Sandhu, Gurpreet S.

    2017-04-01

    Emerging nanotechnologies have enabled the use of magnetic forces to guide the movement of magnetically-labeled cells, drugs, and other therapeutic agents. Endothelial cells labeled with superparamagnetic iron oxide nanoparticles (SPION) have previously been captured on the surface of magnetizable 2205 duplex stainless steel stents in a porcine coronary implantation model. Recently, we have coated these stents with electrospun polyurethane nanofibers to fabricate prototype stent-grafts. Facilitated endothelialization may help improve the healing of arteries treated with stent-grafts, reduce the risk of thrombosis and restenosis, and enable small-caliber applications. When placed in a SPION-labeled endothelial cell suspension in the presence of an external magnetic field, magnetized stent-grafts successfully captured cells to the surface regions adjacent to the stent struts. Implantation within the coronary circulation of pigs (n=13) followed immediately by SPION-labeled autologous endothelial cell delivery resulted in widely patent devices with a thin, uniform neointima and no signs of thrombosis or inflammation at 7 days. Furthermore, the magnetized stent-grafts successfully captured and retained SPION-labeled endothelial cells to select regions adjacent to stent struts and between stent struts, whereas the non-magnetized control stent-grafts did not. Early results with these prototype devices are encouraging and further refinements will be necessary in order to achieve more uniform cell capture and complete endothelialization. Once optimized, this approach may lead to more rapid and complete healing of vascular stent-grafts with a concomitant improvement in long-term device performance.

  9. Repair of Chronic Aneurysmal Aortic Dissection Using a Stent Graft and an Amplatzer(®) Vascular Plug: A Case Study.

    Science.gov (United States)

    Kanaoka, Yuji; Ohki, Takao; Ozawa, Hirotsugu

    2017-02-01

    We report a case in which a stent graft and an Amplatzer(®) vascular plug (AVP) were effective for the treatment of chronic aneurysmal aortic dissection. The patient was a 52-year-old man. At 45 years of age, he developed acute aortic dissection, for which he underwent surgery 4 times with prosthetic graft replacement in the abdominal aorta, descending thoracic, ascending aorta (without neck branch reconstruction), and thoracoabdominal aorta with the reconstruction of the celiac, superior mesenteric, and bilateral renal arteries. At the time of thoracoabdominal aortic surgery, strong adhesion was evident, particularly in the thoracoabdominal area. The adhesion was dissected in a part of the chest, and prosthetic graft replacement was performed the following day. Subsequently, the dissection of the residual distal aortic arch enlarged, and the patient was examined at our hospital. Computed tomography (CT) revealed a small intimal tear at the site of anastomosis distal to the graft in the ascending aorta and a large intimal tear in the descending thoracic aorta with a maximum diameter of 67 mm. Furthermore, open repair by prosthetic graft replacement seemed difficult; therefore, treatment with stent grafting was considered. Because the prosthetic graft in the abdomen was extremely tortuous, stent-graft insertion via the femoral artery seemed to be impossible. The planned treatment involved the placement of a thoracic stent graft using the chimney technique which included reconstruction of the brachiocephalic artery and left common carotid arteries using chimney stent graft and coverage of the left subclavian artery. The thoracic stent graft was planned to be inserted via the abdominal prosthetic graft site because the abdominal prosthetic graft was crooked and was located close to the body surface. However, a small intimal tear distal to the graft in the ascending aorta which had not been revealed by intraoperative aortography was detected by the selective

  10. Severe Lower Limb Ischemia by Massive Arterial Thrombosis Revealing an Acute Myeloid Leukemia Needing for Leg Amputation: Clinical and Emotional Aspects Related to the Communication with the Patient and His Family

    Science.gov (United States)

    Taormina, Calogero; Mosa, Clara; Di Marco, Floriana; Valentino, Fabrizio; Trizzino, Angela; Guadagna, Paola; Talarico, Francesco

    2016-01-01

    Large vessel thrombosis is a very rare clinical presentation of acute leukemia, generally associated with coagulopathy, usually characteristic of acute promyelocytic leukemia. A 13- year-old boy with a previously undiagnosed acute myeloid leukemia was referred to our hospital with acute ischemia of the right lower limb due to occlusion of the right external iliac artery, treated with emergency double surgical thromboembolectomy and chemotherapy. The thrombotic complication resulted in leg amputation. Now the boy is well in complete remission, with a good social integration and quality of life, 30 months after completing treatment. The report highlights the crucial role of early diagnosis and subsequent chemotherapy in avoiding amputation. We particularly focused critical and emotional aspects related to the communication about the leg amputation with the patient and his family. PMID:28058104

  11. Application of GlycoProtein lib/Ⅲa antagonist(Integrilin) in peri-percutaneous transluminal catheter angioplasty and stent implantation in Chinese

    Institute of Scientific and Technical Information of China (English)

    王建安; 孙勇

    2002-01-01

    Objective: to report the application of GPⅡb/Ⅲa antagonist (Integrilin) in peri-opercuta-neous transluminal catheter angioplasty and stent implantation in Chinese. Method: Twenty-one patients who underwent percutaneous transluminal catheter angioplasty(PTCA) and stent implantation were included. After arterial puncture, integrilin was injected at dose of 180ug/kg, and then main-tained at 2μg/kg·min for 18 hours. Asprine, plavix(clopidogrel) and heparin were used at the same time. ACT, PT, KPTT and blood routine were routinely monitored. Results: All sheaths were drawn out 2 to 4 hours after the procedure.. There was no severe complication such as hematoma, acute and subacute thrombosis in coronary artery, or thrombocytopenia. ACT returned to less than 150 aeconds in 2 hours in 15 patients; in 4 hours in 6 patients. There was no significant difference between the preand post-procedure value of PT and platelet count. KPTT was significantly higher than pre-procedure value at 2 hours after the procedure . No recurrence of angina pectoris was observed in the first nine patients within one year follow-up, and no restenosis occurred in stents in the five patients who had coronary angiography one year later. Conclusion: Application of GPⅡb/Ⅲa receptor antagonist (Integrilin)in peri-parcutaneous transluminal catheter angioplasty and stent implantation in combination with aspirin and plavix could significantly reduce the dosage and duration of heparin with benefit of shortening the indwelling time of sheaths, but did not increase risk of bleeding or lead to thrombosis in stent.

  12. Application of GlycoProtein IIb/IIIa antagonist( Integrilin) in peri-percutaneous transluminal catheter angioplasty and stent implantation in Chinese

    Institute of Scientific and Technical Information of China (English)

    王建安; 孙勇

    2002-01-01

    Objective: to report the application of GPIIb/IIIa antagonist (Integrilin) in peri-percutaneous transluminal catheter angioplasty and stent implantation in Chinese. Method: Twenty-one patients who underwent percutaneous transluminal catheter angioplasty(PTCA) and stent implantation were included. After arterial puncture, integrilin was injected at dose of 180ug/kg, and then maintained at 2μg/kgmin for 18 hours. Asprine, plavix(clopidogrel) and heparin were used at the same time. ACT, PT, KPTT and blood routine were routinely monitored. Results: All sheaths were drawn out 2 to 4 hours after the procedure.. There was no severe complication such as hematoma, acute and subacute thrombosis in coronary artery, or thrombocytopenia. ACT returned to less than 150 seconds in 2 hours in 15 patients; in 4 hours in 6 patients. There was no significant difference between the pre- and post-procedure value of PT and platelet count. KPTT was significantly higher than pre-procedure value at 2 hours after the procedure .No recurrence of angina pectoris was observed in the first nine patients within one year follow-up, and no restenosis occurred in stents in the five patients who had coronary angiography one year later. Conclusion: Application of GPIIb/IIIa receptor antagonist (Integrilin) in peri-percutaneous transluminal catheter angioplasty and stent implantation in combination with aspirin and plavix could significantly reduce the dosage and duration of heparin with benefit of shortening the indwelling time of sheaths, but did not increase risk of bleeding or lead to thrombosis in stent.

  13. Firebird stent for the treatment of patients with coronary heart disease: short-term clinical outcome

    Institute of Scientific and Technical Information of China (English)

    Hai-Ying Wang; Jin-Bo Wang; Feng Liang; Da-Yi Hu; Ming-Ying Wu; Tian-Chang Li; Chu-Zhong Tang; Ji-Yun Wang; Chang-Lin Lu

    2009-01-01

    Objective The sirolimus-eluting stent (SES) has dramatically reduced the rate ofrestenosis in comparison to that with the bare-metal stent (BMS).This study aimed to evaluate the short-term efficacy and safety of Firebird stent implantation for patients with coronary heart disease (CHD). Methods From Apri12006 through July 2007, 155 patients (mean age 58.93~10.27 years) with CHD were implanted with Firebird stent or Cypher select stent at Daxing Hospital. Patients were followed up for one year. All-cause mortality, major adverse cardiac events (MACE, including cardiac death, myocardial infarction, recurrence of angina pectoris, heart failure, revascularization, and adverse arrhythmia) and stent thrombosis were compared between the 2 groups. Results Of the 155 consecutive patients, 147 patients were revascularized completely. Of these patients, 48 (with 59 lesions) were treated with Firebird stent, 59 patients (with 75 lesions) with Cypher select stent. The demographic characteristics were similar in the 2 groups. All the angiographic and procedural results were not significantly different between the 2 groups. All-cause mortality, myocardial infarction, recurrence of angina pectoris, MACE and stent thrombosis were almost identical between the 2 groups before discharge, at 6 months and at one year .Conclusion The short-term efficacy and safety of Firebird stent are similar to that of the cypher select stent for the treatment of patients with CHD.

  14. Discrepant ratios of arterial versus venous thrombosis in hemophilia A as compared with hemophilia B.

    Science.gov (United States)

    Girolami, Antonio; Bertozzi, Irene; de Marinis, Giulia Berti; Tasinato, Valentina; Sambado, Luisa

    2014-04-01

    The occurrence of thrombosis in patients with congenital bleeding disorders represents an exceptional event. Hemophilia A and hemophilia B patients have been showed to present both arterial and venous thrombosis (85 cases of arterial thrombosis and 34 cases of venous thrombosis). The great majority of arterial thrombosis are myocardial infarction or other acute coronary syndromes, whereas the majority of venous thrombosis are deep vein thrombosis and/or pulmonary embolisms. However there are discrepancies in the proportion of arterial and venous thrombosis seen in hemophilia A versus hemophilia B. The ratio of arterial versus venous thrombosis in hemophilia A is 3.72 whereas that for hemophilia B is 1.12. This indicates that arterial thrombosis is more frequent in hemophilia A as compared to hemophilia B and the opposite is true for venous thrombosis. The potential significance of this discrepancy is discussed.

  15. Drug-eluting stents below the knee.

    Science.gov (United States)

    Bosiers, M; Deloose, K; Callaert, J; Keirse, K; Verbist, J; Peeters, P

    2011-04-01

    The fear that early thrombosis and late luminal loss due to intimal hyperplasia formation potentially leads to insufficient long-term patency rates can explain the reluctance on implanting stents in small diameter below-the-knee (BTK) arteries. Drug-eluting stent (DES) technology was developed to prevent early thrombosis and late luminal loss to potentially improve long-term patency rates. Currently, the first level 1 evidence from prospective, randomized, controlled DESTINY and ACHILLES studies indicate that the implantation of DES in short lesion lenghts in the infrapopliteal vasculature leads to favorable outcomes with high primary patency rates. This makes that primary DES placement can be recommended as treatment strategy in short BTK-lesions.

  16. Acute Aortic Dissection Mimicking STEMI in the Catheterization Laboratory: Early Recognition Is Mandatory

    Directory of Open Access Journals (Sweden)

    Alessio Arrivi

    2012-01-01

    Full Text Available Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction. Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting. Recognition of these occurrences in the catheterization laboratory is important to look immediately for surgery.

  17. Direct coronary stent implantation: safety, feasibility, and predictors of success of the strategy of direct coronary stent implantation.

    Science.gov (United States)

    Laarman, G; Muthusamy, T S; Swart, H; Westendorp, I; Kiemeneij, F; Slagboom, T; van der Wieken, R

    2001-04-01

    , and 70.2 +/- 11.2 vs. 73.2 +/- 11.2, P = NS). Stent loss occurred in five (2.0%) cases, with successful retrieval in four. One stent was lost permanently in a small branch of the radial artery. Post-percutaneous coronary intervention (post-PCI) myocardial infarction occurred in four (1.6%) patients. There were no other in-hospital events. Six-month-follow up information was obtained in 99% of patients. Subacute stent thrombosis was noted in four (1.6%) cases. Target vessel-related myocardial infarction rate was 3.2%, of which half was caused by subacute stent thrombosis. The overall reintervention rate (coronary artery bypass grafting or PCI) was 9.7%. Target lesion revascularization by PCI occurred in only 4.0%. At 6 months, overall mortality was 2.0%, of which 1.2% was due to coronary events. Direct stent implantation is safe and feasible in the majority of cases with low rate of complications. Unfavorable factors include circumflex lesion, more complex lesion morphology, and increasing length of stent. Severity of stenosis does not appear to be of predictive value. Long-term outcome is favorable with a low target lesion revascularization rate.

  18. THE RUSSIAN DATA OF INTERNATIONAL ENDORSE REGISTER (EPIDEMIOLOGIC INTERNATIONAL DAY FOR THE EVALUATION OF PATIENTS AT RISK OF VENOUS THROMBOSIS IN ACUTE HOSPITAL CARE SETTING

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2008-01-01

    Full Text Available Aim. To estimate a risk factor frequency of venous thromboembolism (VTE in patients urgently hospitalized in hospitals, and also to estimate of patients part having effective prevention of VTE.Material and methods. ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk of Venous Thrombosis in Acute Hospital Care Setting is the international register. Patients of 40 years and older hospitalised in therapeutic departments as well as patients of 18 years and older hospitalised in surgical departments (358 hospitals in 32 countries were included in the register. The case history analysis of all patients was performed for estimation of risk VTE and evaluation of preventive therapy quality according to American College of Chest Physicians (ACCP Recommendation 2004.Results. Totally 68 183 patients (including 30 827 (45% surgical patients and 37 356 (55% therapeutic patients were enrolled in Global ENDORSE Register. Russian centers enrolled 4 788 patients (including 2 829 (59% surgical patients and 1 959 (41% therapeutic patients. Totally 35 329 (51,8% patients enrolled in Global ENDORSE Register (64,4% of surgical patients (19 842 and 41,5% of therapeutic patients (15 487 had VTE risks. In Russia 2 188 enrolled patients (45,7% had VTE risks (52% of surgical patients (1 470 and 36,7% of therapeutic patients (718. Totally 17 732 (50,2% patients enrolled in Global Register ENDORSE and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. In Russia 521 (23,8% patients enrolled in Global ENDORSE Register and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. It is more than 2 times less in comparison with world level (р<0.001.Conclusion. There are a lot of patients with VTE risks in hospitals. It is necessary to improve preventive therapy of VTE due to better hospital management and more active use of АССР Recommendations 2004.

  19. Acute Superior Mesenteric Venous Thrombosis: Transcatheter Thrombolysis and Aspiration Thrombectomy Therapy by Combined Route of Superior Mesenteric Vein and Artery in Eight Patients

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Shuofei, E-mail: yangshuofei@gmail.com; Liu, Baochen, E-mail: 306446264@qq.com; Ding, Weiwei, E-mail: dingwei-nju@hotmail.com; He, Changsheng, E-mail: hechsh@163.com; Wu, Xingjiang, E-mail: wuxingjiang@sohu.com; Li, Jieshou, E-mail: lijieshou2013@sohu.com [Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University (China)

    2015-02-15

    PurposeTo assess the feasibility, effectiveness, and safety of catheter-directed thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery (SMV+SMA) for acute superior mesenteric venous thrombosis (ASMVT).MethodsThis retrospective study reviewed eight ASMVT patients with transcatheter direct thrombolysis and aspiration thrombectomy therapy via SMV and indirect thrombolysis via SMA during a period of 14 months. The demographics, etiology, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. Anatomic and imaging classification of location and extent of thrombus at diagnosis and degree of thrombus lysis were described.ResultsTechnical success was achieved with substantial improvement in symptoms and thrombus resolution after thrombolytic therapy in all patients. The local urokinase infusion by SMA and SMV was performed for 5–7 (6.13 ± 0.83) and 7–15 (12 ± 2.51) days. Anticoagulation was performed catheter-directed and then orally throughout hospitalization and after discharge. Four patients required delayed localized bowel resection after thrombolytic therapy with no death. Thrombolytic therapy was not interrupted despite minor bleeding at the puncture site in two patients and sepsis in another two postoperatively. Nearly complete removal of thrombus was demonstrated by contrast-enhanced CT scan and portography before discharge. Patients were discharged in 10–27 (19.25 ± 4.89) days after admission. No recurrence developed during the follow-up of 10–13 (12.13 ± 0.99) months.ConclusionsCatheter-directed thrombolytic and aspiration therapy via SMV+SMA is beneficial for ASMVT in avoiding patient death, efficient resolving thrombus, rapid improving symptoms, reversing extensive intestinal ischemia, averting bowel resection, or localizing infarcted bowel segment and preventing short bowel syndrome.

  20. Long-term effectiveness and safety of sirolimus drug-eluting stents

    Science.gov (United States)

    Bikkina, Mahesh; Koneru, Jayanth

    2011-01-01

    The root cause of coronary artery disease is atherosclerosis, ie, intraluminal narrowing (stenosis) of the arteries that supply blood to tissues of the heart. The introduction of the drug-eluting stent over the past decade has revolutionized the field of interventional cardiology. It is used extensively in clinical practice for the treatment of coronary artery disease. The first drug-eluting stent to receive US Food and Drug Administration approval was the sirolimus-eluting stent. Recently, two other stent analogs of sirolimus were approved, ie, the zotarolimus-eluting stent and the everolimus-eluting stent. However, concern has arisen in recent years about the long-term safety and efficacy of drug-eluting stents, due to the occurrence of late adverse clinical events, such as stent thrombosis. This review focuses on clinical studies that have been performed with the sirolimus-eluting stent or its analogs. We discuss the pharmacology, safety, and various therapeutic options that exist when choosing stents for coronary artery disease. Our aim is to provide a thorough review of the long-term efficacy and safety of sirolimus drug-eluting stents, and also to discuss currently approved and promising investigational drug-eluting stents, in an effort to provide insight into how these stents are currently evolving and generate further investigation in this area. PMID:22915938

  1. Retrograde Tempofilter II{sup TM} Placement within the Superior Vena Cava in a Patient with Acute Upper Extremity Deep Venous Thrombosis: the Filter Stands on Its Head

    Energy Technology Data Exchange (ETDEWEB)

    Yim, Nam Yeol [The Armed Forces Yangju Hospital, Yangju (Korea, Republic of); Chang, Nam Kyu; Lim, Jae Hoon; Kim, Jae Kyu [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2011-02-15

    The Tempofilter II is a widely used temporary vena cava filter. Its unique design, which includes a long tethering catheter with a subcutaneous anchor, facilitates the deployment and retrieval of the device. Despite this, the Tempofi lter II has been used only in the inferior vena cava of patients with lower extremity deep venous thrombosis. In this article, we present a case of superior vena cava filtering using the Tempofilter II in patients with upper extremity deep venous thrombosis

  2. ANALYSIS OF OUTPATIENT PHYSICIANS, PRESCRIPTION OF DISAGGREGANT THERAPY FOR PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION AND/OR CORONARY ANGIOPLASTY WITH STENT IMPLANTATION WITHIN THE RECVAD REGISTRY

    Directory of Open Access Journals (Sweden)

    A. V. Zagrebelnyi

    2015-01-01

    Full Text Available Objective: to estimate the quality of antiaggregants therapy in patients with coronary heart disease in outpatient settings. Materials and methods. The data of the retrospective outpatient RECVAD registry (3690 patients who lived in Ryazan and its Region and had evidence in their outpatient medical records for one of the diagnoses, such as coronary heart disease, hypertension, chronic heart failure, atrial fibrillation, or their concurrence, were used. Forty­nine patients after acute myocardial infarction (AMI and/or percutaneous coro­ nary interventions (PCI with stenting ≤ 1 year before their inclusion in the registry, who were to undergo dual antiaggregant therapy (DAT according to current clinical guidelines (CG, were identified among 427 patients after AMI and/or PCI with coronary angioplasty. Contra­ indications to DAT were simultaneously revealed and a relationship of the use of therapy to their presence was compared. Results. Among the 49 patients who had indications for DAT that was used in 15 (30.6 % cases and that was not in 3 (6.1 % patients in the presence of contraindications, 25 (51.0 % did not receive DAT in the absence of contraindications and 6 (12.3 % patients received the therapy in the presence of contraindications. Conclusion. DAT prescribed by outpatient physicians does not always meet the current CG. There are cases of not using DAT in the presence of obvious indications for DAT and, on the contrary, those of its use in the presence of contraindications. 

  3. Symptomatic stent cast.

    LENUS (Irish Health Repository)

    Keohane, John

    2012-02-03

    Biliary stent occlusion is a major complication of endoscopic stent insertion and results in repeat procedures. Various theories as to the etiology have been proposed, the most frequently studied is the attachment of gram negative bacteria within the stent. Several studies have shown prolongation of stent patency with antibiotic prophylaxis. We report the case of stent occlusion from a cast of a previously inserted straight biliary stent; a "stent cast" in an 86-year-old woman with obstructive jaundice. This was retrieved with the lithotrypter and she made an uneventful recovery. This is the first reported case of a biliary stent cast.

  4. Symptomatic stent cast.

    Science.gov (United States)

    Keohane, John; Moore, Michael; O'Mahony, Seamus; Crosbie, Orla

    2008-02-01

    Biliary stent occlusion is a major complication of endoscopic stent insertion and results in repeat procedures. Various theories as to the etiology have been proposed, the most frequently studied is the attachment of gram negative bacteria within the stent. Several studies have shown prolongation of stent patency with antibiotic prophylaxis. We report the case of stent occlusion from a cast of a previously inserted straight biliary stent; a "stent cast" in an 86-year-old woman with obstructive jaundice. This was retrieved with the lithotrypter and she made an uneventful recovery. This is the first reported case of a biliary stent cast.

  5. Usefulness of flexible covered stent in malignant colorectal obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Jee Hee; Kang, Sung Gwon; Kim, Hyung Jin; Noh, Hong Gi; Woo, Jae Hong; Suh, Chang Hae [Inha Univ. Hospital, Inchon (Korea, Republic of)

    1998-07-01

    To evaluate the usefulness of flexible covered stent in the treatment of acute colorectal obstruction secondary to colorectal carcinoma. Materials and Methods : Flexible covered stents were placed in 11 patients with clinical and radiologic signs of acute colonic obstruction secondary to colorectal carcinoma. The purposes of stent insertion were pre-operative bowel preparation in seven patients and palliative treatment in four. A fistula was present in two;in one this was between the proximal jejunum and colon, and the other was rectovaginal. The usefulness of stent insertion for the purpose of preoperative bowel preparation was evaluated according to the feasibility and status of bowel preparation, as decided by the operator. Palliative treatment for the relief of symptoms of acute bowel obstruction was evaluated according to the number and amount of defecation,bowel dilatation in simple abdomen radiography, and the presence of complications. Results : Bowel preparation for the purpose of preoperative bowel cleansing was easy in seven patients;the fecal materials remaining in the colon presented no problems during surgery. In one of four patients palliative treatment involved a colostomy;this was due to recurrent stent obstruction by fecal materials after three months, and in two other patients there was stent obstruction after two and five months, respectively. The stent in one of four patients who underwent palliative treatment was removed because of stent migration three days after insertion;the stents in two patients with fistulas covered the fistulas successfully. Complications after stent insertion were anal pain in three patients, anal bleeding in three and stent migration in one. Conclusion : The flexible covered stent was an effective device for the relief of acute colonic obstruction secondary to malignant rectosigmoid neoplasia. It allowed for single-stage operation and covered the fistula. We believe however that for further evaluation of the

  6. A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction.

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2013-04-01

    The use of self-expanding metal stents as a bridge to surgery in the setting of malignant colorectal obstruction has been advocated as an acceptable alternative to emergency surgery. However, concerns about the safety of stenting have been raised following recent randomized studies.

  7. [Treatment of renal vein thrombosis associated with nephrotic syndrome].

    Science.gov (United States)

    Funami, M; Takaba, T; Tanaka, H; Murakami, A; Kadokura, M; Hori, G; Ishii, J

    1988-06-01

    Renal vein thrombosis is a rare entity in which true incidence is unknown. The disease occurs most frequently in patients with nephrotic syndrome, but it also can occur in the presence of other hypercoagulable state. Two cases of renal vein thrombosis with nephrotic syndrome which were treated by thrombectomy are reported here. One patient was successfully treated by renal vein and inferior vena cava thrombectomy before developing severe pulmonary embolism. The other was treated by renal vein thrombectomy by which fatal shock was able to be prevented. In those cases, immediate operation was indicated, primarily to prevent additional, possibly fatal, pulmonary embolism and also to improve perfusion of the kidney. In the hope of salvaging the kidney, thrombectomy may be the treatment of choice for acute renal vein thrombosis, complication of pulmonary embolism and inferior vena cava thrombosis, right renal vein thrombosis without collateral flow and acute renal vein thrombosis with shock.

  8. Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients

    Energy Technology Data Exchange (ETDEWEB)

    Schmelter, Christopher, E-mail: christopher.schmelter@klinikum-ingolstadt.de; Raab, Udo, E-mail: udo.raab@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany); Lazarus, Friedrich, E-mail: friedrich.lazarus@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Nephrology (Germany); Ruppert, Volker, E-mail: volker.ruppert@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Vascular Surgery (Germany); Vorwerk, Dierk, E-mail: dierk.vorwerk@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany)

    2015-08-15

    PurposeThe study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.Materials and Methods63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5 %), followed by complications of angioplasty with vessel rupture or dissection (31.8 %).ResultsA high rate of procedural success was achieved (98.5 %). The most frequent location of the deployed stent-graft was the draining vein (66.7 %). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5 % at 6 month, 31.3 % at 12 month and 19.2 % at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1 %), followed by stenosis at the AV access (29.5 %) and the deployed stent-graft (23.5 %).ConclusionRe-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.

  9. Drug-eluting stents in renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Zaehringer, M. [Marienhospital Stuttgart, Department of Radiology, Stuttgart (Germany); Pattynama, P.M.T. [Erasmus MC-University Medical Center Rotterdam, Rotterdam (Netherlands); Talen, A. [genae associates nv, Antwerp (Belgium); Sapoval, M. [Hopital Europeen Georges Pompidou, Service de Radiologie Cardio-Vasculaire, Paris (France); Inserm U 780 epidemiologie Cardio Vasculaire, Paris (France)

    2008-04-15

    Because of higher acute and long-term success rates compared with balloon angioplasty alone, percutaneous stent implantation has become an accepted therapy for the treatment of atherosclerotic renal artery stenosis. Restenosis rates after successful renal stent placement vary from 6 up to 40%, depending on the definition of restenosis, the diameter of the treated vessel segment and comorbidities. The safety and efficacy of drug-eluting stents for the treatment of renal-artery stenosis is poorly defined. The recently published GREAT study is the only prospective study, comparing bare-metal and sirolimus-coated low profile stent systems in renal artery stenosis, showing a relative risk reduction of angiographic binary in-stent restenosis by 50%. This is an opinion paper on indications, current treatment options and restenosis rates following renal artery stenting and the potential use of drug-eluting stents for this indication. (orig.)

  10. A clinical evaluation of endoscopically placed self-expanding metallic stents in patients with acute large bowel obstruction

    DEFF Research Database (Denmark)

    Pommergaard, H C; Vilmann, Peter; Jakobsen, H L;

    2009-01-01

    in 71.4% of the benign cases with a mortality rate of 28,6%. CONCLUSIONS: Placement of SEMS for acute large bowel obstruction with malignant etiology is an effective and safe procedure with low mortality and morbidity. However results for benign obstructions are questionable and more research is needed...

  11. Risk Factors for Thrombosis

    Institute of Scientific and Technical Information of China (English)

    包承鑫

    2002-01-01

    @@ Thrombotic disease is a multifactorial disease, multiple interactions between genetic and environmental factors contribute to the development of the disease.This review summarized some risk factors reported for arterial thrombosis and venous thrombosis in recent few years.

  12. Deep Vein Thrombosis

    Science.gov (United States)

    Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body. Most deep vein ... the condition is called thrombophlebitis. A deep vein thrombosis can break loose and cause a serious problem ...

  13. Experiment Study of The Preventive Effects of Valsartan Eluting Stent on In- stent Restenosis

    Institute of Scientific and Technical Information of China (English)

    陈津; 陈纪言; 周颖玲; 李光; 罗建方; 余丹青; 张励庭; 黄文晖

    2003-01-01

    Objectives Background -Neointima hyperplasia and arterial re modeling are themain mechanisms of restenosis after percutaneoustransluminal coronary angioplasty. The successful useof coronary stents neutralizes the ac ute elastic recoiland improves the remodeling mode with reducingrestenosis rate by 10 % . But the in - stent neointimahyperplasia becomes more severe. This study aims toset up model of in - stent restenosis in vivo, and to e-valuate the preventive role of implantation of valsartaneluting stent for restenosis. Methods and ResultsTwenty -two male New Zealand white rabbits were di-vided into control group and valsartan group. In-travascular ultrasonic (IVUS) results showed the in-trastent neointimal areas of the control group werelarger than those of the valsartan group ( P < 0.01 ) .The minimal lumen area of control group was smallerthan that of the valsartan group ( P < 0.01). Angiog-raphy results showed the normal lumen diameters weresimilar between two groups ( P> 0.05) . The lumenstenosis rates compared with the normal diameters ofthe valsartan group were significantly improved overthat of the control group ( P < 0. 05) . It was compa-rable to the IVUS analysis. There were no cases of a-neurysm or thrombosis. Conclusions Valsartan e-luting stents produced a significant inhibition ofneointimal hyperplasia and luminal encroachment inrabbits without obviously producing any serious side -effects. These results demonstrate the potential thera-peutic benefit of valsartan eluting stents in the pre-vention and treatment of human coronary restenosis.

  14. Everolimus-eluting stents: update on current clinical studies

    Directory of Open Access Journals (Sweden)

    Allocco DJ

    2011-07-01

    Full Text Available Dominic J Allocco, Anita A Joshi, Keith D DawkinsBoston Scientific Corporation, Natick, MA, USAAbstract: Everolimus-eluting stents (EES have become the most commonly implanted coronary stents worldwide. This review describes and analyzes the clinical data supporting the use of EES, focusing primarily on published, randomized, controlled trials. Everolimuseluting stents have been shown to have less restenosis, stent thrombosis, and periprocedural myocardial infarction compared with earlier generation paclitaxel-eluting stents (PES. Lower rates of adverse events for EES compared with PES were generally seen in all subgroups, with the notable exception of patients with diabetes mellitus. There have been fewer, randomized, clinical trials comparing EES with either sirolimus-eluting stents or zotarolimus-eluting stents, although very good results with EES have been observed in the trials that have been performed. Recent clinical trial data suggest that this excellent safety and efficacy profile is maintained in a next-generation EES designed to have improved mechanical properties and radiopacity.Keywords: drug-eluting stents, everolimus, Xience V, Promus, Promus ElementVideo Abstract:  http://dvpr.es/allocco  

  15. Acute arterial occlusion - kidney

    Science.gov (United States)

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidney can often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury or trauma to ...

