WorldWideScience

Sample records for angioplasty network lessons

  1. Prediction of persistent hemodynamic depression after carotid angioplasty and stenting using artificial neural network model.

    Science.gov (United States)

    Jeon, Jin Pyeong; Kim, Chulho; Oh, Byoung-Doo; Kim, Sun Jeong; Kim, Yu-Seop

    2018-01-01

    To assess and compare predictive factors for persistent hemodynamic depression (PHD) after carotid artery angioplasty and stenting (CAS) using artificial neural network (ANN) and multiple logistic regression (MLR) or support vector machines (SVM) models. A retrospective data set of patients (n=76) who underwent CAS from 2007 to 2014 was used as input (training cohort) to a back-propagation ANN using TensorFlow platform. PHD was defined when systolic blood pressure was less than 90mmHg or heart rate was less 50 beats/min that lasted for more than one hour. The resulting ANN was prospectively tested in 33 patients (test cohort) and compared with MLR or SVM models according to accuracy and receiver operating characteristics (ROC) curve analysis. No significant difference in baseline characteristics between the training cohort and the test cohort was observed. PHD was observed in 21 (27.6%) patients in the training cohort and 10 (30.3%) patients in the test cohort. In the training cohort, the accuracy of ANN for the prediction of PHD was 98.7% and the area under the ROC curve (AUROC) was 0.961. In the test cohort, the number of correctly classified instances was 32 (97.0%) using the ANN model. In contrast, the accuracy rate of MLR or SVM model was both 75.8%. ANN (AUROC: 0.950; 95% CI [confidence interval]: 0.813-0.996) showed superior predictive performance compared to MLR model (AUROC: 0.796; 95% CI: 0.620-0.915, p<0.001) or SVM model (AUROC: 0.885; 95% CI: 0.725-0.969, p<0.001). The ANN model seems to have more powerful prediction capabilities than MLR or SVM model for persistent hemodynamic depression after CAS. External validation with a large cohort is needed to confirm our results. Copyright © 2017. Published by Elsevier B.V.

  2. 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 ...

  3. Functional Angioplasty

    Directory of Open Access Journals (Sweden)

    Rohit Tewari

    2013-01-01

    Full Text Available Coronary angiography underestimates or overestimates lesion severity, but still remains the cornerstone in the decision making for revascularization for an overwhelming majority of interventional cardiologists. Guidelines recommend and endorse non invasive functional evaluation ought to precede revascularization. In real world practice, this is adopted in less than 50% of patients who go on to have some form of revascularization. Fractional flow reserve (FFR is the ratio of maximal blood flow in a stenotic coronary relative to maximal flow in the same vessel, were it normal. Being independent of changes in heart rate, BP or prior infarction; and take into account the contribution of collateral blood flow. It is a majorly specific index with a reasonably high sensitivity (88%, specificity (100%, positive predictive value (100%, and overall accuracy (93%. Whilst FFR provides objective determination of ischemia and helps select appropriate candidates for revascularization (for both CABG and PCI in to cath lab itself before intervention, whereas intravascular ultrasound/optical coherence tomography guidance in PCI can secure the procedure by optimizing stent expansion. Functional angioplasty simply is incorporating both intravascular ultrasound and FFR into our daily Intervention practices.

  4. Carotid Angioplasty and Stenting

    Science.gov (United States)

    Carotid angioplasty and stenting Overview Carotid angioplasty (kuh-ROT-id AN-jee-o-plas-tee) and stenting ... to better see and examine the blood vessels. Food and medications You'll receive instructions on what ...

  5. How to set up an effective national primary angioplasty network: lessons learned from five European countries

    DEFF Research Database (Denmark)

    Knot, Jiri; Widimsky, Petr; Wijns, William

    2009-01-01

    AIMS: Percutaneous coronary interventions (PCI) are used to treat acute and chronic forms of coronary artery disease. While in chronic forms the main goal of PCI is to improve the quality of life, in acute coronary syndromes (ACS) timely PCI is a life-saving procedure - especially in the setting ...

  6. Functionality for learning networks: lessons learned from social web applications

    NARCIS (Netherlands)

    Berlanga, Adriana; Sloep, Peter; Brouns, Francis; Van Rosmalen, Peter; Bitter-Rijpkema, Marlies; Koper, Rob

    2007-01-01

    Berlanga, A. J., Sloep, P., Brouns, F., Van Rosmalen, P., Bitter-Rijpkema, M., & Koper, R. (2007). Functionality for learning networks: lessons learned from social web applications. Proceedings of the ePortfolio 2007 Conference. October, 18-19, 2007, Maastricht, The Netherlands. [See also

  7. Social Networking Sites and Addiction: Ten Lessons Learned

    OpenAIRE

    Kuss, Daria J.; Griffiths, Mark D.

    2017-01-01

    Online social networking sites (SNSs) have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning onl...

  8. Lessons Learned from the Young Breast Cancer Survivorship Network.

    Science.gov (United States)

    Gisiger-Camata, Silvia; Nolan, Timiya S; Vo, Jacqueline B; Bail, Jennifer R; Lewis, Kayla A; Meneses, Karen

    2017-11-30

    The Young Breast Cancer Survivors Network (Network) is an academic and community-based partnership dedicated to education, support, and networking. The Network used a multi-pronged approach via monthly support and networking, annual education seminars, website networking, and individual survivor consultation. Formative and summative evaluations were conducted using group survey and individual survivor interviews for monthly gatherings, annual education meetings, and individual consultation. Google Analytics was applied to evaluate website use. The Network began with 4 initial partnerships and grew to 38 in the period from 2011 to 2017. During this 5-year period, 5 annual meetings (598 attendees), 23 support and networking meetings (373), and 115 individual survivor consultations were conducted. The Network website had nearly 12,000 individual users and more than 25,000 page views. Lessons learned include active community engagement, survivor empowerment, capacity building, social media outreach, and network sustainability. The 5-year experiences with the Network demonstrated that a regional program dedicated to the education, support, networking, and needs of young breast cancer survivors and their families can become a vital part of cancer survivorship services in a community. Strong community support, engagement, and encouragement were vital components to sustain the program.

  9. Phenomenological network models: Lessons for epilepsy surgery.

    Science.gov (United States)

    Hebbink, Jurgen; Meijer, Hil; Huiskamp, Geertjan; van Gils, Stephan; Leijten, Frans

    2017-10-01

    The current opinion in epilepsy surgery is that successful surgery is about removing pathological cortex in the anatomic sense. This contrasts with recent developments in epilepsy research, where epilepsy is seen as a network disease. Computational models offer a framework to investigate the influence of networks, as well as local tissue properties, and to explore alternative resection strategies. Here we study, using such a model, the influence of connections on seizures and how this might change our traditional views of epilepsy surgery. We use a simple network model consisting of four interconnected neuronal populations. One of these populations can be made hyperexcitable, modeling a pathological region of cortex. Using model simulations, the effect of surgery on the seizure rate is studied. We find that removal of the hyperexcitable population is, in most cases, not the best approach to reduce the seizure rate. Removal of normal populations located at a crucial spot in the network, the "driver," is typically more effective in reducing seizure rate. This work strengthens the idea that network structure and connections may be more important than localizing the pathological node. This can explain why lesionectomy may not always be sufficient. © 2017 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

  10. Liberalising Gambling Markets : Lessons from Network Industries?

    NARCIS (Netherlands)

    van Damme, E.E.C.

    2007-01-01

    This paper, based on my concluding remarks at the “Colloquium on the Economic Aspects of Gambling Regulation: EU and US Perspectives” held at Tilburg in November 2006, discusses the question why, in Europe, some service sectors (such as network industries) are liberalised, while others (like the

  11. Social Networking Sites and Addiction: Ten Lessons Learned

    Science.gov (United States)

    Kuss, Daria J.; Griffiths, Mark D.

    2017-01-01

    Online social networking sites (SNSs) have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i) social networking and social media use are not the same; (ii) social networking is eclectic; (iii) social networking is a way of being; (iv) individuals can become addicted to using social networking sites; (v) Facebook addiction is only one example of SNS addiction; (vi) fear of missing out (FOMO) may be part of SNS addiction; (vii) smartphone addiction may be part of SNS addiction; (viii) nomophobia may be part of SNS addiction; (ix) there are sociodemographic differences in SNS addiction; and (x) there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided. PMID:28304359

  12. Social Networking Sites and Addiction: Ten Lessons Learned

    Directory of Open Access Journals (Sweden)

    Daria J. Kuss

    2017-03-01

    Full Text Available Online social networking sites (SNSs have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i social networking and social media use are not the same; (ii social networking is eclectic; (iii social networking is a way of being; (iv individuals can become addicted to using social networking sites; (v Facebook addiction is only one example of SNS addiction; (vi fear of missing out (FOMO may be part of SNS addiction; (vii smartphone addiction may be part of SNS addiction; (viii nomophobia may be part of SNS addiction; (ix there are sociodemographic differences in SNS addiction; and (x there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided.

  13. Social Networking Sites and Addiction: Ten Lessons Learned.

    Science.gov (United States)

    Kuss, Daria J; Griffiths, Mark D

    2017-03-17

    Online social networking sites (SNSs) have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i) social networking and social media use are not the same; (ii) social networking is eclectic; (iii) social networking is a way of being; (iv) individuals can become addicted to using social networking sites; (v) Facebook addiction is only one example of SNS addiction; (vi) fear of missing out (FOMO) may be part of SNS addiction; (vii) smartphone addiction may be part of SNS addiction; (viii) nomophobia may be part of SNS addiction; (ix) there are sociodemographic differences in SNS addiction; and (x) there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided.

  14. Relationship between early administration of abciximab and TIMI flow in STEMI patients undergoing primary angioplasty: findings from a large regional STEMI network.

    Science.gov (United States)

    Izzo, Antonio; Rosiello, Renato; Lucchini, Giuseppe; Tomasi, Luca; Mantovani, Paola; Lettieri, Corrado; Baccaglioni, Nicola; Romano, Michele; Buffoli, Francesca; Izzo, Beatrice; Zanini, Roberto

    2017-06-01

    The aim of this study is to assess whether in S-T Elevation Myocardial Infarction (STEMI) a relationship between early administration of abciximab and Thrombolysis In Myocardial Infarction (TIMI) flow before and after primary percutaneous coronary intervention (PCI) in 960 consecutive patients exists. From 1 February 2001 onward, in the Province of Mantua it has been operating a 'Cardiology Network for the Acute Infarction Care' having its Hub in the Central Coronary ICU/Cath Lab of Mantua Hospital and being its Spokes centers represented by the emergency rooms and Central Coronary ICUs of the four territorial hospitals. T1 (time from symptoms onset to first medical contact) and T2 (time from first medical contact to angioplasty) are shorter for patients rescued by first aid units rather than for those presented in emergency rooms as well as Ta (time from symptoms onset to abciximab administration). Furthermore, the patients that received abciximab before hospital arrival had less frequently a coronary occlusion [odds ratio = 0.74, 95% confidence interval (0.57-0.96), P = 0.013]. The patients with T1 less than 4 h are 753/960 (78.4%). For this type of patients, there was a significant Ta difference between the pre-PCI TIMI-flow classes (F = 4.467, df = 3, P = 0.04). Planned contrasts revealed that mean time of TIMI flow 0 (M = 104.2) is statistically different from mean time of TIMI flow 3 (M = 85.7), P = 0.013. Our results suggest that the use of abciximab, free from pharmacokinetic limits of oral P2Y12 inhibitors, should be considered in STEMI patients with early presentation before primary PCI.

  15. Angioplasty and stent placement - carotid artery

    Science.gov (United States)

    ... medlineplus.gov/ency/article/002953.htm Angioplasty and stent placement - carotid artery To use the sharing features ... to remove plaque buildup ( endarterectomy ) Carotid angioplasty with stent placement Description Carotid angioplasty and stenting (CAS) is ...

  16. Transluminal laser angioplasty

    Science.gov (United States)

    Otto, Wlodzimierz

    1996-03-01

    Twenty seven patients with femoral artery occlusion were treated by transluminal Nd:YAG laser angioplasty, in 16 patients the procedure was combined with intraarterial infusion of rTPA (actilyse-Boehringer Ing). In 5 out of 11 patients from the initial group recanalization was not successful. In 16 patients from the rTPA group satisfactory immediate results were achieved in all cases. In long time observations ranging from 9 to 24 months all patients remained free from symptoms, although in 4 of them angiography and Doppler ultrasound examination reveal no flow in the femoral artery. In the remaining 12 patients (75%), the previously occluded artery is patent. No complications of laser angioplasty nor intraarterial infusion of rTPA were noted in this series.

  17. Aorto-iliac angioplasty

    International Nuclear Information System (INIS)

    Kotb, M.; Bennett, J.; Kadir, S.

    1990-01-01

    This paper reports on the results and complications of aortoiliac balloon percutaneous transluminal angioplasty (PTA) and Simpson atherectomy that are compared to determine the role of the latter procedure in the management of aortoiliac disease. In 1984--1988, 92 patients underwent 126 angioplasties of the aortoiliac region. In 1986--1989, 21 patients underwent iliac artery atherectomy. Both groups had similar symptoms, risk factors, and age ranges. The overall technical success rate was 97.6or PTA and 100% for atherectomy. The initial clinical success was 92.8% for PTA and 100% for atherectomy. The 2-year clinical patency rate was 60% for PTA and 64% for artherectomy. Complications requiring surgery occurred in four of 126 (3%) PTA patients and one of 21 (5%) atherectomy patients. Groin hematomas were observed in 16% of PTA patients and 19% of atherectomy patients

  18. Putting Gino's lesson to work: Actor-network theory, enacted humanity, and rehabilitation.

    Science.gov (United States)

    Abrams, Thomas; Gibson, Barbara E

    2016-02-01

    This article argues that rehabilitation enacts a particular understanding of "the human" throughout therapeutic assessment and treatment. Following Michel Callon and Vololona Rabeharisoa's "Gino's Lesson on Humanity," we suggest that this is not simply a top-down process, but is cultivated in the application and response to biomedical frameworks of human ability, competence, and responsibility. The emergence of the human is at once a materially contingent, moral, and interpersonal process. We begin the article by outlining the basics of the actor-network theory that underpins "Gino's Lesson on Humanity." Next, we elucidate its central thesis regarding how disabled personhood emerges through actor-network interactions. Section "Learning Gino's lesson" draws on two autobiographical examples, examining the emergence of humanity through rehabilitation, particularly assessment measures and the responses to them. We conclude by thinking about how rehabilitation and actor-network theory might take this lesson on humanity seriously. © The Author(s) 2016.

  19. Networking Skills as a Career Development Practice: Lessons from the Earth Science Women's Network (ESWN)

    Science.gov (United States)

    Hastings, M. G.; Kontak, R.; Holloway, T.; Marin-Spiotta, E.; Steiner, A. L.; Wiedinmyer, C.; Adams, A. S.; de Boer, A. M.; Staudt, A. C.; Fiore, A. M.

    2010-12-01

    Professional networking is often cited as an important component of scientific career development, yet there are few resources for early career scientists to develop and build networks. Personal networks can provide opportunities to learn about organizational culture and procedures, expectations, advancement opportunities, and best practices. They provide access to mentors and job placement opportunities, new scientific collaborations, speaker and conference invitations, increased scientific visibility, reduced isolation, and a stronger feeling of community. There is evidence in the literature that a sense of community positively affects the engagement and retention of underrepresented groups, including women, in science. Thus women scientists may particularly benefit from becoming part of a network. The Earth Science Women’s Network (ESWN) began in 2002 as an informal peer-to-peer mentoring initiative among a few recent Ph.D.s. The network has grown exponentially to include over 1000 women scientists across the globe. Surveys of our membership about ESWN report positive impacts on the careers of women in Earth sciences, particularly those in early career stages. Through ESWN, women share both professional and personal advice, establish research collaborations, communicate strategies on work/life balance, connect with women at various stages of their careers, and provide perspectives from cultures across the globe. We present lessons learned through the formal and informal activities promoted by ESWN in support of the career development of women Earth scientists.

  20. Percutaneous transluminal coronary angioplasty

    International Nuclear Information System (INIS)

    Przybojewski, J.Z.; Weich, H.F.H.

    1984-01-01

    The purpose of this article is to review PTCA, percutaneous transluminal coronary angioplasty, which can be considered to be a truly revolutionary and fairly simple invasive form of intervention to atherosclerotic obstruction. The 'epidemic' of IHD, ischaemic heart disease, in the Republic of South Africa calls for the employment of this technique, which has already been carried out in a few teaching hospitals in this country. Very recently, modified balloon dilatation catheters have been used percutaneously in the non-operative transluminal correction of congenital coarctation of the aorta in infants and children, congenital pulmonary value stenosis, and hypoplasia and stenosis of the pulmonary arteries. It has also been employed for PTCA and for the simultaneous occlusion of coronary-bronchial artery anastomosis using a detachable balloon. The isotopes thallium 201 and technetium 99 were also used in scintiscanning

  1. Electric restructuring and consumer choice: lessons from other network industries

    International Nuclear Information System (INIS)

    Crandall, R. W.

    1999-01-01

    The advantages of the U.S. model of private markets with limited regulation as the best alternative for delivering goods and services to consumers are discussed by citing examples from deregulated industries such as transportation, primary energy and financial markets. In all these cases deregulation has been extraordinarily successful. Experiences from these industries are examined in an effort to extract lessons that might be useful in predicting the likely evolution of competition in the electricity and telecommunications industries. A warning is sounded that deregulating these industries without opening access to the infrastructure (which is owned by carriers) could create major problems of natural-monopoly exploitation by the incumbents that would negate any productive and allocative efficiency gains conferred by deregulation. One obvious choice for liberalizing a network industry with natural-monopoly infrastructure is simply to separate the infrastructure from the delivery of the service as was done with railroads in the United Kingdom. A similar, but less far-reaching example might be the solution devised for natural gas pipelines in the U.S. where pipeline owners opened their infrastructure to competitors, albeit at regulated rates. In the electricity industry, separating power generation from transmission and distribution appears to be fairly simple, provided access to transmission and distribution network is granted. In the telecommunication industry where there is no generation, the natural monopoly may be in the local distribution of traffic to subscribers, hence separation of local distribution from national or regional distribution is the normal way to open up the market to new service providers. Experiences in the U. S., the U. K., Canada and New Zealand in electricity and telecommunications industry deregulation are examined and various pitfalls in current approaches are pointed out. It is the author's contention that announcing a date for the end

  2. Formation of community-based hypertension practice networks: success, obstacles, and lessons learned.

    Science.gov (United States)

    Dart, Richard A; Egan, Brent M

    2014-06-01

    Community-based practice networks for research and improving the quality of care are growing in size and number but have variable success rates. In this paper, the authors review recent efforts to initiate a community-based hypertension network modeled after the successful Outpatient Quality Improvement Network (O'QUIN) project, located at the Medical University of South Carolina. Key lessons learned and new directions to be explored are highlighted. ©2014 Wiley Periodicals, Inc.

  3. Angioplasty: MedlinePlus Health Topic

    Science.gov (United States)

    ... segment (Medical Encyclopedia) Also in Spanish Directional coronary atherectomy (DCA) (Medical Encyclopedia) Also in Spanish Percutaneous transluminal ... segment Coronary artery balloon angioplasty - slideshow Directional coronary atherectomy ... transluminal coronary angioplasty (PTCA) Stent Related ...

  4. Progress and lessons learned from water-quality monitoring networks

    Science.gov (United States)

    Myers, Donna N.; Ludtke, Amy S.

    2017-01-01

    Stream-quality monitoring networks in the United States were initiated and expanded after passage of successive federal water-pollution control laws from 1948 to 1972. The first networks addressed information gaps on the extent and severity of stream pollution and served as early warning systems for spills. From 1965 to 1972, monitoring networks expanded to evaluate compliance with stream standards, track emerging issues, and assess water-quality status and trends. After 1972, concerns arose regarding the ability of monitoring networks to determine if water quality was getting better or worse and why. As a result, monitoring networks adopted a hydrologic systems approach targeted to key water-quality issues, accounted for human and natural factors affecting water quality, innovated new statistical methods, and introduced geographic information systems and models that predict water quality at unmeasured locations. Despite improvements, national-scale monitoring networks have declined over time. Only about 1%, or 217, of more than 36,000 US Geological Survey monitoring sites sampled from 1975 to 2014 have been operated throughout the four decades since passage of the 1972 Clean Water Act. Efforts to sustain monitoring networks are important because these networks have collected information crucial to the description of water-quality trends over time and are providing information against which to evaluate future trends.

  5. Lessons from social network analyses for behavioral medicine.

    Science.gov (United States)

    Rosenquist, James N

    2011-03-01

    This study presents an overview of the rapidly expanding field of social network analysis, with an emphasis placed on work relevant to behavioral health clinicians and researchers. I outline how social network analysis is a distinct empirical methodology within the social sciences that has the potential to deepen our understanding of how mental health and addiction are influenced by social environmental factors. Whereas there have been a number of recent studies in the mental health literature that discuss social influences on mental illness and addiction, and a number of studies looking at how social networks influence health and behaviors, there are still relatively few studies that combine the two. Those that have suggest that mood symptoms as well as alcohol consumption are clustered within, and may travel along, social networks. Social networks appear to have an important influence on a variety of mental health conditions. This avenue of research has the potential to influence both clinical practice and public policy.

  6. First Lessons From The Biarritz Trial Network [1

    Science.gov (United States)

    Touyarot, P.; Marc, B.; de Panafieu, A.

    1986-07-01

    Opened for commercial operation in 1984, the trial optical fiber network at Biarritz in south-west France gives 1,500 subscribers access to a whole range of broadband services - videophony, audiovisual databases, TV and stereo sound program distribution, and an on-line TV program library - in addition to conventional narrow-band services like telephony and videotex. The Biarritz network is an outstanding technology and engineering testbed. It is also a sociological testing ground for new services, unique in the world, with results of particular relevance to the interactive cable TV and visual communications networks of the future.

  7. Strategies for establishing networking with partner schools for implementing lesson study in Indonesia

    Directory of Open Access Journals (Sweden)

    Nurwidodo Nurwidodo

    2018-03-01

    Full Text Available Lesson Study for Learning Community (LSLC contains two terminologies underpinning one another. There are many difficult challenges when the plan to create LSLC surfaces. Therefore, strong motivation and precise implementation strategies are of urgency. One of the ways is by developing networking of LSLC between universities and partner schools. The LSLC program will become powerful when it is done collaboratively in a form of strong partnership connected by networks. Writing this article aims to describe strategies for establishing networking with partner schools for implementing lesson study in Indonesia. This review article uses literature comparison study methods and use content analysis. In order for LSLC to manifest and become successful, resourcing and utilizing the partnership with schools are required. In a partnership with schools in order to implement LSLC, both parties must share the same need, which is facing the challenge with the willingness to cooperate for solving the problem. Cooperation with partner schools needs to be nurtured to become networking so that the benefits and the spirit of cooperation in solving problem double fold. Networking with partner schools can be implemented and can function well when the management of this networking conforms to shared needs, nurtures cooperation and mutual respect, gives and takes equally, and also promotes fair acceptance, support, independence, and discipline.

  8. Network Architecture: lessons from the past, vision for the future

    CERN Multimedia

    CERN. Geneva

    2004-01-01

    The Architectural Principles of the Internet have dominated the past decade. Orthogonal to the telecommunications industry principles, they dramatically changed the networking landscape because they relied on iconoclastic ideas. First, the Internet end-to-end principle, which stipulates that the network should intervene minimally on the end-to-end traffic, pushing the complexity to the end-systems. Second, the ban of centralized functions: all the Internet techniques (routing, DNS, management) are based on distributed, decentralized mechanisms. Third, the absolute domination of connectionless (stateless) protocols (as with IP, HTTTP). However, when facing new requirements: multimedia traffic, security, Grid applications, these principles appear sometimes as architectural barriers. Multimedia requires QoS guarantees, but stateless systems are not good at QoS. Security requires active, intelligent networks, but dumb routers or plain end-to-end mail systems are insufficient. Grid applications require...

  9. Teacher Agency in Educational Reform: Lessons from Social Networks Research

    Science.gov (United States)

    Datnow, Amanda

    2012-01-01

    This article provides a context for understanding how social networks among teachers support or constrain school improvement in terms of instructional practice, professional development, and educational reform. It comments on the articles in this special issue, summarizing their contributions to the field. This analysis reveals several important…

  10. Networking of Bibliographical Information: Lessons learned for the Virtual Observatory

    Science.gov (United States)

    Genova, Françoise; Egret, Daniel

    Networking of bibliographic information is particularly remarkable in astronomy. On-line journals, the ADS bibliographic database, SIMBAD and NED are everyday tools for research, and provide easy navigation from one resource to another. Tables are published on line, in close collaboration with data centers. Recent new developments include the links between observatory archives and the ADS, as well as the large scale prototyping of object links between Astronomy and Astrophysics and SIMBAD, following those implemented a few years ago with New Astronomy and the International Bulletin of Variable stars . This networking has been made possible by close collaboration between the ADS, data centers such as the CDS and NED, and the journals, and this partnership being now extended to observatory archives. Simple, de facto exchange standards, like the bibcode to refer to a published paper, have been the key for building links and exchanging data. This partnership, in which practitioners from different disciplines agree to link their resources and to work together to define useful and usable standards, has produced a revolution in scientists' practice. It is an excellent model for the Virtual Observatory projects.

  11. Lessons learned from the design of chemical space networks and opportunities for new applications.

    Science.gov (United States)

    Vogt, Martin; Stumpfe, Dagmar; Maggiora, Gerald M; Bajorath, Jürgen

    2016-03-01

    The concept of chemical space is of fundamental relevance in chemical informatics and computer-aided drug discovery. In a series of articles published in the Journal of Computer-Aided Molecular Design, principles of chemical space design were evaluated, molecular networks proposed as an alternative to conventional coordinate-based chemical reference spaces, and different types of chemical space networks (CSNs) constructed and analyzed. Central to the generation of CSNs was the way in which molecular similarity relationships were assessed and a primary focal point was the network-based representation of biologically relevant chemical space. The design and comparison of CSNs based upon alternative similarity measures can be viewed as an evolutionary path with interesting lessons learned along the way. CSN design has matured to the point that such chemical space representations can be used in practice. In this contribution, highlights from the sequence of CSN design efforts are discussed in context, providing a perspective for future practical applications.

  12. Lessons learned from the design of chemical space networks and opportunities for new applications

    Science.gov (United States)

    Vogt, Martin; Stumpfe, Dagmar; Maggiora, Gerald M.; Bajorath, Jürgen

    2016-03-01

    The concept of chemical space is of fundamental relevance in chemical informatics and computer-aided drug discovery. In a series of articles published in the Journal of Computer- Aided Molecular Design, principles of chemical space design were evaluated, molecular networks proposed as an alternative to conventional coordinate-based chemical reference spaces, and different types of chemical space networks (CSNs) constructed and analyzed. Central to the generation of CSNs was the way in which molecular similarity relationships were assessed and a primary focal point was the network-based representation of biologically relevant chemical space. The design and comparison of CSNs based upon alternative similarity measures can be viewed as an evolutionary path with interesting lessons learned along the way. CSN design has matured to the point that such chemical space representations can be used in practice. In this contribution, highlights from the sequence of CSN design efforts are discussed in context, providing a perspective for future practical applications.

  13. Incentive regulation of electricity distribution networks: Lessons of experience from Britain

    International Nuclear Information System (INIS)

    Jamasb, Tooraj; Pollitt, Michael

    2007-01-01

    This paper reviews the recent experience of the UK electricity distribution sector under incentive regulation. The UK has a significant and transparent history in implementing incentive regulation in the period since 1990. We demonstrate the successes of this period in reducing costs, prices, and energy losses while maintaining quality of service. We also draw out the lessons for other countries in implementing distribution sector reform. We conclude by discussing the place of incentive regulation of networks within the wider reform context, the required legislative framework, the need for appropriate unbundling, the importance of quality of service incentives, the regulatory information requirements, and the role of sector rationalisation. (author)

  14. Percutaneous transluminal angioplasty in arteriosclerosis

    International Nuclear Information System (INIS)

    Chung, Soo Young; Cha, In Ho

    1984-01-01

    Percutaneous transluminal angioplasty (PTA) is a non-operative therapeutic procedure to the dilation of stenosis or to the recanalization of occlusion in atherosclerotic arteries using of dilatation catheters. PTA was performed 37 times in 34 patients with arteriosclerotic for 1 year and 4 months from March, 1982 to June, 1983 at department of radiology, Klinikum Barmen/west Germany. The results were as follows; 1. The male to female ratio was 2 : 1 and peak age range was from 61 to 70. 2. The most common indication was clinical stage II b with 19 cases (51.3%). 3. PTA was performed most commonly in superficial femora artery in 25 cases (67.5%). 4. Acute major complication occurred in 2 cases (5.4%). PTA is a alternative or complementary therapeutic procedure to vascular surgery.

  15. Angioplasty and stent placement - carotid artery - discharge

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000235.htm Angioplasty and stent placement - carotid artery - discharge To use the sharing ... the hospital. You may have also had a stent (a tiny wire mesh tube) placed in the ...

  16. Angioplasty and stent placement - peripheral arteries - discharge

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000234.htm Angioplasty and stent placement - peripheral arteries - discharge To use the sharing ... peripheral artery). You may have also had a stent placed. To perform the procedure: Your doctor inserted ...

  17. Angioplasty and stent placement - peripheral arteries

    Science.gov (United States)

    ... medlineplus.gov/ency/article/007393.htm Angioplasty and stent placement - peripheral arteries To use the sharing features ... inside the arteries and block blood flow. A stent is a small, metal mesh tube that keeps ...

  18. Percutaneous transluminal angioplasty of the carotid artery

    International Nuclear Information System (INIS)

    Numaguchi, Y.; Tulane Univ., New Orleans, LA; Puyau, F.A.; Provenza, L.J.; Richardson, D.E.

    1984-01-01

    The successful dilatation of postsurgical concentric stenosis of an internal carotid artery using percutaneous transluminal angioplasty (PTA) is reported here. Only one such case has been previously documented. Review of the literature disclosed 16 patients who received transluminal angioplasty for stenosis of carotid arteries by percutaneous or open arteriotomy techniques. The authors feel that PTA may be the treatment of choice for postoperative concentric stenosis of a short segment of the carotid artery as opposed to surgical repair. (orig.)

  19. Lessons learned about coordinating academic partnerships from an international network for health education.

    Science.gov (United States)

    Luo, Airong; Omollo, Kathleen Ludewig

    2013-11-01

    There is a growing trend of academic partnerships between U.S., Canadian, and European health science institutions and academic health centers in low- and middle-income countries. These partnerships often encounter challenges such as resource disparities and power differentials, which affect the motivations, expectations, balance of benefits, and results of the joint projects. Little has been discussed in previous literature regarding the communication and project management processes that affect the success of such partnerships. To fill the gap in the literature, the authors present lessons learned from the African Health Open Educational Resources Network, a multicountry, multiorganizational partnership established in May 2008. The authors introduce the history of the network, then discuss actively engaging stakeholders throughout the project's life cycle (design, planning, execution, and closure) through professional development, relationship building, and assessment activities. They focus on communication and management practices used to identify mutually beneficial project goals, ensure timely completion of deliverables, and develop sustainable sociotechnical infrastructure for future collaborative projects. These activities yielded an interactive process of action, assessment, and reflection to ensure that project goals and values were aligned with implementation. The authors conclude with a discussion of lessons learned and how the partnership project may serve as a model for other universities and academic health centers in high-income countries and low- and middle-income countries that are interested in or currently pursuing international academic partnerships.

  20. The child and adolescent psychiatry trials network (CAPTN: infrastructure development and lessons learned

    Directory of Open Access Journals (Sweden)

    Breland-Noble Alfiee

    2009-03-01

    Full Text Available Abstract Background In 2003, the National Institute of Mental Health funded the Child and Adolescent Psychiatry Trials Network (CAPTN under the Advanced Center for Services and Intervention Research (ACSIR mechanism. At the time, CAPTN was believed to be both a highly innovative undertaking and a highly speculative one. One reviewer even suggested that CAPTN was "unlikely to succeed, but would be a valuable learning experience for the field." Objective To describe valuable lessons learned in building a clinical research network in pediatric psychiatry, including innovations intended to decrease barriers to research participation. Methods The CAPTN Team has completed construction of the CAPTN network infrastructure, conducted a large, multi-center psychometric study of a novel adverse event reporting tool, and initiated a large antidepressant safety registry and linked pharmacogenomic study focused on severe adverse events. Specific challenges overcome included establishing structures for network organization and governance; recruiting over 150 active CAPTN participants and 15 child psychiatry training programs; developing and implementing procedures for site contracts, regulatory compliance, indemnification and malpractice coverage, human subjects protection training and IRB approval; and constructing an innovative electronic casa report form (eCRF running on a web-based electronic data capture system; and, finally, establishing procedures for audit trail oversight requirements put forward by, among others, the Food and Drug Administration (FDA. Conclusion Given stable funding for network construction and maintenance, our experience demonstrates that judicious use of web-based technologies for profiling investigators, investigator training, and capturing clinical trials data, when coupled to innovative approaches to network governance, data management and site management, can reduce the costs and burden and improve the feasibility of

  1. Cerebral intolerance during flow arrested carotid angioplasty.

    Science.gov (United States)

    St Louis, Myron; Park, Brian D; Dahn, Michael; Bozeman, Patricia

    2012-01-01

    The use of flow arrest as a means of providing cerebral protection during carotid angioplasty offers the advantages of improved efficiency of debris removal and the ability to provide protection under unfavorable (tortuous) anatomic circumstances. However, in contrast to the filtration methods of cerebral protection, this modality requires complete interruption of antegrade carotid artery flow during balloon angioplasty and stent deployment. We report our experience with 9 patients undergoing carotid angioplasty with the Mo.Ma device, which utilizes common and external carotid artery balloon occlusion during the angioplasty procedure. We assessed the clinical outcomes and intraprocedural hemodynamic data. The average duration of carotid occlusion was 8.3 minutes. Of the 9 patients, 2 patients (22%) experienced cerebral intolerance. No stroke occurred in this patient cohort. There appeared to be a poor relationship between procedure intolerance and the presence of significant contralateral stenosis or low carotid back pressure. Furthermore, the incidence of postangioplasty hypotension was not clearly related to cerebral intolerance. Carotid angioplasty with stenting can be safely conducted with flow arrest as an alternative to filter-type cerebral protection devices. However, because cerebral intolerance is not an infrequent occurrence with this approach, clinicians must be cognizant of management strategies for transient cerebral intolerance.

  2. Winrock International's Renewable Energy Support Office (REPSO) network: success stories and lessons learned from the field

    International Nuclear Information System (INIS)

    Azurdia-Bravo, I.; Panggabean, L.M.; Pereira, O.S.; Ramana, V.V.; Santibanez-Yeneza, G.G.

    2000-01-01

    Winrock International's Clean Energy Group (CEG) is dedicated to the increased use of environmentally sustainable renewable energy technologies in a manner that enhances economic development. One specific objective of the CEG is to reduce the relative risks associated with investing in such technology options and to facilitate their widespread commercialization and use. A key component of the CEG's approach has been to establish a network of Renewable Energy Project Support Offices (REPSOs) in those developing countries with the greatest current and projected growth in demand for electricity and related energy services. Through these locally staffed REPSOs, Winrock has built on-the-ground capacity in renewable energy, accelerated scale-up and commercialization of renewable energy technologies, improved access to rural energy services, and facilitated industry linkages. To date, the consortium of the CEG, the REPSO network, and all Winrock's private and public partners have facilitated the installation of more than 500 MW of on-grid capacity, roughly 7,000 off-grid systems, mobilized at least 50 businesses or joint ventures, and leveraged over 1 billion US dollars in clean energy financing. The following paper shares some of the major lessons learned in the institutional and technical capacity building of the REPSO network and in the projects and activities it has implemented. This paper presents recent noteworthy REPSO successes and results, and also describes Winrock and the REPSOs goals for the new Millennium. (author)

  3. Characteristics and lessons learned from practice-based research networks (PBRNs in the United States

    Directory of Open Access Journals (Sweden)

    Keller S

    2012-09-01

    Full Text Available Melinda M Davis,1,2 Sara Keller,1 Jennifer E DeVoe,1,3 Deborah J Cohen11Department of Family Medicine, 2Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA; 3OCHIN Practice-based Research Network, Portland, OR, USAAbstract: Practice-based research networks (PBRNs are organizations that involve practicing clinicians in asking and answering clinically relevant research questions. This review explores the origins, characteristics, funding, and lessons learned through practice-based research in the United States. Primary care PBRNs emerged in the USA in the 1970s. Early studies explored the etiology of common problems encountered in primary care practices (eg, headache, miscarriage, demonstrating the gap between research conducted in controlled specialty settings and real-world practices. Over time, national initiatives and an evolving funding climate have shaped PBRN development, contributing to larger networks, a push for shared electronic health records, and the use of a broad range of research methodologies (eg, observational studies, pragmatic randomized controlled trials, continuous quality improvement, participatory methods. Today, there are over 160 active networks registered with the Agency for Healthcare Research and Quality's PBRN Resource Center that engage primary care clinicians, pharmacists, dentists, and other health care professionals in research and quality-improvement initiatives. PBRNs provide an important laboratory for encouraging collaborative research partnerships between academicians and practices or communities to improve population health, conduct comparative effectiveness and patient-centered outcomes research, and study health policy reform. PBRNs continue to face critical challenges that include: (1 adapting to a changing landscape; (2 recruiting and retaining membership; (3 securing infrastructure support; (4 straddling two worlds (academia and community and managing

  4. Angiographic assessment of initial balloon angioplasty results.

    Science.gov (United States)

    Gardiner, Geoffrey A; Sullivan, Kevin L; Halpern, Ethan J; Parker, Laurence; Beck, Margaret; Bonn, Joseph; Levin, David C

    2004-10-01

    To determine the influence of three factors involved in the angiographic assessment of balloon angioplasty-interobserver variability, operator bias, and the definition used to determine success-on the primary (technical) results of angioplasty in the peripheral arteries. Percent stenosis in 107 lesions in lower-extremity arteries was graded by three independent, experienced vascular radiologists ("observers") before and after balloon angioplasty and their estimates were compared with the initial interpretations reported by the physician performing the procedure ("operator") and an automated quantitative computer analysis. Observer variability was measured with use of intraclass correlation coefficients and SD. Differences among the operator, observers, and the computer were analyzed with use of the Wilcoxon signed-rank test and analysis of variance. For each evaluator, the results in this series of lesions were interpreted with three different definitions of success. Estimation of residual stenosis varied by an average range of 22.76% with an average SD of 8.99. The intraclass correlation coefficients averaged 0.59 for residual stenosis after angioplasty for the three observers but decreased to 0.36 when the operator was included as the fourth evaluator. There was good to very good agreement among the three independent observers and the computer, but poor correlation with the operator (P definition of success was used. Significant differences among the operator, the three observers, and the computer were not present when the definition of success was based on less than 50% residual stenosis. Observer variability and bias in the subjective evaluation of peripheral angioplasty can have a significant influence on the reported initial success rates. This effect can be largely eliminated with the use of residual stenosis of less than 50% to define success. Otherwise, meaningful evaluation of angioplasty results will require independent panels of evaluators or

  5. Stent-assisted angioplasty for intracranial atherosclerosis

    International Nuclear Information System (INIS)

    Nakahara, Toshinori; Sakamoto, Shigeyuki; Hamasaki, Osamu; Sakoda, Katsuaki

    2002-01-01

    We report on two patients with intracranial atherosclerosis of the carotid artery or vertebral artery treated with stent-assisted angioplasty. Both patients have severe intracranial atherosclerosis (>70%) with refractory symptoms despite optimal medical treatment. In both patients, a coronary balloon-expandable stent was successfully placed using a protective balloon technique without procedural complications. The patients were asymptomatic and neurologically intact at a mean clinical follow-up of 13 months. Follow-up angiograms did not show restenosis 3 or 4 months after procedure, respectively. Stent-assisted angioplasty for intracranial atherosclerosis in the elective patient has proven effective, with an acceptable low rate of morbidity and mortality. (orig.)