  16. Computational Modelling of Multi-folded Balloon Delivery Systems for Coronary Artery Stenting: Insights into Patient-Specific Stent Malapposition.

    Science.gov (United States)

    Ragkousis, Georgios E; Curzen, Nick; Bressloff, Neil W

    2015-08-01

    Despite the clinical effectiveness of coronary artery stenting, percutaneous coronary intervention or "stenting" is not free of complications. Stent malapposition (SM) is a common feature of "stenting" particularly in challenging anatomy, such as that characterized by long, tortuous and bifurcated segments. SM is an important risk factor for stent thrombosis and recently it has been associated with longitudinal stent deformation. SM is the result of many factors including reference diameter, vessel tapering, the deployment pressure and the eccentric anatomy of the vessel. For the purpose of the present paper, virtual multi-folded balloon models have been developed for simulated deployment in both constant and varying diameter vessels under uniform pressure. The virtual balloons have been compared to available compliance charts to ensure realistic inflation response at nominal pressures. Thereafter, patient-specific simulations of stenting have been conducted aiming to reduce SM. Different scalar indicators, which allow a more global quantitative judgement of the mechanical performance of each delivery system, have been implemented. The results indicate that at constant pressure, the proposed balloon models can increase the minimum stent lumen area and thereby significantly decrease SM.

  17. Patient with Recent Coronary Artery Stent Requiring Major Non Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Usha Kiran

    2009-01-01

    Full Text Available Anaesthesiologists are increasingly confronted with patients who had a recent coronary artery stent implanta-tion and are on dual anti-platelet medication. Non cardiac surgery and most invasive procedures increase the risk of stent thrombosis especially when procedure is performed early after stent implantation. Anaesthesiologist faces the dilemma of stopping the antiplatelet therapy before surgery to avoid bleeding versus perioperative stent thrombosis. Individualized approach should be adopted with following precautions. i In a surgical patient with a history of percu-taneous coronary intervention (PCI and coronary stent, determine the date of the procedure, the kind of the stent inserted and the possibility of complications during the procedure. ii Consider all patents with a recent stent implan-tation (e.g. less than three months for bare metal stents and less than one year for brachytherapy or drug eluting stents as high risk and consult an interventional cardiologist. iii Any decision to postpone surgery, continue, modify or discontinue antiplatelet regimes must involve the cardiologist, anaesthesiologist, surgeon, haematologist and the intensivist to balance the risk and benefit of each decision.

  18. Postpartum renal vein thrombosis.

    Science.gov (United States)

    Rubens, D; Sterns, R H; Segal, A J

    1985-01-01

    Renal vein thrombosis in adults is usually a complication of the nephrotic syndrome. Rarely, it has been reported in nonnephrotic women postpartum. The thrombosis may be a complication of the hypercoagulable state associated with both the nephrotic syndrome and pregnancy. Two postpartum patients with renal vein thrombosis and no prior history of renal disease are reported here. Neither patient had heavy proteinuria. In both cases, pyelonephritis was suspected clinically and the diagnosis of renal vein thrombosis was first suggested and confirmed by radiologic examination. Renal vein thrombosis should be considered in women presenting postpartum with flank pain.

  19. Comparison of Bare metal Vs Drug eluting stents for in-stent Restenosis among Diabetics

    Directory of Open Access Journals (Sweden)

    Kakhaber Etsadashvili

    2011-06-01

    Full Text Available Background: Diabetes mellitus is associated with an increased risk of restenosis, stent thrombosis, and death afterpercutaneous coronary interventions. Little is known about the late outcome of patients with diabetes mellitus whoreceive drug-eluting stents (DES or bare metal stents (BMS.Methods: From January 2008 to January 2010, six patients with DES and 20 with BMS, ISR were identified at ourinstitution.Results: The median age of our diabetic cohort was 63 years, and 87 of the patients were male. For two years, ratesof repeat target-vessel revascularization were significantly lower among diabetic patients treated with DEScompared with those treated with BMS (5.8% vs. 17.0%, p=0.003.Conclusions: DES is effective among diabetic patients in substantially reducing the need for repeat TVR.

  20. Coronary Stent Materials and Coatings: A Technology and Performance Update.

    Science.gov (United States)

    O'Brien, Barry; Zafar, Haroon; Ibrahim, Ahmad; Zafar, Junaid; Sharif, Faisal

    2016-02-01

    This paper reviews the current state of the art for coronary stent materials and surface coatings, with an emphasis on new technologies that followed on from first-generation bare metal and drug-eluting stents. These developments have been driven mainly by the need to improve long term outcomes, including late stent thrombosis. Biodegradable drug-eluting coatings aim to address the long term effects of residual durable polymer after drug elution; the SYNERGY, BioMatrix, and Nobori stents are all promising devices in this category, with minimal polymer through the use of abluminal coatings. Textured stent surfaces have been used to attached drug directly, without polymer; the Yukon Choice and BioFreedom stents have some promising data in this category, while a hydroxyapatite textured surface has had less success. The use of drug-filled reservoirs looked promising initially but the NEVO device has experienced both technical and commercial set-backs. However this approach may eventually make it to market if trials with the Drug-Filled Stent prove to be successful. Non-pharmacological coatings such as silicon carbide, carbon, and titanium-nitride-oxide are also proving to have potential to provide better performance than BMS, without some of the longer term issues associated with DES. In terms of biological coatings, the Genous stent which promotes attachment of endothelial progenitor cells has made good progress while gene-eluting stents still have some practical challenges to overcome. Perhaps the most advancement has been in the field of biodegradable stents. The BVS PLLA device is now seeing increasing clinical use in many complex indications while magnesium stents continue to make steady advancements.

  1. Safety and effectiveness of the Genous™ endothelial progenitor cell-capture stent in the first year following ST-elevation acute myocardial infarction: A single center experience and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Pereira-da-Silva, Tiago, E-mail: tiagopsilva@sapo.pt; Bernardes, Luís; Cacela, Duarte; Fiarresga, António; Sousa, Lídia; Patrício, Lino; Ferreira, Rui Cruz

    2013-11-15

    Purpose: The Genous™ stent (GS) is designed to accelerate endothelization, which is potentially useful in the pro-thrombotic environment of ST-elevation acute myocardial infarction (STEMI). We aimed to evaluate the safety and effectiveness of the GS in the first year following primary percutaneous coronary intervention (PCI) and to compare our results with the few previously published studies. Methods and Materials: All patients admitted to a single center due to STEMI that underwent primary PCI using exclusively GS, between May 2006 and January 2012, were enrolled. The primary study endpoints were major adverse cardiac events (MACEs), defined as the composite of cardiac death, acute myocardial infarction and target vessel revascularization, at one and 12 months. Results: In the cohort of 109 patients (73.4% male, 59 ± 12 years), 24.8% were diabetic. PCI was performed in 116 lesions with angiographic success in 99.1%, using 148 GS with median diameter of 3.00 mm (2.50–4.00) and median length of 15 mm (9–33). Cumulative MACEs were 2.8% at one month and 6.4% at 12 months. Three stent thromboses (2.8%), all subacute, and one stent restenosis (0.9%) occurred. These accounted for the four target vessel revascularizations (3.7%). At 12 months, 33.9% of patients were not on dual antiplatelet therapy. Conclusions: GS was safe and effective in the first year following primary PCI in STEMI, with an apparently safer profile comparing with the previously published data. Summary: We report the safety and effectiveness of the Genous™ stent (GS) in the first year following primary percutaneous coronary intervention in ST-elevation acute myocardial infarction. A comprehensive review of the few studies that have been published on this subject was included and some suggest a less safe profile of the GS. Our results and the critical review included may add information and reinforce the safety and effectiveness of the GS in ST-elevation in acute myocardial infarction.

  2. Acute leukemia complicating deep venous thrombosis:5 cases report and literature review%急性白血病合并深静脉血栓5例报道并文献复习

    Institute of Scientific and Technical Information of China (English)

    胡成琳; 曾翰庆; 罗云; 娄世锋

    2015-01-01

    Objective To analyze the clinical characteristics ,diagnosis and treatment of acute leukemia complicating deep ve‐nous thrombosis(DVT) to deepen the cognition on this complication .Methods The clinical data of consecutive patients with acute leukemia were performed the retrospective analysis .The occurrence situation of deep venous thrombosis was investigated and the a‐broad related literatures were reviewed .Results A total of 116 cases of acute leukemia in our department from July 2011 to March 2014 were treated ,in which 85 cases were acute myeloid leukemia and 31 cases were acute lymphoblastic leukemia;5 cases devel‐oped DVT with the proportion of 4 .31% (5/116) .Of these cases ,3 cases were acute promyelocytic leukemia and 2 cases were acute lymphoblastic leukemia .Conclusion The occurrence rate of DVT in the patients with acute promyelocytic leukemia is relatively higher ,if the patients have the corresponding symptom ,timely diagnosis and treatment should be conducted .%目的:分析急性白血病合并深静脉血栓患者的临床特点,加深对此合并症的认识。方法回顾分析重庆医科大学附属第二医院血液科连续收治急性白血病患者的临床资料,调查深静脉血栓发生情况,并复习国外相关文献。结果该科于2011年7月至2014年3月间共收治急性白血病患者116例,其中急性髓细胞白血病85例,急性淋巴细胞白血病31例;共有5例患者发生深静脉血栓,占4.31%(5/116)。5例患者中急性早幼粒细胞白血病3例,急性淋巴细胞白血病2例。结论急性早幼粒细胞白血病患者深静脉血栓发生率相对较高,如有相应症状应及时诊治。

  3. Catheter directed thrombolysis for deep vein thrombosis during the first trimester of pregnancy: two case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Kwun, Woo Hyung; Suh, Bo Yang [College of Medicine, Yeungnam University, Daegu (Korea, Republic of); Park, Kyeong Seok [Yeungnam University, Medical Center, Daegu (Korea, Republic of)

    2008-02-15

    Anticoagulation with heparin has been the standard management therapy of deep vein thrombosis during pregnancy. Pregnancy is generally considered as a contraindication for thrombolysis. However, anticoagulation therapy alone does not protect the limbs from post-thrombotic syndrome and venous valve insufficiency. Catheter-directed thrombolysis, combined with angioplasty and stenting, can remove the thrombus and restore patency of the veins, resulting in prevention of post-thrombotic syndrome and valve insufficiency. We report successful catheter-directed thrombolysis and stenting in two early gestation patients with a deep vein thrombosis of the left lower extremity.

  4. [Safety of magnetic resonance imaging after coronary stenting].

    Science.gov (United States)

    Sinitsyn, V E; Stukalova, O V; Kupriianova, O M; Ternovoĭ, S K

    2007-01-01

    Magnetic resonance imaging (MRI) is contraindicated to some patients with certain types of metallic devices and implants (e.g. cerebral surgical clips, defibrillators). There are some controversies concerning safety of MRI in patients with metallic coronary stents in cases when MRI examination is performed earlier then one month after stent implantation. Analysis of published data has shown that MRI performed with systems having field strength up to 3 Tesla does not cause migration and heating of both bare and coated stent and is not associated with increased risk of coronary artery thrombosis. MRI can be performed safely in first days after coronary stent implantation. Small local artifacts on MRI images do not influence interpretation of the data (except for cases of coronary magnetic resonance angiography).

  5. Long-term efficacy and safety of domestic drug-eluting stents in patients with acute coronary syndrom%急性冠脉综合征患者植入国产药物支架的长期疗效和安全性分析

    Institute of Scientific and Technical Information of China (English)

    姚海木; 孙同文; 张晓娟; 万有栋; 付新; 沈德良; 张金盈; 李凌

    2015-01-01

    efficacy and safety of domestic drug-eluting stents (DES) in patients with acute coronary syndrome (ACS) following percutaneous coronary intervention (PCI).Methods All patients with ACS treated with successful PCI from July 2009 to December 2010 were included in this study.Patients were excluded from analysis if they were implanted with bare metal stents or different kinds of stents (domestic and imported DES) simultaneously.Clinical,laboratory,angiographic and procedural data were collected.Clinical follow-up was done through patient visits,telephone interview,and medical record review and adverse cardiac events were recorded.The patients were divided into two groups according to different stents implanted:domestic DES and imported DES.Comparisons between continuous variables were made using the Student t-test or Wilcoxon rank-sum test.Categorical data were tested using x2 test or the Fisher exact test.Multivariate logistic regression analysis was performed to identify independent predictors of events.Cumulative survival curves were constructed using the Kaplan-Meier method and comparisons made using log-rank tests.All statistical analyses were performed using SPSS 17.0 software,and a two-tailed P value of < 0.05 was considered statistically significant.Results (1) There were 1683 patients enrolled in the analysis and 1558 (92.6%) of them were successfully followed-up.Mean follow-up time was (29.1 ±5.9) months.There were 130 (8.3%) cases subjected to major adverse cardiovascular events (MACE),including 32 (2.1%) cases with cardiac death,16 (1%) cases with re-myocardial infarction,and 94 (6%) cases with revascularization.(2) The rates of all cause death,cardiac death,re-infarction,revascularization,in-stent restenosis,in-stent thrombosis and MACE were not significantly different between the two groups (all P > 0.05).(3) Multivariate logistic regression revealed that diabetes mellitus (OR =1.75,95% CI:1.09-2.82,P =0.021),vascular numbers of PCI (OR =2

  6. Mechanism of nano silver stents in the treatment of acute cholangitis of severe type and the antibacterial property of nano silver stents%纳米银支架治疗重症胆管炎的机制及抗菌性研究

    Institute of Scientific and Technical Information of China (English)

    呼增吉; 贾长库; 韩霖; 符誉; 黄小龙

    2015-01-01

    目的:研究内镜下纳米银支架治疗急性重症胆管炎(ACST)的机制及纳米银支架的抗菌性。方法将20头猪随机分为纳米银支架组(n=8)、普通支架组(n=8)和对照组(n=4)。对照组采用内镜下逆行胆管造影(ERC),胆总管内注入大肠杆菌,乳头口用钛夹夹闭,封闭乳头。支架组在造模成功后行ERC+支架置入,支架末端在乳头口处以钛夹固定。观察术后猪的一般情况,分别于术前、术后1d、3d、5d采集猪血检测其白细胞计数、谷丙转氨酶(ALT)、碱性磷酸酶(ALP)、血清胆红素(TB)、血清肿瘤坏死因子(TNF-α)和白细胞介素-1(IL-1),观察猪死亡后的胆管病理改变。结果三组猪术前的各项观察指标比较差异均无统计学意义(P>0.05);术后对照组的白细胞及分类、ALT、ALP、TB、TNF-α和IL-1水平均逐步上升,且在各时点均明显高于两支架组,差异均有统计学意义(P<0.05);纳米银支架组和普通支架组在术后第五天白细胞计数及分类、血清TNF-α和IL-1比较差异均有统计学意义(P<0.05)。结论细菌感染和胆道梗阻是ACST的主要病因,内镜下置入支架治疗ACST,微创有效,纳米银支架有抗菌性。%Objective To study the mechanism of nano silver stents in the treatment of acute cholangitis of severe type (ACST) and the antibacterial property of nano silver stents under endoscope. Methods Twenty pigs were randomly divided into nano silver stent group (n=8), ordinary stent group (n=8) and control group (n=4). The control group was treated by endoscopic retrograde biliary imaging (ERC), followed by injecting E. coli through bile duct and enclosing papilla with titanium clips. The nano silver stent group and ordinary stent group were treated by ERC com-bined with stent implantation, followed by enclosing papilla with titanium clips. The peripheral blood samples were collected pre-operatively and at 1 day, 3 day, 5 day post

  7. [Edge effect and late thrombosis -- inevitable complications of vascular brachytherapy?].

    Science.gov (United States)

    Schiele, T M; Staber, L; Kantlehner, R; Pöllinger, B; Dühmke, E; Theisen, K; Klauss, V

    2002-11-01

    Restenosis is the limiting entity after percutaneous coronary angioplasty. Vascular brachytherapy for the treatment of in-stent restenosis has been shown to reduce the repeat restenosis rate and the incidence of major adverse events in several randomized trials. Besides the beneficial effects, brachytherapy yielded some unwanted side effects. The development of new stenoses at the edges of the target lesion treated with radiation is termed edge effect. It occurs after afterloading brachytherapy as well as after implantation of radioactive stents. It is characterized by extensive intimal hyperplasia and negative remodeling. As contributing factors the axial dose fall-off, inherent to all radioactive sources, and the application of vessel wall trauma by angioplasty have been identified. The combination of both factors, by insufficient overlap of the radiation length over the injured vessel segment, has been referred to as geographic miss. It has been shown to be associated with a very high incidence of the edge effect. Avoidance of geographic miss is strongly recommended in vascular brachytherapy procedures. Late thrombosis after vascular brachytherapy is of multifactorial origin. It comprises platelet recruitment, fibrin deposition, disturbed vasomotion, non-healing dissection and stent malapposition predisposing to turbulent blood flow. The strongest predictors for late thrombosis are premature discontinuation of antiplatelet therapy and implantation of new stents during the brachytherapy procedure. With a consequent and prolonged antiplatelet therapy, the incidence of late thrombosis has been reduced to placebo levels. Edge effect and late thrombosis represent unwanted side effects of vascular brachytherapy. By means of a thorough treatment planning and prolonged antiplatelet therapy their incidences can be largely reduced. With regard to the very favorable net effect, they do not constitute relevant limitations of vascular brachytherapy.

  8. Ultrasonographic diagnosis of acute superior mesenteric venous thrombosis%急性肠系膜上静脉血栓形成的超声诊断

    Institute of Scientific and Technical Information of China (English)

    陈顺平; 胡元平; 陈丽霞

    2011-01-01

    目的:探讨急性肠系膜上静脉血栓形成的超声诊断价值。方法回顾性分析17例手术病理、CT及临床随访证实的急性肠系膜上静脉血栓形成患者的临床资料及超声影像特点。结果 17例急性肠系膜上静脉血栓形成的超声影像学表现中,9例肠系膜上静脉内可见低回声及无血流信号或(和)血流信号充盈缺损,4例门静脉或(和)脾静脉内可见低回声及无血流信号和血流信号充盈缺损,2例肠管扩张及肠壁增厚,2例可见腹腔积液。超声对急性肠系膜上静脉血栓形成诊断准确率为65% (11/17)。根据肠系膜上静脉血栓形成时门静脉或(和)脾静脉是否同时受累其被分为大血管型(10例)和小血管型(7例)。超声对大血管型和小血管型急性肠系膜上静脉血栓形成的诊断准确率分别为90%(9/10)和29%(2/7),两者差异有统计学意义(x2=3.41,P<0.05)。结论超声检查对急性肠系膜上静脉血栓形成有较高的诊断价值,对大血管型急性肠系膜上静脉血栓形成的诊断率更高。%Objective To investigate the diagnosis of acute superior mesenteric venous thrombosis(MVT) by ultrasonography. Methods Seventeen patients with MVT were confirmed by operation or CT scanning and followed-up, whose ultrasonographic features were analyzed retrospectively. Results Ultrasonographic features of seventeen patients with MVT were enlarged superior mesenteric vein filled with hypoecho without flow signals( n =9) ,portal vein and(or) splenic vein filled with hypoecho without flow signals (n =4), intestine wall thickening and intestine distension( n =2) and ascites( n =2). The accuracy of ultrasonographic examination for SMV was 65% (11/17). According to MVT with or without splenic or portal vein involvement,MVT were been classified as two type:large vessel type(n =10) and small vessel type(n =7). The accuracy of ultrasonographic examination for large vessel type and small vessel

  9. Acute limb ischemia secondary to radiation-induced arteritis: case report

    Directory of Open Access Journals (Sweden)

    Jose Emerson dos Santos Souza

    2013-09-01

    Full Text Available Radiation-induced arteritis is a rare but well-known complication of radiotherapy. This report describes the case of a 34-year-old woman with uterine cervical cancer who was diagnosed with left iliofemoral deep vein thrombosis (DVT 2 years after radiotherapy, and 2 months later, during the treatment of DVT with effective anticoagulation, developed an episode of acute arterial ischemia of the left lower limb secondary to a long subocclusive lesion of the external iliac artery. The patient was treated with angioplasty and stenting of the lesion and recovered uneventfully after the endovascular procedure.

  10. Absence of gender disparity in short-term clinical outcomes in patients with acute ST-segment elevation myocardial infarction undergoing irolimus-eluting stent based primary coronary intervention: a report from Shanghai Acute Coronary Event (SACE) Registr

    Institute of Scientific and Technical Information of China (English)

    ZHANG Qi; LIAO Min-lei; HU Jian; SHEN Wei-feng; QIU Jian-ping; ZHANG Rui-yan; LI Yi-gang; HE Ben; JIN Hui-gen; ZHANG Jun-feng; WANG Xiao-long; JIANG Li

    2010-01-01

    Background Randomized, controlled trials have demonstrated the superiority of sirolimus-eluting stent (SES) implantation during primary percutaneous coronary intervention (PCI), as opposed to bare-metal stents, in patients with ST-elevation myocardial infarction (STEMI). This study aimed to test the hypothesis that clinical benefits of SES treatment were independent of gender in this setting.Methods A total of 2042 patients with STEMI undergoing SES-based primary PCI were prospectively enrolled into Shanghai Acute Coronary Event (SACE) registry (1574 men and 468 women). Baseline demographics, angiographic and PCI features, and in-hospital and 30-day major adverse cardiac events (MACE) were analyzed as a function of gender. Results Compared with men, women were older and more frequently had hypertension, diabetes, and hypercholesterolemia. Use of platelet glycoprotein IIb/IIIa receptor inhibitor (GPI, 65.5% vs. 62.2%, P=0.10) and procedural success rate (95.0% vs. 94.2%, P=0.52) were similar in both genders. In-hospital death and MACE occurred in 3.8% and 7.6%, and 4.5% and 8.1% in the male and female patients, respectively (all P >0.05). At 30-day follow-up, survival (94.3% vs. 93.8%, P=0.66) and MACE-free survival (90.2% vs. 89.3%, P=0.52) did not significantly differ between men and women. After adjustment for differences in patient demographics, angiographic and proceduralfeatures, there were no significant difference in either in-hospital (OR=0.77, 95%C/ of 0.48 to 1.22, P=0.30) or 30-day mortality (OR=1.28, 95%C/ of 0.73 to 2.23, P=0.38) between women and men.Conclusion Despite more advanced age and clustering of risk factors in women, female patients with STEMI treated by SES-based primary PCI had similar in-hospital and short-term clinical outcomes as their male counterparts.

  11. 急性肠系膜上静脉血栓形成35例分析%Acute Superior Mesenteric Venous Thrombosis:An Analysis of 35 Patients

    Institute of Scientific and Technical Information of China (English)

    李保松; 何向辉; 戴向晨; 朱理玮

    2011-01-01

    Objective To discuss the etiology, manifestations, diagnosis and therapy of acute superior mesenteric venous thrombosis. Methods Of all thirty-five patients with acute superior mesenteric venous thrombosis, twenty-six patients were treated medically by anticoagulant and thrombolytic therapy. Nine patients under surgical management were treated by partial resection of the small intestine and after operation thrombolytic therapies were administrated. Results Twenty-two patients in anticoagulant and thrombolytic therapy group were cured. Five patients showed recurrence. Four of them needted surgical intervention and one patient died after surgery. Nine patients received emergency surgical treatment, eight of them survived while one died.Conclusion The main causes of acute superior mesenteric venous thrombosis are abdominal surgery, hypercoagulation disorders and portal hypertension. Appropriate use of abdominal enhanced CT examination, early diagnosis and anticoagulant thrombolytic therapy are crucial for better therapeutic results. An appropriate timed surgery with removal of necrotic bowel adequately and postoperative anticoagulation therapy are keys to reduce morality.%目的:探讨急性肠系膜上静脉血栓形成的病因、临床表现及诊断治疗.方法:35例急性肠系膜上静脉血栓形成患者中26例确诊后给予抗凝溶栓治疗.9例确诊后即行手术治疗,均行小肠部分切除术,术后继续抗凝治疗.结果:抗凝溶栓组26例中22例治愈,5例出院后于两年内复发再次入院治疗,4例中转手术,1例术后死亡.急症手术组9例治愈8例,术后死亡1例.结论:急性肠系膜上静脉血栓形成与腹部手术、高凝状态及门脉高压有关.腹部强化CT检查,早期诊断并抗凝溶栓治疗,可取得较好的疗效.手术时机把握合适,术中正确判断切除坏死肠管范围及术后抗凝治疗,是降低死亡率的关键.

  12. Effect of Shuxinyin (舒心饮) on In-Stent Restenosis after Coronary Artery Stenting

    Institute of Scientific and Technical Information of China (English)

    王显; 林钟香; 葛均波; 刘旭; 何燕; 张振贤; 沈琳

    2002-01-01

    Objective: To evaluate the effect of anti-platelet regimens and it's combination with Shuxinyin (SXY, 舒心饮,) on in-stent restenosis after stent implantation. Methods: Forty-four patients with successful stent implantation in a coronary artery were randomly assigned to the treated group (n=20) and the control group (n=24). The treated group received: SXY and anti-platelet therapy. The control group were treated with anti-platelet regimens only. Platelet activation was assessed before and immediately after the stenting by flow cytometry, the expression of P-selectin (CD62P) and glycoprotein(GP) Ⅱb/Ⅲa receptor. It was reassessed on the 30th day after stenting. Plasma fibrinogen (Fg) and C-reaction protein (CRP) were measured by biuret and laser scattering turbidimetry respectively at the same time. Observation was made on the scoring of the symptoms of Qi deficiency syndrome, Qi-Yin deficiency syndrome and blood stasis syndrome in the two groups. Differences between groups were compared. Results: Compared with the control group, combination with SXY and anti-platelet therapy was remarkable in reducing plasma CRP (P<0.05), and also with the tendency to decrease plasma Fg, GPⅡb/Ⅲa and CD62P. It could also evidently decrease the scoring of Qi-Yin deficiency syndrome, Qi deficiency syndrome and blood stasis syndrome after stenting (P<0.05, 0.01, 0.01) respectively. Follow-up survey found 40% relapse of angina pectoris with 4 cases of in-stent restenosis proved by angiography in the treated group. But the relapse of angina pectoris in the control group was 67% with 2 cases of myocardial infarction (MI), 7 cases of in-stent restenosis proved by angiography and one death. Conclusions: Combination with SXY and anti-platelet regimens can prevent stent thrombosis and in-stent restenosis after stent implantation, and it seems superior to anti-platelet therapy only.

  13. [Ischaemic lesions of cerebral after carotid stenting].

    Science.gov (United States)

    Medvedev, R B; Tanashian, M M; Kuntsevich, G I; Lagoda, O V; Skrylev, S I; Krotenkova, M V; Koshcheev, A Iu; Suslin, A S; Gemdzhian, É G

    2015-01-01

    Carotid angioplasty with stenting is a reliable method of primary and secondary prevention of ischaemic stroke in patients with stenosing lesions of the internal carotid artery. However, carrying out such operations is sometimes associated with risk for the development of intraoperative impairments of cerebral circulation due to arterioarterial embolism in cerebral arteries, as well as vasospasm. Presented herein are the results of following up a total of 64 patients with pronounced atherosclerotic lesions of internal carotid arteries (>70%) - "symptomatic" and "asymptomatic", undergoing carotid stenting. Acute foci of ischaemia in the brain after stenting according to the findings of diffusion-weighted magnetic resonance tomography were revealed in 40% of cases, and in only 6% of patients they manifested themselves by symptoms of acute cerebral circulatory impairment. We revealed a direct correlation between the number, size of infarctions in the brain, and the appearance of neurological symptomatology. Intraoperative monitoring of blood flow in the middle cerebral artery during stenting makes it possible to predict the appearance of acute foci of cerebral ischaemia, to specify the genesis of perioperative stroke, as well as to evaluate clinical significance of vasospasm and material microembolism. The obtained findings should concentrate neurologists' attention on active postoperative follow up of patients subjected to carotid angioplasty with stenting in order to perform adequate personified neuroprotective correction, including preventive one.

  14. Implante de stents farmacológicos na artéria descendente anterior: indicadores de eventos tardios Implante de Stents farmacológicos en la arteria descendente anterior: indicadores de eventos tardíos Pharmacological stent deployment in the left anterior descending artery: late event indicators

    Directory of Open Access Journals (Sweden)

    Marcelo de Freitas Santos

    2009-01-01

    cardiac event risk. METHODS: From May 2002 to August 2005, 205 patients were treated with 236 pharmacological stent implants, guided by the intravascular US (IVUS. RESULTS: After a mean follow-up period of 711 days, the rate of stent thrombosis was 0.48%, the same observed for acute myocardial infarction or revascularization surgery. The revascularization rate of the treated lesion was 7.31% and the general event rate was 10.24%. The event indicators, according to the multivariate analysis were the implant of more than one stent in the same artery, concentric lesions and the minimal intra-stent area measured by IVUS 3.88 mm² obtained in the small reference-diameter segments is an independent indicator of event-free evolution.

  15. Feasibility, safety, and preliminary efficacy of a novel ePTFE-covered self-expanding stent in saphenous vein graft lesions: the Symbiot II trial.

    Science.gov (United States)

    Laarman, Gerrit J; Kiemeneij, Ferdinand; Mueller, Ralf; Guagliumi, Giuglio; Cobaugh, Michael; Serruys, Patrick W

    2005-03-01

    Compared with percutaneous interventions in native coronary arteries, revascularization of saphenous vein graft (SVG) lesions is associated with increased rates of immediate and long-term major adverse cardiac events (MACE). The Symbiot II trial was a multicenter prospective study designed to evaluate the feasibility and safety of a novel self-expanding polytetrafluoroethylene (ePTFE)-covered stent in the treatment of de novo and restenotic SVG lesions. The primary endpoint was MACE through 30 days postprocedure. Successful Symbiot stent deployment was achieved in 75 of 77 patients (97.4%) with SVG lesions < or = 35 mm in length (visual assessment). The procedural success rate (defined as < 30% residual stenosis at the target site and no clinical complications) was 83%, and all study device procedures provided grade 3 TIMI flow postprocedure. Within the first 30 days postprocedure, four patients (5.2%) experienced MACE (defined as death, Q-wave or non-Q-wave myocardial infarction, and clinically driven target vessel revascularization), of whom three patients (3.9%) experienced periprocedural non-Q-wave myocardial infarction. No subacute stent thrombosis was observed over the 6-month follow-up period. No relevant luminal loss at the target site (mean, 0.3 +/- 0.9 mm) was observed in the 58 patients (77.3% of enrolled patients) who underwent quantitative coronary angiography at 6 months. The incidences of binary in-stent restenosis, in-segment restenosis, and target vessel failure (defined as acute and late-term MACE through 6 months postprocedure) were low (7.0%, 8.6%, and 14.3%, respectively). The Symbiot self-expanding ePTFE membrane-covered stent was associated with a high procedural success rate (97.4%), low incidences of MACE at 30 days (5.2%) and 6 months (14.3%), suggesting that it is safe and effective in the treatment of SVG disease.