  6. Local stakeholder involvement in the perspective of nuclear waste management: lessons form the Cowam network

    International Nuclear Information System (INIS)

    Heriard Dubreuil, G.; Gadbois, S.

    2004-01-01

    The management of high level radioactive waste is nowadays recognised as a complex decision-making process entailing technical, environmental, ethical, social, political and economic dimensions where no solution can be reached solely on the basis of technical considerations. While this issue is acknowledged as a problem for the community as a whole, waste management remains a global problem looking for a local solution. Starting from this view, COWAM network (Community Waste Management), developed under the Fifth Framework Programme of the European Commission, addressed the following objectives: 1) To empower local actors through a networking process; 2) To gather and discuss the available experiences of decision-making processes at the local level within their national context in Europe; 3) To set up an arena for balanced exchanges between local actors, NGOs, regulators and implementers; 4) To promote new approaches to decision-making in national contexts in Europe. COWAM network comprises 230 delegates from 10 European countries, involving in priority local communities and NGOs. The emphasis put on the local participation enabled members of COWAM network to overcome distrust and to build common lessons and views beyond usual stakeholder positions. Through the analysis of case studies different issues were identified, among them two relate more specifically to: 1) Expertise what is the purpose of expertise on environmental impact in the decision-making process? How is this expertise linked with other scientific and non scientific issues? What is the role of stakeholders in expertise? 2) Environmental quality in the long term and sustainable development how is the impact of radioactive waste management facilities on the environment in the long term taken into account? how is this associated with the sustainable development of the hosting community? How are local stakeholders involved in these issues and what is the expected benefit from their participation? (author)

  7. Percutaneous angioplasty of carotid artery stenoses

    Energy Technology Data Exchange (ETDEWEB)

    Freitag, G.; Freitag, J.; Koch, R.D.; Wagemann, W.

    1986-03-01

    Percutaneous transluminal angioplasty (PTA) is a well-established method to remedy stenoses and short occlusions in the femoro-popliteal region and has also proved worthwhile in dilating stenoses of pelvic, renal and coronary arteries. Following successful experiments in animals, Mathias et al. employed angioplasty to treat carotid artery stenoses in the same way. To date, successful treatment of carotid artery stenoses has been described only in isolated recent reports. For fear of embolism, angioplasty has not yet become standard practice in this region. Because of the limited number of carotid artery stenoses treated so far, the risk involved cannot be reliably assessed. It is remarkable that no embolism has been reported for the greater number of dilated stenoses of the subclavian artery. Moreover, the report by Mathias et al. indicated that for 350 angioplasties of pelvifemoral arteries 1.1% embolisms occured after artery occlusions only, while no embolism was observed after stenoses. Having gained experience of applying PTA to the treatment of vascular obstructions of extremities, we have adopted this technique in the carotid area as well.

  8. Evaluating Career Development Resources: Lessons from the Earth Science Women's Network (ESWN)

    Science.gov (United States)

    Kogan, M.; Laursen, S. L.

    2010-12-01

    inextricably linked for women scientists, who still perform a disproportionate share of domestic and parenting duties, as our data show. ESWN members of all career stages cited work/life balance as among their top career obstacles. Here the intimate tone of ESWN discussion list proves helpful once again: women feel safe to exchange their experiences and suggestions for handling a variety of work/life dilemmas. Our data offer a snapshot of the population that is not well documented by researchers so far - young women scientists at various early-career stages, ranging from graduate students and postdocs to young faculty. We will offer a glimpse of their career needs and present the strategies that have enabled ESWN to provide them with relevant career resources through establishing a supportive community, as well as suggest future directions for the Network to develop. These lessons learned from ESWN should be helpful to all interested in supporting young scientists through critical career junctures.

  9. Angioplasty for Non-arteriosclerotic Renal Artery Stenosis: The Efficacy of Cutting Balloon Angioplasty Versus Conventional Angioplasty

    International Nuclear Information System (INIS)

    Tanaka, Ryoichi; Higashi, Masahiro; Naito, Hiroaki

    2007-01-01

    Purpose. We examined the efficacy of conventional balloon angioplasty and cutting balloon angioplasty (CBA) for the treatment of non-arteriosclerotic renal artery stenosis (RAS). Materials and Methods. From 1993 to 2005, 20 patients underwent 27 percutaneous transluminal renalangioplasty (PTRA) for non-arteriosclerotic RAS (men: 8, women: 12, 25.5 +/- 2 years old; 16 fibromuscular dysplasia (FMD), 4 Takayasu disease). We evaluated the efficacy of CBA by comparing the rate of initial technical success and surgical conversion. Results. Before the clinical authorization of CBA, three of twelve patients (25 %) underwent surgical bypass due to the failure of PTRA due to the hardness of the lesion. After the approval of cutting balloon, we performed CBA in four cases (2 FMD,2 Takayasu disease) to dilate hard lesions, within which a properly sized balloon could not dilate due to their hardness, or to reduce the risk of local dissection. Initial successes were obtained in all patients (8/8, 100%) and none of the patients underwent surgical conversion. Despite of the good initial result, restenosis was observed in three cases within 6 month (3/4, 75 %). Additional interventions were performed in all patients, then, the severity of the restenotic lesion was found not to be exceeded comparing with the initial lesion. Conclusion. The cutting balloon angioplasty may be safe and useful procedure for hard lesions of RAS caused by non-arteriosclerotic disease? especially fibromuscular dysplasia. The cutting balloon may provide the initial success, but the effect on long-term patency is still controversial

  10. Cerebral hyperperfusion syndrome after carotid angioplasty

    International Nuclear Information System (INIS)

    Milosevic, Z.; Surlan, M.; Zvan, B.; Zaletel, M.

    2002-01-01

    Background. Cerebral hyperperfusion syndrome after carotid endarterectomy is an uncommon but well-defined entity. There are only few reports of ''hyperperfusion injury'' following carotid angioplasty. Case report. We report an unstable arterial hypertension and high-grade carotid stenosis in a 58-year-old, right-handed woman. After a stroke in the territory of middle cerebral artery carotid angioplasty was performed in the patient. Among risk factors, the long lasting arterial hypertension was the most pronounced. Immediately after the procedure, the patient was stable without any additional neurologic deficit. The second day, the patient had an epileptic seizure and CT revealed a small haemorrhage in the left frontal lobe. Conclusions. The combination of a high-grade carotid stenosis and unstable arterial pressure is probably an important prognostic factor in the pathogenesis of hyperperfusion syndrome. (author)

  11. Design Issues for Therapeutic Ultrasound Angioplasty Waveguides

    OpenAIRE

    Noone, Declan; Gavin, Graham; McGuinness, Garrett

    2008-01-01

    Therapeutic ultrasound angioplasty is a new minimally invasive cardiovascular procedure for disrupting atherosclerotic lesions. Mechanical energy is transmitted in the form of ultrasound waves via long, flexible wire waveguides navigated to the lesion site through the vascular system. The underpinning principle of this technology is that plaque may be disrupted through a combination of direct contact ablation, pressure waves, cavitation and acoustic streaming, which all depend on the amplitud...

  12. Coronary stenting as an adjunct to balloon angioplasty

    NARCIS (Netherlands)

    B.H. Strauss (Bradley)

    1991-01-01

    textabstractAndreas Gruentzig initiated the era of interventional cardiology in 19n with the introduction of percutaneous transluminal coronary angioplasty (PTCA) (1). The acceptance of coronary angioplasty is obvious by the widespread use of the procedure (>300,000 cases in the United States in

  13. OCT evaluation of directional atherectomy compared to balloon angioplasty

    International Nuclear Information System (INIS)

    Marmagkiolis, Konstantinos; Lendel, Vasili; Cilingiroglu, Mehmet

    2015-01-01

    Directional atherectomy (DA) is one of the most commonly used modalities for the treatment of obstructive femoropopliteal peripheral arterial disease (PAD), especially in patients with large and calcified atherosclerotic plaques. The effect of directional atherectomy to the vascular wall compared to balloon angioplasty by optical coherence tomography (OCT) has not been previously described. We present the first case of OCT after directional atherectomy with SilverHawk followed by angiosculpt balloon angioplasty. - Highlights: • Directional atherectomy avoids the vascular mechanical damage caused by angioplasty balloons and the exposure of stent struts or the potential of stent fracture with stents. • OCT can accurately assess the effect of endovacular interventions to the vessel wall. • Although angiographic results after directional atherectomy are acceptable, OCT use demonstrated suboptimal improvement of the MLA requiring additional balloon angioplasty. • Longer studies are needed to define whether the improved OCT results with angioplasty compared to DA may offer better clinical outcomes.

  14. OCT evaluation of directional atherectomy compared to balloon angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Marmagkiolis, Konstantinos [Citizens Memorial Hospital Heart and Vascular Institute, Bolivar, MO (United States); Lendel, Vasili [Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR (United States); Cilingiroglu, Mehmet, E-mail: mcilingiroglu@yahoo.com [Arkansas Heart Hospital, Peripheral Vascular Institute, Little Rock, AR (United States); Koc University, School of Medicine, Istanbul (Turkey)

    2015-09-15

    Directional atherectomy (DA) is one of the most commonly used modalities for the treatment of obstructive femoropopliteal peripheral arterial disease (PAD), especially in patients with large and calcified atherosclerotic plaques. The effect of directional atherectomy to the vascular wall compared to balloon angioplasty by optical coherence tomography (OCT) has not been previously described. We present the first case of OCT after directional atherectomy with SilverHawk followed by angiosculpt balloon angioplasty. - Highlights: • Directional atherectomy avoids the vascular mechanical damage caused by angioplasty balloons and the exposure of stent struts or the potential of stent fracture with stents. • OCT can accurately assess the effect of endovacular interventions to the vessel wall. • Although angiographic results after directional atherectomy are acceptable, OCT use demonstrated suboptimal improvement of the MLA requiring additional balloon angioplasty. • Longer studies are needed to define whether the improved OCT results with angioplasty compared to DA may offer better clinical outcomes.

  15. Coronary angioplasty with second generation Monorail catheters.

    Science.gov (United States)

    Pande, A K; Meier, B; Urban, P; Villavicencio, R; de la Serna, F; Moles, V

    1991-07-01

    The Monorail system (Schneider) consists of a balloon catheter in which the guidewire passes through the balloon itself, exits the catheter proximal to the balloon, and runs alongside its small shaft (3 French) through the length of the guiding catheter. It offers distinct advantages over conventional systems of coronary angioplasty. It facilitates contrast injections and permits rapid balloon exchanges. This system was used for coronary angioplasty in 273 unselected consecutive patients (age 59 +/- 10, mean 35 to 73 years). There were 216 patients (84%) undergoing single-vessel and 57 patients (16%) with multi-vessel coronary angioplasty. A total of 335 coronary stenoses were dilated, which included 35 total occlusions. The size of balloon used ranged from 2.0 to 4.25 mm (3.0 +/- 0.5 mm) and the severity of stenosis was 85 +/- 11%. Technical success was defined as a residual stenosis of less than 50% as determined angiographically. Clinical success was defined as technical success, and absence of a major inhospital complication defined as absence of myocardial infarction, lack of need for coronary arterial bypass surgery, and survival. The Monorail system was technically successful in 294/300 stenotic lesions (98%). It was clinically successful for 281 lesions (94%). Of the 35 total occlusions, technical success was obtained in 25 (71%). The residual stenosis of successful cases was 26 +/- 21%. The Monorail system was also successful in 5 patients with stenosis of more than 90% in whom conventional systems failed. The complications included acute occlusion causing acute myocardial infarction in 13 cases (5%), emergency coronary arterial bypass surgery in 1 patient (0.4%), and death in 4 patients (1.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Carotid angioplasty and stenting in the elderly

    International Nuclear Information System (INIS)

    Kadkhodayan, Yasha; Cross, DeWitte T.; Moran, Christopher J.; Derdeyn, Colin P.

    2007-01-01

    To investigate the technical success rate as well as the procedural and mid-term complication rates of carotid angioplasty and stenting in elderly patients, a group excluded from large randomized endarterectomy trials given their perceived high surgical risk. Of 200 consecutive carotid angioplasty and/or stenting procedures performed between March 1996 and March 2005, 21 procedures were performed without cerebral protection devices in 20 patients over the age of 79 years (mean age: 83 years, 12 men, eight women). These patients' medical records were retrospectively reviewed for vascular imaging reports and available clinical follow-up. Procedural and mid-term complication rates were calculated and compared to a previously published cohort of 133 consecutive patients ≤79 years of age who also underwent endovascular treatment at our institution. Carotid stenosis was reduced from a mean of 82% to no significant stenosis in all procedures. The procedural stroke rate was zero of 21 procedures. The procedural transient ischemic attack rate (TIA) was one of 21 procedures (4.8%). Mean follow-up was 24.6 months (range: 1.0-79.5 months) with at least a 30-day follow-up for 20 of the 21 procedures (95.2%). There were no new strokes. There was one recurrent ipsilateral TIA at 1.9 months. In five cases with follow-up carotid ultrasonography, no hemodynamically significant restenosis had occurred. There were three myocardial infarctions (MI) occurring at 0.5, 2.1, and 15.2 months, of which the last MI was fatal. The composite 30-day stroke and death rate was zero of 21 procedures (95% confidence interval: 0-14%). No significant difference was found in the 30-day rate of stroke, TIA, MI, or death between the elderly and younger patients. Carotid angioplasty and stenting in elderly patients can be performed successfully with acceptable procedural and mid-term complication rates comparable to younger patients. (orig.)

  17. Primary coronary angioplasty in a nonagenarian

    Directory of Open Access Journals (Sweden)

    Baracioli Luciano M.

    2002-01-01

    Full Text Available A woman aged 98 years entered the tertiary hospital service with a picture of acute myocardial infarction of the extensive anterior wall, which began 4 hours earlier. Due to the large myocardial risk area suggested by the electrocardiogram, the patient was taken to the hemodynamics laboratory for the performance of emergency coronary arteriography, which revealed occlusion in the proximal third of the anterior descending artery. Primary angioplasty followed by stent grafting was successfully performed. The patient had a satisfactory evolution (Killip I and was discharged from the hospital on the seventh postinfarction day. We discuss here aspects of thrombolysis and coronary percutaneous interventions in the aged.

  18. Treatment of renovascular hypertension by transluminal angioplasty

    DEFF Research Database (Denmark)

    Øvrehus, Kristian A; Andersen, Poul E; Jacobsen, Ib A

    2007-01-01

    : with improved control of blood pressure; group III: unchanged blood pressure control. Grouping was performed immediately after treatment, at 1 month, 6 months and at the latest follow-up. One hundred-and-twenty-two patients (124 atherosclerotic and 12 fibromuscular lesions) were treated during 13 years......OBJECTIVE: The study is a follow-up on treatment of renovascular hypertension (RVH) with percutaneous transluminal renal angioplasty (PTRA). METHODS: Patients were screened on the basis of clinical criteria of increased probability of RVH with renography and in selected cases with renal vein renin...

  19. Thalamic hemorrhage following carotid angioplasty and stenting

    International Nuclear Information System (INIS)

    Friedman, Jonathan A.; Kallmes, David F.; Wijdicks, Eelco F.M.

    2004-01-01

    Carotid angioplasty and stenting (CAS) has emerged as an alternative treatment of carotid stenosis for patients poorly suited for endarterectomy. Intracerebral hemorrhage following carotid revascularization is rare and thought to be related to hyperperfusion injury in most cases. Early experience suggests an increased incidence of hemorrhage following CAS as compared to endarterectomy. We describe a patient who suffered a thalamic hemorrhage following CAS. Because this hemorrhage occurred in a vascular territory unlikely to have been supplied by the treated artery, this case suggests that the mechanism of intracerebral hemorrhage following CAS may in some cases be different from the hyperperfusion hemorrhage classically described following endarterectomy. (orig.)

  20. Percutaneous transluminal angioplasty (PTA) after kidney transplantation

    International Nuclear Information System (INIS)

    Fava, C.; Grosso, M.; Sandrone, M.; Malfi, B.; Segoloni, G.P.; Colla, L.

    1988-01-01

    Renal artery stenosis is a frequent complication of kidney transplantation (10%). Percutaneous transluminal angioplasty (PTA) has recently been proposed as a potential therapeutic procedure. Twelve transplant patients with arterial stenosis underwent PTA. The procedure was successful in 10 cases (83.3%). Restenosis occurred in 2 patients (16.7%); both of them underwent PTA successfully. No complications occurred. A considerable improvement in glomerular filtration rate and a reduction in high blood pressure were observed in all patients after successful PTA. The authors belive PTA to be the therapy of choice in the treatment of arterial stenoses in kidney transplant patients

  1. Engage the Public in Phenology Monitoring: Lessons Learned from the USA National Phenology Network

    Science.gov (United States)

    Crimmins, T. M.; Lebuhn, G.; Miller-Rushing, A. J.

    2009-12-01

    The USA National Phenology Network (USA-NPN) is a recently established network that brings together citizen scientists, government agencies, non-profit groups, educators and students of all ages to monitor the impacts of climate change on plants and animals in the United States. Though a handful of observers participated in the USA-NPN monitoring program in 2008, 2009 was the first truly operational year for the program. With a goal of 100,000 observers for this nationwide effort, we are working to engage participants both directly and through established organizations and agencies. The first year of operational monitoring and program advertisement has yielded many insights that are shaping how we move forward. In this presentation, we will highlight some of our most prominent “lessons learned” from our experience engaging participants, mainly through partnerships with organizations and agencies. One successful partnership that the USA-NPN established in 2009 was with the Great Sunflower Project, a citizen science effort focused on tracking bee activity. By piggy-backing on this established program, we were able to invite tens of thousands of self-selected individuals to learn about plant phenology and to contribute to the program. A benefit to the Great Sunflower Project was that monitoring phenology of their sunflowers gave observers something to do while waiting for the plant to attract bees. Observers’ experiences, data, and comments from the 2009 season are yielding insights into how this partnership can be strengthened and USA-NPN and GSP goals can more effectively be met. A second partnership initiated in 2009 was with the US National Park Service (NPS). Partnering with federal and state agencies offers great opportunities for data collection and education. In return, agencies stand to gain information that can directly influence management decisions. However, such efforts necessitate careful planning and execution. Together the USA-NPN and NPS drafted

  2. Percutaneous transluminal angioplasty of infrarenal arteries in intermittent claudication

    DEFF Research Database (Denmark)

    Henriksen, L O; Jørgensen, B; Holstein, P E

    1988-01-01

    Percutaneous transluminal angioplasty was performed on 55 iliac and 31 femoropopliteal arteries in 71 patients with intermittent claudication (23 women, 48 men). The two-year patency rate was 80% after iliac and 41% after femoropopliteal angioplasty. In 17 femoropopliteal cases with lesions greater...... than or equal to 5 cm the 2-year patency rate was only 32%, but the corresponding figure for shorter lesions was 53%. Complicating haematoma appeared in 10% of the cases and the arterial state deteriorated in one patient. There was no distal embolization. Percutaneous transluminal angioplasty...

  3. Renal artery stent angioplasty for renovascular hypertension

    International Nuclear Information System (INIS)

    Li Gang; Li Haiqing; Wang Lin

    2005-01-01

    Objective: To evaluate the therapeutic results of expandable stent for treatment of atherosclerotic renovascular obstructive disease. Methods: 15 patients (10 men and 5 women, 41-75 years old; mean age, 52 years) with renal arterial hypertension underwent renal stent angioplasty including renal arterial stenosis 89%(n=13) and fully obstruction without function in 2, of which 2 patients had bilateral involvement. The stenotic range of all arterial segments showed 60% to 90% width of the normal arterial diameter. 16 stents were implanted under the guidance of fluoroscopy. The most of stents implanted were Palmaz (n=12, 75%) with regular clinical and angiographic follow up. Results: Technical success (residual stenosis <30%) was achieved in all patients without serious complication. During the follow-up (6-15 months; mean, 8 ± 4 months), hypertension was improved in 9 patients and cured in 4 patients with a total benefit of 86% and no efficacy in 2(13%). The average systolic blood pressure decreased from 27.12 ± 3.09 kPa to 18.62 ± 3.12 kPa and the average diastolic blood pressure decreased from 17.73 ± 1.92 kPa to 11.12 ± 2.43 kPa after stent treatment (P<0.05). Serum creatinine remained stable in 60% (n=9) patients with improvement in 33% (n=5) and worsened in 6% (n=1) patients. Follow-up angiography was performed in all patients with 1 case of a restenosis. 6 months after expanding through stent by using balloon, the two follow up angiographies showed a stable restenosis about 20%. Conclusions: Percutaneous transluminal stent placement is highly beneficial for patients who had renal arterial obstructive disease. The success of stent angioplasty of complete obstructive renal arteries reveals wide prospects for interventional method. (authors)

  4. OCT evaluation of directional atherectomy compared to balloon angioplasty.

    Science.gov (United States)

    Marmagkiolis, Konstantinos; Lendel, Vasili; Cilingiroglu, Mehmet

    2015-09-01

    Directional atherectomy (DA) is one of the most commonly used modalities for the treatment of obstructive femoropopliteal peripheral arterial disease (PAD), especially in patients with large and calcified atherosclerotic plaques. The effect of directional atherectomy to the vascular wall compared to balloon angioplasty by optical coherence tomography (OCT) has not been previously described. We present the first case of OCT after directional atherectomy with SilverHawk followed by angiosculpt balloon angioplasty. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. False coronary dissection with the new Monorail angioplasty balloon catheter.

    Science.gov (United States)

    Esplugas, E; Cequier, A R; Sabaté, X; Jara, F

    1990-01-01

    During percutaneous transluminal coronary angioplasty, the appearance of persistent staining in the vessel by contrast media suggests coronary dissection. We report seven patients in whom a false image of severe coronary dissection was observed during angioplasty performed with the new Monorail balloon catheter. This image emerges at the moment of balloon inflation, is distally located to the balloon, and disappears with balloon catheter deflation. No complications were associated with the appearance of this image.

  6. Transluminal angioplasty of a stenotic surgical splenorenal shunt

    International Nuclear Information System (INIS)

    Beers, B. van; Roche, A.; Cauquil, P.

    1988-01-01

    A stenosis of a side-to-side splenorenal shunt was treated by percutaneous angioplasty two years after the performance of the shunt. After dilatation, there was a fall of the splenorenal pressure gradient from 28 to 17 cm H 2 O and good transanastomotic flow was re-estabilshed. As in other arterial and venous territories, angioplasty may be an interesting alternative to surgery. (orig.)

  7. Lessons learned from use of social network strategy in HIV testing programs targeting African American men who have sex with men.

    Science.gov (United States)

    McCree, Donna H; Millett, Gregorio; Baytop, Chanza; Royal, Scott; Ellen, Jonathan; Halkitis, Perry N; Kupprat, Sandra A; Gillen, Sara

    2013-10-01

    We report lessons derived from implementation of the Social Network Strategy (SNS) into existing HIV counseling, testing, and referral services targeting 18- to 64-year-old Black gay, bisexual, and other men who have sex with men (MSM). The SNS procedures used in this study were adapted from a Centers for Disease Control and Prevention-funded, 2-year demonstration project involving 9 community-based organizations (CBOs) in 7 cities. Under the SNS, HIV-positive and HIV-negative men at high risk for HIV (recruiters) were enlisted to identify and recruit persons from their social, sexual, or drug-using networks (network associates) for HIV testing. Sites maintained records of modified study protocols for ascertaining lessons learned. The study was conducted between April 2008 and May 2010 at CBOs in Washington, DC, and New York, New York, and at a health department in Baltimore, Maryland. Several common lessons regarding development of the plan, staffing, training, and use of incentives were identified across the sites. Collectively, these lessons indicate use of SNS is resource-intensive, requiring a detailed plan, dedicated staff, and continual input from clients and staff for successful implementation. SNS may provide a strategy for identifying and targeting clusters of high-risk Black MSM for HIV testing. Given the resources needed to implement the strategy, additional studies using an experimental design are needed to determine the cost-effectiveness of SNS compared with other testing strategies.

  8. "Supporting Early Career Women in the Geosciences through Online Peer-Mentoring: Lessons from the Earth Science Women's Network (ESWN)"

    Science.gov (United States)

    Holloway, T.; Hastings, M. G.; Barnes, R. T.; Fischer, E. V.; Wiedinmyer, C.; Rodriguez, C.; Adams, M. S.; Marin-Spiotta, E.

    2014-12-01

    The Earth Science Women's Network (ESWN) is an international peer-mentoring organization with over 2000 members, dedicated to career development and community for women across the geosciences. Since its formation in 2002, ESWN has supported the growth of a more diverse scientific community through a combination of online and in-person networking activities. Lessons learned related to online networking and community-building will be presented. ESWN serves upper-level undergraduates, graduate students, professionals in a range of environmental fields, scientists working in federal and state governments, post-doctoral researchers, and academic faculty and scientists. Membership includes women working in over 50 countries, although the majority of ESWN members work in the U.S. ESWN increases retention of women in the geosciences by enabling and supporting professional person-to-person connections. This approach has been shown to reduce feelings of isolation among our members and help build professional support systems critical to career success. In early 2013 ESWN transitioned online activities to an advanced social networking platform that supports discussion threads, group formation, and individual messaging. Prior to that, on-line activities operated through a traditional list-serve, hosted by the National Center for Atmospheric Research (NCAR). The new web center, http://eswnonline.org, serves as the primary forum for members to build connections, seek advice, and share resources. For example, members share job announcements, discuss issues of work-life balance, and organize events at professional conferences. ESWN provides a platform for problem-based mentoring, drawing from the wisdom of colleagues across a range of career stages.

  9. Social Networks and Students' Performance in Secondary Schools: Lessons from an Open Learning Centre, Kenya

    Science.gov (United States)

    Muhingi, Wilkins Ndege; Mutavi, Teresia; Kokonya, Donald; Simiyu, Violet Nekesa; Musungu, Ben; Obondo, Anne; Kuria, Mary Wangari

    2015-01-01

    Given the known positive and negative effects of uncontrolled social networking among secondary school students worldwide, it is necessary to establish the relationship between social network sites and academic performances among secondary school students. This study, therefore, aimed at establishing the relationship between secondary school…

  10. Community-Based Research Networks: Development and Lessons Learned in an Emerging Field.

    Science.gov (United States)

    Stoecker, Randy; Ambler, Susan H.; Cutforth, Nick; Donohue, Patrick; Dougherty, Dan; Marullo, Sam; Nelson, Kris S.; Stutts, Nancy B.

    2003-01-01

    Compares seven multi-institutional community-based research networks in Appalachia; Colorado; District of Columbia; Minneapolis-St. Paul; Philadelphia; Richmond, Virginia; and Trenton, New Jersey. After reviewing the histories of the networks, conducts a comparative SWOT analysis, showing their common and unique strengths, weaknesses,…

  11. Innovation, networking, and proximity: lessons from small high-technology firms in the UK

    NARCIS (Netherlands)

    Romijn, H.A.; Albu, Mike

    2002-01-01

    The article explores how the innovative performance of small high-tech firms relates to their external networking activities, and whether geographical proximity in their network relations matters. Data from a small sample of electronics firms and software developers in South East England are used to

  12. Reporting standards for angioplasty and stent-assisted angioplasty for intracranial atherosclerosis.

    Science.gov (United States)

    Schumacher, H Christian; Meyers, Philip M; Higashida, Randall T; Derdeyn, Colin P; Lavine, Sean D; Nesbit, Gary M; Sacks, David; Rasmussen, Peter; Wechsler, Lawrence R

    2010-12-01

    Intracranial cerebral atherosclerosis causes ischemic stroke in a significant number of patients. Technological advances over the past 10 years have enabled endovascular treatment of intracranial atherosclerotic stenosis. The number of patients treated with angioplasty or stent-assisted angioplasty for this condition is increasing. Given the lack of universally accepted definitions, the goal of this document is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting clinical and radiological evaluation, technique, and outcome of endovascular treatment using angioplasty or stent-assisted angioplasty for stenotic and occlusive intracranial atherosclerosis. This article was written under the auspices of Joint Writing Group of the Technology Assessment Committee, Society of Neurolnterventional Surgery, Society of Interventional Radiology; Joint Section on Cerebro-vascular Neurosurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and the Section of Stroke and Interventional Neurology of the American Academy of Neurology. A computerized search of the National Library of Medicine database of literature (PubMed) from January 1997 to December 2007 was conducted with the goal to identify published endovascular cerebrovascular interventional data in stenotic intracranial atherosclerosis that could be used as benchmarks for quality assessment. We sought to identify those risk adjustment variables that affect the likelihood of success and complications. This document offers the rationale for different clinical and technical considerations that may be important during the design of clinical trials for endovascular treatment of intracranial stenotic and occlusive atherosclerosis. Included in this guidance document are suggestions for uniform reporting standards for such trials. These definitions and standards are primarily intended for research purposes; however, they should

  13. Yoga lessons for consciousness research: a paralimbic network balancing brain resource allocation

    Directory of Open Access Journals (Sweden)

    Hans C Lou

    2011-12-01

    Full Text Available Consciousness has been proposed to play a key role in shaping flexible learning and as such is thought to confer an evolutionary advantage. Attention and awareness are the perhaps most important underlying processes, yet their precise relationship is presently unclear. Both of these processes must, however, serve the evolutionary imperatives of survival and procreation. They are thus intimately bound by reward and emotion to help to prioritize efficient brain resource allocation in order to predict and optimize behaviour. Here we show how this process is served by a paralimbic network consisting primarily of regions located on the midline of the human brain. Using many different techniques, experiments have demonstrated that this network is effective and specific for self-awareness and contributes to the sense of unity of consciousness by acting as a common neural path for a wide variety of conscious experiences. Interestingly, haemodynamic activity in the network decreases with focusing on external stimuli, which has led to the idea of a default mode network. This network is one of many networks that wax and vane as resources are allocated to accommodate the different cyclical needs of the organism primarily related the fundamental pleasures afforded by evolution: food, sex and conspecifics. Here we hypothesize, however, that the paralimbic network serves a crucial role in balancing and regulating brain resource allocation, and discuss how it can be thought of as a link between current theories of so-called default mode, resting state networks and global workspace. We show how major developmental disorders of self-awareness and self-control can arise from problems in the paralimbic network as demonstrated here by the example of Asperger syndrome. We conclude that attention, awareness and emotion are integrated by a paralimbic network that helps to efficiently allocate brain resources to optimize behaviour and help survival.

  14. Network-Based Coordination of Civil-Service Training: Lessons from the Case of Estonia

    Directory of Open Access Journals (Sweden)

    Metsma Merilin

    2017-06-01

    Full Text Available The focus of this article is on the coordination of civil-service training in a decentralized civil-service system. The Estonian case is studied. The article investigates network-based coordination, analyzes the power sources of the central coordinator and discusses the opportunities and limitations of creating coherence through network-type cooperation. The article concludes that the key power sources for the central coordinator are financial, human and technical resources paired with knowledge, leadership and commitment. The case study shows that, in a decentralized civil service system, a common understanding on training and development can be fostered by intense collaboration through networks.

  15. Endovascular brachytherapy to prevent restenosis after angioplasty

    International Nuclear Information System (INIS)

    Wohlgemuth, W.A.; Bohndorf, K.

    2003-01-01

    Endovascular radiotherapy is the first effective prophylaxis of restenosis after percutaneous transluminal angioplasty (PTA) and stenting. The FDA recently approved two devices for the delivery of intracoronary radiation following coronary artery stenting. Published multicenter, double-blind, randomized trials of intracoronary radiation therapy report good results for preventing in-stent restenosis, while the data for the peripheral circulation are still inconclusive. Beta-emitters are easier applicable and probably also safer, whereas gamma-emitters have been more extensively evaluated clinically so far. Primary indication for endovascular brachytherapy are patients at high risk for restenosis, such as previous restenoses, in-stent hyperplasia, long stented segment, long PTA lesion, narrow residual vascular lumen and diabetes. Data from coronary circulation suggest a safety margin of at least 4 to 10 mm at both ends of the angioplastic segment to avoid edge restenosis. To prevent late thrombosis of the treated coronary segment, antiplatelet therapy with clopidogrel and aspirin are recommended for at least 6 months after PTA and for 12 months after a newly implanted stent. An established medication regimen after radiotherapy of peripheral arteries is still lacking. (orig.) [de

  16. A perspective of percutaneous transluminal angioplasty.

    Science.gov (United States)

    Stanson, A W

    1983-01-01

    PTA is a relatively new procedure which is still evolving. More technical improvements are needed. Stiffer balloon plastics and devices to measure arterial wall compliance during balloon inflation are predicted to lead to better long-term success rates. Increasing case numbers provide greater expertise and subsequent refinements in performance and case selection. These factors will lead to improved statistics. Other features of overall patient care must be considered also. The procedure is easy for patients to tolerate, and they can return to activities and work in three or four days. The overall cost is much cheaper than surgery, even at a conservative success rate of 65 percent. There is minimal risk and morbidity, and virtually no mortality. PTA can be repeated if the lesion recurs. Severe complications are rare and almost always surgically treatable. If PTA fails to achieve success, a traditional surgical procedure can be performed. Percutaneous transluminal angioplasty is an important therapeutic alternative to traditional medical and surgical treatment for occlusive arterial disease. It can save legs, veins, time, and money. We need to refine and accurately record the use of this procedure. Total cooperation among clinicians, surgeons, and radiologists is essential for proper utilization of PTA.

  17. Experience and Lessons learnt from running High Availability Databases on Network Attached Storage

    CERN Document Server

    Guijarro, Manuel

    2008-01-01

    The Database and Engineering Services Group of CERN's Information Technology Department supplies the Oracle Central Database services used in many activities at CERN. In order to provide High Availability and ease management for those services, a NAS (Network Attached Storage) based infrastructure has been setup. It runs several instances of the Oracle RAC (Real Application Cluster) using NFS (Network File System) as shared disk space for RAC purposes and Data hosting. It is composed of two private LANs (Local Area Network), one to provide access to the NAS filers and a second to implement the Oracle RAC private interconnect, both using Network Bonding. NAS filers are configured in partnership to prevent having single points of failure and to provide automatic NAS filer fail-over.

  18. Lessons learned on solar powered wireless sensor network deployments in urban, desert environments

    KAUST Repository

    Dehwah, Ahmad H.; Mousa, Mustafa; Claudel, Christian G.

    2015-01-01

    The successful deployment of a large scale solar powered wireless sensor network in an urban, desert environment is a very complex task. Specific cities of such environments cause a variety of operational problems, ranging from hardware faults

  19. Experience and lessons learnt from running high availability databases on network attached storage

    International Nuclear Information System (INIS)

    Guijarro, M; Gaspar, R

    2008-01-01

    The Database and Engineering Services Group of CERN's Information Technology Department supplies the Oracle Central Database services used in many activities at CERN. In order to provide High Availability and ease management for those services, a NAS (Network Attached Storage) based infrastructure has been setup. It runs several instances of the Oracle RAC (Real Application Cluster) using NFS (Network File System) as shared disk space for RAC purposes and Data hosting. It is composed of two private LANs (Local Area Network), one to provide access to the NAS filers and a second to implement the Oracle RAC private interconnect, both using Network Bonding. NAS filers are configured in partnership to prevent having single points of failure and to provide automatic NAS filer fail-over

  20. Oversight and Management of a Cell Therapy Clinical Trial Network: Experience and Lessons Learned

    OpenAIRE

    Moyé, Lemuel A.; Sayre, Shelly L.; Westbrook, Lynette; Jorgenson, Beth C.; Handberg, Eileen; Anwaruddin, Saif; Wagner, Kristi A.; Skarlatos, Sonia I.

    2011-01-01

    The Cardiovascular Cell Therapy Research Network (CCTRN), sponsored by the National Heart, Lung, and Blood Institute (NHLBI), was established to develop, coordinate, and conduct multiple collaborative protocols testing the effects of cell therapy on cardiovascular diseases. The Network was born into a difficult political and ethical climate created by the recent removal of a dozen drugs from the US formulary and the temporary halting of 27 gene therapy trials due to safety concerns. This arti...

  1. Emerging marine protected area networks in the coral triangle: Lessons and way forward

    Directory of Open Access Journals (Sweden)

    Stuart J Green

    2011-01-01

    Full Text Available Marine protected areas (MPAs and MPA networks are valuable tools for protecting coral reef habitats and managing near-shore fisheries, while playing an essential role in the overall conservation of marine biodiversity. In addition, MPAs and their networks are often the core strategy for larger scale and more integrated forms of marine resource management that can lead to ecosystem-based management regimes for seascapes and eco-regions. This study conducted in 2008 documents the status of selected MPAs and MPA networks in Indonesia, Philippines and Papua New Guinea, to better understand development and their level of success in the Coral Triangle. Findings reveal that substantial gaps exist between the theory and practice of creating functional MPA networks. Across these sites, biophysical and social science knowledge, required to build functional and effective MPAs or MPA networks, lagged behind substantially. Aspects that appeared to require the most attention to improve MPA network effectiveness included essential management systems, institutional arrangements, governance and sustainable financing. Common indicators of success such as increased fish catch and habitat quality parameters were consistently associated with several independent variables: sustainable financing for management, clarity of MPA network rules, enforcement by community level enforcers, local skills development, and involvement in management by local elected politicians, a functional management board, multi-stakeholder planning mechanisms and participatory biophysical assessments. Conclusions are that although considerable investments have been made in MPAs and potential MPA networks in the Coral Triangle, management effectiveness is generally poor throughout the region and that not many large, formally declared MPAs are well managed.