  16. Clinical experience in coronary stenting with the Vivant Z Stent.

    Science.gov (United States)

    Chee, K H; Siaw, F S; Chan, C G; Chong, W P; Imran, Z A; Haizal, H K; Azman, W; Tan, K H

    2005-06-01

    This single centre study was designed to demonstrate feasibility, safety and efficacy of the Vivant Z stent (PFM AG, Cologne, Germany). Patients with de novo lesion were recruited. Coronary angioplasty was performed with either direct stenting or after balloon predilatation. Repeated angiogram was performed 6 months later or earlier if clinically indicated. Between January to June 2003, a total of 50 patients were recruited (mean age 55.8 +/- 9 years). A total of 52 lesions were stented successfully. Mean reference diameter was 2.77 mm (+/-0.59 SD, range 2.05-4.39 mm) with mean target lesion stenosis of 65.5% (+/-11.6 SD, range 50.1-93.3%). Forty-six lesions (88.5%) were American College of Cardiologist/American Heart Association class B/C types. Direct stenting was performed in 18 (34.6%) lesions. Mean stent diameter was 3.18 mm (+/-0.41 SD, range 2.5-4 mm), and mean stent length was 14.86 mm (+/-2.72 SD, range 9-18 mm). The procedure was complicated in only one case which involved the loss of side branch with no clinical sequelae. All treated lesions achieved Thrombolysis In Myocardial Infarction 3 flow. Mean residual diameter stenosis was 12.2% (+/-7.55 SD, range 0-22.6%) with acute gain of 1.72 mm (+/-0.50 SD, range 0.5-2.8). At 6 months, there was no major adverse cardiovascular event. Repeated angiography after 6 months showed a restenosis rate of 17% (defined as >50% diameter restenosis). Mean late loss was 0.96 mm (+/-0.48 SD) with loss index of 0.61 (+/-0.38 SD). The restenosis rate of those lesions less than 3.0 mm in diameter was 22.2% compared with 6.25% in those lesions more than 3.0 mm in diameter. The Vivant Z stent was shown to be safe and efficacious with low restenosis rate in de novo coronary artery lesion.

  17. Medical device-induced thrombosis: what causes it and how can we prevent it?

    Science.gov (United States)

    Jaffer, I H; Fredenburgh, J C; Hirsh, J; Weitz, J I

    2015-06-01

    Blood-contacting medical devices, such as vascular grafts, stents, heart valves, and catheters, are often used to treat cardiovascular diseases. Thrombus formation is a common cause of failure of these devices. This study (i) examines the interface between devices and blood, (ii) reviews the pathogenesis of clotting on blood-contacting medical devices, (iii) describes contemporary methods to prevent thrombosis on blood-contacting medical devices, (iv) explains why some anticoagulants are better than others for prevention of thrombosis on medical devices, and (v) identifies future directions in biomaterial research for prevention of thrombosis on blood-contacting medical devices.

  18. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology.

    Science.gov (United States)

    Hamon, Martial; Pristipino, Christian; Di Mario, Carlo; Nolan, James; Ludwig, Josef; Tubaro, Marco; Sabate, Manel; Mauri-Ferré, Josepa; Huber, Kurt; Niemelä, Kari; Haude, Michael; Wijns, William; Dudek, Dariusz; Fajadet, Jean; Kiemeneij, Ferdinand

    2013-03-01

    Radial access use has been growing steadily but, despite encouraging results, still varies greatly among operators, hospitals, countries and continents. Twenty years from its introduction, it was felt that the time had come to develop a common evidence-based view on the technical, clinical and organisational implications of using the radial approach for coronary angiography and interventions. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has, therefore, appointed a core group of European and non-European experts, including pioneers of radial angioplasty and operators with different practices in vascular access supported by experts nominated by the Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology (ESC). Their goal was to define the role of the radial approach in modern interventional practice and give advice on technique, training needs, and optimal clinical indications.

  19. Iron-induced platelet aggregation measurement : a novel method to measure platelet function in stenting for ST segment elevation myocardial infarction

    NARCIS (Netherlands)

    Smit, J. J. J.; van Oeveren, W.; Ottervanger, J. P.; Slingerland, R. J.; Remijn, J. A.; Zijlstra, F.; van 't Hof, A. W. J.

    2009-01-01

    Iron and (stainless) steel are potent platelet aggregation activators, and may be involved in stent thrombosis, a serious complication after intracoronary stenting. Current platelet function tests are suboptimal, because of inappropriate agonists and/or lack of reproducibility. We tested the feasibi

  20. Coated stents to prevent restenosis in coronary heart disease

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2005-11-01

    .20; 0.43] and an equivalent reduction in the rate of combined events. The 7-hexanoyltaxol-eluting stents caused, however, a significant increase of stent thrombosis as well as of myocardial infarctions. Economic evaluation: The allocation to polymer-based sirolimus and paclitaxel eluting stents resulted in incremental costs (compared with uncoated stents of approximately 1,421 € and 1,234 € per patient, taking in account expected revascularisations during the first year after implantation. The mean incremental cost-effectiveness-ratios per avoided revascularisation was 8,881 € and 13,711 €, respectively. The "break-even"-prices for these stenttypes in the used model were 707 € and 551 €, and the "break-even"-risks for ISR after stenting with uncoated stent, was 76% and 65%, respectively. The use of the other evaluated coated stents seems not to be cost-effective. Discussion: The absolute effects and cost savings for patient groups with a higher risk of restenosis could be considerably higher than for patient groups with a lower risk of restenosis. The transferability of the results from the present analysis to other (sub-populations and technology modifications is limited. The direct comparability of the results for sirolimus and paclitaxel eluting stents is also restricted. Conclusions: From a medical point of view the use of polymer-based sirolimus or paclitaxel eluting stents can be recommended. The use of gold coated, 7-hexanoyltaxol and actinomycin-D eluting stents is in contrast not recommendable. From an economical point of view and on the basis of current stent prices the polymer-based eluting sirolimus and paclitaxel stents should primarily be recommended for patients with a higher risk of restenosis.

  1. A Novel Thin Film Nitinol Covered Neurovascular Stent Significantly Decreases Intra-Aneurysmal Flow In Vitro

    Science.gov (United States)

    Chun, Youngjae; Hur, Soojung; Shayan, Mahdis; Kealey, Colin; Levi, Daniel; Mohanchandra, Kp; di Carlo, Dino; Carman, Gregory

    2013-11-01

    A novel thin film nitinol (TFN) stent has been developed to promote aneurysm quiescence by diminishing flow across the aneurysm's neck. Laboratory aneurysm models were used to assess the flow changes produced by stents covered with different patterns of TFN. Flow diversion stents were constructed by covering Wingspan stents (Boston Scientific, DxL:4x20mm) with TFNs (i.e., 77 and 82 percent porosity). The flow changes that occur after deployment of two different porous TFN covered stent in intracranial aneurysm models were evaluated in vitro. The 82 percent porous TFN covered stent reduced the intra-aneurysmal mean flow velocity by 86.42 percent, while a 77 percent porous TFN covered stent reduced to intra-aneurysmal mean flow velocity to 93.44 percent compared to a nonstented model. Local wall shear rates were also significantly reduced in wide-neck aneurysm model (i.e., 97.52 - 98.92 percent) with TFN stent placement. The results showed that TFN covered stents significantly reduced intra-aneurysmal flow velocity magnitudes and local wall shear rates. This suggests that TFN covered stents with both 77 and 82 percent porosity have great potential to promote thrombosis in both wide-necked and fusiform aneurysm sacs.

  2. Biodegradable Metals for Cardiovascular Stents: from Clinical Concerns to Recent Zn-Alloys.

    Science.gov (United States)

    Bowen, Patrick K; Shearier, Emily R; Zhao, Shan; Guillory, Roger J; Zhao, Feng; Goldman, Jeremy; Drelich, Jaroslaw W

    2016-05-01

    Metallic stents are used to promote revascularization and maintain patency of plaqued or damaged arteries following balloon angioplasty. To mitigate the long-term side effects associated with corrosion-resistant stents (i.e., chronic inflammation and late stage thrombosis), a new generation of so-called "bioabsorbable" stents is currently being developed. The bioabsorbable coronary stents will corrode and be absorbed by the artery after completing their task as vascular scaffolding. Research spanning the last two decades has focused on biodegradable polymeric, iron-based, and magnesium-based stent materials. The inherent mechanical and surface properties of metals make them more attractive stent material candidates than their polymeric counterparts. A third class of metallic bioabsorbable materials that are based on zinc has been introduced in the last few years. This new zinc-based class of materials demonstrates the potential for an absorbable metallic stent with the mechanical and biodegradation characteristics required for optimal stent performance. This review compares bioabsorbable materials and summarizes progress towards bioabsorbable stents. It emphasizes the current understanding of physiological and biological benefits of zinc and its biocompatibility. Finally, the review provides an outlook on challenges in designing zinc-based stents of optimal mechanical properties and biodegradation rate.

  3. Factors Associated with the Use of Drug-Eluting Stents in Patients Presenting with Acute ST-Segment Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Jose F. Chavez

    2015-01-01

    Full Text Available Background. Drug-eluting stents (DES have proven clinical superiority to bare-metal stents (BMS for the treatment of patients with ST-segment elevation myocardial infarction (STEMI. Decision to implant BMS or DES is dependent on the patient’s ability to take dual antiplatelet therapy. This study investigated factors associated with DES placement in STEMI patients. Methods. Retrospective analysis was performed on 193 patients who presented with STEMI and were treated with percutaneous coronary intervention at an urban, tertiary care hospital. Independent factors associated with choice of stent type were determined using stepwise multivariate logistic regression. Odds ratio (OR was used to evaluate factors significantly associated with DES and BMS. Results. 128 received at least one DES, while 65 received BMS. BMS use was more likely in the setting of illicit drug or alcohol abuse ([OR] 0.15, 95% CI 0.05–0.48, p≤0.01, cardiogenic shock (OR 0.26, 95% CI 0.10–0.73, p=0.01, and larger stent diameter (OR 0.28, 95% CI 0.11–0.68, p≤0.01. Conclusions. In this analysis, BMS implantation was associated with illicit drug or alcohol abuse and presence of cardiogenic shock. This study did not confirm previous observations that non-White race, insurance, or income predicts BMS use.

  4. Endovascular Treatment for Iliac Vein Compression Syndrome: a Comparison between the Presence and Absence of Secondary Thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Lou, Wen Sheng; Gu, Jian Ping; He, Xu; Chen, Liang; Su, Hao Bo; Chen, Guo Ping; Song, Jing Hua; Wang, Tao [Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing (China)

    2009-04-15

    To evaluate the value of early identification and endovascular treatment of iliac vein compression syndrome (IVCS), with or without deep vein thrombosis (DVT). Three groups of patients, IVCS without DVT (group 1, n = 39), IVCS with fresh thrombosis (group 2, n = 52) and IVCS with non-fresh thrombosis (group 3, n = 34) were detected by Doppler ultrasonography, magnetic resonance venography, computed tomography or venography. The fresh venous thrombosis were treated by aspiration and thrombectomy, whereas the iliac vein compression per se were treated with a self-expandable stent. In cases with fresh thrombus, the inferior vena cava filter was inserted before the thrombosis suction, mechanical thrombus ablation, percutaneous transluminal angioplasty, stenting or transcatheter thrombolysis. Stenting was performed in 111 patients (38 of 39 group 1 patients and 73 of 86 group 2 or 3 patients). The stenting was tried in one of group 1 and in three of group 2 or 3 patients only to fail. The initial patency rates were 95% (group 1), 89% (group 2) and 65% (group 3), respectively and were significantly different (p = 0.001). Further, the six month patency rates were 93% (group 1), 83% (group 2) and 50% (group 3), respectively, and were similarly significantly different (p = 0.001). Both the initial and six month patency rates in the IVCS patients (without thrombosis or with fresh thrombosis), were significantly greater than the patency rates of IVCS patients with non-fresh thrombosis. From the cases examined, the study suggests that endovascular treatment of IVCS, with or without thrombosis, is effective

  5. Lifestyle and venous thrombosis

    NARCIS (Netherlands)

    Pomp, Elisabeth Rebekka

    2008-01-01

    In the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis (MEGA study), a large population-based case-control study, we investigated lifestyle factors as risk factors for venous thrombosis. Overweight, smoking and alcohol consumption were addressed and pregnancy and

  6. SMART Control stents in femoropopliteal region

    Directory of Open Access Journals (Sweden)

    Jagić Nikola

    2008-01-01

    Full Text Available Introduction/Aim. Occlusive disease of lower limb arteries have been so far traditionally best treated with bypass surgery, but we want to find minimally invasive approach that should be at least as good as conventional surgery, and hopefully better. The aim of this study was to evaluate SMART Control stents (Cordis, J&J in Trans Atlantic Society Consensus (TASC B and C femoropopliteal lesions during one-year follow-up. Methods. Retrospective nonrandomized analysis included forty arteries in consecutive 40 patients who were stented with SMART Control stents. Primary patency at 12-month verified with Duplex Ultrasound and Acute Brachial Index (ABI as well as freedom from Target Vessel Revascularization (TVR were primary endpoints. Results. Primary technical success at stent implantation was 100%. Mean ABI values were preprocedurally 0.50, postprocedurally 0.83, at one month 0.86, at six months 0.84, at one year 0.78. After one year 39 stents were patent (97.5%. Conclusion. Excellent performance of the stent from technical point of view and a midterm results in vessel patency, as well as the absence of need for TVR were achieved. Yet, life expectancy in this cohort group of patients demands longer follow up data to draw a definite sustained positive conclusion.

  7. Nursing for patients with acute or chronic pulmonary deep venous thrombosis%急、慢性肺血栓栓塞症患者的护理

    Institute of Scientific and Technical Information of China (English)

    张平; 姜波; 季颖群; 赵广东; 张中和

    2007-01-01

    @@ 静脉血栓栓塞症(venous thromboembolism,VTE)是把深静脉血栓栓塞症(deep venous thrombosis,DVT)和肺栓塞(pulmonary embolism,PE)作为整体理解,肺栓塞是来自全身静脉系统或右心的栓子游离后阻塞肺动脉或其分支引起的肺循环和呼吸功能障碍的临床综合征.

  8. Single-session endovascular treatments for iliac vein compression syndrome with secondary acute segmental iliofemoral deep vein thrombosis%髂静脉受压综合征并发急性节段性髂股静脉血栓的血管腔内治疗

    Institute of Scientific and Technical Information of China (English)

    朱桥华; 周成宇; 陈勇; 赵剑波; 黄维; 罗美华; 莫海鹰; 于新发

    2014-01-01

    Objective To evaluate the feasibility,safety and effectiveness of single-session endovascular treatment with manual aspiration thrombectomy (MAT) as first-line thrombus removal method for iliac vein compression syndrome (IVCS) with secondary acute segmental iliofemoral deep vein thrombosis (DVT).Methods Twenty-six patients [19 women,7 men,and mean age (55±13) years] with left-sided acute iliac-common femoral DVT secondary to IVCS were enrolled in this prospective clinical study.All patients presented with leg swelling or pains.The duration of symptoms ranged from 1 to 11 days (mean time 5.2 days).IVCS were diagnosed by CT venography.Anticoagulation therapy was given to all patients upon diagnosed and maintained for minimum 6 months after interventions.Endovascular treatment,consisted of MAT,balloon angioplasty and stent placement,was performed via ipsilateral popliteal vein and completed in the same setting.Overnight antegrade thrombolysis (urokinase 800 000 units lasting for 12 h) was performed in patients with residual thrombus after MAT.Patients were followed up on long-term.Results Single-session endovascular procedures were performed successfully in all patients.The mean procedure time was (67± 13) min (ranging from 45 to 90 min).Complete thrombus removal,including almost 100% of removal in 24 patients and little residual thrombus (<5%) in 2,was achieved after repeated MAT.Thrombolysis was used in these 2 patients.Complete symptomatic relief was achieved in 25 patients (96%) and partial relief in one.The hospital stay ranged from 2 to 4 days [mean (2.7 ±0.3) days].Recurrent thrombosis within the stent was observed in one case and recanalized with thrombolysis.The 1-year primary and secondary patency rate was 96%(25/26) and 100%(26/26),respectively.No symptomatic pulmonary embolization,bleeding and venous reflux were observed.Five patients complained about transitory low back pains during balloon angioplasty.The mean follow-up period was 18

  9. The interventional thrombolysis and stenting of acute internal carotid occlusion%颈内动脉急性闭塞的溶栓及支架置入治疗

    Institute of Scientific and Technical Information of China (English)

    廖凯兵; 祝望才; 郑传胜

    2014-01-01

    Objective:To investigate the efficacy and safety of the interventional thrombolysis and stenting in patients with acute internal carotid occlusion.Methods:Intra-arterial thrombolysis was carried out and followed by stent implantation for the residual vascular stenosis in 6 patients with acute internal carotid occlusion.The neurological impairment score be-fore the treatment and at 24 hours after the treatment were evaluated.The incidence of complications and the changes in limbs activity and consciousness were observed.Results:6 patients got arterial recanalization and the blood flow recovered. The clinical symptoms were improved rapidly.At 24 hours after the treatment,the muscle strength increased by 3 grades in 4 patients and 2 grades in 2 patients.Conclusion:The efficacy of the interventional thrombolysis and stenting in acute inter-nal carotid occlusion is positive.It is more effective and safer when the treatment is given earlier.%目的:探讨颈内动脉急性闭塞的溶栓及支架置入治疗的有效性及安全性。方法:对6例颈内动脉急性闭塞的患者行动脉内溶栓治疗,其后对残余狭窄行支架置入治疗。溶栓前及治疗后24 h 进行神经功能缺损评分,同时观察脑内及其他系统有无出血并发症,并观察肢体活动及意识改善情况。结果:6例患者颈内动脉完全再通,血流量恢复,临床症状改善迅速,24h后4例瘫痪肢体肌力提高3级,2例提高2级。结论:颈内动脉急性闭塞患者的溶栓及支架置入治疗的疗效是值得肯定的。治疗时间越早疗效越好,安全性越高。

  10. Coronary bifurcation angle from 3-D predicts clinical outcomes after stenting bifurcation lesions

    Institute of Scientific and Technical Information of China (English)

    CHEN Shao-liang; DING Shi-qing; Tak W Kwan; Teguh Santoso; ZHANG Jun-jie; YE Fei; XU Ya-wei; FU Qiang; KAN Jing; Chitprapai Paiboon; ZHOU Yong

    2012-01-01

    Background The predictive value of bifurcation angle (BA) for worse events after stenting bifurcation lesions remains to be unknown.The present study was to investigate the dynamic change of BA and clinical relevance for patients with coronary bifurcation lesions treated by drug-eluting stent (DES).Methods BA was calculated by 3-D quantitative coronary analysis from 347 patients in DKCRUSH-Ⅱ study.Primary endpoint was the occurrence of composite major adverse cardiac events (MACE) at 12-month,including cardiac death,myocardial infarction (MI) and target vessel revascularization (TVR).Secondary end points were the rate of binary restenosis and stent thrombosis at 12-month.Results Stenting was associated with the reduction of distal BA.The cut-off value of distal BAfor predicting MACE was 60° Distal BA in <60° group had less reduction after stenting ((-1.96±13.58)° vs.(-12.12±23.58)°,P <0.001 ); two-stent technique was associated with significant reduction of distal BA (△(-4.05±14.20)°),compared to single stent group (△+1.55±11.73,P=0.003); the target lesion revascularization (TLR),TVR and MACE rate was higher in one-stent group (16.5%,19.0% and 21.5%),compared to two-stent group (3.8%,P=0.002; 7.5%,P=0.016; and 9.8%,P=0.024),respectively.Among patients in ≥60° group,there were no significant differences in distal BA,stent thrombosis (ST),MI,MACE,death,TLR,TVR between one- and two-stent groups; after stenting procedure,there was only slight change of distal BA in left anterior descending (LAD)-Ieft circumflex (LCX) subgroup (from (88.54±21.33)° at baseline to (82.44±31.72)° post-stenting),compared to either LAD-diagonal branch (Di),or LCX-obtuse marginal branch (OM),or RCA distal (RCAd) (all P <0.001 ).Conclusion Two-stent technique was associated with significant reduction of distal BA.DK crush stenting had reduced rate of MACE in patients in <60° group,compared to one-stent technique.

  11. Deep vein thrombosis.

    Science.gov (United States)

    Bandyopadhyay, Gargi; Roy, Subesha Basu; Haldar, Swaraj; Bhattacharya, Rabindra

    2010-12-01

    Occlusive clot formation in the veins causes venous thrombosis, the site most common in the deep veins of leg, called deep vein thrombosis. The clot can block blood flow and when it breaks off, called an embolism which in turn can damage the vital organs. Venous thrombosis occurs via three mechanisms ie, Virchow's triad. The mechanisms are decreased flow rate of blood, damage to the blood vessel wall and an increased tendency of the blood to clot. There are several factors which can increase a person's risk for deep vein thrombosis. The symptoms of deep vein thrombosis in the legs are pain, swelling and redness of the part. One variety of venous thrombosis is phlegmasia alba dolens where the leg becomes pale and cool. Investigations include Doppler ultrasound examination of the limb, D-dimer blood test, plethysmography of the legs, x-rays to show vein in the affected area (venography). Hospitalisation is necessary in some cases with some risk factors. The mainstream of treatment is with anticoagulants, mostly low molecular weight heparin for 6 months. Deep venous thrombosis is a rising problem. Early diagnosis and treatment is associated with a good prognosis.

  12. Ovarian vein thrombosis in Behçet disease.

    Science.gov (United States)

    Tan, Justina Wei Lynn; Howe, Hwee Siew; Chng, Hiok Hee

    2012-03-01

    We describe a 35-year-old Chinese woman with Behçet disease complicated by recurrent gastrointestinal flares. During admission for acute lower abdominal pain, a computed tomographic scan of the abdomen showed thrombosis of the left ovarian vein. She was treated with increased immunosuppressant and oral anticoagulant. Although she was not compliant to oral anticoagulant with her international normalized ratio frequently subtherapeutic, her symptoms abated and the thrombosis resolved. There has been only 1 reported case of a patient with Behçet disease presenting with postpartum ovarian vein thrombosis and pulmonary embolism and no reported case of Behçet disease with ovarian vein thrombosis occurring outside pregnancy and the puerperium. Ovarian vein thrombosis is a rare cause of abdominal pain that should be considered in patients with Behçet disease.

  13. Pause med trombocytaggregationshaemmere hos kirurgiske patienter med kardiel stent

    DEFF Research Database (Denmark)

    Johansen, Mathias; Afshari, Arash; Kristensen, Billy

    2010-01-01

    Dual antiplatelet therapy with aspirin and clopidogrel is increasingly used for secondary prevention of cardiovascular events in patients with percutaneous coronary intervention. Anesthesiologists and surgeons are faced with the challenge of managing these patients prior to a surgical procedure. ....... Premature discontinuation of antiplatelet therapy constitutes a substantial risk of stent thrombosis, myocardial infarction and death. Continuing therapy increases the risk of bleeding. We provide the latest evidence on this topic for patients awaiting non-cardiac surgery....

  14. Which criteria demand additive stenting during catheter-directed thrombolysis?

    DEFF Research Database (Denmark)

    Bækgaard, N; Just, S; Foegh, P

    2014-01-01

    Many factors are necessary for obtaining satisfactory results after catheter-directed thrombolysis (CDT) for iliofemoral deep venous thrombosis (DVT). Selections of patients, composition of the thrombolytic fluid, anticoagulation per- and post-procedural, recognition and treatment of persistent...... is used for iliofemoral DVT, but strict criteria for stenting are not available in the existing literature. The potential value of intravascular ultrasound (IVUS) is also discussed....

  15. Pediatric transplantation: preventing thrombosis.

    Science.gov (United States)

    Robertson, J D

    2015-06-01

    Due to progressive advances in surgical techniques, immunosuppressive therapies, and supportive care, outcomes from both solid organ transplantation and hematopoietic stem cell transplantation continue to improve. Thrombosis remains a challenging management issue in this context, with implications for both graft survival and long-term quality of life. Unfortunately, there remains a general paucity of pediatric-specific data regarding thrombosis incidence, risk stratification, and the safety or efficacy of preventative strategies with which to guide treatment algorithms. This review summarizes the available evidence and rationale underlying the spectrum of current practices aimed at preventing thrombosis in the transplant recipient, with a particular focus on risk factors, pathophysiology, and described antithrombotic regimens.

  16. Postpartal right ventricular thrombosis.

    Science.gov (United States)

    Velicki, Lazar; Milosavljević, Aleksandar; Majin, Marijan; Vujin, Bojan; Kovacević, Pavle

    2008-11-01

    The discovery of an intracardial mass in patients presents a serious diagnostic dilemma. The differential diagnosis of this condition may seem abundant, but myxomas and intracardial thrombosis are the most frequent diagnoses. A connection between pregnancy and the presence of thrombosis has been documented frequently. Normal pregnancy leads to changes of the coagulative and fibrinolytic status toward a hypercoagulable condition which has its own physiological justification (the risk of blood loss decreases during labor). The case of a patient suffering from postpartal right ventricular thrombosis, which was successfully resolved by surgery as described in this contribution, demonstrates the value of a multidisciplinary approach.

  17. Comparison of in-hospital and long-term outcomes between a Cypher stent and a Taxus stent in Chinese diabetic patients with coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    YANG Yue-jin; WU Yong-jian; LIU Hai-bo; YOU Shi-jie; LI Jian-jun; DAI Jun; GAO Run-lin; XU Bo; KANG Sheng; PEI Wei-dong; CHEN Ji-lin; QIAO Shu-bin; QIN Xue-wen; YAO Min; CHEN Jue

    2007-01-01

    Background The sirolimus and paclitaxel distribution patterns and tissue residence time may be modified in atherosclerotic lesions for patients with diabetes, and the biological mechanisms of action for these agents differ significantly. Previous clinical trials have yielded discrepant results of major adverse cardiac events and restenosis between a sirolimus-eluting stent and a paclitaxel-eluting stent in coronary artery disease. Therefore, this study was conduced to compare in-hospital and long-term clinical outcomes between patients receiving sirolimus-eluting stent(Cypher or Cypher Select stent) and paclitaxel-eluting stent (Taxus Express stent) after percutaneous intervention (PCI)in Chinese patients with diabetes.Methods One hundred and sixty-four consecutive diabetic patients underwent PCI in Fuwai Hospital from April 2004 to December 2004. Of them, 101 patients received Cypher or Cypher Select stents (Cypher group, 145 stents) and 63patients received Taxus Express stents (Taxus group, 129 stents). Repeat coronary angiography was performed at6-month and clinical outcomes were evaluated at 1- and 3-year follow-up. Stent thrombosis was classified according to Academic Research Consortium (ARC).Results The two groups did not differ significantly with respect to cardiac death, recurrent myocardial infarction (re-MI),target vessel revascularization (TVR) and occurrence of major adverse cardiac events (MACE). And the MACE-free cumulative survival at 1- and 3-year follow-up and early, late and very late thrombosis rates were also similar in the two groups (all P>0.05). There was a trend favoring PES over SES with regard to reducing cardiac death (0 vs 2.0%,P=0.524), re-MI (0 vs 2.0%, P=0.524), the composite of the cardiac death and re-MI (0 vs 4.0%, P=0.299) and very late thrombosis (0 vs 3.0%, P=0.295) between 1-year and 3-year follow-up.Conclusion The study indicates that PCI with either Cypher or Taxus stents is associated with similar efficacy and safety in

  18. Morphodynamic interpretation of acute coronary thrombosis, with special reference to volcano-like eruption of atheromatous plaque caused by coronary artery spasm.

    Science.gov (United States)

    Lin, C S; Penha, P D; Zak, F G; Lin, J C

    1988-06-01

    Routine autopsy studies of hearts with coronary thrombosis, collected over a period of eleven years, showed unique morphologic features of rupture of soft atheromatous plaques. These features include: (1) irregular luminar outline: angulation, invagination, upheaval, and/or wrinkles, (2) wavy outline of atheromatous cavity, (3) volcano-like rupture with seepage or gushing of semiliquid atheromatous contents into lumen, (4) cholesterol crystals arranged in rheologic vector direction, (5) rupture of deeper intimal fibrous tissue, (6) one or multiple intimal upheavals, (7) focal thickening of contracted media, (8) vestige of volcano-like eruption with organized thrombus, and (9) old thrombotic occlusion with wavy appearance of thick intimal fibrous tissue. The authors present a dynamic model of vasoconstriction or artery spasm that accounts for these features and the rupture of soft atheromatous plaques.

  19. Pharmacomechanical thrombectomy and catheter-directed thrombolysis of acute lower extremity deep venous thrombosis in a 9-year-old boy with inferior vena cava atresia.

    Science.gov (United States)

    Hamidian Jahromi, Alireza; Coulter, Amy H; Bass, Patrick; Zhang, Wayne W; Tan, Tze-Woei

    2015-04-01

    Lower extremity deep venous thrombosis (DVT) is uncommon in the pediatric population, but it can be associated with severe symptoms and potential long-term morbidity secondary to post-thrombotic syndrome. Inferior vena cava (IVC) atresia can predispose a patient to the development of extremity DVT. There is no clear consensus on optimal management of extensive extremity DVT in pediatric patients, especially in patients with IVC anomalies. We report a case of iliofemoral DVT in a 9-year-old boy with IVC atresia and presumed protein S deficiency that was treated successfully using pharmacomechanical thrombectomy and catheter-directed thrombolysis. He was maintained on long-term anticoagulation and remained symptom free at 6 months' follow-up.

  20. Safety and efficacy of everolimus-eluting stents for bare-metal in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ota, Hideaki [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Mahmoudi, Michael [University of Surrey, Guildford Road, Surrey, GU2-7XH (United Kingdom); Torguson, Rebecca; Satler, Lowell F.; Suddath, William O.; Pichard, Augusto D. [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Waksman, Ron, E-mail: ron.waksman@medstar.net [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States)

    2015-04-15

    Objective: The aim of this study was to compare the safety and efficacy of the everolimus-eluting stents (EES) with the paclitaxel-eluting stent (PES) and sirolimus-eluting stent (SES) for the treatment of bare-metal in-stent restenosis. Background: The optimal treatment for bare-metal in-stent restenosis remains controversial. Methods: The study cohort comprised 322 consecutive patients (543 lesions) who presented with bare-metal in-stent restenosis to our institution and underwent coronary artery stent implantation with EES (114 patients; 181 lesions), PES (65 patients; 116 lesions) and SES (143 patients; 246 lesions). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac events (MACE) defined as the composite of death, MI, or TLR at 1-year. Results: The three groups were well matched for the conventional risk factors except for age and chronic kidney disease. The 1-year analyzed clinical parameters were similar in the three groups: death (EES = 3.5%, PES = 4.6%, SES = 4.2%; p = 0.94), MI (EES = 3.5%, PES = 6.3%, SES = 2.1%; p = 0.31), TLR (EES = 9.8%, PES = 9.5%, SES = 5.7%; p = 0.42), TVR (EES = 14.3%, PES = 11.1%, SES = 11.3%; p = 0.74), definite ST (EES = 0.9%, PES = 3.1%, SES = 3.5%; p = 0.38) and MACE (EES = 14.0%, PES = 15.4%, SES = 10.5%; p = 0.54). Male gender (hazard ratio = 0.47; 95% confidence interval = 0.25–0.88) and number of treated lesions (hazard ratio = 1.47; 95% confidence interval = 1.06–2.05) were found to be independent predictors of MACE. Conclusion: The results of the present study indicate that EES may provide similar safety and efficacy as first generation DES for the treatment of patients presenting with bare-metal in-stent restenosis.