  2. Lessons learned on solar powered wireless sensor network deployments in urban, desert environments

    KAUST Repository

    Dehwah, Ahmad H.

    2015-05-01

    The successful deployment of a large scale solar powered wireless sensor network in an urban, desert environment is a very complex task. Specific cities of such environments cause a variety of operational problems, ranging from hardware faults to operational challenges, for instance due to the high variability of solar energy availability. Even a seemingly functional sensor network created in the lab does not guarantee reliable long term operation, which is absolutely necessary given the cost and difficulty of accessing sensor nodes in urban environments. As part of a larger traffic flow wireless sensor network project, we conducted several deployments in the last two years to evaluate the long-term performance of solar-powered urban wireless sensor networks in a desert area. In this article, we share our experiences in all domains of sensor network operations, from the conception of hardware to post-deployment analysis, including operational constraints that directly impact the software that can be run. We illustrate these experiences using numerous experimental results, and present multiple unexpected operational problems as well as some possible solutions to address them. We also show that current technology is far from meeting all operational constraints for these demanding applications, in which sensor networks are to operate for years to become economically appealing.

  3. Citizen-sensor-networks to confront government decision-makers: Two lessons from the Netherlands.

    Science.gov (United States)

    Carton, Linda; Ache, Peter

    2017-07-01

    This paper presents one emerging social-technical innovation: The evolution of citizen-sensor-networks where citizens organize themselves from the 'bottom up', for the sake of confronting governance officials with measured information about environmental qualities. We have observed how citizen-sensor-networks have been initiated in the Netherlands in cases where official government monitoring and business organizations leave gaps. The formed citizen-sensor-networks collect information about issues that affect the local community in their quality-of-living. In particular, two community initiatives are described where the sensed environmental information, on noise pollution and gas-extraction induced earthquakes respectively, is published through networked geographic information methods. Both community initiatives pioneered in developing an approach that comprises the combined setting-up of sensor data flows, real-time map portals and community organization. Two particular cases are analyzed to trace the emergence and network operation of such 'networked geo-information tools' in practice: (1) The Groningen earthquake monitor, and (2) The Airplane Monitor Schiphol. In both cases, environmental 'externalities' of spatial-economic activities play an important role, having economic dimensions of national importance (e.g. gas extraction and national airport development) while simultaneously affecting the regional community with environmental consequences. The monitoring systems analyzed in this paper are established bottom-up, by citizens for citizens, to serve as 'information power' in dialogue with government institutions. The goal of this paper is to gain insight in how these citizen-sensor-networks come about: how the idea for establishing a sensor network originated, how their value gets recognized and adopted in the overall 'system of governance'; to what extent they bring countervailing power against vested interests and established discourses to the table and

  4. Health in All Policies (HiAP) governance: lessons from network governance.

    Science.gov (United States)

    Khayatzadeh-Mahani, Akram; Ruckert, Arne; Labonté, Ronald; Kenis, Patrick; Akbari-Javar, Mohammad Reza

    2018-05-25

    The Health in All Policies (HiAP) approach requires formal and sustained governance structures and mechanisms to ensure that the policies of various non-health sectors maximize positive and minimize negative impacts on population health. In this paper, we demonstrate the usefulness of a network perspective in understanding and contributing to the effectiveness of HiAP. We undertook an exploratory, qualitative case study of a HiAP structure in Iran, the Kerman province Council of Health and Food Security (CHFS) with diverse members from health and non-health sectors. We analyzed relevant policy texts and interviewed 32 policy actors involved in the CHFS. Data were analyzed using within-case analysis and constant comparative methodology. Our findings suggest that CHFS governance from a network perspective drew in practice on elements of two competing network governance modes: the network administrative organization (NAO) and the lead organization mode. Our results also show that a shift from a hierarchical and market-based mode of interaction to a network logic within CHFS has not yet taken place. In addition, CHFS suffers from large membership and an inability to address complex 'wicked problems', as well as low trust, legitimacy and goal consensus among its members. Drawing on other HiAP studies and commentaries, insights from organization network theory, and in-depth findings from our case study, we conclude that a NAO may be the most effective mode of governance for tackling complex social problems in HiAP structures. Since similar studies are limited, and our single case study may not be transferable across all contexts, we suggest that further research be undertaken to explore HiAP structures from a network perspective in different institutional and cultural settings. With increasing emphasis given to HiAP approaches in national and international health policy discourse, it is important that comparative knowledge about the effectiveness of HiAP governance

  5. Oversight and management of a cell therapy clinical trial network: experience and lessons learned.

    Science.gov (United States)

    Moyé, Lemuel A; Sayre, Shelly L; Westbrook, Lynette; Jorgenson, Beth C; Handberg, Eileen; Anwaruddin, Saif; Wagner, Kristi A; Skarlatos, Sonia I

    2011-09-01

    The Cardiovascular Cell Therapy Research Network (CCTRN), sponsored by the National Heart, Lung, and Blood Institute (NHLBI), was established to develop, coordinate, and conduct multiple collaborative protocols testing the effects of cell therapy on cardiovascular diseases. The Network was born into a difficult political and ethical climate created by the recent removal of a dozen drugs from the US formulary and the temporary halting of 27 gene therapy trials due to safety concerns. This article describes the Network's challenges as it initiated three protocols in a polarized cultural atmosphere at a time when oversight bodies were positioning themselves for the tightest vigilance of promising new therapies. Effective strategies involving ongoing education, open communication, and relationship building with the oversight community are discussed. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. Health 2.0-Lessons Learned: Social Networking With Patients for Health Promotion.

    Science.gov (United States)

    Sharma, Suparna; Kilian, Reena; Leung, Fok-Han

    2014-07-01

    The advent of social networking as a major platform for human interaction has introduced a new dimension into the physician-patient relationship, known as Health 2.0. The concept of Health 2.0 is young and evolving; so far, it has meant the use of social media by health professionals and patients to personalize health care and promote health education. Social networking sites like Facebook and Twitter offer promising platforms for health care providers to engage patients. Despite the vast potential of Health 2.0, usage by health providers remains relatively low. Using a pilot study as an example, this commentary reviews the ways in which physicians can effectively harness the power of social networking to meaningfully engage their patients in primary prevention. © The Author(s) 2014.

  7. Balloon angioplasty in acute and chronic coronary artery disease

    International Nuclear Information System (INIS)

    Holmes, D.R. Jr.; Vlietstra, R.E.

    1989-01-01

    Percutaneous transluminal coronary angioplasty has grown exponentially since its introduction. Currently, selection criteria include single-vessel and multivessel disease, stable and unstable angina, and acute infarction. The outcome depends on specific patient and antiographic characteristics. In ideal lesions, success rates should be greater than 90%, with low morbidity and mortality. With more severe and diffuse multivessel disease, success rates are lower and complication rates are higher. In these cases, percutaneous transluminal coronary angioplasty still offers a reasonable option, provided complete revascularization can be achieved or the angina-producing lesion dilated. Numerous issues remain unresolved, including (1) the role of percutaneous transluminal coronary angioplasty vs coronary surgery (currently being tested), (2) restenosis, which occurs in approximately 30% of treated lesions, and (3) organizational adjustments such as training and certification to maintain high standards of care

  8. State of the art of CO laser angioplasty system

    Science.gov (United States)

    Arai, Tsunenori; Mizuno, Kyoichi; Miyamoto, Akira; Sakurada, Masami; Kikuchi, Makoto; Kurita, Akira; Nakamura, Haruo; Takaoka, Hidetsugu; Utsumi, Atsushi; Takeuchi, Kiyoshi

    1994-07-01

    A unique percutaneous transluminal coronary angioplasty system new IR therapy laser with IR glass fiber delivery under novel angioscope guidance was described. Carbon monoxide (CO) laser emission of 5 mm in wavelength was employed as therapy laser to achieve precise ablation of atheromatous plaque with a flexible As-S IR glass fiber for laser delivery. We developed the first medical CO laser as well as As-S IR glass fiber cable. We also developed 5.5 Fr. thin angioscope catheter with complete directional manipulatability at its tip. The system control unit could manage to prevent failure irradiations and fiber damages. This novel angioplasty system was evaluated by a stenosis model of mongrel dogs. We demonstrated the usefulness of our system to overcome current issues on laser angioplasty using multifiber catheter with over-the-guidewire system.

  9. Angioplasty or Stenting of Extra- and Intracranial Vertebral Artery Stenoses

    International Nuclear Information System (INIS)

    Hauth, Elke A.M.; Gissler, H. Martin; Drescher, Robert; Jansen, Christian; Jaeger, Horst J.; Mathias, Klaus D.

    2004-01-01

    Purpose: To determine the feasibility and safety of angioplasty or angioplasty and stenting of extra- and intracranial vertebral artery (VA) stenosis. Methods: In 16 consecutive patients (9 men, 7 women; mean age 61 years, range 49-74 years) 16 stenotic VAs were treated with angioplasty orangioplasty and stenting. Eleven stenoses were localized in V1 segment,1 stenosis in V2 segment and 4 stenoses in V4 segment of VA. Fourteen VA stenoses were symptomatic, 2 asymptomatic. The etiology of the stenoses was atherosclerotic in all cases. Results:Angioplasty was performed in 8 of 11 V1 and 2 of 4 V4 segments of the VA. In 3 of 11 V1 segments and 2 of 4 V4 segments of the VA we combined angioplasty with stenting. The procedures were successfully performed in 14 of 16 VAs (87%). Complications were asymptomatic vessel dissection resulting in vessel occlusion in 1 of 11 V1 segments and asymptomatic vessel dissection in 2 of 4 V4 segments of the VA. One patient died in the 24-hr period after the procedure because of subarachnoid hemorrhage as a complication following vessel perforation of the treated V4 segment. Conclusion: Angioplasty orangioplasty and stenting of extracranial VA stenoses can be performed with a high technical success rate and a low complication rate. In intracranial VA stenosis the procedure is technically feasible but complications can be life-threatening. The durability and procedural complication rates of primary stenting without using predilation in extra- and intracranial VA stenosis should be defined in the future

  10. Blood pressure normalization post-jugular venous balloon angioplasty.

    Science.gov (United States)

    Sternberg, Zohara; Grewal, Prabhjot; Cen, Steven; DeBarge-Igoe, Frances; Yu, Jinhee; Arata, Michael

    2015-05-01

    This study is the first in a series investigating the relationship between autonomic nervous system dysfunction and chronic cerebrospinal venous insufficiency in multiple sclerosis patients. We screened patients for the combined presence of the narrowing of the internal jugular veins and symptoms of autonomic nervous system dysfunction (fatigue, cognitive dysfunction, sleeping disorders, headache, thermal intolerance, bowel/bladder dysfunction) and determined systolic and diastolic blood pressure responses to balloon angioplasty. The criteria for eligibility for balloon angioplasty intervention included ≥ 50% narrowing in one or both internal jugular veins, as determined by the magnetic resonance venography, and ≥ 3 clinical symptoms of autonomic nervous system dysfunction. Blood pressure was measured at baseline and post-balloon angioplasty. Among patients who were screened, 91% were identified as having internal jugular veins narrowing (with obstructing lesions) combined with the presence of three or more symptoms of autonomic nervous system dysfunction. Balloon angioplasty reduced the average systolic and diastolic blood pressure. However, blood pressure categorization showed a biphasic response to balloon angioplasty. The procedure increased blood pressure in multiple sclerosis patients who presented with baseline blood pressure within lower limits of normal ranges (systolic ≤ 105 mmHg, diastolic ≤ 70 mmHg) but decreased blood pressure in patients with baseline blood pressure above normal ranges (systolic ≥ 130 mmHg, diastolic ≥ 80 mmHg). In addition, gender differences in baseline blood pressure subcategories were observed. The coexistence of internal jugular veins narrowing and symptoms of autonomic nervous system dysfunction suggests that the two phenomena may be related. Balloon angioplasty corrects blood pressure deviation in multiple sclerosis patients undergoing internal jugular vein dilation. Further studies should investigate the

  11. Late Departures from Paper-Based to Supported Networked Learning in South Africa: Lessons Learned

    Science.gov (United States)

    Kok, Illasha; Beter, Petra; Esterhuizen, Hennie

    2018-01-01

    Fragmented connectivity in South Africa is the dominant barrier for digitising initiatives. New insights surfaced when a university-based nursing programme introduced tablets within a supportive network learning environment. A qualitative, explorative design investigated adult nurses' experiences of the realities when moving from paper-based…

  12. Citizen-sensor-networks to confront government decision-makers: Two lessons from the Netherlands

    NARCIS (Netherlands)

    Carton, L.J.; Ache, P.M.

    2017-01-01

    This paper presents one emerging social-technical innovation: The evolution of citizen-sensor-networks where citizens organize themselves from the ‘bottom up’, for the sake of confronting governance officials with measured information about environmental qualities. We have observed how

  13. Lessons learned from SONOPA : (SOcial Networks for Older adults to Promote an Active life)

    NARCIS (Netherlands)

    Allouch, S. Ben; Jaschinski, C.; Deboeverie, F.; Aghajan, Hamid; Philips, Wilfried

    This paper describes the development and testing of an Ambient Assisted Living (AAL) solution that combines state-of-the- art sensor technology with a social network application to empower elders to stay active, autonomous and socially connected and consequently support and unburden family

  14. The Benefits of Peer-to-Peer Mentoring: Lessons from The Earth Science Women's Network (ESWN)

    Science.gov (United States)

    Holloway, T.; Steiner, A.; Fiore, A.; Hastings, M.; McKinley, G.; Staudt, A.; Wiedinmyer, C.

    2007-12-01

    The Earth Science Women's Network (ESWN) is a grassroots organization that began with the meeting of six women graduate students and recent Ph.D.s at the Spring 2002 AGU meeting in Washington, DC. Since then, the group has grown to over 400 members, completely by word of mouth. We provide an informal, peer-to-peer network developed to promote and support careers of women in the Earth sciences. Through the network, women have found jobs, established research collaborations, shared strategies on work/life balance, and built a community stretching around the world. We maintain an email list for members to develop an expanded peer network outside of their own institution, and we have recently launched a co-ed jobs list to benefit the wider geoscience community. We will present a summary of strategies that have been discussed by group members on how to transition to a new faculty position, build a research group, develop new research collaborations, and balance career and family.

  15. The Aethereal Network on Chip after Ten Years: Goals, Evolution, Lessons, and Future

    NARCIS (Netherlands)

    Goossens, Kees; Hansson, A.

    2010-01-01

    The goals for the Æthereal network on silicon, as it was then called, were set in 2000 and its concepts were defined early 2001. Ten years on, what has been achieved? Did we meet the goals, and what is left of the concepts? In this paper we answer those questions, and evaluate different

  16. The aethereal network on chip after ten years: Goals, evolution, lessons and future

    NARCIS (Netherlands)

    Goossens, K.G.W.; Hansson, M.A.

    2010-01-01

    The goals for the Æthereal network on silicon, as it was then called, were set in 2000 and its concepts were defined early 2001. Ten years on, what has been achieved? Did we meet the goals, and what is left of the concepts? In this paper we answer those questions, and evaluate different

  17. Activating the adoption of innovation : lessons from a passive house network

    NARCIS (Netherlands)

    Mlecnik, E.

    2016-01-01

    Purpose – The purpose of this paper is to explore innovation adoption theory and to define a model to investigate operational activities and communication in innovation networks that can stimulate both supply and demand. It also aims to exemplify this model with the activities of an innovation

  18. Lessons Learnt from and Sustainability of Adopting a Personal Learning Environment & Network (Ple&N)

    Science.gov (United States)

    Tsui, Eric; Sabetzadeh, Farzad

    2014-01-01

    This paper describes the feedback from the configuration and deployment of a Personal Learning Environment & Network (PLE&N) tool to support peer-based social learning for university students and graduates. An extension of an earlier project in which a generic and PLE&N was deployed for all learners, the current PLE&N is a…

  19. Regulating peer-to-peer network currency : Lessons from Napster and payment Systems

    NARCIS (Netherlands)

    Kasiyanto, Safari

    2015-01-01

    It was only yesterday when the central banks across the world shared a similar concerns about the rise of e-money as a ‘new’ form of money. Theoretically, e-money as a network good has the potential to achieve a position necessary to replace traditional money. If this happens, the central bank’s

  20. Biologically plausible learning in neural networks: a lesson from bacterial chemotaxis.

    Science.gov (United States)

    Shimansky, Yury P

    2009-12-01

    Learning processes in the brain are usually associated with plastic changes made to optimize the strength of connections between neurons. Although many details related to biophysical mechanisms of synaptic plasticity have been discovered, it is unclear how the concurrent performance of adaptive modifications in a huge number of spatial locations is organized to minimize a given objective function. Since direct experimental observation of even a relatively small subset of such changes is not feasible, computational modeling is an indispensable investigation tool for solving this problem. However, the conventional method of error back-propagation (EBP) employed for optimizing synaptic weights in artificial neural networks is not biologically plausible. This study based on computational experiments demonstrated that such optimization can be performed rather efficiently using the same general method that bacteria employ for moving closer to an attractant or away from a repellent. With regard to neural network optimization, this method consists of regulating the probability of an abrupt change in the direction of synaptic weight modification according to the temporal gradient of the objective function. Neural networks utilizing this method (regulation of modification probability, RMP) can be viewed as analogous to swimming in the multidimensional space of their parameters in the flow of biochemical agents carrying information about the optimality criterion. The efficiency of RMP is comparable to that of EBP, while RMP has several important advantages. Since the biological plausibility of RMP is beyond a reasonable doubt, the RMP concept provides a constructive framework for the experimental analysis of learning in natural neural networks.

  1. Subclavian steal syndrome: treatment by percutaneous transluminal angioplasty

    International Nuclear Information System (INIS)

    Abath, Carlos Gustavo Coutinho; Silva, Marcos Antonio Barbosa da; Brito, Norma Maria Tenorio; Marques, Silvio Romero; Santa Cruz, Rodolfo

    1995-01-01

    The subclavian steal syndrome is a rare vascular disease that can be managed by interventional radiology. It is presented the experience with three cases of this syndrome that underwent percutaneous transluminal angioplasty, and a brief literature review is done. Two patients remained asymptomatic 23 and 30 months, respectively, after the procedure. One patient presented with recurrent symptoms 12 months after the dilatation. Considering the low morbidity and good clinical and technical results, percutaneous transluminal angioplasty is the first choice in the subclavian steal syndrome treatment. (author). 9 refs., 3 figs

  2. Aspirin inhibition of platelet deposition at angioplasty sites: demonstration by platelet scintigraphy

    International Nuclear Information System (INIS)

    Cuningham, D.A.; Kumar, B.; Siegel, B.A.; Gilula, L.A.; Totty, W.G.; Welch, M.J.

    1984-01-01

    In-111 platelet scintigraphy was used to evaluate the effects of prior aspirin administration on the accumulation of In-111-labeled autologous platelets at sites of arterial injury resulting from iliac, femoral, or popliteal transluminal angioplasty in a nonrandomized study of 17 men. The degree of platelet localization at angioplasty sites was significantly less in nine men who had received aspirin in varying doses within the 4 days before angioplasty than in eight men who had not received aspirin for at least two weeks. The results suggest that aspirin treatment before angioplasty limits the early platelet deposition at the angioplasty site in men

  3. Explorations Around "Graceful Failure" in Transportation Infrastructure: Lessons Learned By the Infrastructure and Climate Network (ICNet)

    Science.gov (United States)

    Jacobs, J. M.; Thomas, N.; Mo, W.; Kirshen, P. H.; Douglas, E. M.; Daniel, J.; Bell, E.; Friess, L.; Mallick, R.; Kartez, J.; Hayhoe, K.; Croope, S.

    2014-12-01

    Recent events have demonstrated that the United States' transportation infrastructure is highly vulnerable to extreme weather events which will likely increase in the future. In light of the 60% shortfall of the $900 billion investment needed over the next five years to maintain this aging infrastructure, hardening of all infrastructures is unlikely. Alternative strategies are needed to ensure that critical aspects of the transportation network are maintained during climate extremes. Preliminary concepts around multi-tier service expectations of bridges and roads with reference to network capacity will be presented. Drawing from recent flooding events across the U.S., specific examples for roads/pavement will be used to illustrate impacts, disruptions, and trade-offs between performance during events and subsequent damage. This talk will also address policy and cultural norms within the civil engineering practice that will likely challenge the application of graceful failure pathways during extreme events.

  4. Experience and Lessons learnt from running high availability databases on Network Attached Storage

    CERN Document Server

    Guijarro, Juan Manuel; Segura Chinchilla, Nilo

    2008-01-01

    The Database and Engineering Services Group of CERN's Information Technology Department provides the Oracle based Central Data Base services used in many activities at CERN. In order to provide High Availability and ease management for those services, a NAS (Network Attached Storage) based infrastructure has been set up. It runs several instances of the Oracle RAC (Real Application Cluster) using NFS as share disk space for RAC purposes and Data hosting. It is composed of two private LAN's to provide access to the NAS file servers and Oracle RAC interconnect, both using network bonding. NAS nodes are configured in partnership to prevent having single points of failure and to provide automatic NAS fail-over. This presentation describes that infrastructure and gives some advice on how to automate its management and setup using a Fabric Management framework such as Quattor. It also covers aspects related with NAS Performance and Monitoring as well Data Backup and Archive of such facility using already existing i...

  5. Lessons learned from SONOPA: (SOcial Networks for Older adults to Promote an Active life)

    OpenAIRE

    Allouch, S. Ben; Jaschinski, C.; Deboeverie, F.; Aghajan, Hamid; Philips, Wilfried

    2016-01-01

    This paper describes the development and testing of an Ambient Assisted Living (AAL) solution that combines state-of-the- art sensor technology with a social network application to empower elders to stay active, autonomous and socially connected and consequently support and unburden family caregivers. From a very early development phase both social scientists and engineers worked together to ensure a holistic approach to the development of the technology. To get a better insight into the need...

  6. [Coronary transluminal angioplasty and determination of the intracoronary gradient with a new monorail system].

    Science.gov (United States)

    Freitas, A D; Medina, A; Bethencourt, A; Coello, I; Hernández, E; Peraza, C; Melian, F; Jiménez, F; Laraudogoitia, E; Goicolea, J

    1989-10-01

    To evaluate the results obtained in coronary angioplasty using the new very low profile monorail catheter. A retrospective study to define the causes and frequency of successful and unsuccessful coronary angioplasty on proximal and distal lesions located in the three coronary vessels. Patients referred to the Hemodynamic Unit for coronary angioplasty. Coronary angioplasty was performed in 106 patients with cardiac ischemic disease (stable angina, unstable angina and myocardial infarction after thrombolytic therapy). To perform coronary angioplasty using a monorail system, including dilatation of vessels (angioplasty) and to measure the intracoronary gradient. A high success rate was achieved (92%) independent of vessel dilated or of the position of the stenosis. There was a lower success rate in complex lesions. In this study, this newly modified system for coronary angioplasty with balloon catheter and monorail pressure catheter gave a very high performance.

  7. Integration of the Watcher Telescope into the Sierra Stars Observatory NetworkLessons Learned for GLORIA

    Directory of Open Access Journals (Sweden)

    Martin Topinka

    2013-01-01

    Full Text Available The UCD Watcher robotic telescope is planning to participate in the Sierra Stars Observatory Network (SSON, a US-based organisation that provides astronomical images upon request to subscribing users, who are typically either amateurs or university/college students. Implementing the tasks required for the integration of Watcher to SSON, such as remote scheduling, file transfer, image quality validation and the provision of meteorological information, have provided useful experience for the GLORIA project. It has also become apparent that managing user expectations will be important for GLORIA.

  8. Subintimal angioplasty: predictors of long-term success.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2009-08-01

    To determine the clinical outcomes and success rates after percutaneous subintimal angioplasty (SIA) in patients with lower-limb occlusive lesions causing intermittent claudication (IC) or critical limb ischemia (CLI) at midterm to long-term follow-up. The secondary aim was to elicit factors predictive of a successful outcome.

  9. Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    Muinck, Ebo Derk de

    1994-01-01

    In this thesis several aspects of passive and active coronary perfusion during coronary angioplasty are investigated. The autoperfusion balloon catheters that were evaluated are the Stack® and the RX-60® catheters (Advanced Cardiovascular Systems, inc., Santa Clara, California, U.S.A). The coronary

  10. Direct venous thrombolysis and venous angioplasty in the upper extremity

    International Nuclear Information System (INIS)

    Hollmann, J.P.; Guenther, R.W.

    1987-01-01

    Venous thromboses of stenoses in the upper extremity are often the result of a compression syndrome of the shoulder girdle, the Paget-von Schroetter syndrome, vascular surgery, space-occupying lesions in the mediastinum or the result of catheterisation. Direct venous thrombolysis and venous angioplasty were performed successfully in six patients. (orig.) [de

  11. Segmentally enclosed thrombolysis in percutaneous transluminal angioplasty for femoropopliteal occlusions

    DEFF Research Database (Denmark)

    Jørgensen, B; Tønnesen, K H; Nielsen, J D

    1991-01-01

    Segmentally enclosed thrombolysis (SET) was performed immediately following 34 percutaneous transluminal angioplasties (PTAs) for femoropopliteal occlusions. The dilated segment was sealed off with a double balloon catheter, and recombinant tissue plasminogen activator (rt-PA) 1 mg/ml and heparin...

  12. Lessons learned in building a global information network on chemicals (GINC)

    International Nuclear Information System (INIS)

    Kaminuma, Tsuguchika

    2005-01-01

    The Global Information Network on Chemicals (GINC) was a project to construct a worldwide information network linking international, national, and other organizations working for the safe management of chemicals. Proposed in 1993, the project started the next year and lasted almost 10 years. It was begun as a joint project of World Health Organization (WHO), International Labor Organization (ILO), and United Nations Environment Program (UNEP), and later endorsed by the Intergovernmental Forum on Chemical Safety (IFCS). Asia, particularly East Asia and the Pacific islands, was chosen as the feasibility study region. The author's group then at the National Institute of Health Sciences (NIHS) of Japan led this initiative and hosted numerous meetings. At these meetings, tutorial sessions for communicating chemical safety expertise and emerging new information technologies relevant to the safe management of chemicals were offered. Our experience with this project, particularly the Web-based system and the tutorial sessions, may be of use to others involved with Web-based instruction and the training of chemical safety specialists from both developed and developing countries

  13. Conducting multicenter research in healthcare simulation: Lessons learned from the INSPIRE network.

    Science.gov (United States)

    Cheng, Adam; Kessler, David; Mackinnon, Ralph; Chang, Todd P; Nadkarni, Vinay M; Hunt, Elizabeth A; Duval-Arnould, Jordan; Lin, Yiqun; Pusic, Martin; Auerbach, Marc

    2017-01-01

    Simulation-based research has grown substantially over the past two decades; however, relatively few published simulation studies are multicenter in nature. Multicenter research confers many distinct advantages over single-center studies, including larger sample sizes for more generalizable findings, sharing resources amongst collaborative sites, and promoting networking. Well-executed multicenter studies are more likely to improve provider performance and/or have a positive impact on patient outcomes. In this manuscript, we offer a step-by-step guide to conducting multicenter, simulation-based research based upon our collective experience with the International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE). Like multicenter clinical research, simulation-based multicenter research can be divided into four distinct phases. Each phase has specific differences when applied to simulation research: (1) Planning phase , to define the research question, systematically review the literature, identify outcome measures, and conduct pilot studies to ensure feasibility and estimate power; (2) Project Development phase , when the primary investigator identifies collaborators, develops the protocol and research operations manual, prepares grant applications, obtains ethical approval and executes subsite contracts, registers the study in a clinical trial registry, forms a manuscript oversight committee, and conducts feasibility testing and data validation at each site; (3) Study Execution phase , involving recruitment and enrollment of subjects, clear communication and decision-making, quality assurance measures and data abstraction, validation, and analysis; and (4) Dissemination phase , where the research team shares results via conference presentations, publications, traditional media, social media, and implements strategies for translating results to practice. With this manuscript, we provide a guide to conducting quantitative multicenter

  14. Dosimetry of beta emitting radionuclides for use in balloon angioplasty

    International Nuclear Information System (INIS)

    Fox, R.A.

    1997-01-01

    The dose at varying distances from the surface of an infinite cylinder containing 90 Y, 32 P and 188 Re respectively is calculated using published scaled point dose kernels for these three radionuclides. It is shown that all are suitable radionuclides for use in the irradiation of arteries subsequent to balloon angioplasty. All three may be used as a radioactive liquid in the angioplasty balloon, thereby simplifying the procedure and enabling a uniform radiation dose to be given to the arterial wall. It is however shown that there is a rapid reduction in dose with distance from the arterial wall which demands careful specification of the prescribed radiation dose. A similar rapid reduction with distance is also found with a central radioactive wire or with a radioactive stent containing the same radionuclides. (author)

  15. A Rare and Serious Unforeseen Complication of Cutting Balloon Angioplasty

    Directory of Open Access Journals (Sweden)

    Praveen Vemula

    2014-01-01

    Full Text Available Cutting balloon angioplasty (CBA is one of the adept ways of treating “in-stent restenosis.” Various complications related to cutting balloon angioplasty have been reported including arterial rupture, delayed perforation and fracture of microsurgical blades. Here we report a very unusual and inadvertent extraction of a stent previously deployed in the ramus intermedius coronary branch by a cutting balloon catheter. This required repeat stenting of the same site for an underlying dissection. Even though stent extraction is a rare complication it can be serious due to dissection, perforation, and closure of the artery. Physicians performing coronary artery interventions would need to be aware of this rare and serious complication especially if any difficulty is encountered while withdrawing the cutting balloon. Therefore, after removal, cutting balloon should be examined thoroughly for possible stent dislodgment or extraction when used for “in-stent restenosis.”

  16. The RAFT Telemedicine Network: Lessons Learnt and Perspectives from a Decade of Educational and Clinical Services in Low- and Middle-Incomes Countries.

    Science.gov (United States)

    Bediang, Georges; Perrin, Caroline; Ruiz de Castañeda, Rafael; Kamga, Yannick; Sawadogo, Alexandre; Bagayoko, Cheick Oumar; Geissbuhler, Antoine

    2014-01-01

    The objectives of this paper are to (i) provide an overview of the educational and clinical experiences of the Réseau en Afrique Francophone pour la Télémédecine (RAFT) network, (ii) analyze key challenges and lessons learnt throughout a decade of activity, and (iii) draw a vision and perspectives of its sustainability. The study was carried out following three main stages: (i) a literature review, (ii) the analysis of key documents, and (iii) discussions with key collaborators of the RAFT. Réseau en Afrique Francophone pour la Télémédecine has been offering an important quantity of educational, clinical, and public health activities during the last decade. The educational activities include the weekly delivery of video-lectures for continuing and post-graduate medical education, the use of virtual patients for training in clinical decision making, research training activities using ICTs and other e-learning activities. The clinical and public health activities include tele-expertise to support health professionals in the management of difficult clinical cases, the implementation of clinical information systems in African hospitals, the deployment of mHealth projects, etc. Since 2010, the RAFT has been extended to the Altiplano in Bolivia and Nepal (in progress). Lessons Learnt and Perspectives: Important lessons have been learnt from the accumulated experiences throughout these years. These lessons concern: social and organization, human resources, technologies and data security, policy and legislation, and economy and financing. Also, given the increase of the activities and the integration of eHealth and telemedicine in the health system of most of the countries, the RAFT network faces many other challenges and perspectives such as learning throughout life, recognition, and valorization of teaching or learning activities, the impact evaluation of interventions, and the scaling up and transferability out of Africa of RAFT activities. Based on the RAFT

  17. Transluminal coronary angioplasty in the treatment of silent ischemia

    International Nuclear Information System (INIS)

    Bergin, P.; Myler, R.K.; Shaw, R.E.; Stertzer, S.H.; Clark, D.A.; Ryan, C.; Murphy, M.C.

    1988-01-01

    Fifty-four asymptomatic patients with positive thallium exercise tests underwent coronary angiography followed by coronary angioplasty (PTCA), as the primary therapy for silent ischemia. The procedure was technically successful in 89% of these patients. Emergency bypass graft surgery was necessary in 2 (3.6%) and q-wave myocardial infarction occurred in 1 (1.8%) of these. All fifty-four patients have been followed for a mean of 35 months since angioplasty. Of the 48 patients with initially successful PTCA, 12 had either clinical restenosis (9/14 or 19%) or a new lesion (3/48 or 6%) during follow-up, which required a repeat PTCA. At the longest follow-up, 46 (85%) had been successfully treated with on or more PTCA procedures. Two patients (3.6%) had sustained late q-wave myocardial infarction and two additional patients reported angina pectoris. There were no deaths. Angioplasty as a primary therapy for silent ischemia appears efficacious, with success and restenosis rates comparable to those in the symptomatic population. Event-free survival is improved, compared with natural history data for patients with silent ischemia from other studies. Prudent risk/benefit analysis may help to define subgroups most likely to benefit from this intervention

  18. [Surgical angioplasty of the left main coronary artery].

    Science.gov (United States)

    Vranes, Mile; Velinović, Milos; Kocica, Mladen; Mikić, Aleksandar; Velimirović, Dusan; Djukić, Petar

    2010-01-01

    The conventional treatment for isolated stenosis of the left main coronary artery is bypass surgery (myocardial revascularization). However, the process of atherosclerosis is not arrested by myocardial revascularization and it will lead to the occlusion of the left main coronary artery. Revascularization will establish retrograde perfusion for 50-70% of the myocardium of the left ventricle. Direct surgical angioplasty of the left main coronary artery enables normal physiological perfusion of the whole myocardium and better myocardial function. The aim of our study is to point out a new surgical approach of treating left main coronary artery stenosis. Between October 2002 and October 2003, direct surgical angioplasty of the main left coronary artery was performed on three patients with isolated stenosis of the left main coronary artery using the anterior approach and the pericardium as a patch. The procedure was performed under total endotracheal anaesthesia and standard cardiopulmonary circulation, moderate hypothermia, anterograde St. Tomas cardioplegia and local cooling. Patients were followed clinically, echocardiographically and by load-tests. All three patients were without complications. In postoperative follow-up (54-68 months) neither angina pectoris nor electrocardiographically registered ischaemic changes were found. Load-tests performed every six months on all three patients were negative. Surgical angioplasty of isolated stenosis of the left main coronary artery is a preferred method for treating this type of coronary disease. Contraindications for this type of treatment are stenosis of the left main coronary artery with bifurcation and advanced calcification of the left main coronary artery.

  19. CO laser angioplasty system: efficacy of manipulatable laser angioscope catheter

    Science.gov (United States)

    Arai, Tsunenori; Kikuchi, Makoto; Mizuno, Kyoichi; Sakurada, Masami; Miyamoto, Akira; Arakawa, Koh; Kurita, Akira; Nakamura, Haruo; Takeuchi, Kiyoshi; Utsumi, Atsushi; Akai, Yoshiro

    1992-08-01

    A percutaneous transluminal coronary angioplasty system using a unique combination of CO laser (5 micrometers ) and As-S infrared glass fiber under the guidance of a manipulatable laser angioscope catheter is described. The ablation and guidance functions of this system are evaluated. The angioplasty treatment procedure under angioscope guidance was studied by in vitro model experiment and in vivo animal experiment. The whole angioplasty system is newly developed. That is, a transportable compact medical CO laser device which can emit up to 10 W, a 5 F manipulatable laser angioscope catheter, a thin CO laser cable of which the diameter is 0.6 mm, an angioscope imaging system for laser ablation guidance, and a system controller were developed. Anesthetized adult mongrel dogs (n equals 5) with an artificial complete occlusion in the femoral artery and an artificial human vessel model including occluded or stenotic coronary artery were used. The manipulatability of the catheter was drastically improved (both rotation and bending), therefore, precise control of ablation to expand stenosis was obtained. A 90% artificial stenosis made of human yellow plaque in 4.0 mm diameter in the vessel was expanded to 70% stenosis by repetitive CO laser ablations of which total energy was 220 J. All procedures were performed and controlled under angioscope visualization.

  20. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2011-03-01

    To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI).

  1. Usefulness of cutting balloon angioplasty for the treatment of congenital heart defects.

    Science.gov (United States)

    Kusa, Jacek; Mazurak, Magdalena; Skierska, Agnieszka; Szydlowski, Leslaw; Czesniewicz, Pawel; Manka, Lukasz

    2018-01-01

    Patients with complex congenital heart defects may have different hemodynamic prob-lems which require a variety of interventional procedures including angioplasty which involves using high-pressure balloons. After failure of conventional balloon angioplasty, cutting balloon angioplasty is the next treatment option available. The purpose of this study was to evaluate the safety and efficacy of cutting balloon angioplasty in children with different types of congenital heart defects. Cutting balloon angioplasty was performed in 28 children with different congenital heart defects. The indication for cutting balloon angioplasty was: pulmonary artery stenosis in 17 patients, creating or dilatation of interatrial communication in 10 patients, and stenosis of left subclavian artery in 1 patient. In the pulmonary arteries group there was a significant decrease in systolic blood pressure (SBP) in the proximal part of the artery from the average 74.33 ± 20.4 mm Hg to 55 ± 16.7 mm Hg (p cutting balloon angioplasty was performed after an unsuccessful classic Rashkind procedure. After cutting balloon angioplasty there was a significant widening of the interatrial communication. Cutting balloon angioplasty is a feasible and effective treatment option in different con-genital heart defects.

  2. Percutaneous transluminal angioplasty of iliac and femoral arteries in severe lower-limb ischaemia

    DEFF Research Database (Denmark)

    Jørgensen, B; Henriksen, L O; Karle, A

    1988-01-01

    angioplasty) or persistent greater than or equal to 0.15 rise in arm/ankle blood pressure index (femoropopliteal angioplasty). The respective technical success rates were 82% and 64%. The complication rate was 10.9%, including 5.4% distal embolization. Patency rates were higher in iliac than...

  3. Impact of Diabetes on Long-Term Outcome After Primary Angioplasty

    DEFF Research Database (Denmark)

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

    2012-01-01

    Diabetes has been shown to be associated with worse survival and repeat target vessel revascularization (TVR) after primary angioplasty. The aim of the current study was to evaluate the impact of diabetes on long-term outcome in patients undergoing primary angioplasty treated with bare metal sten...

  4. Percutaneous transluminal angioplasty of the superficial femoral artery by retrograde catheterization via the popliteal artery

    DEFF Research Database (Denmark)

    Tønnesen, K H; Sager, P; Karle, A

    1988-01-01

    We report the results of 50 angioplasty procedures via the popliteal artery. A 3-year follow-up including control of blood pressures at ankle and toe levels show results comparable to reports in the literature. This new approach for angioplasty of the superficial femoral artery and eventually of ...