  1. Point-of-care seeding of nitinol stents with blood-derived endothelial cells.

    Science.gov (United States)

    Jantzen, Alexandra E; Noviani, Maria; Mills, James S; Baker, Katherine M; Lin, Fu-Hsiung; Truskey, George A; Achneck, Hardean E

    2016-11-01

    Nitinol-based vascular devices, for example, peripheral and intracranial stents, are limited by thrombosis and restenosis. To ameliorate these complications, we developed a technology to promote vessel healing by rapidly seeding (QuickSeeding) autologous blood-derived endothelial cells (ECs) onto modified self-expanding nitinol stent delivery systems immediately before implantation. Several thousand micropores were laser-drilled into a delivery system sheath surrounding a commercial nitinol stent to allow for exit of an infused cell suspension. As suspension medium flowed outward through the micropores, ECs flowed through the delivery system attaching to the stent surface. The QuickSeeded ECs adhered to and spread on the stent surface following 24-h in vitro culture under static or flow conditions. Further, QuickSeeded ECs on stents that were deployed into porcine carotid arteries spread to endothelialize stent struts within 48 h (n = 4). The QuickSeeded stent struts produced significantly more nitric oxide in ex vivo flow circuits after 24 h, as compared to static conditions (n = 5). In conclusion, ECs QuickSeeded onto commercial nitinol stents within minutes of implantation spread to form a functional layer in vitro and in vivo, providing proof of concept that the novel QuickSeeding method with modified delivery systems can be used to seed functional autologous endothelium at the point of care. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1658-1665, 2016.

  2. Combined arteriovenous thrombolytic infusion for refractory renal vein thrombosis.

    Science.gov (United States)

    Heafner, Thomas A; Scott, Daniel; Watson, J Devin; Propper, Brandon; Johnson, Chatt; Arthurs, Zachary M

    2014-08-01

    Acute renal vein thrombosis can rapidly lead to significant impairment and eventual loss of renal function. Classically presenting with flank pain, hematuria, and laboratory markers consistent with acute kidney injury, therapeutic anticoagulation is the mainstay of treatment. However, endovascular surgery offers a safe and effective alternative for renal salvage in the setting of acute renal vein thrombosis. Described is the use of combined arteriovenous thrombolytic infusion for refractory renal vein thromboses to quickly and effectively decrease clot burden in the micro- and macrovenous circulations while limiting systemic exposure.

  3. Neointimal coverage of sirolimus-eluting stents 6 months and 12 months after implantation: evaluation by optical coherence tomography

    Institute of Scientific and Technical Information of China (English)

    YAO Zhu-hua; Tetsuo Matsubara; Tsuyoshi Inada; Yasuyoshi Suzuki; Takahiko Suzuki

    2008-01-01

    Background Optical coherence tomography (OCT)is a new imaging modality with resolution of approximately 10 μm and can be employed to visualize intracoronary characteristics.Sirolimus-eluting stents(SES)are susceptible to late thrombosis due to delayed re-endothelialization over the stent struts,which may result in acute myocardial infarction or death.This study was designed to evaluate the re-endothelialization and neointimal coverage of SES with OCT 6 months and 12 months after implantation.Methods A total of 36 patients enrolled in the study underwent OCT examination 6 months(17 patients)and 12 months (19 patients)after SES implantation.The strut apposition to the vessel wall and neointimal coverage on SES struts were evaluated by OCT.Results Forty-six SES and 6561 struts were analyzed.At 6 months,3041 struts(98.7%)were well-apposed and 39 struts(1.3%)were malapposed.At 12 months,3434 struts(98.6%)were well-apposed and 47 struts(1.4%)were malapposed.Furthermore,only 4 SES at 6 months(18.2%)and 10 SES at 12 months(41.7%)were fully covered by neointimal growth.The average neointimal thicknesses covering the analyzed struts at 6 months and 12 months were (42±28)μm and (88±32) μm,respectively.There were 1989 struts at 6 months(72.1%)and 1461 struts at 12 months (45.6%)with neointimal thickness <100 μm.Conclusions OCT was able to visualize the strut apposition to the vessel wall and neointimal coverage on SES struts.At 6-month and 12-month follow-up examinations most struts were covered with thin neointima,but few of the entire SES showed full coverage.To prevent late-stent thrombosis in the presence of uncovered stent struts,longer dual antiplatelet drugs therapy should be recommended.

  4. Stents Eluting 6-Mercaptopurine Reduce Neointima Formation and Inflammation while Enhancing Strut Coverage in Rabbits.

    Directory of Open Access Journals (Sweden)

    Matthijs S Ruiter

    Full Text Available The introduction of drug-eluting stents (DES has dramatically reduced restenosis rates compared with bare metal stents, but in-stent thrombosis remains a safety concern, necessitating prolonged dual anti-platelet therapy. The drug 6-Mercaptopurine (6-MP has been shown to have beneficial effects in a cell-specific fashion on smooth muscle cells (SMC, endothelial cells and macrophages. We generated and analyzed a novel bioresorbable polymer coated DES, releasing 6-MP into the vessel wall, to reduce restenosis by inhibiting SMC proliferation and decreasing inflammation, without negatively affecting endothelialization of the stent surface.Stents spray-coated with a bioresorbable polymer containing 0, 30 or 300 μg 6-MP were implanted in the iliac arteries of 17 male New Zealand White rabbits. Animals were euthanized for stent harvest 1 week after implantation for evaluation of cellular stent coverage and after 4 weeks for morphometric analyses of the lesions.Four weeks after implantation, the high dose of 6-MP attenuated restenosis with 16% compared to controls. Reduced neointima formation could at least partly be explained by an almost 2-fold induction of the cell cycle inhibiting kinase p27Kip1. Additionally, inflammation score, the quantification of RAM11-positive cells in the vessel wall, was significantly reduced in the high dose group with 23% compared to the control group. Evaluation with scanning electron microscopy showed 6-MP did not inhibit strut coverage 1 week after implantation.We demonstrate that novel stents coated with a bioresorbable polymer coating eluting 6-MP inhibit restenosis and attenuate inflammation, while stimulating endothelial coverage. The 6-MP-eluting stents demonstrate that inhibition of restenosis without leaving uncovered metal is feasible, bringing stents without risk of late thrombosis one step closer to the patient.

  5. Cerebral venous sinus thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Renowden, Shelley [Frenchay Hospital, Bristol BS16 1LE (United Kingdom)

    2004-02-01

    A comprehensive synopsis on cerebral venous thrombosis is presented. It emphasizes the various aetiologies, the wide clinical spectrum and the unpredictable outcome. Imaging techniques and pitfalls are reported and the therapeutic options are discussed. (orig.)

  6. Cancer and Thrombosis

    Institute of Scientific and Technical Information of China (English)

    刘敏涓

    2011-01-01

    @@ Relationship between cancer and thromboembolic disease, the research has been going on for more than a century.Armand trousseau in 1865 first reported the formation of venous thrombosis prone patients with gastric cancer.

  7. Cerebral venous thrombosis presenting with cerebellar ataxia and cortical blindness.

    Science.gov (United States)

    Ben Sassi, Samia; Mizouni, Habiba; Nabli, Fatma; Kallel, Lamia; Kefi, Mounir; Hentati, Fayçal

    2010-01-01

    Venous infarction in the cerebellum has been reported only rarely, probably because of the abundant venous collateral drainage in this region. Bilateral occipital infarction is a rare cause of visual loss in cerebral venous thrombosis. We describe a 50-year-old woman with a history of ulcerative colitis who developed acute cerebellar ataxia and cortical blindness. She had bilateral cerebellar and occipital lesions related to sigmoid venous thrombosis and achieved complete recovery with anticoagulation therapy. Cerebral venous thrombosis should be considered in cases of simultaneous cerebellar and occipital vascular lesions.

  8. Cancer and Thrombosis

    Institute of Scientific and Technical Information of China (English)

    李家增

    2006-01-01

    @@ Since 1865, Aremand Trousseau first reported on the association between cancer and thrombosis. For many years, it has been recognized that venous thromboembolism (VTE) is a common occurrence in patients with malignant disease. Compared to other groups of patients with VTE the cancer population is unique because the pathogenesis of thrombosis differs, the frequency of VTE is greater and the clinical management required is more complex.

  9. Auxetic coronary stent endoprosthesis

    DEFF Research Database (Denmark)

    Amin, Faisal; Ali, Murtaza Najabat; Ansari, Umar;

    2014-01-01

    BACKGROUND: Cardiovascular heart disease is one of the leading health issues in the present era and requires considerable health care resources to prevent it. The present study was focused on the development of a new coronary stent based on novel auxetic geometry which enables the stent to exhibit...... a negative Poisson's ratio. Commercially available coronary stents have isotropic properties, whereas the vascular system of the body shows anisotropic characteristics. This results in a mismatch between anisotropic-isotropic properties of the stent and arterial wall, and this in turn is not favorable...... for mechanical adhesion of the commercially available coronary stents with the arterial wall. It is believed that an auxetic coronary stent with inherent anisotropic mechanical properties and negative Poisson's ratio will have good mechanical adhesion with the arterial wall. METHODS: The auxetic design...

  10. Impacted calculus within a urethral stent: A rare cause of urinary retention

    Directory of Open Access Journals (Sweden)

    Shanmugasundaram Rajaian

    2011-01-01

    Full Text Available An elderly male presented to the emergency department with acute urinary retention. He had poor flow of urine associated with serosanguinous discharge per urethra for 3 days duration. Earlier he underwent permanent metallic urethral stenting for post TURP bulbar urethral stricture. Plain X-ray of Pelvis showed an impacted calculus within the urethral stent in bulbar urethra. Urethrolitholapaxy was done with semirigid ureteroscope. Urethral stent was patent and well covered. Subsequently he had an uneventful recovery. We describe a unique case of acute urinary retention due to calculus impaction within a urethral stent.

  11. Effects of IABP on patients with acute ST-elevated myocardial infarction

    Directory of Open Access Journals (Sweden)

    Tai-lian HONG

    2016-06-01

    Full Text Available Objective  To evaluate the clinical efficacy and safety of intra-aortic balloon pump (IABP counterpulsation for the patients with acute ST-elevated myocardial infarction (STEMI. Methods  To retrospectively analyze the data collected from the Management System of Cardiovascular Interventional Treatment in Military Hospitals. A total of 8878 consecutive patients with acute STEMI undergoing percutaneous coronary intervention (PCI were recruited in present study, of whom 732 patients received IABP therapy were assigned into IABP group and the other 8146 patients received no IABP into control group. Contrastive analysis was performed to analyze the baseline data of the two groups, and 1:1 propensity matching was done to compare the differences between the two groups of intraoperative mortality, in-hospital mortality, stent thrombosis and postoperative hemorrhage. Results  Multi-logistic regression revealed that age, heart failure and renal dysfunction were the risk factors for in-hospital mortality. By 1:1 propensity matching analysis, no statistical differences were found between the two groups in intraoperative mortality, postoperative hemorrhage and stent thrombosis, and the in-hospital mortality was higher in IABP group than in control group (10.4% vs 2.5%, P<0.05. Conclusion  IABP can't reduce the in-hospital mortality of patients with STEMI. DOI: 10.11855/j.issn.0577-7402.2016.06.02

  12. Efficacy and Safety of Drug-Eluting Stents in the Real World: 8-Year Follow-Up

    Energy Technology Data Exchange (ETDEWEB)

    Pellegrini, Denise Oliveira, E-mail: dennizmo@yahoo.com.br; Gomes, Vitor Osório; Lasevitch, Ricardo; Smidt, Luis; Azeredo, Marco Aurélio; Ledur, Priscila; Bodanese, Rodrigo; Sinnott, Leonardo; Moriguchi, Emílio; Caramori, Paulo [Hospital São Lucas PUC, Porto Alegre, RS (Brazil)

    2014-09-15

    Drug-eluting stents have been used in daily practice since 2002, with the clear advantages of reducing the risk of target vessel revascularization and an impressive reduction in restenosis rate by 50%-70%. However, the occurrence of a late thrombosis can compromise long-term results, particularly if the risks of this event were sustained. In this context, a registry of clinical cases gains special value. To evaluate the efficacy and safety of drug-eluting stents in the real world. We report on the clinical findings and 8-year follow-up parameters of all patients that underwent percutaneous coronary intervention with a drug-eluting stent from January 2002 to April 2007. Drug-eluting stents were used in accordance with the clinical and interventional cardiologist decision and availability of the stent. A total of 611 patients were included, and clinical follow-up of up to 8 years was obtained for 96.2% of the patients. Total mortality was 8.7% and nonfatal infarctions occurred in 4.3% of the cases. Target vessel revascularization occurred in 12.4% of the cases, and target lesion revascularization occurred in 8% of the cases. The rate of stent thrombosis was 2.1%. There were no new episodes of stent thrombosis after the fifth year of follow-up. Comparative subanalysis showed no outcome differences between the different types of stents used, including Cypher®, Taxus®, and Endeavor®. These findings indicate that drug-eluting stents remain safe and effective at very long-term follow-up. Patients in the 'real world' may benefit from drug-eluting stenting with excellent, long-term results.

  13. Effects of sirolimus-eluting stent on calcified coronary lesions

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun; WU Yong-jian; YUAN Jin-qing; CHEN Jue; YOU Shi-jie; DAI Jun; XIA Ran; GAO Run-lin; XU Bo; YANG Yue-jin; CHEN Ji-lin; QIAO Shu-bing; MA Wei-hua; QIN Xue-wen; YAO Min; LIU Hai-bo

    2008-01-01

    Background Calcified coronary lesions carry the risk of suboptimal stent expansion, subsequently leading to restenosis. The effectiveness of sirolimus-eluting stents (SES) for the treatment of calcified lesion has not been fully investigated. In the present study, therefore, we evaluated the effectiveness of SES Implantation for the treatment of calcified coronary lesions.Mothods A total of 333 consecutive patients with 453 lesions were enrolled in this study. They were divided into two groups according to whether the lesion treated with SES was calcified or not; no calcification group (n=264) and calcification group (n=189). Lesions treated with SES were subjected to quantitative coronary angiography (QCA) immediately and 8 months following stenting.Results Baseline clinical, demographic or angiographic characteristics were well balanced in both groups. Angiographic follow-up at 8 months, the in-stent restenosis and in-segment restenosis rates were not significantly different between the two groups; in-stent restenosis: 3.8% vs 4.2%; P=0.081; in-segment restenosis: 8.7% vs 10.6%, P=0.503. The target lesion revascularization (TLR) was also not significantly different between the two groups; 4.9% vs 6.9%, P=0.378. In addition, the in-stent late loss was similar in both groups; (0.16±0.40) mm vs (0.17±0.33) mm, P>0.05. Meantime, overall thrombosis rates were also similar in both groups; 1.6% vs 1.6%, P>0.05.Conclusion Although calcified coronary lesion was hard to stent, successful percutaneous coronary intervention with SES stenting for calcified lesions was conferred by the similar favorable results that were seen when comparing non-calcified and calcified coronary lesions.

  14. Acute massive splenic infarction with splenic vein thrombosis following altitude exposure of a Sri Lankan male with undetected sickle cell trait.

    Science.gov (United States)

    Abeysekera, Walimuni Yohan Mendis; de Silva, Warusha Dhammika Dulantha; Pinnaduwa, Sharika Shashindrani; Banagala, Anura Sarath Kumara

    2012-12-01

    Even though sickle cell disease is not common in Sri Lanka, we report an acute splenic infarction at high altitude of a Sri Lankan male with previously undetected sickle cell trait (SCT). This is the first time such a case is reported from the South Asian region. Early recognition of this hematological condition would simplify the management of acute splenic infarction in these patients, avoiding irreversible surgery.

  15. Clinical results with the Resolute zotarolimus-eluting stent in total coronary occlusions

    DEFF Research Database (Denmark)

    Kelbæk, Henning; Holmvang, Lene; Richardt, Gert;

    2015-01-01

    and results: Patients were divided into three groups: chronic TO (CTO; n=256), non-chronic TO (n=292), and no occlusion (n=2,941). Clinical and safety outcomes assessed through two years included target lesion failure (TLF: cardiac death, target vessel myocardial infarction, and clinically driven target...... lesion revascularisation) and Academic Research Consortium definite or probable stent thrombosis. The rate of TLF at two years was not significantly different among patients in the CTO (9.1%), TO (9.8%), and no occlusion (10.4%) groups (log-rank p=0.800); neither were the components of TLF. Definite...... or probable stent thrombosis occurred more frequently in the TO group (2.8% vs. 1.2% in the CTO and 1.1% in the group with no occlusion, p=0.027). There were 10 late and six very late stent thrombosis events. Conclusions: Apart from a higher rate of stent thrombosis in patients with TO, patients with totally...

  16. 支架象鼻手术治疗急性Stanford B型主动脉夹层%Stented elephant trunk in surgical approach for acute Standford type B aortic dissection in 146 cases

    Institute of Scientific and Technical Information of China (English)

    邓宏平; 王志维; 夏军; 徐鹏; 胡小平; 周桢; 任宗力

    2012-01-01

    Objective To review the experience of stented elephant trunk( SET )procedure under deep hypothermic cardiopulmonary bypass for acute Stanford type B aortic dissection. Methods From January 2003 to January 2011,146 consecutive patients with acute Standford type B aortic dissection received transaortic stented graft implantation into the descending aorta under deep hypothermia circulatory arrest. The in - hospital mortality rate and complication rate between Standford type A and Standford type B were analysed. Results Average cardiopulmonary bypass time was( 155 ±30 )min, average - cross clamp time was( 32 ± 3 )min, and average deep hypothermia circulatory arrest time was( 20 ± 3 )min. The in - hospital mortality was 2. 05% ( 3/146 ). A total of 138 patients were followed up for 4 ~ 98 months ( mean,57. 3 months ),and the 1 - year survival rate was 97. 16%. One patient died from massive bowel necrosis after 11 months. There was no paraplegia or reoperation. The complication rate of acute Standford type B aortic dissection was 14.4% and that of Standford type A aortic dissection was 35. 3% ,respectively. The difference was statistically significant. Conclusion SET implantation under deep hypothermic cardiopulmonary bypass is a simple,safe and effective method for acute Stanford type B aortic dissection.%目的 总结深低温停循环下支架象鼻手术治疗急性Stanford B型主动脉夹层的临床经验.方法 对146例急性Stanford B 型主动脉夹层患者行支架象鼻手术.结果 平均体外循环时间(155±30)min,平均心肌阻断时间(32±3)min,停循环时间(20±3)min.住院死亡3例(2.05 %,3/146),术后脑栓塞及脑出血各1例.随访138例,随访时间4~98个月,平均57.3个月,1年生存率为97.16%(137/141),1例11个月后死于广泛性肠坏死.无截瘫及再次手术者.结论 支架象鼻植入术治疗急性Stanford B 型主动脉夹层简单、安全、有效.

  17. Titanium-nitride-oxide-coated coronary stents: insights from the available evidence.

    Science.gov (United States)

    Karjalainen, Pasi P; Nammas, Wail

    2016-11-12

    Coating of stent surface with a biocompatible material is suggested to improve stent safety profile. A proprietary process was developed to coat titanium-nitride-oxide on the stent surface, based on plasma technology that uses the nano-synthesis of gas and metal. Preclinical in vitro and in vivo investigation confirmed blood compatibility of titanium (nitride-) oxide films. Titanium-nitride-oxide-coated stents demonstrated a better angiographic outcome, compared with bare-metal stents at mid-term follow-up; however, they failed to achieve non-inferiority for angiographic outcome versus second-generation drug-eluting stents. Observational studies showed adequate clinical outcome at mid-term follow-up. Non-randomized studies showed an outcome of titanium-nitride-oxide-coated stents comparable to - or better than - first-generation drug-eluting stents at long-term follow-up. Two randomized controlled trials demonstrated comparable efficacy outcome, and a better safety outcome of titanium-nitride-oxide-coated stents versus drug-eluting stents at long-term follow-up. Evaluation by optical coherence tomography at mid-term follow-up revealed better neointimal strut coverage associated with titanium-nitride-oxide-coated stents versus drug-eluting stents; yet, neointimal hyperplasia thickness was greater. Key messages Stents coated with titanium-nitride-oxide demonstrated biocompatibility in preclinical studies: they inhibit platelet and fibrin deposition, and reduce neointimal growth. In observational and non-randomized studies, titanium-nitride-oxide-coated stents were associated with adequate safety and efficacy outcome. In randomized trials of patients with acute coronary syndrome, titanium-nitride-oxide-coated stents were associated with a better safety outcome, compared with drug-eluting stents; efficacy outcome was comparable.

  18. Clinical Effects Analysis of Combination of Rehabilitation Exercises with Herbal Medicine on Acute Cerebral Thrombosis%康复锻炼联合中药治疗急性脑血栓的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    揭凤英; 何平

    2014-01-01

    Objective:To explore the clinical curative effects of combination of rehabilitation exercise with herbal medicine on acute cerebral thrombosis. Methods 56 patients with acute cerebral thrombosis were randomly divided into observation group and control group (n = 28). The observation group was adopted rehabilitation exercise combined with herbal medicine treatment while the control group was given herbal medicine therapy, to evaluate the curative effects of patients in the two groups. Results:total effective rate of the observation group was 92.9%while that of the control group was 75.0%, that the combined therapy obviously effective than simple herbal medicine therapy. Compared to that of the control group, the daily life Barthel index of the observation group was significantly higher. Conclusion: Combination of rehabilitation exercise with herbal medicine treatment can significantly improve the brain function state, increase cerebral blood flow and reduce morbidity, which is worth popularly application.%目的:探讨康复锻炼联合中药在治疗急性脑血栓中的临床疗效。方法将56例急性脑血栓患者随机分为观察组和对照组各28例。观察组采用康复锻炼联合中药治疗,对照组给予中药治疗,对两组患者的疗效进行评估。结果观察组总有效率为92.9%,对照组的总有效率为75.0%,联合组治疗的总有效率明显高于中药组,两组患者日常生活Barthel指数相比较,观察组明显高于对照组。结论康复锻炼联合中药治疗可以明显改善脑功能状态,增加脑血流量,降低致残率,值得在临床推广应用。

  19. The Use of Solitaire AB Stents in Coil Embolization of Wide-Necked Cerebral Aneurysms.

    Directory of Open Access Journals (Sweden)

    Teng-Fei Li

    Full Text Available The Solitaire AB stent is one of many assistant stents used for treating wide-necked cerebral aneurysm, and has been used since 2003. However, large sample studies on its safety and effectiveness are lacking. The objective of this study was to evaluate the effectiveness and safety of the Solitaire AB stent in the coil embolization of wide-necked cerebral aneurysms.Retrospective review of the clinical and image data of 116 patients with wide-necked cerebral aneurysms who had been enrolled at six interventional neuroradiology centers from February 2010 to February 2014 and had been treated by coil embolization; in total, 120 Solitaire AB stents were used. The degree of aneurysm occlusion was examined using digital subtraction angiography (DSA immediately after the procedure and during follow-up, and was graded using the modified Raymond classification. We also observed complications to evaluate the safety and effectiveness of this therapy.The 120 Solitaire AB stents (4 mm × 15 mm, four stents; 4 mm × 20 mm, 16 stents; 6 mm × 20 mm, 36 stents; 6 mm × 30 mm, 64 stents were inserted to treat 120 wide-necked cerebral aneurysms. All stents were inserted successfully. DSA immediately post-surgery revealed 55 cases of complete occlusion, 59 cases of neck remnant, and six cases of aneurysm remnant. Perioperatively, there were four cases of hemorrhage and four cases of stent thrombosis. The follow-up spanned 3-37 months; of 92 patients examined by DSA at the 6-month follow up, 12 had disease recurrence.The Solitaire AB stent is effective with a good technical success rate and short-term effect for assisting coil embolization of wide-necked cerebral aneurysms.

  20. Vessel healings after stenting with different polymers in STEMI patients

    Science.gov (United States)

    Jin, Qin-Hua; Chen, Yun-Dai; Tian, Feng; Guo, Jun; Jing, Jing; Sun, Zhi-Jun

    2016-01-01

    Background Different stents implantation in ST-segment elevation myocardial infarction (STEMI) patients may influence the long term prognosis by affecting vessel healings after stenting. The aim of this study was to evaluate the vessel healings after implantation of drug eluting stents (DES) with biodegradable or durable polymer or of bare-metal stents (BMS) in patients with acute STEMI. Methods This study included 50 patients, who underwent follow up angiogram and optical coherence tomography (OCT) assessment about one year after percutaneous coronary intervention (PCI) for STEMI. According to the initial stents types, these patients were classified to durable (n = 19) or biodegradable polymer sirolimus-eluting stents (n = 15), or BMS (n = 16) groups. The conditions of stent struts coverage and malapposition were analyzed with OCT technique. Results A total of 9003 struts were analyzed: 3299, 3202 and 2502 from durable or biodegradable polymer DES, or BMS, respectively. Strut coverage rate (89.0%, 94.9% and 99.3%, respectively), malapposition presence (1.7%, 0.03% and 0 of struts, respectively) and average intimal thickness over struts (76 ± 12 µm, 161 ± 30 µm and 292 ± 29 µm, respectively) were significantly different among different stent groups (all P < 0.001). Conclusions Vessel healing status in STEMI patients is superior after implantation of biodegradable polymer DES than durable polymer DES, while both are inferior to BMS. PMID:27403139

  1. Drug-eluting stents and bare metal stents in patients with NSTE-ACS

    DEFF Research Database (Denmark)

    Pedersen, Sune Haahr; Pfisterer, Matthias; Kaiser, Christoph;

    2014-01-01

    Aims: The use of drug-eluting stents (DES) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is controversial and not yet endorsed in clinical guidelines. Methods and results: This was an a priori planned post hoc analysis involving 754 NSTE-ACS patients from the random...

  2. Long-term outcome in patients treated with sirolimus-eluting stents in complex coronary artery lesions: 3-year results of the SCANDSTENT (Stenting Coronary Arteries in Non-Stress/Benestent Disease) trial

    DEFF Research Database (Denmark)

    Kelbaek, H.; Klovgaard, L.; Helqvist, S.;

    2008-01-01

    data of the long-term outcome of patients with complex coronary artery lesions. METHODS: We randomly assigned 322 patients with total coronary occlusions or lesions located in bifurcations, ostial, or angulated segments of the coronary arteries to have SES or BMS implanted. RESULTS: At 3 years, major...... performed between 1 and 3 years after the index treatment (p = NS). According to revised definitions, stent thrombosis occurred in 5 patients (3.1%) in the SES group and in 7 patients (4.4%) in the BMS group (p = NS); very late stent thrombosis was observed in 4 versus 1 patient. CONCLUSIONS: A continued...

  3. Mesenteric venous thrombosis after prolonged air travel-a case report

    Institute of Scientific and Technical Information of China (English)

    Joaqun Salas-Coronas; Jos L Serrano-Carrillo; Ana B Lozano-Serrano; Jos C Snchez-Snchez; Leticia Miras-Lucas; Rosario Prez-Moyano

    2014-01-01

    We present a case of acute mesenteric venous thrombosis after a long distance flight in a traveller presenting with abdominal pain, diarrhoea and vomiting within 48 h of prolonged immobility situation. Venous thrombosis in the lower limbs and venous thromboembolism has been clearly associated with prolonged air travel (economy class syndrome). Thrombosis was diagnosed by computed tomography of the abdomen, and after starting anticoagulant therapy with acenocumarol, symptoms yielded completely in a few weeks. The study of thrombophilia was negative, although the existence of two first-degree relatives (mother and grandmother) with a history of venous thrombosis with a history of venous thrombosis makes it likely a situation of inherited thrombophilia. Although exceptional, mesenteric venous thrombosis should be considered in travellers with acute abdominal pain after prolonged air travel when there are thrombophilic conditions.

  4. Mesenteric venous thrombosis after prolonged air travel-a case report

    Directory of Open Access Journals (Sweden)

    Joaquín Salas-Coronas

    2014-07-01

    Full Text Available We present a case of acute mesenteric venous thrombosis after a long distance flight in a traveller presenting with abdominal pain, diarrhoea and vomiting within 48 h of prolonged immobility situation. Venous thrombosis in the lower limbs and venous thromboembolism has been clearly associated with prolonged air travel (economy class syndrome. Thrombosis was diagnosed by computed tomography of the abdomen, and after starting anticoagulant therapy with acenocumarol, symptoms yielded completely in a few weeks. The study of thrombophilia was negative, although the existence of two first-degree relatives (mother and grandmother with a history of venous thrombosis with a history of venous thrombosis makes it likely a situation of inherited thrombophilia. Although exceptional, mesenteric venous thrombosis should be considered in travellers with acute abdominal pain after prolonged air travel when there are thrombophilic conditions.

  5. Evaluating acute or chronic portal vein system thrombosis using multiple slice spiral computer tomography%CT增强扫描评价急慢性门静脉系统血栓

    Institute of Scientific and Technical Information of China (English)

    张青; 鲜军舫; 燕飞; 刘中林; 郭鹏德; 史旭波

    2014-01-01

    目的:采用多排螺旋CT增强扫描及三维重建技术评价急慢性门静脉系统血栓(PVT)。方法回顾性分析已证实的住院患者PVT的增强螺旋CT表现。根据症状发作时间将PVT分为急性期、慢性期,根据形态将血栓分为Ⅰ型完全型和Ⅱ型偏心型,分别评价门静脉直径、血栓位置、形态、密度、强化及伴随征象。结果 PVT形成患者19例。急性期3例,均为完全型;2例同时累及门静脉主干、左右分支、肠系膜上静脉及脾静脉,1例累及除门静脉主干外的其他3支血管。血栓CT值平均为(39±19)Hu,2例在血栓内部或边缘可见轻度强化。均有肠壁增厚、肠腔扩张积液、肠系膜水肿、腹水及侧支循环形成。慢性期16例,3例累及4支血管,4例累及3支,7例累及2支,2例累及1支。5例为完全型,11例为偏心型(68.8%),其中8例(72.7%)血栓宽径小于门脉宽径的50%。血栓 CT值平均为(41±12)Hu,3例强化。腹水15例,肠系膜水肿10例,侧支循环形成14例。结论 MSCT增强扫描可对急慢性PVT的累及范围及形态特点做出准确评价。%Objective To evaluate acute or chronic portal vein system thrombosis(PVT)using multiple slice spiral computer tomography(MSCT).Enhancement MSCT and three-dimensional CT reconstruction technique were applied in all patients.Methods Findings from inpatients proved portal vein system thrombosis were retrospectively reviewed.The portal venous system thrombosis was divided into acute or chronic stages according to the time from the onset of symptoms.The form of the blood clots fell into Ⅰ complete type and Ⅱ eccentric type.The diameter of the portal vein(DPV)was measured,and the location,shape,density,enhancement of the thrombi and the accompanying signs were assessed.Results Nineteen inpatients with portal vein system thrombosis were enrolled.Three cases were acute PVT and all were type Ⅰ.There were

  6. ST-elevation acute myocardial infarction due to arterial thrombosis in a 29-year-old woman with normal coronary arteries

    Science.gov (United States)

    Male, Eneida; Morton, Talitha; Farber, Adam

    2017-01-01

    Acute myocardial infarction (AMI) is rare in young adults. We present a case of a 29-year-old black woman who presented with an acute onset of chest pain while sleeping. Anterior wall ST-elevation AMI was diagnosed based on clinical presentation, electrocardiographic findings, and elevated cardiac biomarkers. Coronary angiography revealed a totally occluded proximal left anterior descending artery. The obstructing lesion, thrombus, was removed. There was no evidence of atherosclerotic disease or dissection. An evaluation for a hypercoagulable state was unrevealing. Echocardiography 1 year later revealed normal left ventricular wall motion and systolic function. PMID:28127135

  7. Deep venous thrombosis and postthrombotic syndrome: invasive management.

    Science.gov (United States)

    Comerota, A J

    2015-03-01

    Invasive management of postthrombotic syndrome encompasses the two ends of the deep vein thrombosis spectrum, patients with acute iliofemoral deep vein thrombosis and those with chronic postthrombotic iliofemoral venous obstruction. Of all patients with acute deep vein thrombosis, those with involvement of the iliofemoral segments have the most severe chronic postthrombotic morbidity. Catheter-based techniques now permit percutaneous treatment to eliminate thrombus, restore patency, potentially maintain valvular function, and improve quality of life. Randomized trial data support an initial treatment strategy of thrombus removal. Failure to eliminate acute thrombus from the iliofemoral system leads to chronic postthrombotic obstruction of venous outflow. Debilitating chronic postthrombotic symptoms of the long-standing obstruction of venous outflow can be reduced by restoring unobstructed venous drainage from the profunda femoris vein to the vena cava.