  5. Carotid angioplasty and stent placement for restenosis after endarterectomy

    International Nuclear Information System (INIS)

    Kadkhodayan, Yasha; Moran, Christopher J.; Cross, DeWitte T.; Derdeyn, Colin P.

    2007-01-01

    Recurrent carotid stenosis following endarterectomy is a common complication, and reoperation may be associated with increased morbidity. The goal of this study was to determine the procedural safety and long-term complication rates of carotid angioplasty and stenting for recurrent stenosis. Of 248 consecutive carotid angioplasty and/or stenting procedures performed at our institution between March 1996 and November 2005, 83 procedures for recurrent stenosis following endarterectomy were performed in 75 patients (mean age 68 years; 43 men, 32 women) without cerebral protection devices. The patients' medical records were retrospectively reviewed for vascular imaging reports and available clinical follow-up. Procedural and long-term complication rates were calculated. Recurrent stenosis was reduced from a mean of 80.6% to no significant stenosis in 82 of 83 procedures. The procedural stroke rate was 3 out of 83 procedures (3.6%). The procedural transient ischemic attack (TIA) rate was 2 out of 83 procedures (2.4%). Mean follow-up was 22.4 months (range 0.1 to 86.7 months) with at least 6 months follow-up for 54 of 83 procedures (65%). There were five TIAs and no strokes on follow-up (new TIAs at 25.5 and 43.4 months; recurrent TIAs at 1, 11.1, and 12 months, all with normal angiograms). The composite 30-day stroke, myocardial infarction, or death rate was 5 of 83 procedures (6.0%). In this series, angioplasty and stenting were effective in relieving stenosis secondary to recurrent carotid disease after endarterectomy, and have low rates of ischemic complications. (orig.)

  6. Primary balloon angioplasty for symptomatic, high-grade intracranial stenosis.

    Science.gov (United States)

    Tomycz, Luke; Bansal, Neil K; Lockney, Tim; Strothers, Megan; Connors, John J; Shay, Scott; Singer, Robert J

    2013-01-01

    In light of recent controversy about the safety and efficacy of intracranial stenting, we sought to evaluate our experience with primary balloon angioplasty for symptomatic, high-grade intracranial stenosis. All intracranial angioplasty cases performed at Vanderbilt University Medical Center from 2006 to 2011 were retrospectively reviewed for degree of stenosis pre- and post-procedure. Immediate peri-procedural complications were evaluated as well as one-month and long-term outcomes. A total of 26 patients were included in the study with a mean age of 63.0 years and a mean follow-up of 350.2 days. The average pre-procedure stenosis was 71.2%. The immediate, average post-procedure stenosis was 46.6%, and the average post-procedure stenosis at last angiographic follow-up was 44.5%. Retreatment was required in only 3.8% of patients. The primary end-point of major stroke or death at 30 days was observed in 11.5%, and the overall intra-procedural complication rate was 7.7%. The incidence of stroke or death at last follow-up was 15.4%, which is comparable to the one-year stroke or death rate in the medical arm of the SAMPRISS trial. In this retrospective series, primary balloon angioplasty was found to be effective as a treatment option for symptomatic intracranial stenosis with the risk of stroke or death at 30 days higher than the medical arm of SAMPRIS but lower than the stenting arm. The one-year risk of stroke was comparable to that reported for the one-year outcomes in the SAMPRISS medical arm.

  7. Absence of Bacteria on Coronary Angioplasty Balloons from Unselected Patients

    DEFF Research Database (Denmark)

    Hansen, Gorm Mørk; Nilsson, Martin; Nielsen, Claus Henrik

    2015-01-01

    Periodontitis is a chronic, bacterially-induced inflammatory disease of the tooth-supporting tissues, which may result in transient bacteremia and a systemic inflammatory response. Periodontitis is associated with coronary artery disease independently of established cardiovascular risk factors...... and purification steps, and demonstration of sensitivity levels of 25-125 colony forming units (CFU), we did not detect bacterial DNA from any of the coronary angioplasty balloons. A subsequent questionnaire indicated that the prevalence of periodontitis in the study cohort was at least 39.5%. Although coronary...

  8. Long-term results of brachiocephalic artery percutaneous transluminal angioplasty

    International Nuclear Information System (INIS)

    Mc Namara, T.O.; Gardner, K.

    1990-01-01

    This paper establishes the ling-term and angiographic sequelae of percutaneous transluminal angioplasty (PTA) of stenoses of the origins of the brachycephalic arteries. From November of the proximal segments of the brachycephalic arteries. Clinical follow-up after PTA was 45 months. Two patients had recurrence of vertigo, after 16 and 75 months. There was no evidence of restenosis in the patient whose recurrence was after 16 months, but considerable restenosis was noted in the patient whose symptoms recurred after 75 months. That patient underwent successful repeated PTA

  9. Endovascular stent-support angioplasty for cerebral venous sinus stenosis

    Directory of Open Access Journals (Sweden)

    Xin-feng LI

    2011-06-01

    Full Text Available Objective To investigate the pathophysiological features of cerebral venous sinus stenosis,and the modus and therapeutic effect of stent-support angioplasty.Methods The clinical data of 36 patients with cerebral venous sinus stenosis,admitted to Neurosurgical Department of General Hospital of PLA from Dec.2001 to Jun.2010,were retrospectively analyzed.Of the 36 cases,10 were males and 26 females,aged from 14 to 57 years with a mean of 37.8 years,and the disease course ranged from 4 days to 9 years.The main clinical manifestations included headache,vomiting,optical visual blurring,and limb weakness with anesthesia in some patients.The diagnosis of all patients was confirmed by digital subtraction angiography,and the results showed that the local stenosis located in right transverse-sigmoid sinus in 21 cases,left transverse-sigmoid sinus in 12 cases,and on both sides in 3 cases.All patients received thrombolytic therapy via carotid artery or a microcatheter inserted in the venous sinus,followed by stent angioplasty of venous sinus.Meanwhile,general anticoagulant and antiplatelet therapy were essential.Results All the 36 patients were successively treated with balloon dilatation and stent angioplasty of venous sinus with exception of 3 cases,who failed because of the circuitous jugular foramen preventing the insertion of the stent.The successful rate was 91.7%.The cerebrospinal fluid pressure of the patients was lowered from 374.7±82.9mmH2O before operation to 230.3±48.1mmH2O after operation.Thirty-three patients were followed-up for 1 month to 8 years by brain angiography and examinations in the outpatient clinic.Among them 32 showed persistent relief of clinical symptoms.The remaining patient presented severe headache and optical visual blurring 1 month after stent implantation,however the symptoms were alleviated obviously after thrombolytic therapy via the carotid artery with adequate anticoagulation.Conclusions Stent angioplasty of venous

  10. Risk assessment after coronary angioplasty with SPECT myocardial perfusion studies

    International Nuclear Information System (INIS)

    Camilletti, Jorge A.; Erriest, Juan; Mele, Anibal A.

    2007-01-01

    The chest pain can be use for stratifying the risk of the patients after coronary angioplasty. Nevertheless this strategy has shown to have a low accuracy in the detection of restenosis and myocardial ischemia. Aims: To establish the usefulness of the SPECT studies in the risk stratification after the coronary angioplasty. Evaluate the incidence of silent ischemia or symptomatic, and its impact on the prognosis. Method: There were included 107 patients (p) submitted to a gated SPECT between the year of the coronary angioplasty. The analysis of the images was performed according to different scores (SSS, SRS, SDS). These data was correlated with the symptoms of the patients. We define group 1 (G1) as the asymptomatic without ischemia (n 59p), group 2 (G2) as silent ischemia (n = 28p) and group 3 (G3) as symptomatic with ischemia (n = 20p). A clinical follow-up was done in search of events (target vessel revascularization, unstable angina, AMI and death). Results: Significant differences were not observed in the clinical variables between the different groups. The SSS was lower in the G1 compare with G2 and G3 (p 0.0001) and was similar between the last two, p = NS (SSS: G1: 2.2 ± 4.9; G2: 7.6 ± 5.9; G3: 9.5 ± 6.8). The SDS was greater in G3 vs. G1 and G2, p = 0.0001, and greater in G2 vs. G1, p = 0.0001 (SDS: G1: 0; G2: 4.8 ± 3.5; G3: 7.2 ± 6.5). No differences where observed in the SRS between the three groups. In the follow-up the total percentage of events was lesser when compare the G1 with the G2 and G3 (G1: 3.3%; G2 and G3: 18.7%; p 0.02). The percentage of annual events of the G3 symptomatic with ischemia (11.03%) and G2 silent ischemia (4.04%) did not present differences (p 0.7). When the events of the G2 (4.04%) were compared with the G1 (1.24%) we observed a trend to major frequency of events in the G2 (p = 0.6). Conclusions: The presence of myocardial ischemia after coronary angioplasty is a determinant of the prognosis. Nevertheless, the extension

  11. Subintimal angioplasty in femoropopliteal region-Mid-term results

    International Nuclear Information System (INIS)

    Koecher, Martin; Cerna, Marie; Utikal, Petr; Kozak, Jiri; Sisola, Ivan; Thomas, Rohit P.; Bachleda, Petr; Drac, Petr; Sekanina, Zdenek; Langova, Katerina

    2010-01-01

    Purpose: Subintimal angioplasty is becoming more frequently used treatment option for patients with long arterial occlusions or diffuse atherosclerotic changes as an alternative to surgical treatment in claudicants especially in patients with critical limb ischemia. The aim of our article is to retrospectively assess mid-term outcomes of subintimal angioplasty of chronic arterial occlusions in femoropopliteal region followed clinically and by Doppler ultrasonography. Materials and methods: From May 2002 to December 2007, 133 femoropopliteal artery occlusions in 123 patients were indicated for subintimal recanalisation. The indications for treatment were intermittent claudications in 84 patients (63.15%) and critical limb ischemia in 49 patients (36.85%). The median length of lesions was 11.4 cm, range 2-30 cm. Except doppler ultrasonographic examination done 24 h after the procedure and clinical examination before discharge, both clinical and ultrasonographic examinations were performed 6 and 12 months after the procedure and yearly thereafter. Statistical analysis of our cohort was performed by Kaplan-Meier analysis, log-rank test and Cox regression. Results: Technical success was achieved in 86.46%. Primary patency rate was 83.1% (SE: 3.9%), 67.5% (SE: 5%), 58% (SE: 5.9%) a 48.4% (SE: 7.1%) at 6, 12, 24 and 36 months respectively. No statistically significant difference of primary patency was found between the group of claudicants and the group of patient with critical limb ischemia. Statistically significant prediction factors for primary patency were only the quality of the run off and the length of the occlusion. Limb salvage rate in our group of patients with critical limb ischemia was 80.8% at 12 months. Conclusion: Subintimal recanalisation is a simple and safe procedure for treatment of chronic peripheral arterial occlusions with high primary technical success rate, acceptable primary patency rate, low percentage of complications and mortality is as low as

  12. How prepared were the Puerto Rico Seismic Network sites for the arrival of Hurricane Maria? Lessons learned on communications, power and infrastructure.

    Science.gov (United States)

    Vanacore, E. A.; Lopez, A. M.; Huerfano, V.; Lugo, J.; Baez-Sanchez, G.

    2017-12-01

    For exactly 85 years the island of Puerto Rico in the northeastern Caribbean was spared from catastrophic category 4 hurricane winds. Then Hurricane Maria arrived on September 20, 2017 with maximum sustained winds of up to 155 mph. The eye of the hurricane crossed the island from southeast to northwest in eight hours leaving almost a meter of rainfall on its path. Sustained winds, gusts and precipitation were most certainly going to affect the seismic and geodetic equipment the Puerto Rico Seismic Network (PRSN) use for locating earthquakes in the region. PRSN relies on 35 seismic stations (velocity and strong-motion) to characterize the seismic behavior of the island and 15 geodetic (GNSS) stations to determine crustal deformation of the Puerto Rico - Virgin Islands microplate. PRSN stations have been designed to withstand earthquakes. However, the equipment suffered considerable damage due to the strong winds especially station communication towers. This coupled with catastrophic damage to the telecommunication and power grids of the island had severe effects on the network. Additionally, the level of devastation was such that it hampered the ability of PRSN staff to visit the sites for assessment and repair. Here we present the effects of category 4 hurricane had on our seismic and geodetic sites, examine the susceptibility of the PRSN stations' power and communications, and discuss future plans to recuperate and improve station resiliency for future catastrophic events. These lessons learned hopefully will help harden sites of networks, agencies and/or institutions that rely on similar infrastructure.

  13. A randomized trial comparing primary angioplasty versus stent placement for symptomatic intracranial stenosis

    Science.gov (United States)

    Qureshi, Adnan I; Chaudhry, Saqib A; Siddiq, Farhan; Majidi, Shahram; Rodriguez, Gustavo J; Suri, M Fareed K

    2013-01-01

    Background: Both primary angioplasty alone and angioplasty with a self-expanding stent have been compared in non-randomized concurrent clinical studies that suggest equivalent results. However, there is no randomized trial that has compared the two procedures in patients with symptomatic high grade intracranial stenosis. Objective: The primary aim of the randomized trial was to compare the clinical and angiographic efficacy of primary angioplasty and angioplasty followed by stent placement in preventing restenosis, stroke, requirement for second treatment, and death in patients with symptomatic intracranial stenosis. Methods: The study prospectively evaluated efficacy and safety of the two existing neurointerventional techniques for treatment of moderate intracranial stenosis (stenosis ≥ 50%) with documented failure of medical treatment or severe stenosis (≥70%) with or without failure of medical treatment. Results: A total of 18 patients were recruited in the study (mean age [±SD] was 64.7 ± 15.1 years); out of these, 12 were men. Of these 18, 10 were treated with primary angioplasty and 8 were treated with angioplasty followed by self-expanding stent. The technical success rates of intracranial angioplasty and stent placements defined as ability to achieve <30% residual stenosis when assessed by immediate post-procedure angiography was 5 of 10 and 5 of 8 patients, respectively. The total fluoroscopic time (mean [±SD]) was lower in patients undergoing primary angioplasty 37 [±11] min versus those undergoing angioplasty followed by self-expanding stent 42 [±15] min, P = 0.4321. The stroke and death rate within 1 month was very low in both patient groups (1 of 10 versus 0 of 8 patients). One patient randomized to stent placement continued to have recurrent ischemic symptoms requiring another angioplasty in the vertebral artery on post-procedure Day 2. Conclusions: The trial suggests that a randomized trial comparing primary angioplasty to angioplasty

  14. Early Results of Retrograde Transpopliteal Angioplasty of Iliofemoral Lesions

    International Nuclear Information System (INIS)

    Saha, Saumitra; Gibson, Matthew; Magee, Timothy R.; Galland, Robert B.; Torrie, E. Peter H.

    2001-01-01

    Purpose: To assess whether the retrograde transpopliteal approach is a safe, practical and effective alternative to femoral puncture for percutaneous transluminal angioplasty (PTA).Methods: Forty PTAs in 38 patients were evaluated. Intentional subintimal recanalization was performed in 13 limbs. Ultrasound evaluation of the popliteal fossa was carried out 30 min and 24 hr post procedurally in the first 10 patients to exclude local complications. All patients had a follow-up of at least 6 weeks.Results: The indication for PTA was critical ischemia in seven limbs and disabling claudication in the remainder.Stenoses (single or multiple) were present in 24 and occlusion in 15.The superficial femoral artery (SFA) was the commonest segment affected(36) followed by common femoral artery (CFA) in four and iliac artery in four. Technical success was achieved in 38 of 39 limbs where angioplasty was carried out. In one limb no lesion was found.Immediate complications were distal embolization in two and thrombosis in one. None of these required immediate surgery. There were no puncture site hematomas or popliteal arteriovenous fistulae.Symptomatic patency at 6 weeks was 85%. Further reconstructive surgery was required in three limbs and amputation in two.Conclusion: The transpopliteal approach has a high technical success rate and a low complication rate with a potential to develop into an outpatient procedure. It should be considered for flush SFA occulsions or iliac disease with tandem CFA/SFA disease where the contralateral femoral approach is often technically difficult

  15. The influence of depression and anxiety in the development of heart failure after coronary angioplasty.

    Science.gov (United States)

    Gegenava, T; Gegenava, M; Kavtaradze, G

    2009-03-01

    The aim of our study was to investigate the association between history of depressive episode and anxiety and complications in patients after 6 months of coronary artery angioplasty. The research was conducted on 70 patients, the grade of coronary occlusion that would not respond to therapeutic treatment and need coronary angioplasty had been established. Complications were estimated in 60 patients after 6 months of coronary angioplasty. To evaluate depression we used Beck depression scale Anxiety was assessed by Spilberger State-trait anxiety scale. Statistic analysis of the data was made by means of the methods of variation statistics using Students' criterion and program of STATISTICA w 5.0. Complications were discovered in 36 (60%) patients; 24 (40%) patients had not complications. There was not revealed significant statistical differences in depression and anxiety degree in coronary angioplasty period and after 6 months of coronary angioplasty. There was not revealed significant statistical differences in depression and anxiety degree in coronary angioplasty period and after 6 months of coronary angioplasty. Our study demonstrated that complications were revealed in patients who had high degree of depression and anxiety.

  16. Percutaneous transluminal angioplasty (PTA) of supra-aortic arteries especially the internal carotid artery

    Energy Technology Data Exchange (ETDEWEB)

    Kachel, R.; Basche, S. (Medizinische Akademie, Erfurt (Germany, F.R.). Radiologische Klinik); Heerklotz, I.; Grossmann, K. (Medizinische Akademie, Erfurt (Germany, F.R.). Klinik fuer Innere Medizin); Endler, S. (Medizinische Akademie, Erfurt (Germany, F.R.). Klinik fuer Neurologie und Psychiatrie)

    1991-06-01

    We present our experience with 105 patients in whom percutaneous transluminal angioplasty was performed in 112 stenosed or occluded supra-aortic arteries. Symtoms of cerebrovascular and/or vertebrobasilar insufficiency were present in 104 of the 105 patients. The angioplasty was successful in 35 stenoses of the internal carotid artery, 2 stenoses of the common carotid artery, 1 stenosis of the external carotid artery, 15 stenoses of the vertebral artery, 3 stenoses of the innominate artery and 44 stenoses of the subclavian artery. There were only 4 minor-complications (2 haematomas, 1 transient ischemic attack, 1 small thrombus of the internal carotid artery which was detected by 111-indium platelet scintigraphy and treated by thrombendarterectomy before the appearance of neurological symptoms). All patients were symptom free after angioplasty. During the observations period of 3 to 109 months (average 58 months) there were only two cases with re-stenosis after subclavian angioplasty. The results of more than 700 personal and international published percutaneous transluminal angioplasties of supra-aortic arteries are presented. The results suggest that angioplasty of supra-aortic arteries is an effective method. On strict definition of the indications, the complication rate for angioplasty of the supra-aortic arteries is not likely to be higher than that for operative treatment. (orig.).