  8. A randomized multicenter comparison of hybrid sirolimus-eluting stents with bioresorbable polymer versus everolimus-eluting stents with durable polymer in total coronary occlusion: rationale and design of the Primary Stenting of Occluded Native Coronary Arteries IV study

    Directory of Open Access Journals (Sweden)

    Teeuwen Koen

    2012-12-01

    Full Text Available Abstract Background Percutaneous recanalization of total coronary occlusion (TCO was historically hampered by high rates of restenosis and reocclusions. The PRISON II trial demonstrated a significant restenosis reduction in patients treated with sirolimus-eluting stents compared with bare metal stents for TCO. Similar reductions in restenosis were observed with the second-generation zotarolimus-eluting stent and everolimus-eluting stent. Despite favorable anti-restenotic efficacy, safety concerns evolved after identifying an increased rate of very late stent thrombosis (VLST with drug-eluting stents (DES for the treatment of TCO. Late malapposition caused by hypersensitivity reactions and chronic inflammation was suggested as a probable cause of these VLST. New DES with bioresorbable polymer coatings were developed to address these safety concerns. No randomized trials have evaluated the efficacy and safety of the new-generation DES with bioresorbable polymers in patients treated for TCO. Methods/Design The prospective, randomized, single-blinded, multicenter, non-inferiority PRISON IV trial was designed to evaluate the safety, efficacy, and angiographic outcome of hybrid sirolimus-eluting stents with bioresorbable polymers (Orsiro; Biotronik, Berlin, Germany compared with everolimus-eluting stents with durable polymers (Xience Prime/Xpedition; Abbott Vascular, Santa Clara, CA, USA in patients with successfully recanalized TCOs. In total, 330 patients have been randomly allocated to each treatment arm. Patients are eligible with estimated duration of TCO ≥4 weeks with evidence of ischemia in the supply area of the TCO. The primary endpoint is in-segment late luminal loss at 9-month follow-up angiography. Secondary angiographic endpoints include in-stent late luminal loss, minimal luminal diameter, percentage of diameter stenosis, in-stent and in-segment binary restenosis and reocclusions at 9-month follow-up. Additionally, optical coherence

  9. Treatment of splenic artery aneurysm with double overlapping bare stents: case report

    Energy Technology Data Exchange (ETDEWEB)

    Kwak, Hyo Sung; Han, Young Min; Jin, Gong Yong [School of Medicine, Chonbuk National Univ., Chonju (Korea, Republic of)

    2004-09-01

    The traditional treatment of splenic artery aneurysm (SAA) is generally surgery and/or transcatheter arterial embolization, but recently, the treatment of SAA using a stent graft has been reported. However, the acute angle of the celiac axis, as well as the tortuous path of the splenic artery makes the use of stent graft difficult for treatment of aneurysma. We report here a case of SAA treated with the technique of double overlapping metallic stents.

  10. Transcatheter Aortic Heart Valve Thrombosis

    DEFF Research Database (Denmark)

    Hansson, Nicolaj C; Grove, Erik L; Andersen, Henning R;

    2016-01-01

    BACKGROUND: There is increasing focus on transcatheter heart valve (THV) thrombosis. However, there are limited data on incidence, clinical implications and predisposing factors of THV thrombosis following transcatheter aortic valve replacement (TAVR). OBJECTIVES: We assessed the incidence...

  11. Venous thrombosis: an overview

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, C.W.

    1986-07-01

    Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler, /sup 125/I-radiofibrinogen-uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long-term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by prevention. 61 references.

  12. An automatic algorithm for detecting stent endothelialization from volumetric optical coherence tomography datasets

    Science.gov (United States)

    Bonnema, Garret T.; O'Halloran Cardinal, Kristen; Williams, Stuart K.; Barton, Jennifer K.

    2008-06-01

    Recent research has suggested that endothelialization of vascular stents is crucial to reducing the risk of late stent thrombosis. With a resolution of approximately 10 µm, optical coherence tomography (OCT) may be an appropriate imaging modality for visualizing the vascular response to a stent and measuring the percentage of struts covered with an anti-thrombogenic cellular lining. We developed an image analysis program to locate covered and uncovered stent struts in OCT images of tissue-engineered blood vessels. The struts were found by exploiting the highly reflective and shadowing characteristics of the metallic stent material. Coverage was evaluated by comparing the luminal surface with the depth of the strut reflection. Strut coverage calculations were compared to manual assessment of OCT images and epi-fluorescence analysis of the stented grafts. Based on the manual assessment, the strut identification algorithm operated with a sensitivity of 93% and a specificity of 99%. The strut coverage algorithm was 81% sensitive and 96% specific. The present study indicates that the program can automatically determine percent cellular coverage from volumetric OCT datasets of blood vessel mimics. The program could potentially be extended to assessments of stent endothelialization in native stented arteries.

  13. Development and characterization of a coronary polylactic acid stent prototype generated by selective laser melting.

    Science.gov (United States)

    Flege, Christian; Vogt, Felix; Höges, Simon; Jauer, Lucas; Borinski, Mauricio; Schulte, Vera A; Hoffmann, Rainer; Poprawe, Reinhart; Meiners, Wilhelm; Jobmann, Monika; Wissenbach, Konrad; Blindt, Rüdiger

    2013-01-01

    In-stent restenosis is still an important issue and stent thrombosis is an unresolved risk after coronary intervention. Biodegradable stents would provide initial scaffolding of the stenosed segment and disappear subsequently. The additive manufacturing technology Selective Laser Melting (SLM) enables rapid, parallel, and raw material saving generation of complex 3- dimensional structures with extensive geometric freedom and is currently in use in orthopedic or dental applications. Here, SLM process parameters were adapted for poly-L-lactid acid (PLLA) and PLLA-co-poly-ε-caprolactone (PCL) powders to generate degradable coronary stent prototypes. Biocompatibility of both polymers was evidenced by assessment of cell morphology and of metabolic and adhesive activity at direct and indirect contact with human coronary artery smooth muscle cells, umbilical vein endothelial cells, and endothelial progenitor cells. γ-sterilization was demonstrated to guarantee safety of SLM-processed parts. From PLLA and PCL, stent prototypes were successfully generated and post-processing by spray- and dip-coating proved to thoroughly smoothen stent surfaces. In conclusion, for the first time, biodegradable polymers and the SLM technique were combined for the manufacturing of customized biodegradable coronary artery stent prototypes. SLM is advocated for the development of biodegradable coronary PLLA and PCL stents, potentially optimized for future bifurcation applications.

  14. The Development of Coronary Artery Stents: From Bare-Metal to Bio-Resorbable Types

    Directory of Open Access Journals (Sweden)

    Ming-Yun Ho

    2016-07-01

    Full Text Available Coronary artery disease is the leading cause of death worldwide. Conventional balloon angioplasty is associated with high rates of complications such as coronary dissection and vessel recoil. The deployment of bare-metal stents (BMSs can overcome these problems and achieve a better patency rate than simple balloon angioplasty. It has been shown that the stent design including structure platform, size, length, and strut thickness has a major influence on the clinical results. Even though angioplasty with BMS implantation is widely used in coronary interventions, the restenosis rate due to neointimal hyperplasia remains high. Therefore, drug-eluting stents (DESs coated with anti-proliferative agents and polymers have been developed to reduce the restenosis rate and improve the clinical outcomes. Although the repeat revascularization rate of DESs is lower than that of BMSs, the long-term stent thrombosis rate is higher than for BMSs. Therefore, new and emerging generations of stents, in which, for example, thinner struts and bioresorbable polymers are used, are available for clinical use. However, there are only a limited number of clinical trials, in which these newer stents have been compared with BMSs and first- and second-generation DESs. The purpose of this review was to provide up-to-date information on the evolution of coronary artery stents from BMSs to DESs to bioresorbable stents (BRSs.

  15. The clinical outcomes of triple antiplatelet therapy versus dual antiplatelet therapy for high-risk patients after coronary stent implantation: a meta-analysis of 11 clinical trials and 9,553 patients

    Science.gov (United States)

    Fan, Zhong-Guo; Ding, Guo-Bin; Li, Xiao-Bo; Gao, Xiao-Fei; Gao, Ya-Li; Tian, Nai-Liang

    2016-01-01

    Background The optimal antiplatelet regimen after in-coronary intervention among patients presenting with complex coronary artery lesions or acute coronary syndrome (ACS) has remained unclear. This study sought to evaluate the clinical outcomes of triple antiplatelet treatment (TAPT) (cilostazol added to aspirin plus clopidogrel) in these patients. Methods The PubMed, EMBASE, MEDLINE, and other Internet sources were searched for relevant articles. The primary end point was major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction, and target vessel revascularization. The incidence of definite/probable stent thrombosis and bleeding were analyzed as the safety end points. Results Eleven clinical trials involving 9,553 patients were analyzed. The risk of MACE was significantly decreased following TAPT after stent implantation in the ACS subgroup (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.61–0.85; P<0.001), which might mainly result from the lower risk of all-cause mortality in this subset (OR: 0.62; 95% CI: 0.48–0.80; P<0.001). The risk of bleeding was not increased with respect to TAPT. Conclusion TAPT after stent implantation was associated with feasible benefits on reducing the risk of MACE, especially on reducing the incidence of all-cause mortality among patients suffering from ACS, without higher incidence of bleeding. Larger and more powerful randomized trials are still warranted to prove the superiority of TAPT for such patients. PMID:27799743

  16. [Epidemiology and maternal thrombosis].

    Science.gov (United States)

    Bosson, Jean-Luc

    2003-01-01

    The monthly incidence of deep vein thrombosis during pregnancy varies from 0.1 to 0.8 per 1000 pregnancies, depending on the study. These figures are undoubtedly an underestimation because they were determined from clinical events with no estimation of asymptomatic forms which, in general, increase the prevalence about 3-fold. Although the absolute figures are reliable, the consequences in terms of maternal mortality and post-phlebitis sequelae warrant the careful attention paid to this condition. Moreover, it should be recalled that the prevalence of superficial venous thrombosis is similar and may be associated with a risk of pulmonary embolism.

  17. Colorectal stenting for colonic obstruction: The indications, complications, effectiveness and outcome-5-Year review

    Energy Technology Data Exchange (ETDEWEB)

    Athreya, S. [Department of Radiology, Gartnavel General Hospital, Great Western Road, Glasgow (United Kingdom)]. E-mail: harshavbs@yahoo.com; Moss, J. [Department of Radiology, Gartnavel General Hospital, Great Western Road, Glasgow (United Kingdom)]. E-mail: j.moss@clinmed.gla.ac.uk; Urquhart, G. [Department of Radiology, Southern General Hospital, Glasgow (United Kingdom); Edwards, R. [Department of Radiology, Gartnavel General Hospital, Great Western Road, Glasgow (United Kingdom); Downie, A. [Department of Radiology, Victoria Infirmary, Glasgow (United Kingdom); Poon, F.W. [Department of Radiology, Royal Infirmary, Glasgow (United Kingdom)

    2006-10-15

    Introduction: Currently self-expanding metallic stents are being used for palliation and acute decompression of colonic obstruction. The aim of this study is to review our experience of using these metallic stents over a 5-year period. Materials and methods: Case records of 102 patients who had colorectal stenting between 1998 and 2004 were reviewed retrospectively. The indications for colorectal stenting, efficacy of the procedure in relieving the obstruction, complications and clinical outcome were analysed. Results: Ninety-nine patients had malignant disease and in three patients a benign cause of obstruction was demonstrated. All procedures were performed during normal working hours. Stenting was technically successful in 87 patients (85%). A single stent was placed in 80 patients. Seven patients required two stents. Of the successful cases, 67 had stents placed by fluoroscopy alone and 20 by a combined fluoroscopy/endoscopy procedure. Four percent had early complications (within 30 days) which included four perforations. There were late complications (over 30 days) in 9% which included five stent migrations, two blocked stents and one colovesical fistula. Ninety percent (n = 76) of the successful patients needed no further radiological or surgical intervention later. Survival ranged from 14 days to 2 years. Conclusion: Colorectal stenting when technically successful is an effective procedure for both preoperative and palliative decompression of colonic obstruction.

  18. Biomechanical Challenges to Polymeric Biodegradable Stents.

    Science.gov (United States)

    Soares, Joao S; Moore, James E

    2016-02-01

    Biodegradable implants have demonstrated clinical success in simple applications (e.g., absorbable sutures) and have shown great potential in many other areas of interventional medicine, such as localized drug delivery, engineered tissue scaffolding, and structural implants. For endovascular stenting and musculoskeletal applications, they can serve as temporary mechanical support that provides a smooth stress-transfer from the degradable implant to the healing tissue. However, for more complex device geometries, in vivo environments, and evolving load-bearing functions, such as required for vascular stents, there are considerable challenges associated with the use of biodegradable materials. A biodegradable stent must restore blood flow and provide support for a predictable appropriate period to facilitate artery healing, and subsequently, fail safely and be absorbed in a controllable manner. Biodegradable polymers are typically weaker than metals currently employed to construct stents, so it is difficult to ensure sufficient strength to keep the artery open and alleviate symptoms acutely while keeping other design parameters within clinically acceptable ranges. These design challenges are serious, given the general lack of understanding of biodegradable polymer behavior and evolution in intimal operating conditions. The modus operandi is mainly empirical and relies heavily on trial-and-error methodologies burdened by difficult, resource-expensive, and time-consuming experiments. We are striving for theoretical advancements systematizing the empirical knowledge into rational frameworks that could be cast into in silico tools for simulation and product development optimization. These challenges are evident when one considers that there are no biodegradable stents on the US market despite more than 30 years of development efforts (and currently only a couple with CE mark). This review summarizes previous efforts at implementing biodegradable stents, discusses the

  19. Endovascular Gene Delivery from a Stent Platform: Gene- Eluting Stents.

    Science.gov (United States)

    Fishbein, Ilia; Chorny, Michael; Adamo, Richard F; Forbes, Scott P; Corrales, Ricardo A; Alferiev, Ivan S; Levy, Robert J

    A synergistic impact of research in the fields of post-angioplasty restenosis, drug-eluting stents and vascular gene therapy over the past 15 years has shaped the concept of gene-eluting stents. Gene-eluting stents hold promise of overcoming some biological and technical problems inherent to drug-eluting stent technology. As the field of gene-eluting stents matures it becomes evident that all three main design modules of a gene-eluting stent: a therapeutic transgene, a vector and a delivery system are equally important for accomplishing sustained inhibition of neointimal formation in arteries treated with gene delivery stents. This review summarizes prior work on stent-based gene delivery and discusses the main optimization strategies required to move the field of gene-eluting stents to clinical translation.

  20. Drug diffusion and biological responses of arteries using a drug-eluting stent with nonuniform coating

    Directory of Open Access Journals (Sweden)

    Saito N

    2016-03-01

    Full Text Available Noboru Saito, Yuhei Mori, Sayaka Uchiyama Terumo Corporation R&D Center, Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, Japan Abstract: The purpose of this study was to determine the effect of a nonuniform coating, abluminal-gradient coating (AGC, which leaves the abluminal surface of the curves and links parts of the stent free from the drug coating, on the diffusion direction of the drug and the biological responses of the artery to drug-eluting stent (DES by comparing the AGC-sirolimus stent and the conventional full-surface coating (CFC sirolimus stent. The study aimed to verify whether the AGC approach was appropriate for the development of a safer DES, minimizing the risks of stent thrombosis due to delayed endothelialization by the drug and distal embolization due to cracking of the coating layer on the hinge parts of the DES on stent expansion. In the in vitro local drug diffusion study, we used rhodamine B as a model drug, and rhodamine B released from the AGC stent diffused predominantly into the abluminal side of the alginate artery model. Conversely, rhodamine B released from the CFC stent quickly spread to the luminal side of the artery model, where endothelial cell regeneration is required. In the biological responses study, the luminal surface of the iliac artery implanted with the AGC-sirolimus stent in a rabbit iliac artery for 2 weeks was completely covered with endothelial-like cells. On the other hand, the luminal surface of the iliac artery implanted with the CFC-sirolimus stent for 2 weeks only showed partial coverage with endothelial-like cells. While thrombosis was observed in two of the three CFC-sirolimus stents, it was observed in only one of the three AGC-sirolimus stents. Taken together, these findings indicate that the designed nonuniform coating (AGC is an appropriate approach to ensure a safer DES. However, the number of studies is limited and a larger study should be conducted to reach a statistically

  1. Deep Vein Thrombosis

    Centers for Disease Control (CDC) Podcasts

    2012-04-05

    This podcast discusses the risk for deep vein thrombosis in long-distance travelers and ways to minimize that risk.  Created: 4/5/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/5/2012.

  2. Testosterone, thrombophilia, and thrombosis.

    Science.gov (United States)

    Glueck, Charles J; Richardson-Royer, Caitlin; Schultz, Reiker; Burger, Tim; Labitue, Fanta; Riaz, Muhammad K; Padda, Jagjit; Bowe, Dedrick; Goldenberg, Naila; Wang, Ping

    2014-01-01

    We describe thrombosis, deep venous thrombosis (DVT) pulmonary embolism (PE; n = 9) and hip-knee osteonecrosis (n = 5) that developed after testosterone therapy (median 11 months) in 14 previously healthy patients (13 men and 1 woman; 13 Caucasian and 1 African American), with no antecedent thrombosis and previously undiagnosed thrombophilia-hypofibrinolysis. Of the 14 patients, 3 were found to be factor V Leiden heterozygotes, 3 had high factor VIII, 3 had plasminogen activator inhibitor 1 4G4G homozygosity, 2 had high factor XI, 2 had high homocysteine, 1 had low antithrombin III, 1 had the lupus anticoagulant, 1 had high anticardiolipin antibody Immunoglobulin G, and 1 had no clotting abnormalities. In 4 men with thrombophilia, DVT-PE recurred when testosterone was continued despite therapeutic international normalized ratio on warfarin. In 60 men on testosterone, 20 (33%) had high estradiol (E2 >42.6 pg/mL). When exogenous testosterone is aromatized to E2, and E2-induced thrombophilia is superimposed on thrombophilia-hypofibrinolysis, thrombosis occurs. The DVT-PE and osteonecrosis after starting testosterone are associated with previously undiagnosed thrombophilia-hypofibrinolysis. Thrombophilia should be ruled out before administration of exogenous testosterone.

  3. Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS),or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis,and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures,seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications, and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.

  4. Role of colonic stents in the management of colorectalcancers

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Colorectal cancer is one of the commonly encounteredcancers across the Western World. In United Kingdom,this constitutes third most common ranked cancer andsecond most common ranked cause of cancer relateddeaths. Its acute presentation as a malignant colonicobstruction imposes challenges in its management.Colonic stent has been used for many years to alleviateSubmit a Manuscript http://www.wjgnet.com/esps/Help Desk: http://www.wjgnet.com/esps/helpdesk.aspxDOI: 10.4253/wjge.v8.i4.198World J Gastrointest Endosc 2016 February 25; 8(4): 198-204ISSN 1948-5190 (online)? 2016 Baishideng Publishing Group Inc. All rights reserved.acute obstruction in such cases allowing optimisationof patient's physiological status and adequate stagingof cancer. In this review, current literature evidenceregarding use of colonic stent in acute malignant colonicobstruction is critically appraised and recommendationson the use of colonic stent are advocated.

  5. Nobori-Biolimus-Eluting Stents versus Resolute Zotarolimus-Eluting Stents in Patients Undergoing Coronary Intervention: A Propensity Score Matching

    Science.gov (United States)

    Tantawy, Ayman; Ahn, Chul-Min; Shin, Dong-Ho; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Choi, Donghoon; Jang, Yangsoo

    2017-01-01

    Purpose To compare the 1-year outcomes of a durable polymer Zotarolimus-eluting stent (ZES) versus a biodegradable polymer Biolimus-eluting stent (BES) in patients undergoing percutaneous coronary intervention. Materials and Methods A total of 2083 patients from 2 different registries, 1125 treated with BES in NOBORI registry and 858 received ZES in CONSTANT registry were included in this study. Clinical outcomes were compared with the use of propensity score matching (PSM). The primary endpoint was a composite of major adverse cardiovascular and cerebrovascular events (MACCEs) including cardiac death, myocardial infarction, clinically driven target lesion revascularization and stroke. Secondary end points were individual components of MACCEs as well as the incidence of stent thrombosis at 1-year follow-up. Results After PSM, 699 matched pairs of patients (n=1398) showed no significant difference between BES and ZES in the risk of composite MACCEs at 1 year (2.6% vs. 1.7%; p=0.36). Cardiac death was not statistically different between groups (0.7% vs. 0.4%, p=0.73). Target lesion revascularization rate was also similar between BES and ZES (1.1% vs. 0.7%, p=0.579). Non-Q wave myocardial infarction, as well as target-vessel revascularization rate, was similar between the two groups (0.14% for BES and 0.72% for ZES). Both stent types were excellent with no cases of stent thrombosis and rate of Q wave myocardial infarction reported during the follow-up period. Conclusion In this cohort of patients treated with BES or ZES, the rate of MACCEs at 1 year was low and significantly not different between both groups. PMID:28120558

  6. Arterial stenting with self-expandable and balloon-expandable endoprostheses

    NARCIS (Netherlands)

    W.J. van der Giessen (Wim); P.W.J.C. Serruys (Patrick); L.J. van Woerkens (L.); K.J. Beatt (Kevin); W.J. Visser (W.); J.F. Jongkind; R.H. van Bremen (Robert); E. Ridderhof; H. van Loon (Heleen); L.K. Soei (Lou Kie); H.M.M. van Beusekom (Heleen); P.D. Verdouw (Pieter)

    1990-01-01

    textabstractCoronary angioplasty is complicated by acute occlusion (within 24 hours) and late restenosis (within 6 months) in 2-5% and 20-40% of the cases, respectively. Vascular endoprostheses (stents) may provide the cardiologist with a solution to some of these complications. Several stent-device

  7. Endovascular Therapy Is Effective for Leriche Syndrome with Deep Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Tasuku Higashihara

    2015-01-01

    Full Text Available A 65-year-old man presented to our hospital due to intermittent claudication and swelling in his left leg. He had Leriche syndrome and deep vein thrombosis. We performed endovascular therapy (EVT for Leriche syndrome, and a temporary filter was inserted in the inferior vena cava. He received anticoagulation therapy for deep vein thrombosis. The stenotic lesion in the terminal aorta was stented with an excellent postprocedural angiographic result and dramatic clinical improvement after EVT. This case suggests that EVT can be a treatment for Leriche syndrome.

  8. An autopsy case of traumatic sinus thrombosis.

    Science.gov (United States)

    Seto, Y; Takeichi, S

    1996-02-01

    A 38-year-old male slipped accidentally and fell from a height of 4.6 m, and was admitted to a hospital. A radiograph indicated a linear fracture of the parietal bone across the sagittal sutura, and a computed tomography scan of the head showed severe subdural hematoma on both parietal sides, so an operation was performed to remove the hematoma. Five hours after the operation, brain death due to a cerebral herniation occurred, and he died six days later. Autopsy revealed a linear fracture of the parietal bones, which crossed obliquely the sagittal sutura. A slightly lacerated wound of the dura mater was seen on the sagittal sutura, from where the latter half of that point to the left and right transverse sinuses were occluded completely with thrombosis. The brain was markedly swollen. From these findings, the victim was considered to have died from acute cerebral swelling due to traumatic thrombosis of the superior sagittal sinus.

  9. Idiopathic Thrombosis of the Inferior Vena Cava and Bilateral Femoral Veins in an Otherwise Healthy Male Soldier

    Directory of Open Access Journals (Sweden)

    Sarah Gordon

    2013-01-01

    Full Text Available Thrombosis of the inferior vena cava is less common than deep venous thrombosis of the lower extremities, particularly in the absence of an obvious congenital caval abnormality or hypercoagulable state. We present a case of IVC thrombosis in an otherwise healthy and active 28-year-old male soldier secondary to dehydration and venous webbing. IVC thrombosis is an uncommon and underrecognized condition; in this case, the patient’s caval thrombosis was initially mistaken for acute back strain. Prompt recognition is necessary to minimize long-term sequelae.

  10. Efficacy of drug-eluting stents for treating in-stent restenosis of drug-eluting stents (from the Korean DES ISR multicenter registry study [KISS]).

    Science.gov (United States)

    Ko, Young-Guk; Kim, Jung-Sun; Kim, Byeong-Keuk; Choi, Donghoon; Hong, Myeong-Ki; Jeon, Dong Woon; Yang, Joo-Young; Ahn, Young Keun; Jeong, Myung Ho; Yu, Cheol Woong; Yun, Kyeong-Ho; Lim, Do-Sun; Jang, Yangsoo

    2012-03-01

    There is currently no established standard treatment for in-stent restenosis (ISR) after the implantation of a drug-eluting stent (DES). The aim of this study was to investigate the efficacy of DES versus balloon angioplasty (BA) for the treatment of DES ISR in a multicenter registry cohort. After matching propensity scores of 805 patients with DES ISR treated with either DES (n = 422) or BA (n = 383), 268 matched pairs were selected and analyzed for major adverse cardiac events, a composite of death, myocardial infarction, and target-vessel revascularization, as the primary end point. Baseline clinical and lesion characteristics of the matched pairs were similar. Survival free of major adverse cardiac events at 2 years was higher with DES compared to BA (88.9% vs 78.7%, p ISR, and previous implantation of a sirolimus-eluting stent. Survival free of death, myocardial infarction, or stent thrombosis did not differ between the 2 groups. Whereas there was no significant difference in survival free of target vessel revascularization between DES and BA for focal ISR lesions, DES was superior to BA in diffuse ISR lesions (94.3% vs 75.2% at 2 years, p ISR.

  11. Biocompatibility evaluation of NiTi SMA stent via intervenient therapy

    Institute of Scientific and Technical Information of China (English)

    FENG; Jing-su; LIU; Kun-peng; KOU; Ya-ming

    2005-01-01

    NiTi shape memory alloy (SMA) stent with film are the long-term implanted medical devices which could be used in human's organ, such as esophagus, bile duct, urethra-prostate and blood vessel, by intervene therapy. It is very important to have a good biocompatibility for implanted device. According to standard ISO 10993, we completed biocompatibility evaluation of NiTi stent that included following tests: cytotoxicity, sensitization, genotoxicity, hemolysis and acute systemic toxicity, The results of tests qualify the NiTi stent, and provide an optimistic conclusion for the eventual use of NiTi stent as implanted medical devices.

  12. Coronary Stents: The Impact of Technological Advances on Clinical Outcomes.

    Science.gov (United States)

    Mennuni, Marco G; Pagnotta, Paolo A; Stefanini, Giulio G

    2016-02-01

    Percutaneous coronary interventions (PCI) were proposed in the late 1970s as an alternative to surgical coronary artery bypass grafting for the treatment of coronary artery disease. Important technological progress has been made since. Balloon angioplasty was replaced by bare metal stents, which allowed to permanently scaffold the coronary vessel avoiding acute recoil and abrupt occlusion. Thereafter, the introduction of early generation drug-eluting stents (DES) has significantly improved clinical outcomes, primarily by markedly reducing the risk of restenosis. New generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new limus antiproliferative agents, have further improved upon the safety and efficacy profile of early generation DES. The present article aims to review the impact of technological advances on clinical outcomes in the field of PCI with coronary stents, and to provide a brief overview on clinical margins of improvement and unmet needs of available DES.

  13. Perioperative management of a patient with recently placed drug-eluting stents requiring urgent spinal surgery.

    Science.gov (United States)

    Roth, Eira; Purnell, Chad; Shabalov, Olga; Moguillansky, Diego; Hernandez, Caridad A; Elnicki, Michael

    2012-08-01

    Patients receiving drug-eluting coronary stents (DES) require antiplatelet therapy for at least 12 months to prevent stent thrombosis (ST), a potentially calamitous event. Since interruption of antiplatelet therapy is the greatest risk factor for ST, it is imperative that the decision to discontinue these agents be based on an accurate assessment of the patient's risk for bleeding complications. Individuals who are regarded as being at a high risk are those undergoing intracranial, spinal or intraocular surgeries. These patients require alternative agents during the perioperative period to minimize both their risk of perioperative thrombosis and intraoperative hemorrhage. We report the case of a woman who required spinal surgery 3 months after she underwent placement of two drug-eluting stents. The patient's clopidogrel was stopped 5 days prior to surgery and an infusion of eptifibatide was used to "bridge" antiplatelet therapy during the perioperative period. Postoperatively, anticoagulation therapy was reinstituted using aspirin with clopidogrel. This case serves as a successful example of bridging therapy using a short acting and gycoprotein (GP) IIb/IIIa inhibitor as a means of maintaining antiplatelet therapy during the perioperative period to minimize the risk of stent thrombosis and the risk of intraoperative bleeding.

  14. International Society of Thrombosis and Hemostasis Scoring System for disseminated intravascular coagulation ≥ 6: a new predictor of hemorrhagic early death in acute promyelocytic leukemia.

    Science.gov (United States)

    Mitrovic, Mirjana; Suvajdzic, Nada; Bogdanovic, Andrija; Kurtovic, Nada Kraguljac; Sretenovic, Aleksandra; Elezovic, Ivo; Tomin, Dragica

    2013-03-01

    High-hemorrhagic early death (ED) rate is a major impediment in the managing of acute promyelocytic leukemia (APL). In our group of 56 newly diagnosed APL patients, ED occurred in 12 subjects, due to endocranial bleeding (8/12), differentiation syndrome (2/12), or infection (2/12). Predictors of hemorrhagic ED were as follows: white blood cells count ≥ 20 × 10(9)/L (P = 0.002337), Eastern cooperative oncology group performance status ≥ 3 (P = 0.00173), fibrinogen level disseminated intravascular coagulation (ISTH DIC score) ≥ 6 (P = 0.00741). Multivariate analysis indicated ISTH DIC score ≥ 6 to be the most significant predictor for hemorrhagic ED (P = 0.008). The main finding of this study is that simple coagulation-related tests, performed on hospital admission and combined in the ISTH DIC score, might help to identify patients at high risk for fatal bleeding needing more aggressive supportive measures.

  15. Renal Artery Stent Outcomes

    Science.gov (United States)

    Murphy, Timothy P.; Cooper, Christopher J.; Matsumoto, Alan H.; Cutlip, Donald E.; Pencina, Karol M.; Jamerson, Kenneth; Tuttle, Katherine R.; Shapiro, Joseph I.; D’Agostino, Ralph; Massaro, Joseph; Henrich, William; Dworkin, Lance D.

    2016-01-01

    BACKGROUND Multiple randomized clinical trials comparing renal artery stent placement plus medical therapy with medical therapy alone have not shown any benefit of stent placement. However, debate continues whether patients with extreme pressure gradients, stenosis severity, or baseline blood pressure benefit from stent revascularization. OBJECTIVES The study sought to test the hypothesis that pressure gradients, stenosis severity, and/or baseline blood pressure affects outcomes after renal artery stent placement. METHODS Using data from 947 patients with a history of hypertension or chronic kidney disease from the largest randomized trial of renal artery stent placement, the CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) study, we performed exploratory analyses to determine if subsets of patients experienced better outcomes after stent placement than the overall cohort. We examined baseline stenosis severity, systolic blood pressure, and translesion pressure gradient (peak systolic and mean) and performed interaction tests and Cox proportional hazards analyses for the occurrence of the primary endpoint through all follow-up, to examine the effect of these variables on outcomes by treatment group. RESULTS There were no statistically significant differences in outcomes based on the examined variables nor were there any consistent nonsignificant trends. CONCLUSIONS Based on data from the CORAL randomized trial, there is no evidence of a significant treatment effect of the renal artery stent procedure compared with medical therapy alone based on stenosis severity, level of systolic blood pressure elevation, or according to the magnitude of the transstenotic pressure gradient. (Benefits of Medical Therapy Plus Stenting for Renal Atherosclerotic Lesions [CORAL]; NCT00081731) PMID:26653621

  16. Hyperperfusion syndrome after carotid stent angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Politi, M.; Reith, W.; Krick, C.; Karp, K.; Zimmer, A.; Struffert, T.; Kuehn, A.L.; Papanagiotou, P. [University of the Saarland, Department for Interventional and Diagnostic Neuroradiology, Homburg (Germany); Roth, C.; Haass, A. [University of the Saarland, Clinic for Neurology, Homburg (Germany)

    2009-03-15

    This study assesses the incidence and causes of hyperperfusion syndrome occurring after carotid artery stenting (CAS). We retrospectively reviewed the clinical database of 417 consecutive patients who were treated with CAS in our department to identify patients who developed hyperperfusion syndrome and/or intracranial hemorrhage. Magnetic resonance imaging (MRI) including fluid-attenuated inversion recovery and diffusion-weighted imaging was performed before and after CAS in 269 cases. A Spearman's rho nonparametric correlation was performed to determine whether there was a correlation between the occurrence/development of hyperperfusion syndrome and the patient's age, degree of stenosis on the stented and contralateral side, risk factors such as diabetes, smoking, hypertension, adiposity, gender and fluoroscopy time, and mean area of postprocedural lesions as well as preexisting lesions. Significance was established at p < 0.05. Of the 417 carotid arteries stented and where MRI was also completed, we found hyperperfusion syndrome in 2.4% (ten cases). Patients who had preexisting brain lesions (previous or acute stroke) were at a higher risk of developing hyperperfusion syndrome (p = 0.022; Spearman's rho test). We could not validate any correlation with the other patient characteristics. Extensive microvascular disease may be a predictor of hyperperfusion syndrome after carotid stent placement. We believe that further studies are warranted to predict more accurately which patients are at greater risk of developing this often fatal complication. (orig.)

  17. [Stent implantation as initial coronary interventional therapy? A theoretical model on clinical and economical consequences of in-stent restenosis].

    Science.gov (United States)

    Pfund, A; Wendland, G; Baer, F; Lauterbach, K; Höpp, H W

    2000-08-01

    The reduction of acute complications and late restenosis compared to conventional PTCA has led to a rapid increase in stent implantation as initial treatment for coronary stenosis. As a result, in-stent restenosis has become an important clinical and economical problem, especially the diffuse form, which is much more likely to reappear. In order to compare the consequences of initial stenting and initial angioplasty, we developed an analytic model, considering the differences between diffuse and focal in-stent restenosis. The simulation based on the optimized therapeutic proceeding following an elective 1-vessel revascularization of a 60-year-old patient, dealing with probabilities for acute complications and late restenosis taken from the literature and in-hospital costs obtained from 200 elective interventions. In the stent group 71.0% of patients were free of any target lesion-related event, compared to 60.2% in the PTCA group. Catheter reintervention was necessary for 32.1% of the patients initially treated with angioplasty and for 17.6% of the initially stented patients, whereas 7.7% of the stent patients had to undergo elective bypass surgery as final treatment compared to 2.8% in the PTCA arm. Long-term medical costs for initial stenting (6,237 Euros) were 14% higher than for conventional PTCA (5,345 Euros). Taking also into consideration the indirect costs (loss of productivity) for a collective with an employment rate of 50%, the difference between stent implantation (9,067 Euros) and angioplasty (8,581 Euros) is smaller. Initial treatment of coronary stenosis by stent implantation decreases the rate of repeat revascularization compared to initial PTCA, but there is a greater likelihood that elective bypass surgery will become necessary. This difference in following treatment is related to the occurrence of diffuse in-stent restenosis. When calculating the long-term costs stenting still appeared to be more expensive than PTCAA because the savings in

  18. The virtual histology intravascular ultrasound appearance of newly placed drug-eluting stents.

    Science.gov (United States)

    Kim, Sang-Wook; Mintz, Gary S; Hong, Young-Joon; Pakala, Rajbabu; Park, Kyung-Sook; Pichard, Augusto D; Satler, Lowell F; Kent, Kenneth M; Suddath, William O; Waksman, Ron; Weissman, Neil J

    2008-11-01

    Intravascular ultrasound (IVUS) is used before and after intervention and at follow-up to assess the quality of the acute result as well as the long-term effects of stent implantation. Virtual histology (VH) IVUS classifies tissue into fibrous and fibrofatty plaque, dense calcium, and necrotic core. Although most interventional procedures include stent implantation, VH IVUS classification of stent metal has not been validated. In this study, the VH IVUS appearance of acutely implanted stents was assessed in 27 patients (30 lesions). Most stent struts (80%) appeared white (misclassified as "calcium") surrounded by red (misclassified as "necrotic core"); 2% appeared just white, and 17% were not detectable (compared with grayscale IVUS because of the software-imposed gray medial stripe). The rate of "white surrounded by red" was similar over the lengths of the stents; however, undetectable struts were mostly at the distal edges (31%). Quantitatively, including the struts within the regions of interest increased the amount of "calcium" from 0.23 +/- 0.35 to 1.07 +/- 0.66 mm(2) (p stents have an appearance that can be misclassified by VH IVUS as "calcium with or without necrotic core." It is important not to overinterpret VH IVUS studies of chronically implanted stents when this appearance is observed at follow-up. A separate classification for stent struts is necessary to avoid these misconceptions and misclassifications.

  19. A stent for co-delivering paclitaxel and nitric oxide from abluminal and luminal surfaces: Preparation, surface characterization, and in vitro drug release studies

    Energy Technology Data Exchange (ETDEWEB)

    Gallo, Annemarie; Mani, Gopinath, E-mail: Gopinath.Mani@usd.edu

    2013-08-15

    Most drug-eluting stents currently available are coated with anti-proliferative drugs on both abluminal (toward blood vessel wall) and luminal (toward lumen) surfaces to prevent neointimal hyperplasia. While the abluminal delivery of anti-proliferative drugs is useful for controlling neointimal hyperplasia, the luminal delivery of such drugs impairs or prevents endothelialization which causes late stent thrombosis. This research is focused on developing a bidirectional dual drug-eluting stent to co-deliver an anti-proliferative agent (paclitaxel – PAT) and an endothelial cell promoting agent (nitric oxide – NO) from abluminal and luminal surfaces of the stent, respectively. Phosphonoacetic acid, a polymer-free drug delivery platform, was initially coated on the stents. Then, the PAT and NO donor drugs were co-coated on the abluminal and luminal stent surfaces, respectively. The co-coating of drugs was collectively confirmed by the surface characterization techniques such as Fourier transform infrared spectroscopy, scanning electron microscopy (SEM), 3D optical surface profilometry, and contact angle goniometry. SEM showed that the integrity of the co-coating of drugs was maintained without delamination or cracks formation occurring during the stent expansion experiments. In vitro drug release studies showed that the PAT was released from the abluminal stent surfaces in a biphasic manner, which is an initial burst followed by a slow and sustained release. The NO was burst released from the luminal stent surfaces. Thus, this study demonstrated the co-delivery of PAT and NO from abluminal and luminal stent surfaces, respectively. The stent developed in this study has potential applications in inhibiting neointimal hyperplasia as well as encouraging luminal endothelialization to prevent late stent thrombosis.

  20. Stent Fracture after Everolimus-Eluting Stent Implantation

    Directory of Open Access Journals (Sweden)

    Ali S. Almasood

    2011-01-01

    Full Text Available Compared with bare-metal stents, drug-eluting stents (DES have greatly reduced the risk of in-stent restenosis (ISR by inhibiting neointimal growth. Nevertheless, DES are still prone to device failure, which may lead to cardiac events. Recently, stent fracture (SF has emerged as a potential mechanism of DES failure that is associated with ISR. Stent fracture is strongly related to stent type, and prior reports suggest that deployment of sirolimus eluting stents (SES may be associated with a higher risk of SF compared to other DES. Everolimus eluting stents (EESs represent a new generation of DES with promising results. The occurrence of SF with EES has not been well established. The present paper describes two cases of EES fracture associated with ISR.

  1. Novel side branch ostial stent (BIGUARDTTM): first-in-man study

    Institute of Scientific and Technical Information of China (English)

    CHEN Shao-liang; ZHANG Jun-jie; YE Fei

    2009-01-01

    Background Stenting a bifurcation lesion is technically challenging. No study has reported the clinical outcome of a dedicated bifurcation stent in China. We aimed to analyze the safety and clinical outcome of a novel side branch ostial stent (BIGUARDTM) stent in treating coronary bifurcation lesions.Methods Forty-seven patients were enrolled in this first-in-man study, with 61.7% true bifurcation lesions (0,1,1 and 1,1,1) and 26.7% diabetes. A two-stent technique was used in 27.6% of the patients, and 64.7% of patients crossed from the one-stent technique to the two-stent arm. Clinical and angiographic follow-up data at 12 months were available in all the 47 patients and in 43 patients (91.9%), respectively. The study endpoint was the occurrence of major adverse cardiac events (MACE) at 12 months.Results Only one patient had a non-ST segment elevation myocardial infarction, which led to 2% of the in-hospital composite MACE. Notably, the target lesion revascularization at 12 months was 8.6%, with a 10.6% composite MACE at 12 months. Neither cardiac death nor stent thrombosis was seen during the follow-up. By quantitative coronary analysis, the restenosis rate at the main vessel and ostium of the side branch was 9.4% and 2.1%, respectively. Four of 12 patients (33.3%) treated with one-stent and kissing balloon inflation had restenosis in the main vessel.Conclusion BIGUARDTM stent was safe and feasible in treatment of bifurcation lesions.

  2. Sirolimus-eluting cobalt-chromium stents: two-year clinical results from first-in-man study on the Firebird 2TM stent

    Institute of Scientific and Technical Information of China (English)

    Xu Bo; LI Jian-ping; CHEN Ji-lin; HUO Yong; GAO Run-lin; SHEN Wei-feng; ZHANG Qi; YANG Yue-jin; QIAO Shu-bin; ZHANG Rui-yan; ZHANG Jian-sheng; HU Jian; QIN Xue-wen; HONG Tao

    2008-01-01

    Background Drug-eluting stents(DES)have been shown to significantly reduce clinical events and angiographic restenosis in the treatment of coronary artery disease(CAD).This study was conducted to assess the long-term efficacy and safety of the polymer-based sirolimus-eluting cobalt-chromium Firebird 2TM stents in the treatment of patients with CAD.Methods This first-in-man study using the Firebird 2TM stent is a prospective,historically-controlled multicenter clinical study,which enrolled 67 patients with CAD who were treated with the sirolimus-eluting cobalt-chromium stent(Firebird 2TM,Microport Shanghai,Firebird 2 group),compared to another 49 patients treated with a bare cobalt alloy stent(Driver,Medtronic,control group).Continued 2-year clinical follow-up was performed after getting the initial 6-month angiographic and 1-year clinical follow-up.The incidence of major adverse cardiac events(MACE)including cardiac death,reinfarction and target lesion revascularization(TLR)and stent thrombosis were compared between the two groups.Results All patients in the Firebird 2 group(100.0%)and 48 patients in the control group(98.O%)completed the 2-year clinical follow-up.At the 1-year follow-up the use of the Firebird 2 stent was highly effective,resulting in a significant 94% decrease of TLR (26.5%in the control group and 1.5%in the Firebird 2 group,P<0.0001).A significant difference in TLR was maintained at 2-year follow-up,Firebird 2 group 1.5%and the control group 31.3%(P<0.0001).Between 1-and 2-year post-stenting.no more TLR occurred in the Firebird 2 group compared with two cases in the control group (P>0.05).There was a 1.5%incidence of MACE at 1-and 2-year follow-up in the Firebird 2 group,compared with 26.5% and 33.3%in the control group,respectively(all P<0.0001).The cumulative 1-and 2-year MACE free survival rates were 98.5%in the Firebird 2 group vs 73.5%and 66.7% in the control group (log rank P<0.0001).No case of stent thrombosis occurred during 2

  3. Arteriovenous Fistula Complicated by Popliteal Venous Access for Endovascular Thrombolytic Therapy of Deep Vein Thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Sung Su; Kim, Jeong Ho; Park, Chul Hi; Hwang, Hee Young; Kim, Hyung SiK [Gacheon University Gil Medical Center, Gacheon (Korea, Republic of); Jeon, Young Sun; Kim, Won Hong [Inha University College of Medicine, Incheon (Korea, Republic of)

    2008-10-15

    We report a case of an iatrogenic arteriovenous fistula complicated by catheter- directed thrombolytic therapy in a patient with acute deep vein thrombosis of a lower extremity. To the best of our knowledge, this is the first report of an arteriovenous fistula between the sural artery and popliteal vein in that situation. As the vessels have a close anatomical relationship, the arteriovenous fistula seems to be a potential complication after endovascular thrombolytic therapy of acute deep vein thrombosis.

  4. Biodegradable polymer Biolimus-eluting stent (Nobori® for the treatment of coronary artery lesions: review of concept and clinical results

    Directory of Open Access Journals (Sweden)

    Schurtz G

    2014-02-01

    Full Text Available Guillaume Schurtz,1,2 Cédric Delhaye,1 Christopher Hurt,1,2 Henri Thieuleux,1,2 Gilles Lemesle1–3 1Centre Hémodynamique et Unité des Soins Intensifs de Cardiologie, Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Lille, France; 2Faculté de Médecine de Lille, Lille, France; 3Unité INSERM UMR744, Institut Pasteur de Lille, Lille, France Abstract: First-generation drug-eluting stents have raised concerns regarding the risk of late and very late stent thrombosis compared with bare metal stents and require prolonged dual antiplatelet therapy. Despite extensive investigations, the physiopathology of these late events remains incompletely understood. Aside from patient- and lesion-related risk factors, stent polymer has been cited as one of the potential causes. In fact, the persistence of durable polymer after complete drug release has been shown to be responsible for local hypersensitivity and inflammatory reactions. Third-generation drug-eluting stents with more biocompatible or biodegradable polymers have subsequently been developed to address this problem. In this article, we evaluate and discuss the concept and clinical results (safety and efficacy of a third-generation drug-eluting stent with biodegradable polymer: the Nobori® stent. Keywords: percutaneous coronary intervention, stent thrombosis, antiplatelet therapy

  5. Percutaneous treatment of superior vena cava syndrome using metallic stents

    Energy Technology Data Exchange (ETDEWEB)

    De Gregorio Ariza, Miguel Angel; Gimeno, Maria Jose; Alfonso, Eduardo; Mainar, Antonio; Medrano, Joaquin; Lopez-Marin, Paloma [Department of Interventional Radiology, ' ' Lozano Blesa' ' University Hospital, Avda. San Juan Bosco 15, 50009 Zaragoza (Spain); Gamboa, Pablo [Division of Interventional Radiology, Ohio State University Hospital, Columbus, Ohio (United States); Tobio, Ricardo [Interventional Radiology, Clinica de la Zarzuela, Madrid (Spain); Herrera, Marcos [Division of Interventional Radiology, University of Minnesota, Minneapolis, Minnesota (United States)

    2003-04-01

    The purpose of this study was to evaluate the results of treatment of superior vena cava syndrome (SVCS) in patients with benign and malignant disease using expandable metallic stent. From January 1995 to April 2000, 87 expandable stents were implanted in 82 patients (59 men, 23 women; mean age 57.8 years, age range 39-79 years) for the treatment of SVCS. The SVCS was defined as symptomatic bilateral obstruction of venous drainage from head, neck and upper extremities. In 68 patients SVCS was due to malignant neoplasia, and in 14 cases it was due to benign aetiology. All patients were treated with expandable stent. We implanted 81 Wallstent prostheses and 6 Palmaz stents. Adjuvant thrombolysis was applied in 12 patients who required fibrinolysis. After recanalization, the stent was implanted in all cases in SVC (infra- or supra-azygos vein). All patients were treated with heparin of low molecular weight (HBPM) during 6 months. Patency was analyzed according to clinical symptoms and Doppler US or venograms exploration. Technical success was observed in all cases. Clinical success was reached in 78 of 82 patients (95.1%) (absence of symptoms in 2 or 3 days). Four patients suffered immediate thrombosis which required fibrinolitic treatment with a new prosthesis placement in 1 case. The follow-up for the malignant process was of 7.1 months (range 1-39 months) and in benign cases was 31.2 months (range 11-61 months). Sixty-two (91.1%) patients with malignancy died without SVCS symptomatology. All the patients with benign pathology are alive. Clinical primary patency in malignant cases was 87% with assisted patency of 96.2%. Endovascular therapy using metallic stent and thrombolysis is a successful method to treat SVCS due to benign or malignant aetiology. (orig.)

  6. Sensor to detect endothelialization on an active coronary stent

    Directory of Open Access Journals (Sweden)

    Coffey Arthur C

    2010-11-01

    Full Text Available Abstract Background A serious complication with drug-eluting coronary stents is late thrombosis, caused by exposed stent struts not covered by endothelial cells in the healing process. Real-time detection of this healing process could guide physicians for more individualized anti-platelet therapy. Here we present work towards developing a sensor to detect this healing process. Sensors on several stent struts could give information about the heterogeneity of healing across the stent. Methods A piezoelectric microcantilever was insulated with parylene and demonstrated as an endothelialization detector for incorporation within an active coronary stent. After initial characterization, endothelial cells were plated onto the cantilever surface. After they attached to the surface, they caused an increase in mass, and thus a decrease in the resonant frequencies of the cantilever. This shift was then detected electrically with an LCR meter. The self-sensing, self-actuating cantilever does not require an external, optical detection system, thus allowing for implanted applications. Results A cell density of 1300 cells/mm2 on the cantilever surface is detected. Conclusions We have developed a self-actuating, self-sensing device for detecting the presence of endothelial cells on a surface. The device is biocompatible and functions reliably in ionic liquids, making it appropriate for implantable applications. This sensor can be placed along the struts of a coronary stent to detect when the struts have been covered with a layer of endothelial cells and are no longer available surfaces for clot formation. Anti-platelet therapy can be adjusted in real-time with respect to a patient's level of healing and hemorrhaging risks.

  7. Nanomedicine for the reduction of the thrombogenicity of stent coatings

    Directory of Open Access Journals (Sweden)

    Varvara C Karagkiozaki

    2010-03-01

    Full Text Available Varvara C Karagkiozaki1,2, Stergios D Logothetidis2, Spyridon N Kassavetis2, George D Giannoglou11Aristotle University of Thessaloniki, Medical School, AHE PA University General Hospital, 1st Cardiology Department, Cardiovascular Engineering and Atherosclerosis Laboratory, Greece; 2Aristotle University of Thessaloniki, Physics Department, Laboratory for Thin Films – Nanosystems and Nanometrology (LTFN, GreeceAbstract: The treatment of patients with drug-eluting stents (DES continues to evolve with the current emergence of DES technology that offers a combination of pharmacological and mechanical approaches to prevent arterial restenosis. However, despite the promising short-term and mid-term outcomes of DES, there are valid concerns about adverse clinical effects of late stent thrombosis. In this study, we present an example of how nanomedicine can offer solutions for improving stent coating manufacturing, by producing nanomaterials with tailored and controllable properties. The study is based on the exploitation of human platelets response towards carbon-based nanocoatings via atomic force microscope (AFM. AFM can facilitate the comprehensive analysis of platelets behavior onto stent nanocoatings and enable the study of thrombogenicity. Platelet-rich plasma from healthy donors was used for the real-time study of biointerfacial interactions. The carbon nanomaterials were developed by rf magnetron sputtering technique under controllable deposition conditions to provide favorable surface nanotopography. It was shown that by altering the surface topography of nanocoatings, the activation of platelets can be affected, while the carbon nanocoatings having higher surface roughness were found to be less thrombogenic in terms of platelets adhesion. This is an actual solution for improving the stent coating fabrication.Keywords: stents nanomedicine, carbon coating, atomic force microscopy platelets nanotechnology

  8. [Portal vein thrombosis in patients with thrombophilia--own observations].

    Science.gov (United States)

    Swiatkowska-Stodulska, Renata; Kazimierska, Ewa; Weyer-Hepka, Jolanta; Dworakowska, Dorota; Lubińska, Monika; Gnacińska, Maria; Bakowska, Alicja; Czestochowska, Eugenia

    2005-04-01

    Portal vein thrombosis is one of the main prehepatic causes of portal hypertension. The most frequent causes of thrombosis in this localization, apart from hepatic cirrhosis, are the following: acute inflammatory diseases and abdominal cancers, traumas, proliferative diseases of the hematopoietic system. In recent years attention was given to disorders in hemostasis, such as thrombophilia, in the course of which thrombosis development is particularly common. The authors present 10 patients after an incident of portal vein thrombosis, in which primary hepatic pathology was excluded and tests directed at thrombophilia were performed. In seven patients abnormalities in the examined parameters were found, and what is more, in two cases they had a complex character and involved more than one parameter. In five patients hyperhomocysteinemia was found. Among them, in two patients there was also a decreased protein S activity and in one of them there was also APC-resistance. In the next two patients there were abnormalities in one of the examined parameters - APC-resistance. Hyperhomocysteinemia was found in all patients with idiopathic thrombosis, and in one of them there were concurrent changes in protein S activity and APC-resistance. In patients with the history of portal vein thrombosis diagnostics of thrombophilia should be performed.

  9. Cobalt chromium stents versus stainless steel stents in diabetic patients

    Directory of Open Access Journals (Sweden)

    Mahmoud Ahmed Tantawy

    2014-03-01

    Conclusions: We concluded that no significant statistical difference was found between the two stents (cobalt-chromium alloy bare metal stent versus conventional bare metal stainless steel stent in diabetic patients regarding (initial procedural success, in-hospital complications, the incidence of ISR at follow up, event-free survival at follow up.

  10. Clinical results from first use of prostate stent as fiducial for radiotherapy of prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Carl, Jesper; Nielsen, Jane (Dept. of Medical Physics, Dept. of Oncology, Aalborg Hospital, Aarhus Univ. Hospital, Aalborg (Denmark)), e-mail: jhc@rn.dk; Holmberg, Mats (Dept. of Oncology, Aalborg Hospital, Aarhus Univ. Hospital, Aalborg (Denmark)); Larsen, Erik Hoejkjaer; Fabrin, Knud (Dept. of Urology, Aalborg Hospital, Aarhus Univ. Hospital, Aalborg (Denmark)); Fisker, Rune V. (Dept. of Radiology, Aalborg Hospital, Aarhus Univ. Hospital, Aalborg (Denmark))

    2011-05-15

    Purpose. A clinical feasibility study using a removable prostate stent as fiducial for image-guided radiotherapy (IGRT) of localized prostate cancer (PC). Material and methods. The study included patients with local or locally advanced PC. The clinical target volume (CTV) was outlined on magnetic resonance (MR) images co-registered to planning computer tomography (CT) images. Daily online IGRT was delivered using the stent as fiducial. Risk of migration was estimated using multiple MR. Acute urinary toxicity was scored using the international prostate symptom score (IPSS). Late gastro-intestinal (GI) and genito-urinary (GU) toxicity was scored using the Radio Therapy Oncology Group (RTOG) score, biochemical failure (BF) was defined as an elevation of prostate specific antigen (PSA) above nadir plus 2 ng/ml after radiotherapy. Results. One hundred men were enrolled in the study. Ninety completed radiotherapy with the stent as fiducial. No migration of the stent was seen, but three cases of dislocation of the stent to the bladder were observed. Acute urinary toxicity based on IPSS was comparable to toxicity in patients who had gold markers (GM) as fiducials. Removal of the stent was associated with a high frequency of urinary retention. Late GI and GU toxicity and BF were comparable to those of other studies, but longer observation time is needed. Conclusions. This study reports the first clinical results of using a prostate stent as fiducial. No migration of the stent observed. Dislocation of the stent to the urinary bladder was observed in three cases, requiring removal of the stent and insertion of a new fiducial. Acute toxicity during radiotherapy evaluated from IPSS was comparable to toxicity in patients with GM. Removal of the stent was associated with a high frequency of post procedural urinary retention. Late toxicity and BF were comparable to those of other studies, though longer observation time is needed

  11. Are drug-eluting stents the future of SFA treatment?

    Science.gov (United States)

    Bosiers, M; Deloose, K; Keirse, K; Verbist, J; Peeters, P

    2010-02-01

    Drug-eluting stent (DES) technology was developed to prevent early thrombosis and late luminal loss to potentially improve long-term patency rates. Although favorable DES results have recently become available with the Zilver PTX and STRIDES studies, the high price of DES is a major drawback for this technology to become the golden standard for peripheral endovascular therapy in de novo femoro-popliteal (FP) lesions. Nevertheless, DES has the potential to make the difference and to establish itself as an important treatment option in patients presenting with TASC C&D FP lesions who are at high-risk for surgery and for the treatment of in-stent restenosis, where until now, no valuable treatment option has proven to be beneficial.

  12. Clopidogrel discontinuation within the first year after coronary drug-eluting stent implantation

    DEFF Research Database (Denmark)

    Thim, Troels; Johansen, Martin Berg; Chisholm, Gro Egholm

    2014-01-01

    -eluting stents in Western Denmark for 1 year and obtained data on redeemed clopidogrel prescriptions and major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, or stent thrombosis) from medical databases. RESULTS: Discontinuation of clopidogrel within the first 3 months after...... associated with smaller, not statistically significant, increases in MACE rates. Among patients who discontinued clopidogrel, MACE rates were highest within the first 2 months after discontinuation. CONCLUSIONS: Discontinuation of clopidogrel was associated with an increased rate of MACE among patients...

  13. Similar five-year outcome with paclitaxel- and sirolimus-eluting coronary stents

    DEFF Research Database (Denmark)

    Bligaard, Niels; Thuesen, Leif; Saunamäki, Kari;

    2014-01-01

    patients with ST-segment elevation myocardial infarction (STEMI), non-STEMI, stable or unstable angina pectoris were randomized to receive Cypher™ (n = 1.065) or Taxus™ (n = 1.033) stents and were followed for 5 years. RESULTS: The primary end-point; the composite of cardiac death, myocardial infarction...... and target vessel revascularization (major adverse cardiac event, MACE), occurred in 467 patients (22.3%); Cypher™ n = 222 (20.8%), Taxus™ n = 245 (23.7%), ns. Definite and probable stent thrombosis occurred in 107 patients (5.1%); Cypher™ n = 51 (4.8%), Taxus™ n = 56 (5.4%), ns. No statistically significant...

  14. Excellent long-term results with iliac stenting in local anesthesia for post-thrombotic syndrome

    DEFF Research Database (Denmark)

    Klitfod, Lotte; Just, Sven; Foegh, Pia

    2015-01-01

    BACKGROUND: Only 20% of iliac veins will recanalize on anticoagulation (AC) treatment alone and may, therefore, develop venous obstruction after iliofemoral deep venous thrombosis (DVT). A considerable number of these patients will suffer from post-thrombotic syndrome (PTS) leading to impaired qu...... stent was 89% (17/19) and 16 patients (84 %) had almost or total symptom relief at follow-up. CONCLUSION: Endovascular stenting of iliac obstruction in local anesthesia is minimally invasive and shows excellent long-term outcomes for patients suffering from PTS....

  15. Treatment of Malignant Biliary Obstruction with a PTFE-Covered Self-Expandable Nitinol Stent

    Energy Technology Data Exchange (ETDEWEB)

    Han, Young-Min; Kwak, Hyo-Sung; Jin, Gong-Yong; Lee, Seung-Ok; Chung, Gyung-Ho [Chonbuk National University Medical School and Hospital, Chonju (Korea, Republic of)

    2007-10-15

    We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction. Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50 80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2 81 weeks). Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively. The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.

  16. 中央型急性期下肢DVT置管溶栓与外周溶栓的比较%Outcomes of anticoagulation and thrombolysis for acute deep venous thrombosis via central venous catheter and peripheral venous injection

    Institute of Scientific and Technical Information of China (English)

    朱少问; 郑小兵; 冯翔

    2013-01-01

    目的:比较中央型急性期DVT经外周静脉溶栓与局部置管溶栓治疗的效果,以指导临床治疗.方法:通过回顾性分析我院及江苏南通大学附属医院2010年9月~2012年7月期间收治的共42例下肢深静脉血栓形成患者的临床资料,按照治疗方法分为置管溶栓组(A组)、外周溶栓组(B组).其中外周溶栓组共20例,左侧13例,右侧6例,双侧1例.置管溶栓组共22例,左侧15例,右侧6例,双侧1例.通过监测患者临床症状,测量下肢周径变化比较两组治疗效果.结果:置管溶栓治疗方法具有平均起效时间快、总溶栓疗程短、溶栓药物总剂量低、并发症发生率及PTS发生率低等优点,而远期复发率与外周溶栓组无明显差异.结论:置管溶栓治疗方法优于外周溶栓治疗.%Objective :To compare the curative efficacy of anticoagulation and thrombolysis for acute deep venous thrombosis( DVT ) via central venous catheter management or peripheral venous management for summary of the clinical experience. Methods :The clinical data were reviewed in 42 patients with DVT undergone treatment respectively in our institution and the Affiliated Hospital of Nantong University between Sept. 2010 and Jul. 2012. The patients were randomized into either group A( n=22; 15 were symptoms of left lower extremity,6 of right and 1 of both extremities ) by thrombolytic therapy via central venous catheter or group B( n =20; 13 were acute episode of left lower limb, 6 of right and 1 of both lower limbs. ) managed with peripheral venous anticoagulation and thrombolysis. Two groups of patients were assessed for the curative efficacy by observing the relief of clinical symptoms and measuring the changes of the limb circumference. Results:Thrombolytic therapy for acute DVT via central venous catheter demonstrated advantages by earlier effects, shortened therapy duration, requirement of lower drug dosage, fewer incidence of complications and risk of developing the

  17. Cerebral venous thrombosis: An Indian perspective

    Directory of Open Access Journals (Sweden)

    Deepa Dash

    2015-01-01

    Full Text Available Cerebral venous thrombosis (CVT is an uncommon cause of stroke with extremely varied clinical presentations, predisposing factors, imaging findings, and outcomes, and thus can be extremely challenging to diagnose. Accurate and prompt diagnosis of CVT is crucial because timely and appropriate therapy can reverse the disease process and significantly reduce the risk of acute complications and long-term squel. In this article, we have reviewed the epidemiology, causative factors, clinical features, diagnosis and treatment of CVT from an Indian perspective. Over the last decade, a change in trends in the causative factors has been noted from India.

  18. Presentation of Neonatal Sinovenous Thrombosis

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2008-09-01

    Full Text Available Signs, risk factors, comorbidities, and radiographic findings in 59 neonates presenting with sinovenous thrombosis are reported from Indiana University School of Medicine, Indianapolis, IN.

  19. Comparison of paclitaxal vs.sirolimus eluting stents with bio-degradable polymer for the treatment of coronary bifurcation lesions: subgroup analysis from DKCRUSH-I and DKCRUSH-Ⅱ studies

    Institute of Scientific and Technical Information of China (English)

    CHEN Shao-liang; ZHOU Yong; DING Shi-qin; Tak W Kwan; Gary Mintz; Teguh Santoso; ZHANG Jun-jie; YE Fei; XU Ya-wei; FU Qiang; KAN Jing; Chitprapai Paiboon

    2012-01-01

    Background The difference in clinical outcome between paclitaxal-eluting stents (PES) and sirolimus-eluting stents with bio-degradable polymer (SES-BDP) for bifurcation lesions remains unclear.The present study aimed to investigate the one-year clinical outcome after DK crush stenting using PES (TaxusTM) vs.SES-BDP (ExcelrM) from our database.Methods A total of 275 patients (90 from the DKCRUSH-I and 185 from the DKCRUSH-Ⅱ study) were studied.The primary endpoint was the occurrence of major adverse cardiac events (MACE) at 12 months; including cardiac death,myocardial infarction (MI),or target vessel revascularization (TVR).The rate of binary restenosis and stent thrombosis served as secondary endpoints.Results At follow-up,minimal luminal diameter (MLD) in the Taxus group was (2.11±0.66) mm,with resultant increased target lesion revascularization (TLR) 12.2% and TVR 14.4%,significantly different from the Excel group; (2.47±0.56) mm,P <0.001,3.2%,P=0.006,4.9%,P=0.019,respectively.As a result there was a significant difference in MACE between the Taxus (20.0%) and Excel (10.3%,P=0.038) groups.Overall stent thrombosis was monitored in 11 patients (4.0%),with five in the Excel group (2.7%) and six in the Taxus group (6.7%).All stent thrombosis in the Excel group was classified as early,and all were defined as late in the Taxus group.Conclusion The Excel stent had lower rate of stent thrombosis,TLR,TVR,and composite MACE at 12-month after an indexed stenting procedure,compared to the Taxus stent.

  20. Future developments in biliary stenting

    Directory of Open Access Journals (Sweden)

    Hair CD

    2013-06-01

    Full Text Available Clark D Hair,1 Divyesh V Sejpal21Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA; 2Department of Medicine, Section of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, North Shore University Hospital, Manhasset, NY, USAAbstract: Biliary stenting has evolved dramatically over the past 30 years. Advancements in stent design have led to prolonged patency and improved efficacy. However, biliary stenting is still affected by occlusion, migration, anatomical difficulties, and the need for repeat procedures. Multiple novel plastic biliary stent designs have recently been introduced with the primary goals of reduced migration and improved ease of placement. Self-expandable bioabsorbable stents are currently being investigated in animal models. Although not US Food and Drug Administration approved for benign disease, fully covered self-expandable metal stents are increasingly being used in a variety of benign biliary conditions. In malignant disease, developments are being made to improve ease of placement and stent patency for both hilar and distal biliary strictures. The purpose of this review is to describe recent developments and future directions of biliary stenting.Keywords: plastic stents, self-expandable metal stents, drug eluting stents, bioabsorbable stents, malignant biliary strictures, benign biliary strictures

  1. Clinical Analysis of Catheter Direct Thrombolysis Therapy in 28 Patients with Acute Deep V ein Throm-bosis of Lower Limbs%导管直接溶栓治疗28例急性下肢深静脉血栓临床分析

    Institute of Scientific and Technical Information of China (English)

    宋海龙; 闫笑迎; 李宏

    2015-01-01

    目的:分析研究导管溶栓术( CDT)治疗急性下肢深静脉血栓形成( DVT)的早中期疗效。方法分析2009年1月~2014年9月CDT治疗的28例急性下肢DVT患者的临床资料。全部患者均行患肢静脉造影,以判断疗效。结果28例CDT手术技术成功率100%,全组患者术中、术后均无严重并发症发生。溶栓前后静脉通畅评分比较差异显著(t=13.926,P<0.01)。溶栓后静脉通畅率为(60±19)%。结论 CDT治疗急性下肢DVT早中期疗效较好,并发症少,值得在临床上使用。%Objective To analyze therapeutic effect of early and middle-stage catheter direct thrombolysis therapy in the treatment of acute deep vein thrombosis of lower limbs.Mtehods We retrospectively analyzed the clinical infor-mation among 28patients of acute deep vein thrombosis in lower limbs , who were treated with catheter direct thrombolysis therapy in our hospital from January 2009 to September2014.All patients were detected with the venography at the af -fected limbs,to determine the efficacy.Results The success rate of catheter direct thrombolysis therapy was 100% in 28 patients of acute deep vein thrombosis in lower limbs.No intraoperative and postoperative complications were found. There were significant differences in the venous patency scores before and after thrombolysis therapy ( t=13.926, P<0.01).The venous patency rate was (60 ±19)%after thrombolysis.Conclusions Catheter direct thrombolysis therapy has early and middle-stage efficacy in treatment of acute deep vein thrombosis of lower limbs, and induces few compli-cations, therefore it deserves clinical application.

  2. The experimental study on intracoronary native metallic balloon-expandable stent%冠状动脉内置入国产支架的动物实验研究

    Institute of Scientific and Technical Information of China (English)

    朱锐; 江洪; 李庚山; 漆曙辉; 王小红; 王洪如; 叶泽兵

    2001-01-01

    目的 观察国产支架置入犬冠状动脉后的生物、血液相容性、支架开通率及其内皮化情况。方法 将16个国产支架置入8只犬的冠状动脉内,分别于1、2、3、6个月进行观察。结果 支架置入术后冠脉通畅,无明显狭窄。支架贴内膜良好,血管内腔表面光滑。术后2个月时支架覆盖的新生内膜最厚,其主要为平滑肌细胞和细胞外基质,未见明显炎性细胞浸润。支架置入1个月时,支架表面覆盖的内皮细胞排列不规则;置入2、3、6个月时,其沿血流方向排列规则。支架表面未见明显腐蚀。结论 该国产支架置入后有良好的生物和血液相容性,理化性能稳定,迅速重新内皮化,有良好的开通率。%Objective To investigate the biocompatibility, bloodcompatibility, the patency rates and reendothelialization of native coronary metallic stent after being implanted into canine coronary artery. Methods Sixteen stents were implanted into eight canine coronary artery through femoral artery aproach. The pathological examination was taken at 1 to 6 months after coronary angiography. Results Thirteen stents were successfully implanted into target vessels of six dogs. Two dogs died of coronary spasm and acute stent thrombosis respectively. Coronary angiography demonstrated all vessles patency after intracoronary stenting (ICS). Macroscopy of stented arteries demonstrated complete incorparation of stent wires into the arterial wall and smooth vessle lumens. Light microscope demonstrated the neointima was the thickest at two months and consisted mainly of smooth muscle cells and extracellular matrix. The findings also included slight to moderate media oppression localized to areas of stent wires and no significant inflammatory raction. Scanning electron mcroscope demonstrated the endotheliocytes covering on stents oriented irregularly at one month and regularly at two and three as well as six months

  3. Zotarolimus-eluting durable-polymer-coated stent versus a biolimus-eluting biodegradable-polymer-coated stent in unselected patients undergoing percutaneous coronary intervention (SORT OUT VI)

    DEFF Research Database (Denmark)

    Raungaard, Bent; Jensen, Lisette Okkels; Tilsted, Hans-Henrik

    2015-01-01

    BACKGROUND: New-generation drug-eluting coronary stents have reduced the risk of coronary events, especially in patients with complex disease or lesions. To what extent different stent platforms, polymers, and antiproliferative drugs affect outcomes, however, is unclear. We investigated the safety...... and efficacy of a third-generation stent by comparing a highly biocompatible durable-polymer-coated zotarolimus-eluting stent with a biodegradable-polymer-coated biolimus-eluting stent. METHODS: This open-label, randomised, multicentre, non-inferiority trial was done at three sites across western Denmark. All...... patients who presented with stable coronary artery disease or acute coronary syndromes and at least one coronary artery lesion (more than 50% stenosis) from March, 2011, to August, 2012, were assessed for eligibility. Patients were randomly assigned in a 1:1 ratio to receive either the durable-polymer...

  4. Genetic risk factors in patients with deep venous thrombosis, a retrospective case control study on Iranian population

    OpenAIRE

    Hosseini, Soudabeh; Kalantar, Ebrahim; Hosseini, Maryam Sadat; Tabibian, Shadi; Shamsizadeh, Morteza; Dorgalaleh, Akbar

    2015-01-01

    Background Venous thromboembolism (VTE) could be manifested as deep venous thrombosis (DVT) or pulmonary embolism (PE). DVT is usually the more common manifestation and is usually formation of a thrombus in the deep veins of lower extremities. DVT could occur without known underlying cause (idiopathic thrombosis) which could be a consequence of an inherited underlying risk factor or could be a consequence of provoking events, such as trauma, surgery or acute illness (provoked thrombosis). Our...

  5. [Cerebral venous thrombosis imagiologic features in a pregnant woman].

    Science.gov (United States)

    Ferreira, Maria Madalena; Rios, Ana Cristina; Fragata, Isabel; Baptista, José Tiago; Manaças, Rui; Reis, João

    2011-01-01

    Cerebral venous thrombosis (CVT) is a relatively rare but serious condition potentially reversible upon accurate diagnosis and adequate therapy. The peri-partum state and pregnancy are predisposing factors and TVC accounts for about 6% of maternal deaths. Its clinical symptoms depend on the the thrombus site and extension, and also on the existing collateral vessels network. We present the case of a 33 year-old woman, 13 weeks pregnant, that complained of headaches and whose cranial magnetic resonance imaging revealed a subtotal oclusión of the superior sagittal sinus. We discuss the imaging features of dural venous thrombosis in the acute phase.

  6. Numerical simulations of thrombosis

    Directory of Open Access Journals (Sweden)

    Naveen Kumar G Ramunigari

    2013-01-01

    Full Text Available Background: Mathematical approaches for biological events have gained significant importance in development of biomedical research. Deep vein thrombosis (DVT is caused by blood clot in veins deeply rooted in the body, resulting in loss of blood, pain, and numbness of the body part associated with that vein. This situation can get complicated and can be fatal, when the blood clot travels to other parts of the body which may result in pulmonary embolism (PE. PE causes approximately 300,000 deaths annually in the United States alone. Materials and Methods: We are trying to propose a computational approach for understanding venous thrombosis using the theory of fluid mechanics. In our study, we are trying to establish a computational model that mimics the venous blood flow containing unidirectional venous valves and will be depicting the blood flow in the veins. We analyzed the flow patterns in veins, which are included with lump like substances. This lump like substances can be clots, tissue debris, collagen or even cholesterol. Our study will facilitate better understanding of the biophysical process in case of thrombosis. Results: The predicted model analyzes the consequences that occur due to the clot formations in veins. Knowledge of Navier-Stokes equations in fluid dynamics along with the computational model of a complex biological system would help in diagnosis of the problem at much faster rate of time. Valves of the deep veins are damaged as a result of DVT, with no valves to prevent deep system reflux, the hydrostatic venous pressure in the lower extremity increases dramatically. Conclusion: Our model is used to determine the effects of an interrupted blood flow as a result of thrombin formation, which might result in disturbed systemic circulation. Our results indicated a positive inverse correlation exists between clots and the flow velocity. This would support medical practitioners to recommend faster curing measures.

  7. Testosterone, thrombophilia, thrombosis.

    Science.gov (United States)

    Freedman, Joel; Glueck, Charles J; Prince, Marloe; Riaz, Rashid; Wang, Ping

    2015-05-01

    We screened previously undiagnosed thrombophilia (V Leiden-prothrombin mutations, Factors VIII and XI, homocysteine, and antiphospholipid antibody [APL] syndrome) in 15 men and 2 women with venous thromboembolism (VTE) or osteonecrosis 7 months (median) after starting testosterone therapy (TT), gel (30-50 mg/d), intramuscular (100-400 mg/wk), or human chorionic gonadotropin (HCG) (6000 IU/wk). Thrombophilia was studied in 2 healthy control groups without thrombosis (97 normal controls, 31 subjects on TT) and in a third control group (n = 22) with VTE, not on TT. Of the 17 cases, 76% had ≥1 thrombophilia vs 19% of 97 normal controls (P 150%) (24% vs 7%, P = 0.058), by high homocysteine (29% vs 5%, P = 0.007), and from both normal and TT controls for APL syndrome (18% vs 2%, P = 0.023, vs 0%, P = 0.04). Despite adequate anticoagulation with TT continued after the first deep venous thrombosis-pulmonary embolus (DVT-PE), 1 man sustained 3 DVT-PEs 5, 8, and 11 months later and a second man had 2 DVT-PEs 1 and 2 months later. Of the 10 cases with serum T measured on TT, 6 (60%) had supranormal T (>800 ng/dL) and of 9 with estradiol measured on TT, 7 (78%) had supranormal levels (>42.6 pg/mL). TT interacts with thrombophilia leading to thrombosis. TT continuation in thrombophilic men is contraindicated because of recurrent thrombi despite anticoagulation. Screening for thrombophilia before starting TT should identify subjects at high risk for VTE with an adverse the risk to benefit ratio for TT.

  8. Safety and efficacy of polymer-free paclitaxel-eluting microporous stent in real-world practice: 1-year follow-up of the SERY-I registry

    Institute of Scientific and Technical Information of China (English)

    ZHANG Rui-yan; QIU Jian; WANG Wei; CHEN Xi-ming; YANG Zhi-iian; YAN Jin-chuan; CHEN Shao-liang; HOU Yu-qing; WU Yan-qing; LUO Hai-ming; QIU Jian-ping; ZHANG Oi; ZHU Li; WANG Yan; FU Guo-sheng; WANG Jian-an; MA Kang-hua; YIN Yue-hui; ZHANG Dai-fu; HU Xue-song; ZHU Guo-ying; SHEN Wei-feng; ZHU Jin-zhou; CHEN Liang-long; ZHANG Chen-yun; ZHOU Xu-chen; YUAN Yong; ZHONG Zhi-xiong; LI Lang

    2011-01-01

    BackgroundPolymer coating on coronary stents induces vascular inflammatory response,reduces re-endothelialization,and affects long-term outcome after percutaneous coronary intervention (PCI).The SERY-1 registry aimed to determine whether a novel polymer-free paclitaxel-eluting microporous Yinyi stent could improve 1-year outcome after index procedure in real-world clinical practice.Methods Clinical and angiographic data and follow-up outcome were collected in 1045 patients who underwent PCI with implantation of ≥1 Yinyi stents between June 2008 and August 2009 at 27 medical centers.The primary endpoint was the cumulative rate of composite major adverse cardiac events (MACE) and the secondary endpoint was the incidence of stent thrombosis at 1 year.Results Overall,1376 lesions were treated successfully with 1713 Yinyi stents,and 1019 (98.7%) patients received dual antiplatelet therapy for at least 12 months.During 1-year follow-up,8 patients (0.78%) had cardiac death,6 (0.58%)suffered non-fatal myocardial infarction,and 46 (4.46%) underwent repeat PCI due to recurrence of angina,resulting in 1-year MACE-free survival of 94.09%.Stent thrombosis occurred in 10 (0.97%) patients,and the rate of Academic Research Consortium (ARC) definite or probable stent thrombosis was 0.78%.Conclusions Polymer-free paclitaxel-eluting microporous Yinyi stent is effective and safe for interventional treatment of coronary artery disease in real-world clinical practice,without recourse to carrier polymer.Potential long-term clinical advantages of this stent deserve further investigation.

  9. Endovascular treatment of abdominal aortic aneurysms--6 years of experience with Ella stent-graft system

    Energy Technology Data Exchange (ETDEWEB)

    Koecher, Martin E-mail: martin.kocher@seznam.cz; Utikal, Petr; Koutna, Jirina; Bachleda, Petr; Buriankova, Eva; Herman, Miroslav; Bucil, Jiri; Benysek, Vladimir; Cerna, Marie; Kojecky, Zdenek

    2004-08-01

    Purpose: Evaluation of 6-year results of abdominal aortic aneurysm (AAA) treatment by Ella stent-grafts with regard to safety and effectivity in relation to morphology of the aneurysm. Methods: From a group of 172 patients with AAA, in whom elective endovascular treatment was considered, 120 of them (69.8%) were found to be suitable for this type of therapy. The bifurcated type of stent-graft was implanted in 97 patients, uniiliacal type in 19 patients and only four patients were found to be suitable for tubular type of stent-graft. Additional necessary procedures (internal iliac artery occlusion or contralateral common iliac artery occlusion in a group of patients with uniiliacal type of stent-graft) were performed surgically during the stent-graft implantation. CT and US controls were performed at 3, 6 and 12 months after implantation, later every 12 months. Results: Primary technical success was achieved in 109 of the 120 patients (91%). Primary endoleak was recorded in 11 patients (primary endoleak type Ia in seven patients, type Ib in three patients and type IIIa in one patient). Assisted technical success after reintervention or spontaneous seal was 98.3%. Surgical conversion was indicated in two patients (1.7%). Perioperative mortality rate was 3.3%. Total average follow-up period was 20.7 months (range from 2 to 60 months). In nine patients (7.5%) secondary endoleak type II was found at control CT or US, in three patients partial thrombosis of the stent-graft was found. There was no aneurysm rupture during follow-up. Conclusion: Treatment of AAA with Ella stent-graft system is effective and safe. Bifurcated stent-graft is the most frequently used type. Uniiliacal type of stent-graft is used by us only in cases of complicated morphology.

  10. Reproducibility of haemodynamical simulations in a subject-specific stented aneurysm model--a report on the Virtual Intracranial Stenting Challenge 2007.

    Science.gov (United States)

    Radaelli, A G; Augsburger, L; Cebral, J R; Ohta, M; Rüfenacht, D A; Balossino, R; Benndorf, G; Hose, D R; Marzo, A; Metcalfe, R; Mortier, P; Mut, F; Reymond, P; Socci, L; Verhegghe, B; Frangi, A F

    2008-07-19

    This paper presents the results of the Virtual Intracranial Stenting Challenge (VISC) 2007, an international initiative whose aim was to establish the reproducibility of state-of-the-art haemodynamical simulation techniques in subject-specific stented models of intracranial aneurysms (IAs). IAs are pathological dilatations of the cerebral artery walls, which are associated with high mortality and morbidity rates due to subarachnoid haemorrhage following rupture. The deployment of a stent as flow diverter has recently been indicated as a promising treatment option, which has the potential to protect the aneurysm by reducing the action of haemodynamical forces and facilitating aneurysm thrombosis. The direct assessment of changes in aneurysm haemodynamics after stent deployment is hampered by limitations in existing imaging techniques and currently requires resorting to numerical simulations. Numerical simulations also have the potential to assist in the personalized selection of an optimal stent design prior to intervention. However, from the current literature it is difficult to assess the level of technological advancement and the reproducibility of haemodynamical predictions in stented patient-specific models. The VISC 2007 initiative engaged in the development of a multicentre-controlled benchmark to analyse differences induced by diverse grid generation and computational fluid dynamics (CFD) technologies. The challenge also represented an opportunity to provide a survey of available technologies currently adopted by international teams from both academic and industrial institutions for constructing computational models of stented aneurysms. The results demonstrate the ability of current strategies in consistently quantifying the performance of three commercial intracranial stents, and contribute to reinforce the confidence in haemodynamical simulation, thus taking a step forward towards the introduction of simulation tools to support diagnostics and

  11. Vascular Response to Experimental Stent Malapposition and Under-Expansion.

    Science.gov (United States)

    O'Brien, Caroline C; Lopes, Augusto C; Kolandaivelu, Kumaran; Kunio, Mie; Brown, Jonathan; Kolachalama, Vijaya B; Conway, Claire; Bailey, Lynn; Markham, Peter; Costa, Marco; Ware, James; Edelman, Elazer R

    2016-07-01

    Up to 80% of all endovascular stents have malapposed struts, and while some impose catastrophic events others are inconsequential. Thirteen stents were implanted in coronary arteries of seven healthy Yorkshire pigs, using specially-designed cuffed balloons inducing controlled stent malapposition and under-expansion. Optical coherence tomography (OCT) imaging confirmed that 25% of struts were malapposed (strut-wall distance strut thickness) to variable extent (max. strut-wall distance malapposed group 0.51 ± 0.05 mm vs. apposed group 0.09 ± 0.05 mm, p = 2e-3). Imaging at follow-up revealed malapposition acutely resolved (struts remained malapposed at day 5), with strong correlation between lumen and the stent cross-sectional areas (slope = 0.86, p < 0.0001, R (2) = 0.94). OCT in three of the most significantly malapposed vessels at baseline showed high correlation of elastic lamina area and lumen area (R (2) = 0.96) suggesting all lumen loss was related to contraction of elastic lamina with negligible plaque/intimal hyperplasia growth. Simulation showed this vascular recoil could be partially explained by the non-uniform strain environment created from sub-optimal expansion of device and balloon, and the inability of stent support in the malapposed region to resist recoil. Malapposition as a result of stent under-expansion is resolved acutely in healthy normal arteries, suggesting existing animal models are limited in replicating clinically observed persistent stent malapposition.

  12. Interventional therapy of integrating traditional Chinese and western medicine in the treatment of acute lower extremity deep venous thrombosis%中西医结合介入治疗急性下肢深静脉血栓形成

    Institute of Scientific and Technical Information of China (English)

    张新刚

    2012-01-01

    目的 探讨中西医结合介入治疗急性下肢深静脉血栓形成的应用价值.方法 68例急性下肢深静脉血栓患者均经血管超声及造影证实,所有急性下肢深静脉血栓患者均在置入下腔静脉滤器后,经插管溶栓治疗和采用活血化瘀、益气活血中药和溶栓抗凝等中西药治疗,采用自行设计的治疗效果量化测量表进行量化判定.结果 治疗后1个月复查,临床治愈30例(44.12%),显效36例(52.94%),有效2例(2.94%).总有效率为100%,未出现严重并发症.结论 中西医结合介入治疗方法对急性下肢深静脉血栓形成有良效的效果,结合中医辨证论治综合治疗,可以提高疗效.%Objective To explore the value of interventional therapy of integrating traditional Chinese and western medicine in the treatment of acute lower extremity deep venous thrombosis (ALEDVT). Methods A total of 68 ALEDVT patients whose diagnoses were confirmed by sonography and angiography were enrolled in the study. All the ALEDVT patients underwent catheter- directed thrombolysis and the integrated treatment of traditional Chinese and western medicine after insertion of inferior vena cava filter. The therapeutic efficacy was measured by a self -designed form. Results The results of the re- examination conducted one month later were as follows: totally recovered in 30 patients (44.12%), obviously effective in 36 (52.94%), and effective in 2 patients (2.94%). The overall cure rate was 100% with no serious complications. Conclusion Interventional therapy of integrating traditional Chinese and western medicine has good effect on ALEDVT. It can greatly improve the efficacy.

  13. Trombosis de la vena yugular interna y mediastinitis aguda necrosante descendente debido a una faringoamigdalitis aguda Thrombosis of the internal jugular vein and descending necrotizing mediastinitis due to acute pharyngotonsilitis

    Directory of Open Access Journals (Sweden)

    Celia Sánchez Acedo

    2010-09-01

    Full Text Available El síndrome de Lemierre es una patología muy infrecuente en la época actual, pero muy grave, y siempre debe considerarse ante un cuadro de fiebre con antecedente de infección orofaríngea, tumefacción laterocervical a lo largo del músculo esternocleidomastoideo y signos de sepsis. El diagnóstico de este síndrome es fundamentalmente clínico, y las pruebas complementarias tan sólo ayudan a confirmar el cuadro. Presentamos el caso de un varón de 31 años que acudió a urgencias con clínica de faringoamigdalitis junto con tumefacción en la región submandibular izquierda e importante dolor cervical ipsilateral, que mostró un deterioro rápido y progresivo del estado general pese al tratamiento antibiótico intravenoso. Finalmente tuvo que ser intervenido debido al desarrollo de mediastinitis aguda necrosante descendente desde la región pretiroidea hasta el diafragma, con trombosis de la vena yugular interna izquierda. Se le realizó toracotomía urgente y cervicotomía izquierda con drenaje de abundante material purulento y ligadura de la vena yugular interna.Lemierre syndrome is a potentially fatal condition after an oropharyngeal infection. It is characterized by thrombophlebitis of head and neck veins with systemic dissemination of septic emboli. The diagnosis of this syndrome is mainly clinical and complementary test only serve as aid to confirm it. We report an unusual case of Lemierre syndrome in a 31-year-old man caused by Gemella spp. and Streptococcus pyogenes. It developed following a pharyngotonsillitis infection, which deteriorated rapidly and progressively despite intravenous antibiotic treatment. He finally had to be intervened due to developing acute descending necrotizing mediastinitis from the pre-thyroid region to the diaphragm, with thrombosis of the internal jugular vein. An urgent thoracotomy and left cervicotomy was performed, with drainage of abundant purulent material and ligature of the internal jugular vein

  14. Nitinol Stent Oversizing in Patients Undergoing Popliteal Artery Revascularization: A Finite Element Study.

    Science.gov (United States)

    Gökgöl, Can; Diehm, Nicolas; Nezami, Farhad Rikhtegar; Büchler, Philippe

    2015-12-01

    Nitinol stent oversizing is frequently performed in peripheral arteries to ensure a desirable lumen gain. However, the clinical effect of mis-sizing remains controversial. The goal of this study was to provide a better understanding of the structural and hemodynamic effects of Nitinol stent oversizing. Five patient-specific numerical models of non-calcified popliteal arteries were developed to simulate the deployment of Nitinol stents with oversizing ratios ranging from 1.1 to 1.8. In addition to arterial biomechanics, computational fluid dynamics methods were adopted to simulate the physiological blood flow inside the stented arteries. Results showed that stent oversizing led to a limited increase in the acute lumen gain, albeit at the cost of a significant increase in arterial wall stresses. Furthermore, localized areas affected by low Wall Shear Stress increased with higher oversizing ratios. Stents were also negatively impacted by the procedure as their fatigue safety factors gradually decreased with oversizing. These adverse effects to both the artery walls and stents may create circumstances for restenosis. Although the ideal oversizing ratio is stent-specific, this study showed that Nitinol stent oversizing has a very small impact on the immediate lumen gain, which contradicts the clinical motivations of the procedure.

  15. Neoatherosclerosis:Coronary stents seal atherosclerotic lesions but result in making a new problem of atherosclerosis

    Institute of Scientific and Technical Information of China (English)

    Hidenori; Komiyama; Masamichi; Takano; Noritake; Hata; Yoshihiko; Seino; Wataru; Shimizu; Kyoichi; Mizuno

    2015-01-01

    Chronic inflammation of the native vessel wall with infiltration of lipid-laden foamy macrophages through impaired endothelium results in atherosclerosis. Percutaneous coronary intervention, including metallic stent implantation, is now widely utilized for the treatment of atherosclerotic lesions of the coronary artery. Baremetal stents and the subsequently developed drugeluting stents seal the atherosclerosis and resolve lumen stenosis or obstruction of the epicardial coronary artery and myocardial ischemia. After stent implantation, neointima proliferates within the stented segment. Chronic inflammation caused by a foreign body reaction to the implanted stent and subsequent neovascularization, which is characterized by the continuous recruitment of macrophages into the vessel, result in the transformation of the usual neointima into an atheromatous neointima. Neointima with an atherosclerotic appearance, such as that caused by thin-cap fibroatheromas, is now recognized as neoatherosclerosis, which can sometimes cause in-stent restenosis and acute thrombotic occlusion originating from the stent segment following disruption of the atheroma. Neoatherosclerosis is emerging as a new coronary stent-associated problem that has not yet been resolved. In this review article, we will discuss possible mechanisms, clinical challenges, and the future outlook of neoatherosclerosis.

  16. Biodegradable-Polymer Biolimus-Eluting Stents versus Durable-Polymer Everolimus-Eluting Stents at One-Year Follow-Up: A Registry-Based Cohort Study.

    Science.gov (United States)

    Parsa, Ehsan; Saroukhani, Sepideh; Majlessi, Fereshteh; Poorhosseini, Hamidreza; Lofti-Tokaldany, Masoumeh; Jalali, Arash; Salarifar, Mojtaba; Nematipour, Ebrahim; Alidoosti, Mohammad; Aghajani, Hassan; Amirzadegan, Alireza; Kassaian, Seyed Ebrahim

    2016-04-01

    We compared outcomes of percutaneous coronary intervention patients who received biodegradable-polymer biolimus-eluting stents with those who received durable-polymer everolimus-eluting stents. At Tehran Heart Center, we performed a retrospective analysis of the data from January 2007 through December 2011 on 3,270 consecutive patients with coronary artery disease who underwent percutaneous coronary intervention with the biodegradable-polymer biolimus-eluting stent or the durable-polymer everolimus-eluting stent. We excluded patients with histories of coronary artery bypass grafting or percutaneous coronary intervention, acute ST-segment-elevation myocardial infarction, or the implantation of 2 different stent types. Patients were monitored for 12 months. The primary endpoint was a major adverse cardiac event, defined as a composite of death, nonfatal myocardial infarction, and target-vessel and target-lesion revascularization. Durable-polymer everolimus-eluting stents were implanted in 2,648 (81%) and biodegradable-polymer biolimus-eluting stents in 622 (19%) of the study population. There was no significant difference between the 2 groups (2.7% vs 2.7%; P=0.984) in the incidence of major adverse cardiac events. The cumulative adjusted probability of major adverse cardiac events in the biodegradable-polymer biolimus-eluting stent group did not differ from that of such events in the durable-polymer everolimus-eluting stent group (hazard ratio=0.768; 95% confidence interval, 0.421-1.44; P=0.388). We conclude that in our patients the biodegradable-polymer biolimus-eluting stent was as effective and safe, during the 12-month follow-up period, as was the durable-polymer everolimus-eluting stent.

  17. Impact of Age on Long-Term Outcome After Primary Angioplasty With Bare-Metal or Drug-Eluting Stent (From the DESERT Cooperation)

    DEFF Research Database (Denmark)

    De Luca, Giuseppe; Dirksen, Maurits T; Spaulding, Christian

    2013-01-01

    Despite mechanical reperfusion, elderly patients with ST-segment elevation myocardial infarction (STEMI) still experience unsatisfactory outcomes. Drug-eluting stents (DES) have significantly reduced target-vessel revascularization (TVR), but concerns have emerged about the higher risk of late...... stent thrombosis, which may be more pronounced in elderly patients. Therefore, the aim of this study was to evaluate the impact of age on outcome in patients with STEMI who underwent primary angioplasty with bare-metal stents (BMS) or DES. Our population comprised 6,298 patients who underwent primary...

  18. Computational fluid dynamics evaluation of incomplete stent apposition in a tapered artery

    Science.gov (United States)

    Poon, Eric; Thondapu, Vikas; Ooi, Andrew; Hayat, Umair; Barlis, Peter; Moore, Stephen

    2015-11-01

    Coronary stents are deployed to prop open blocked arteries and restore normal blood flow, however in-stent restenosis (ISR) and stent thrombosis (ST) remain possibly catastrophic complications. Computational fluid dynamics (CFD) analyses can elucidate the pathological impact of alterations in coronary hemodynamics and correlate wall shear stress (WSS) with atherosclerotic processes. The natural tapering of a coronary artery often leads to proximal incomplete stent apposition (ISA) where stent struts are not in contact with the vessel wall. By employing state-of-the-art computer-aided design (CAD) software, generic open-cell and closed-cell coronary stent designs were virtually deployed in an idealised tapered coronary artery. Pulsatile blood flow (80 mL/min at 75 beats/min) was carried out numerically on these CAD models using a finite volume solver. CFD results reveal significant fluctuations in proximal WSS and large recirculation regions in the setting of proximal ISA, resulting in regions of high wall shear stress gradient (WSSG) that have been previously linked to poor endothelial cell coverage and vascular injury. The clinical significance of these proximal high WSSG regions will be correlated with findings from high-resolution in-vivo imaging. Supported by the Australian Research Council (LP120100233) and Victorian Life Sciences Computation Initiative (VR0210).

  19. Plaque components affect wall stress in stented human carotid artery:A numerical study

    Institute of Scientific and Technical Information of China (English)

    Zhen-Min Fan; Xiao Liu; Cheng-Fei Du; An-Qiang Sun; Nan Zhang; Zhan-Ming Fan; Yu-Bo Fan; Xiao-Yan Deng

    2016-01-01

    Carotid artery stenting presents challenges of in-stent restenosis and late thrombosis, which are caused primarily by alterations in the mechanical environment of the artery after stent implantation. The present study con-structed patient-specific carotid arterial bifurcation models with lipid pools and calcified components based on magnetic resonance imaging. We numerically analyzed the effects of multicomponent plaques on the distributions of von Mises stresses (VMSs) in the patient-specific models after stenting. The results showed that when a stent was deployed, the large soft lipid pool in atherosclerotic plaques cushioned the host artery and reduced the stress within the arterial wall;how-ever, this resulted in a sharp increase of VMS in the fibrous cap. When compared with the lipid pool, the presence of the calcified components led to slightly increased stresses on the luminal surface. However, when a calcification was located close to the luminal surface of the host artery and the stenosis, the local VMS was elevated. Overall, compared with calcified components, large lipid pools severely dam-aged the host artery after stenting. Furthermore, damage due to the calcified component may depend on location.

  20. Plaque components affect wall stress in stented human carotid artery: A numerical study

    Science.gov (United States)

    Fan, Zhen-Min; Liu, Xiao; Du, Cheng-Fei; Sun, An-Qiang; Zhang, Nan; Fan, Zhan-Ming; Fan, Yu-Bo; Deng, Xiao-Yan

    2016-09-01

    Carotid artery stenting presents challenges of in-stent restenosis and late thrombosis, which are caused primarily by alterations in the mechanical environment of the artery after stent implantation. The present study constructed patient-specific carotid arterial bifurcation models with lipid pools and calcified components based on magnetic resonance imaging. We numerically analyzed the effects of multicomponent plaques on the distributions of von Mises stresses (VMSs) in the patient-specific models after stenting. The results showed that when a stent was deployed, the large soft lipid pool in atherosclerotic plaques cushioned the host artery and reduced the stress within the arterial wall; however, this resulted in a sharp increase of VMS in the fibrous cap. When compared with the lipid pool, the presence of the calcified components led to slightly increased stresses on the luminal surface. However, when a calcification was located close to the luminal surface of the host artery and the stenosis, the local VMS was elevated. Overall, compared with calcified components, large lipid pools severely damaged the host artery after stenting. Furthermore, damage due to the calcified component may depend on location.

  1. The everolimus-eluting Xience stent in small vessel disease: bench, clinical, and pathology view

    Directory of Open Access Journals (Sweden)

    Sanchez OD

    2014-12-01

    Full Text Available Oscar D Sanchez, Kazuyuki Yahagi, Tobias Koppara, Renu Virmani, Michael Joner CVPath Institute, Inc., Gaithersburg, MD, USA Abstract: Coronary artery disease (CAD is the leading cause of morbidity and mortality worldwide. The pathogenesis of CAD relates to the presence of atherosclerotic plaques in the coronary arteries, which are most frequently treated today by percutaneous coronary intervention. Small vessel disease treatment represents one-third of all percutaneous coronary interventions with higher rates of restenosis and major adverse cardiac events. Initially, drug-eluting stents (DES were developed to reduce in-stent restenosis, improving clinical outcomes and reducing the need for target vessel revascularization. However, late and very late stent thrombosis emerged as a new problem compromising DES's long-term results. The cobalt–chromium everolimus-eluting stent (CoCr-EES represents the results of an evolutionary process in DES technology aimed at improving the shortcomings of first-generation DES. Small vessel CAD has historically been an obstacle to long-term patency following implantation of DES. Antirestenotic efficacy has been shown to be of high relevance in small vessels. Therefore, stent selection may play an important role in determining outcomes in this subgroup of patients. This article will review the performance of CoCr-EES in the treatment of small vessel CAD from preclinical, clinical, and pathology perspectives, and it will highlight the most important findings in this regard. Keywords: small vessel, cobalt–chromiun everolimus-eluting stent, Xience V, pathology

  2. 左半结直肠癌急性梗阻采用肠道支架与梗阻导管治疗的临床体会%Clinical Experience of the Treatment of Acute Obstruction of the Left Colon Cancer With the Use of the Intestinal Stent and the Obstruction Catheter

    Institute of Scientific and Technical Information of China (English)

    王新刚; 王光辉

    2015-01-01

    Objective To explore the therapeutic effect of the treatment of acute obstruction of the left colon cancer with the use of the intestinal stent and the obstruction of the catheter. Methods 39 cases with intestinal stents as stent group,39 cases treated by catheter obstruction as catheter group,and the operation effect and the therapeutic effects of two groups were analyzed. Results Two groups of abdominal pain abdominal distension relief time and obstruction of the proximal bowel contrast of inner diameter had difference(P 0.05. Conclusion Compared with the obstruction catheter,metal stent can improve the symptoms of intestinal obstruction in a certain extent.%目的:探究左半结直肠癌急性梗阻采用肠道支架与梗阻导管的疗效。方法39例采用肠道支架治疗作为支架组,39例采用梗阻导管治疗作为导管组,并分析两组的手术治疗效果。结果两组腹痛腹胀缓解时间与梗阻近端肠管内径差值的对比,P <0.05;两组患者术后疗效对比, P >0.05。结论与梗阻导管相比,金属支架能够在某种程度上改善肠梗阻症状。

  3. Therapeutic effect and safety of bare metal stent in patients with coronary heart disease complicated im-paired glucose tolerance%冠心病合并糖耐量受损患者应用金属裸支架的疗效及安全性

    Institute of Scientific and Technical Information of China (English)

    王德伟; 黄洁; 杨海英

    2014-01-01

    Objective:To analyze the clinical therapeutic effect and safety of bare metal stent (BMS)application in patients with coronary heart disease (CHD)complicated impaired glucose tolerance (IGT).Methods:The data of 68 CHD + IGT patients undergoing stent implantation in our hospital were retrospectively analyzed.According to kind of implanted stents,they were divided into BMS group (n=36)and drug eluting stent (DES)group (n=32). Thrombolysis in myocardial infarction (TIMI)flow grade and Gensini score of coronary lesion were compared be-tween two groups via reviewing coronary angiography six months after operation.Incidence rates of re-stenosis,a-cute thrombosis,sub-acute thrombosis,revascularization and sudden death were compared between two groups after one year follow-up.Results:There were no significant difference in TIMI grade and Gensini score of coronary le-sion between two groups after operation (P>0.05).Compared with DES group after one-year follow-up,there were significant reductions in incidence rates of acute thrombosis (6.25% vs. 2.78%), sub-acute thrombosis (15.63% vs.5.56%)and sudden death (6.25% vs.2.78%)in BMS group (P0.05).Conclusion:Application of bare metal stent can reduce incidence rate of postoperative complications and possess better therapeu-tic effect in patients with coronary heart disease complicated impaired glucose tolerance.%目的:在冠心病(CHD)合并糖耐量受损患者应用金属裸支架的疗效及安全性。方法:回顾性分析68例CHD合并糖耐量受损患者在我院行支架植入术的资料,依据植入支架种类分为:金属裸支架(BMS)组(36例),药物涂层支架(DES)组(32例)。术后6月复查冠脉造影,比较两组的心肌梗死溶栓治疗(TIMI)临床试验血流分级及 Gensini冠脉病变积分的差异。随访1年,比较两组患者再狭窄发生率、急性血栓形成、亚急性血栓形成、血运重建率及猝死率等并发症的差异。

  4. Thrombosis and morphology of plaque rupture using optical coherence tomography

    Institute of Scientific and Technical Information of China (English)

    GUO Jun; CHEN Yun-dai; TIAN Feng; LIU Hong-bin; CHEN Lian; SUN Zhi-jun; REN Yi-hong

    2013-01-01

    Background Thrombosis following plaque rupture is the main cause of acute coronary syndrome,but not all plaque ruptures lead to thrombosis.There are limited in vivo data on the relationship between the morphology of ruptured plaque and thrombosis.Methods We used optical coherence tomography (OCT) to investigate the morphology of plaque rupture and its relation to coronary artery thrombosis in patients with coronary heart disease.Forty-two patients with coronary artery plaque rupture detected by OCT were divided into two groups (with or without thrombus) and the morphological characteristics of ruptured plaque,including fibrous cap thickness and broken cap site,were recorded.Results The fibrous cap of ruptured plaque with thrombus was significantly thinner compared to caps without thrombus ((57.00±17.00) μm vs.(96.00±48.00) μm; P=0.0076).Conclusions Plaque rupture associated with thrombosis occurs primarily in plaque covered by a thin fibrous cap.Thick fibrous caps are associated with greater stability of ruptured plaque.

  5. Immediate re-transplantation following early kidney transplant thrombosis.

    LENUS (Irish Health Repository)

    Phelan, Paul J

    2012-02-01

    Allograft thrombosis is a devastating early complication of renal transplantation that ultimately leads to allograft loss. We report here on our experience of nine cases of immediate re-transplantation following early kidney transplant thrombosis at a single centre between January 1990 and June 2009. The mean age was 42.9 years at time of transplant. For seven patients, the allograft thrombosis was their first kidney transplant and seven of the nine cases had a deceased donor transplant. The initial transplants functioned for a mean of 1.67 days and the patients received a second allograft at a mean of 3.1 days after graft failure. All of the re-transplants worked immediately. Four allografts failed after a mean of 52.5 months (2-155 months). Two of these died with a functioning allograft, one failed owing to chronic allograft nephropathy and one owing to persistent acute cellular rejection. The remaining five patients still have a functioning allograft after a mean of 101.8 months (7-187 months). One year allograft and patient survival after re-transplantation were 87.5% and 100% respectively (after 5 years, both were 57%). Immediate re-transplantation following early kidney transplant thrombosis can be a success. It may be considered in selected cases after allograft thrombosis.

  6. Immediate re-transplantation following early kidney transplant thrombosis.

    LENUS (Irish Health Repository)

    Phelan, Paul J

    2011-08-01

    Allograft thrombosis is a devastating early complication of renal transplantation that ultimately leads to allograft loss. We report here on our experience of nine cases of immediate re-transplantation following early kidney transplant thrombosis at a single centre between January 1990 and June 2009. The mean age was 42.9 years at time of transplant. For seven patients, the allograft thrombosis was their first kidney transplant and seven of the nine cases had a deceased donor transplant. The initial transplants functioned for a mean of 1.67 days and the patients received a second allograft at a mean of 3.1 days after graft failure. All of the re-transplants worked immediately. Four allografts failed after a mean of 52.5 months (2-155 months). Two of these died with a functioning allograft, one failed owing to chronic allograft nephropathy and one owing to persistent acute cellular rejection. The remaining five patients still have a functioning allograft after a mean of 101.8 months (7-187 months). One year allograft and patient survival after re-transplantation were 87.5% and 100% respectively (after 5 years, both were 57%). Immediate re-transplantation following early kidney transplant thrombosis can be a success. It may be considered in selected cases after allograft thrombosis.

  7. Clinical outcome after management of unprotected left main in-stent restenosis after bare metal or drug-eluting stents

    Institute of Scientific and Technical Information of China (English)

    CHEN Shao-liang; QIAN Jun; Kwan Tak W; XU Bo; Gary Mintz; YE Fei; ZHANG Jun-jie; KAN Jing; SUN Xue-wen; ZHANG Ai-ping; CHEN Jin-guo

    2010-01-01

    Background Implantation of either bare metal stent (BMS) or drug-eluting stent (DES) has been used in every day practice for patients with unprotected left main stenosis (UPLMS). There are still a lack of data regading the subsequent results of UPLMS in-stent restenosis (ISR). The present study aimed at determing the clinical outcome of UPLMS ISR patients after implantation of either BMS or DES.Methods Patients with UPLMS ISR after stenting were included. The primary endpoint was the cumulative major adverse cardiac events (MACE), including cardiac death, myocardial infarction (Ml), and target vessel revascularization (TVR).Results UPLMS ISR rate was 14.8% (n=73, 15.7% after BMS, 14.5% for DES) after average of (3.89±2.01) years (range from 1 to 10.5 years) follow-up. Angiographic follow-up between 6-8 months was available in 85.3%. Of these,repeat percutaneous coronary intervention (PCI) was used in 62 (84.9%) patients, with medicine only in 9 (12.4%) and coronary artery bypass graft (CABG) in 2 (2.7%). Most repeat PCI patients were with unstable angina (87.0%), and had decreased left ventricular ejection fraction ((42.58±5.12)%), fewer focal/ostial left circumflex branch (LCX) lesions, in relative to medicine only group. After (31.9±23.3) months, the MACE, Ml, TVR and cardiac death were 31.5%, 1.4%, 24.1% and 8.2%, respectively. Definite and possible stent thrombosis occurred in 1 (1.4%) patient.Conclusions Medical therapy for asymptomatic isolated ostial LCX was safe. Repeat PCI for UPLMS ISR was associated with acceptable early and short-term clinical outcome. Further study was needed to elucidate the role of CABG in treating UPLMS ISR.

  8. Impact of sirolimus-eluting stent fractures without early cardiac events on long-term clinical outcomes: A multislice computed tomography study

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Tsuyoshi [Toyohashi Heart Center, Oyama-cho, Toyohashi (Japan); Nagoya City University Graduate School of Medical Sciences, Department of Cardio-Renal Medicine and Hypertension, Nagoya (Japan); Kimura, Masashi; Ehara, Mariko; Terashima, Mitsuyasu; Nasu, Kenya; Kinoshita, Yoshihisa; Habara, Maoto; Tsuchikane, Etsuo; Suzuki, Takahiko [Toyohashi Heart Center, Oyama-cho, Toyohashi (Japan)

    2014-05-15

    This study sought to evaluate the impact of sirolimus-eluting stent (SES) fractures on long-term clinical outcomes using multislice computed tomography (MSCT). In this study, 528 patients undergoing 6- to 18-month follow-up 64-slice MSCT after SES implantation without early clinical events were followed clinically (the median follow-up interval was 4.6 years). A CT-detected stent fracture was defined as a complete gap with Hounsfield units (HU) <300 at the site of separation. The major adverse cardiac events (MACEs), including cardiac death, stent thrombosis, and target lesion revascularisation, were compared according to the presence of stent fracture. Stent fractures were observed in 39 patients (7.4 %). MACEs were more common in patients with CT-detected stent fractures than in those without (46 % vs. 7 %, p < 0.01). Univariate Cox regression analysis indicated a significant relationship between MACE and stent fracture [hazard ratio (HR) 7.65; p < 0.01], age (HR 1.03; p = 0.04), stent length (HR 1.03; p < 0.01), diabetes mellitus (HR 1.77; p = 0.04), and chronic total occlusion (HR 2.54; p = 0.01). In the multivariate model, stent fracture (HR 5.36; p < 0.01) and age (HR 1.03; p = 0.04) remained significant predictors of MACE. An SES fracture detected by MSCT without early clinical events was associated with long-term clinical adverse events. (orig.)

  9. Computational comparison of the bending behavior of aortic stent-grafts

    CERN Document Server

    Demanget, Nicolas; Badel, Pierre; Orgéas, Laurent; Geindreau, Christian; Albertini, Jean-Noël; Favre, Jean-Pierre; 10.1016/j.jmbbm.2011.09.006

    2012-01-01

    Secondary interventions after endovascular repair of abdominal aortic aneurysms are frequent because stent-graft (SG) related complications may occur (mainly endoleak and SG thrombosis). Complications have been related to insufficient SG flexibility, especially when devices are deployed in tortuous arteries. Little is known on the relationship between SG design and flexibility. Therefore, the aim of this study was to simulate numerically the bending of two manufactured SGs (Aorfix-Lombard Medical (A) and Zenith-Cook Medical Europe (Z)) using finite element analysis (FEA). Global SG behavior was studied by assessing stent spacing variation and cross-section deformation. Four criteria were defined to compare flexibility of SGs: maximal luminal reduction rate, torque required for bending, maximal membrane strains in graft and maximal Von Mises stress in stents. For angulation greater than 60\\degree, values of these four criteria were lower with A-SG, compared to Z-SG. In conclusion, A-SG was more flexible than Z...

  10. Pulmonary thromboembolism associated with renal insufficiency due to renal artery thrombosis

    Directory of Open Access Journals (Sweden)

    Vučičević-Trobok Jadranka

    2002-01-01

    Full Text Available Pulmonary thromboembolism is a clinical and pathophysiological condition caused by occlusion of pulmonary arteries by thrombotic embolus. Deep venous thrombosis needn't necessarily be evident. Acute renal insufficiency is a syndrome manifested by rapid decrease or even complete urinary retention which may be due to obturation of renal arteries by a thrombus. The condition is clinically manifested by hematuria, oliguria, anuria and death due to uremia. Case Report The patient had a history of disease and a chest X-ray finding both irrelevant for establishing the working diagnosis. Blood gas analysis presented prominent hypoxemia with hyperventilation and ECG finding exhibited right heart overload, pointing to pulmonary thromboembolism. On the third day of treatment with heparin, the patient developed hematuria, oliguria and excessive elevation of nitrogen in blood as a sign of acute renal insufficiency, leading to fatal outcome. Autopsy revealed deep venous thrombosis of the left femoral vein, with massive pulmonary thromboembolism and thrombosis of both femoral arteries, inducing acute renal failure. Discussion Although the patient had a typical radiologic presentation of pulmonary thromboembolism, treatment with heparin was initiated on the basis of his blood gas analysis and ECG findings. Deep venous thrombosis was not clinically evident and acute renal failure could not be explained during patient's lifetime. Conclusion This is a rare case of acute renal failure due to a rare occurrence of bilateral acute thrombosis of renal arteries.

  11. Increased rheumatoid factor and deep venous thrombosis

    DEFF Research Database (Denmark)

    Meyer-Olesen, Christine L; Nielsen, Sune F; Nordestgaard, Børge G

    2015-01-01

    BACKGROUND: The risk of deep venous thrombosis is increased in patients with rheumatoid arthritis. We tested the hypothesis that increased concentrations of rheumatoid factor are associated with increased risk of deep venous thrombosis in individuals without autoimmune rheumatic disease...... venous thrombosis. CONCLUSIONS: Increased rheumatoid factor in the general population was associated with up to 3-fold increased long-term risk and up to 9-fold increased 1-year risk of deep venous thrombosis....... was incident deep venous thrombosis. There were no losses to follow-up. RESULTS: During 368381 person-years, 670 individuals developed deep venous thrombosis. A rheumatoid factor concentration ≥ vs venous thrombosis, with multivariable adjusted hazard...

  12. Epidemiology of recurrent venous thrombosis

    Directory of Open Access Journals (Sweden)

    D.D. Ribeiro

    2012-01-01

    Full Text Available Venous thrombosis, including deep vein thrombosis and pulmonary embolism, is a common disease that frequently recurs. Recurrence can be prevented by anticoagulants, but this comes at the risk of bleeding. Therefore, assessment of the risk of recurrence is important to balance the risks and benefits of anticoagulant treatment. This review briefly outlines what is currently known about the epidemiology of recurrent venous thrombosis, and focuses in more detail on potential new risk factors for venous recurrence. The general implications of these findings in patient management are discussed.

  13. Acute myocardial infarction in a young athlete: Optical coherence tomographic features of the culprit lesion

    Directory of Open Access Journals (Sweden)

    Matjaz Klemenc

    2016-04-01

    Full Text Available Objectives: We report on a young male athlete who suffered from acute myocardial infarction immediately after a vigorous training. Methods: A comprehensive optical coherence tomographic investigation of the culprit coronary artery was performed after the combined mechanical and pharmacological thrombus removal. Results and Conclusion: The imaging discovered a tear at the junction of the non-obstructive, largely fibrotic plaque with the normal arterial wall. This exertion-related vessel damage resulted in a dynamic thrombosis that almost completely occluded the culprit artery. As the vessel obstruction was not considered flow-limiting, the stent implantation was not required and the patient was discharged on the double antiplatelet therapy and statin.

  14. Delayed complications after flow-diverter stenting: reactive in-stent stenosis and creeping stents.

    Science.gov (United States)

    Cohen, José E; Gomori, John Moshe; Moscovici, Samuel; Leker, Ronen R; Itshayek, Eyal

    2014-07-01

    We assessed the frequency and severity of changes in stent configuration and location after the treatment of intracranial aneurysms, and patterns of in-stent stenosis. We retrospectively reviewed data for consecutive aneurysm patients managed with endovascular implantation of flow-diverter stents (Silk Flow Diverter [Balt Extrusion, Montmorency, France] and Pipeline Embolization Device [ev3/Coviden, Minneapolis, MN, USA]) from October 2011 to July 2012. Routine 2, 6, 9-12, and 16-20 month follow-up angiograms were compared, with a focus on changes in stent configuration and location from immediately after deployment to angiographic follow-up, and the incidence and development of in-stent stenosis. Thirty-four patients with 42 aneurysms met inclusion criteria. The Silk device was implanted in 16 patients (47%, single device in 15), the Pipeline device in 18 (53%, single device in 16). On first follow-up angiography, in-stent stenosis was observed in 38% of Silk devices and 39% of Pipeline devices. In-stent stenosis was asymptomatic in 12 of 13 patients. One woman presented with transient ischemic attacks and required stent angioplasty due to end tapering and mild, diffuse in-stent stenosis. Configuration and location changes, including stent creeping and end tapering were seen in 2/16 patients (13%) with Silk devices, and 0/18 patients with Pipeline devices. We describe stent creeping and end tapering as unusual findings with the potential for delayed clinical complications. In-stent stenosis, with a unique behavior, is a frequent angiographic finding observed after flow-diverter stent implant. The stenosis is usually asymptomatic; however, close clinical and angiographic monitoring is mandatory for individualized management.

  15. Effect of pioglitazone on in-stent restenosis after coronary drug-eluting stent implantation: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Ming-duo Zhang

    Full Text Available In-stent restenosis (ISR remains a common life-threatening complication and some studies have shown that pioglitazone can reduce the incidence of ISR in patients with drug-eluting stents (DES implantation. We conducted a meta-analysis to assess the effect of pioglitazone in preventing ISR after DES implantation.Randomized controlled trials (RCTs investigating the effects of pioglitazone for ISR after DES implantation were identified by systematic searches of multiple online databases and manual searches of related reference lists of identified trials through May 2014. The primary endpoint was the rate of ISR. Secondary endpoints included minimum lumen diameter, percentage stenosis of stented vessels, late loss, in-stent neointimal volume, target vessel revascularization (TVR, target lesion revascularization, myocardial infarction, stent thrombosis and death.Five studies, comprising 255 pioglitazone-treated patients and 245 controls, were identified in the current meta-analysis. Pioglitazone did not significantly reduce the rate of ISR (P = 0.20 with low heterogeneity (I2 = 13.3%, P = 0.32. For the secondary outcomes, pioglitazone did not substantially affect the pooled estimates of these endpoints except late loss (P = 0.01 and TVR (P = 0.04.The limited evidence indicates that pioglitazone does not demonstrate markedly beneficial effect in patients subjected to coronary DES implantation. However, the results should be interpreted with care given the small sample size. Further large-scale RCTs are needed.

  16. Early and long-term outcome of elective stenting of the infarct-related artery in patients with viability in the infarct-area: Rationale and design of the Viability-guided Angioplasty after acute Myocardial Infarction-trial (The VIAMI-trial

    Directory of Open Access Journals (Sweden)

    Visser Cees A

    2004-11-01

    Full Text Available Abstract Background Although percutaneous coronary intervention (PCI is becoming the standard therapy in ST-segment elevation myocardial infarction (STEMI, to date most patients, even in developed countries, are reperfused with intravenous thrombolysis or do not receive a reperfusion therapy at all. In the post-lysis period these patients are at high risk for recurrent ischemic events. Early identification of these patients is mandatory as this subgroup could possibly benefit from an angioplasty of the infarct-related artery. Since viability seems to be related to ischemic adverse events, we initiated a clinical trial to investigate the benefits of PCI with stenting of the infarct-related artery in patients with viability detected early after acute myocardial infarction. Methods The VIAMI-study is designed as a prospective, multicenter, randomized, controlled clinical trial. Patients who are hospitalized with an acute myocardial infarction and who did not have primary or rescue PCI, undergo viability testing by low-dose dobutamine echocardiography (LDDE within 3 days of admission. Consequently, patients with demonstrated viability are randomized to an invasive or conservative strategy. In the invasive strategy patients undergo coronary angiography with the intention to perform PCI with stenting of the infarct-related coronary artery and concomitant use of abciximab. In the conservative group an ischemia-guided approach is adopted (standard optimal care. The primary end point is the composite of death from any cause, reinfarction and unstable angina during a follow-up period of three years. Conclusion The primary objective of the VIAMI-trial is to demonstrate that angioplasty of the infarct-related coronary artery with stenting and concomitant use of abciximab results in a clinically important risk reduction of future cardiac events in patients with viability in the infarct-area, detected early after myocardial infarction.

  17. Efficacy and safety of a novel nano-porous polymer-free sirolimuseluting stent in pigs

    Institute of Scientific and Technical Information of China (English)

    CHEN Ming; ZHENG Bo; WU Zheng; PENG Hong-yu; WANG Xin-gang; ZHANG bin; HUO Yong

    2013-01-01

    Background Drug-eluting stents represent a major advance in interventional cardiology.However,the current drugeluting stents have significant limitations.One of the major problems is very late stent thrombosis,which is likely caused by inflammation and a hypersensitivity reaction related to a polymer on the stent.A polymer-free sirolimus-eluting stent with a unique nano-porous surface has been developed.This study aimed to evaluate this novel polymer-free sirolimuseluting stent for its efficacy and safety in a pig model.Methods Stents were directly coated with sirolimus (a drug concentration of 2.2 μg/mm2 on the stent surface).The polymer-free sirolimus-eluting stents (PFSES) were compared to standard polymer-coated sirolimus-eluting stents (PCSES) and bare-metal stents (BMS) in 18 pigs.Results At one month the degree of neointimal hyperplasia was similar between the two sirolimus-eluting stent groups and was significantly less compared to BMS ((1.93±0.51) mm2,(1.57±0.69) mm2 vs.(4.45±1.05) mm2,P <0.05) At three months,PFSES maintained the low level of neointima ((2.41±0.99) mm2 vs.(4.32±1.16) mm2,P <0.05),whereas PCSES had developed significant neointimal proliferation similar to BMS.The inflammation level was significantly higher in PCSES when compared with BMS three months post-implantation (2.50±0.55 vs.0.83±0.75,P <0.05) whereas PFSES showed a low level of inflammation comparable to PCSES (1.33±0.52 vs.2.50±0.55,P <0.05).Conclusion The PFSES is effective and safe,and appears to be superior to standard PCSEs.

  18. Development of epigallocatechin gallate-eluting polymeric stent and its physicochemical, biomechanical and biological evaluations

    Energy Technology Data Exchange (ETDEWEB)

    Han, Dong-Wook [Department of Nanomedical Engineering, College of Nanoscience and Nanotechnology, Pusan National University, Busan 609-735 (Korea, Republic of); Lee, Jun Jae [Division of Advanced Fibro-Science, Kyoto Institute of Technology, Kyoto 606-8585 (Japan); Jung, Duk-Young [Senior Products Industrial Center, Busan Techno-Park, Busan-617-030 (Korea, Republic of); Park, Jong-Chul [Cellbiocontrol Laboratory, Department of Medical Engineering, Yonsei University College of Medicine, Seoul 120-752 (Korea, Republic of); Hyon, Suong-Hyu, E-mail: nanohan@pusan.ac.k, E-mail: biogen@frontier.kyoto-u.ac.j [Department of Medical Simulation Engineering, Institute for Frontier Medical Sciences, Kyoto University, Kyoto 606-8507 (Japan)

    2009-08-15

    Localized drug delivery from drug-eluting stents has been accepted as one of the most promising treatment methods for preventing restenosis after stenting. However, hypersensitivity reactions caused by their nonresorbable polymer coatings and bare-metal stents may result in serious clinical sequelae. Epigallocatechin-3-O-gallate (EGCG), the predominant catechin from tea, has been shown to exert anti-thrombotic, anti-inflammatory and anti-proliferative activities. In this study, it was hypothesized that sustainedly released EGCG from biodegradable poly(lactide-co-epsilon-caprolactone, PLCL) would suppress the proliferation of vascular smooth muscle cells (VSMCs). EGCG-releasing PLCL (E-PLCL) was prepared by blending PLCL with EGCG. The surface morphology, roughness and melting temperature of PLCL were not changed despite EGCG addition. EGCG was uniformly dispersed into E-PLCL and sustainedly released for periods up to 7 days by controlled diffusion rather than PLCL degradation. Moreover, EGCG did not affect tensile strength at break, but significantly increased the elastic modulus of PLCL. The proliferation of VSMCs onto E-PLCL was significantly suppressed although the cell attachment onto E-PLCL had been higher than that onto PLCL. On the other hand, EGCG-eluting polymeric stents were prepared with neither cracks nor webbings between struts, and their structural integrity was maintained without delamination or destruction. These results suggest that E-PLCL can be potentially applied for fabricating an EGCG-eluting vascular stent, namely an EGCG-eluting polymeric stent, or even an EGCG-releasing polymer-coated metal stent, to prevent thrombosis, inflammation and in-stent restenosis.

  19. Angioplasty and stent - heart - discharge

    Science.gov (United States)

    Drug-eluting stents - discharge; PCI - discharge; Percutaneous coronary intervention - discharge; Balloon angioplasty - discharge; Coronary angioplasty - discharge; Coronary artery angioplasty - discharge; Cardiac ...

  20. Renal vein thrombosis

    Science.gov (United States)

    ... Saunders; 2012:chap 34. Read More Acute kidney failure Arteriogram Blood clots Dehydration Nephrotic syndrome Pulmonary embolus Renal Tumor Review Date 5/19/2015 Updated by: Charles Silberberg, ...