  17. Endovascular Management of the Popliteal Artery: Comparison of Atherectomy and Angioplasty

    Science.gov (United States)

    Semaan, Elie; Hamburg, Naomi; Nasr, Wael; Shaw, Palma; Eberhardt, Robert; Woodson, Jonathan; Doros, Gheorghe; Rybin, Denis; Farber, Alik

    2013-01-01

    Purpose Symptomatic atherosclerotic disease of the popliteal artery presents challenges for endovascular therapy. We evaluated the technical success, complications and midterm outcomes of atherectomy and angioplasty involving the popliteal segment. Methods We conducted a retrospective review of outcomes of popliteal artery intervention using atherectomy or angioplasty performed between 2003 and 2008. Results A total of 56 patients (36% women, age 72.8±12.2 years, 77% critical limb ischemia) underwent popliteal atherectomy (n=18) or angioplasty (n=38). These patients had similar clinical characteristics, TASC/TASC II classification, mean lesion length, and run-off scores. We observed a trend toward higher rates of technical success defined as atherectomy compared to angioplasty (94% vs. 71%, p=0.08). While angioplasty was associated with a higher frequency of arterial dissection (23% vs. 0%, p=0.003), atherectomy was associated with a higher rate of thromboembolic events (22% vs 0%, p=0.01). Adjunctive stenting was used more frequently following angioplasty compared to atherectomy (45% vs. 6%, p=0.005). Thrombolysis was used to treat embolization in 4 patients in the atherectomy group. The improvement in the ankle-brachial index was similar between the two treatment groups. Primary patency of the popliteal artery at 3, 6, and 12 months was 94%, 88%, and 75% in the atherectomy group and 89%, 82%, and 73% in the angioplasty group (p=NS). There were no significant differences in limb salvage and freedom from reintervention at 1 year between the atherectomy and angioplasty groups. Conclusions Our experience with popliteal artery endovascular therapy indicates a distinct pattern of procedural complications with atherectomy compared to angioplasty but similar midterm patency, limb salvage and freedom from intervention. PMID:19942598

  18. Percutaneous balloon angioplasty for the treatment of iliofemoral arterial stenosis resulting from hyperhomocysteinemia in a child

    Energy Technology Data Exchange (ETDEWEB)

    Maynar, Manuel; Lopez-Benitez, Ruben [Diagnostic and Therapeutic Endoluminal Unit, Hospiten Rambla, Tenerife (Spain); Kirsch, David S.; Qian, Zhong [Department of Radiology, Louisiana State University Health Science Center, 1542 Tulane Avenue, LA 70112-2822, New Orleans (United States); Gomez-Sirvent, Jorge [Department of Pediatrics, Hospiten Rambla, Tenerife (Spain); Zerolo-Saez, Ignacio [Department of Surgery, Hospiten Rambla, Tenerife (Spain)

    2003-08-01

    Angioplasty has long been used in the treatment of peripheral arterial occlusive disease with variable long-term results. In this case report, we present a patient with marfanoid features and acute ischemia of the lower extremity. Angioplasty provided us with the means of emergently relieving the acute symptoms. The patient was subsequently found on further work-up to have hyperhomocysteinemia (HC) and appropriate medical therapy was initiated. We conclude that angioplasty should be considered in pediatric patients with acute occlusive limb ischemia, providing excellent immediate results to preserve the limb as well as the time to investigate the underlying causes. (orig.)

  19. Percutaneous balloon angioplasty for the treatment of iliofemoral arterial stenosis resulting from hyperhomocysteinemia in a child

    International Nuclear Information System (INIS)

    Maynar, Manuel; Lopez-Benitez, Ruben; Kirsch, David S.; Qian, Zhong; Gomez-Sirvent, Jorge; Zerolo-Saez, Ignacio

    2003-01-01

    Angioplasty has long been used in the treatment of peripheral arterial occlusive disease with variable long-term results. In this case report, we present a patient with marfanoid features and acute ischemia of the lower extremity. Angioplasty provided us with the means of emergently relieving the acute symptoms. The patient was subsequently found on further work-up to have hyperhomocysteinemia (HC) and appropriate medical therapy was initiated. We conclude that angioplasty should be considered in pediatric patients with acute occlusive limb ischemia, providing excellent immediate results to preserve the limb as well as the time to investigate the underlying causes. (orig.)

  20. Transluminal coronary angioplasty (TCA) techniques, indications and results

    International Nuclear Information System (INIS)

    Kober, G.; Lang, H.; Vallbracht, C.; Bussmann, W.D.; Hopf, R.; Kunkel, B.; Kaltenbach, M.

    1985-01-01

    Transluminal coronary angioplasty (TCA) was introduced in 1977 for dilatation of coronary stenoses. From October 1977 to December 1984 1087 procedures have been performed in Frankfurt. The mean success rate was 77% with an increase from 58% to 84% since 1977. Recurrences were seen within the first year in 15% of the patients, which could be treated successfully in a high percentage with a second TCA. Emergency bypass operations were necessary in 5.2%. Four patients (fatality rate 0.37%) died as the consequence of the intervention. Within few years TCA has become an established procedure for myocardial revascularisation, with a high success rate. Major progress has been possible in the last few years due to technical developments, which are still going on. They may lead to further improvement of the results and enlargement of the indication for TCA. (orig.) [de

  1. [Networks of experiences on community health as an information system in health promotion: lessons learned in Aragon (Spain)].

    Science.gov (United States)

    Gállego-Diéguez, Javier; Aliaga Traín, Pilar; Benedé Azagra, Carmen Belén; Bueno Franco, Manuel; Ferrer Gracia, Elisa; Ipiéns Sarrate, José Ramón; Muñoz Nadal, Pilar; Plumed Parrilla, Manuela; Vilches Urrutia, Begoña

    2016-11-01

    Networks of community health experiences promote interaction and knowledge management in health promotion among their participants. These networks integrate both professionals and social agents who work directly on the ground in small environments, with defined objectives and inclusion criteria and voluntary participation. In this article, networks in Aragon (Spain) are reviewed in order to analyse their role as an information system. The Health Promotion Projects Network of Aragon (Red Aragonesa de Proyectos de Promoción de la Salud, RAPPS) was launched in 1996 and currently includes 73 projects. The average duration of projects is 12.7 years. RAPPS interdisciplinary teams involve 701 people, of which 89.6% are professionals and 10.6% are social agents. The Aragon Health Promoting Schools Network (Red Aragonesa de Escuelas Promotoras de Salud, RAEPS) integrates 134 schools (24.9% of Aragon). The schools teams involve 829 teachers and members of the school community, students (35.2%), families (26.2%) and primary care health professionals (9.8%). Experiences Networks boost citizen participation, have an influence in changing social determinants and contribute to the formulation of plans and regional strategies. Networks can provide indicators for a health promotion information and monitoring system on: capacity building services in the territory, identifying assets and models of good practice, cross-sectoral and equity initiatives. Experiences Networks represent an opportunity to create a health promotion information system, systematising available information and establishing quality criteria for initiatives. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Web 2.0 and internet social networking: a new tool for disaster management?--lessons from Taiwan.

    Science.gov (United States)

    Huang, Cheng-Min; Chan, Edward; Hyder, Adnan A

    2010-10-06

    Internet social networking tools and the emerging web 2.0 technologies are providing a new way for web users and health workers in information sharing and knowledge dissemination. Based on the characters of immediate, two-way and large scale of impact, the internet social networking tools have been utilized as a solution in emergency response during disasters. This paper highlights the use of internet social networking in disaster emergency response and public health management of disasters by focusing on a case study of the typhoon Morakot disaster in Taiwan. In the case of typhoon disaster in Taiwan, internet social networking and mobile technology were found to be helpful for community residents, professional emergency rescuers, and government agencies in gathering and disseminating real-time information, regarding volunteer recruitment and relief supplies allocation. We noted that if internet tools are to be integrated in the development of emergency response system, the accessibility, accuracy, validity, feasibility, privacy and the scalability of itself should be carefully considered especially in the effort of applying it in resource poor settings. This paper seeks to promote an internet-based emergency response system by integrating internet social networking and information communication technology into central government disaster management system. Web-based networking provides two-way communication which establishes a reliable and accessible tunnel for proximal and distal users in disaster preparedness and management.

  3. Conceptualizing the Science-Practice Interface: Lessons from a Collaborative Network on the Front-Line of Climate Change

    Directory of Open Access Journals (Sweden)

    Nathan P. Kettle

    2017-06-01

    Full Text Available The gap between science and practice is widely recognized as a major concern in the production and application of decision-relevant science. This research analyzed the roles and network connections of scientists, service providers, and decision makers engaged in climate science and adaptation practice in Alaska, where rapid climate change is already apparent. Our findings identify key actors as well as significant differences in the level of bonding ties between network members who perceive similarity in their social identities, bridging ties between network members across different social groups, and control of information across roles—all of which inform recommendations for adaptive capacity and the co-production of usable knowledge. We also find that some individuals engage in multiple roles in the network suggesting that conceptualizing science policy interactions with the traditional categories of science producers and consumers oversimplifies how experts engage with climate science, services, and decision making. Our research reinforces the notion that the development and application of knowledge is a networked phenomenon and highlights the importance of centralized individuals capable of playing multiple roles in their networks for effective translation of knowledge into action.

  4. Subintimal Angioplasty for Peripheral Arterial Occlusive Disease: A Systematic Review

    International Nuclear Information System (INIS)

    Met, Rosemarie; Lienden, Krijn P. Van; Koelemay, Mark J. W.; Bipat, Shandra; Legemate, Dink A.; Reekers, Jim A.

    2008-01-01

    The objective of this study was to summarize outcomes of subintimal angioplasty (SA) for peripheral arterial occlusive disease. The Cochrane Library, Medline and Embase databases were searched to perform a systematic review of the literature from 1966 through May 2007 on outcomes of SA for peripheral arterial occlusive disease of the infrainguinal vessels. The keywords 'percutaneous intentional extraluminal revascularization,' 'subintimal angioplasty,' 'peripheral arterial disease,' 'femoral artery,' 'popliteal artery,' and 'tibial artery' were used. Assessment of study quality was done using a form based on a checklist of the Dutch Cochrane Centre. The recorded outcomes were technical and clinical success, primary (assisted) patency, limb salvage, complications, and survival, in relation to the clinical grade of disease (intermittent claudication or critical limb ischemia [CLI] or mixed) and location of lesion (femoropopliteal, crural, or mixed). Twenty-three cohort studies including a total of 1549 patients (range, 27 to 148) were included in this review. Methodological and reporting quality were moderate, e.g., there was selection bias and reporting was not done according to the reporting standards. These and significant clinical heterogeneity obstructed a meta-analysis. Reports about length of the lesion and TASC classification were too various to summarize or were not mentioned at all. The technical success rates varied between 80% and 90%, with lower rates for crural lesions compared with femoral lesions. Complication rates ranged between 8% and 17% and most complications were minor. After 1 year, clinical success was between 50% and 70%, primary patency was around 50% and limb salvage varied from 80% to 90%. In conclusion, taking into account the methodological shortcomings of the included studies, SA can play an important role in the treatment of peripheral arterial disease, especially in the case of critical limb ischemia. Despite the moderate patency

  5. Short- and long-term functional effects of percutaneous transluminal angioplasty in hemodialysis vascular access

    NARCIS (Netherlands)

    J. van der Linden (Joke); J.H. Smits (Johannes); J.H. Assink (Jan Hendrik); D.W. Wolterbeek (Derk); J.J. Zijlstra (Jan); G.H.T. de Jong (Gijs); M.A. van den Dorpel (Marinus); P.J. Blankestijn (Peter)

    2002-01-01

    textabstractThe efficacy of percutaneous transluminal angioplasty (PTA) is usually expressed as the angiographic result. Access flow (Qa) measurements offer a means to quantify the functional effects. This study was performed to evaluate the short-term functional and

  6. Simple risk stratification at admission to identify patients with reduced mortality from primary angioplasty

    DEFF Research Database (Denmark)

    Thune, Jens Jakob; Hoefsten, Dan Eik; Lindholm, Matias Greve

    2005-01-01

    BACKGROUND: Randomized trials comparing fibrinolysis with primary angioplasty for acute ST-elevation myocardial infarction have demonstrated a beneficial effect of primary angioplasty on the combined end point of death, reinfarction, and disabling stroke but not on all-cause death. Identifying...... a patient group with reduced mortality from an invasive strategy would be important for early triage. The Thrombolysis in Myocardial Infarction (TIMI) risk score is a simple validated integer score that makes it possible to identify high-risk patients on admission to hospital. We hypothesized that a high...... as high risk. There was a significant interaction between risk status and effect of primary angioplasty (P=0.008). In the low-risk group, there was no difference in mortality (primary angioplasty, 8.0%; fibrinolysis, 5.6%; P=0.11); in the high-risk group, there was a significant reduction in mortality...

  7. Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution Thallium scintigraphy

    NARCIS (Netherlands)

    W. Wijns (William); P.W.J.C. Serruys (Patrick); J.H.C. Reiber (Johan); P.J. de Feyter (Pim); M.J.B.M. van den Brand (Marcel); M.L. Simoons (Maarten); P.G. Hugenholtz (Paul)

    1985-01-01

    textabstractThe value of exercise testing and thallium scintigraphy in predicting recurrence of angina pectoris and restenosis after a primary successful transluminal coronary angioplasty (PTCA) was prospectively evaluated. In 89 patients, a symptom-limited exercise electrocardiogram (ECG) and

  8. Effects of a behavioural intervention on quality of life and related variables in angioplasty patients

    DEFF Research Database (Denmark)

    Appels, Ad; van Elderen, Therese; Bär, Frits

    2006-01-01

    The EXhaustion Intervention Trial investigated the effect of a behavioural intervention programme on exhaustion, health-related quality of life (HRQL), depression, anxiety, hostility, and anginal complaints in angioplasty patients who felt exhausted after percutaneous coronary intervention (PCI)....

  9. Transmural coil embolization—alternative technique for management of arterial perforation during subintimal angioplasty

    Directory of Open Access Journals (Sweden)

    Karthikeyan Damodharan

    2016-01-01

    Full Text Available Subintimal angioplasty of lower limb arterial occlusion carries a relatively higher risk of vessel perforation compared to transluminal angioplasty. Vessel perforation is a potentially life threatening complication which requires prompt recognition and management. They are usually managed by endovascular techniques such as low-pressure balloon tamponade, covered stents, and coil embolization of the ruptured artery. We describe a technique of treating vessel perforation following balloon angioplasty. Patient developed a large perforation of the proximal superficial femoral artery (SFA after balloon inflation during subintimal angioplasty of complete SFA occlusion. Following failure of balloon tamponade in sealing the perforation, we successfully treated it by deploying an embolization coil at the site of perforation through the vessel wall followed by balloon tamponade. Our technique could be a useful relatively inexpensive alternative treatment option in the management of vessel perforation compared to covered stents.

  10. Transcutaneous oximetry compared to ankle-brachial-index measurement in the evaluation of percutaneous transluminal angioplasty

    International Nuclear Information System (INIS)

    Wildgruber, Moritz; Wolf, Oliver; Weiss, Wolfgang; Berger, Hermann; Lutzenberger, Werner; Eckstein, Hans-Henning; Heider, Peter

    2007-01-01

    Objective: To investigate transcutaneous oximetry as parameter of the microcirculation is correlated to ankle-brachial-index as parameter of the macrocirculation after peripheral angioplasty procedures. Design: Prospective study. Materials and methods: 60 patients suffering from intermittent claudication were scheduled for angioplasty treatment. 45 patients were considered as eligible for angioplasty after angiographic evaluation, 15 patients underwent angiography only. Transcutaneous oximetry measurements were performed before the procedure, at the end of intervention, 24 h as well as 2 and 4 weeks after percutaneous transluminal angioplasty. Ankle-brachial-indices were obtained before intervention, 24 h as well as 2 and 4 weeks later. Results: Ankle-brachial-indices increased significantly at 24 h after angioplasty in patients being treated with angioplasty. Transcutaneous oximetry values dropped significantly at the end of the procedure and returned close to the baseline levels at 2 and 4 weeks after angioplasty. Ankle-brachial-indices and transcutaneous oximetry were positively correlated before (r = 0.3833, p = 0.009) as well as 4 weeks after angioplasty (r = 0.4596, p = 0.001). Immediately after radiological interventions, ankle-brachial-indices and transcutaneous oximetry are not positively correlated. In patients undergoing angiography only, transcutaneous oximetry levels drop significantly immediately after angiography and remain at decreased levels even at 4 weeks after intervention. Conclusion: Transcutaneous oximetry as parameter of the microcirculation is positively correlated with ankle-brachial-index as parameter of the macrocirculation before and at 4 weeks after angioplasty. Intraarterial angiography leads to a sudden decrease in skin microcirculation without affecting macrocirculation. As indicated by a lack of recovery in transcutaneous oximetry levels after 4 weeks, angiography alone results in a prolonged impaired microcirculation which may

  11. Successful angioplasty of tripolar renal arteries in a single setting: a case report.

    Science.gov (United States)

    Sharma, Gyarsi Lal; Morice, Marie-Claude; Catineau, Patrick

    2002-08-01

    Renal artery stenosis (RAS) is one of the important causes of correctable hypertension. There are various modes of therapy for RAS, including percutaneous transluminal renal angioplasty (PTRA) and surgery. PTRA has emerged as the treatment of choice in cases of renal artery stenosis. PTRA combined with stenting is associated with good immediate and long-term results. This case report describes successful angioplasty of bilateral multiple renal arteries in a single setting with good immediate and follow-up results.

  12. Angioplasty of symptomatic high-grade internal carotid artery stenosis with intraluminal thrombus: therapeutic approach

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, A.; Mayol, A. [Seccion de Neurorradiologia Intervencionista, Servicio de Radiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Gil-Peralta, A.; Gonzalez-Marcos, J.R. [Servicio de Neurologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Boza, F. [Servicio de Neurofisiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Ruano, J. [Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain)

    2004-04-01

    Intraluminal thrombus in the internal carotid artery (ICA) is usually found in patients with severe atheromatous stenosis. Having reviewed 300 carotid angioplasties for symptomatic >70% ICA stenosis, we found three patients (1%) with intraluminal thrombus. Conservative treatment with anticoagulants and double antiplatelet coverage can result in lysis of the thrombus without severe risks. Percutaneous transluminal angioplasty and stenting, preferably with distal protection, can be an excellent alternative to carotid endarterectomy. (orig.)

  13. Recanalisation of Chronically Occluded Remote Superficial Femoral Artery Endarterectomy Through Angioplasty for Limb Salvage

    Energy Technology Data Exchange (ETDEWEB)

    Husainy, Mohammad Ali, E-mail: m.husainy@nhs.net [King’s College Hospital, Department of Radiology (United Kingdom); Slim, Hani; Rashid, Hisham [King’s College Hospital, Department of Vascular Surgery (United Kingdom); Huang, Dean Y. [King’s College Hospital, Department of Radiology (United Kingdom)

    2017-02-15

    We report a novel application of balloon angioplasty to recanalise a chronically occluded remote endarterectomy superficial femoral artery. This patient previously had two occluded surgical bypass grafts in an attempt to revascularise the limb and presented with critical limb ischaemia and necrotic foot ulcerations. Following the angioplasty, the patient showed significant improvement in rest pain and healing of the ulcerations. This technique may be useful for limb salvage in patients where surgical options have been exhausted.

  14. Cerebral angioplasty practice at major medical centers in the United States

    International Nuclear Information System (INIS)

    Chaturvedi, S.; St Pierre, M.E.; Bertasio, B.

    2000-01-01

    Concern has been expressed recently regarding the proliferation of angioplasty and/or stenting of cerebral vessels. However, little is known about the volume of angioplasties being performed or the number of experienced interventionalists. A questionnaire was mailed to directors of accredited radiology residency programs in the United States, to define the level of expertise available at teaching hospitals in terms of angioplasty and/or stenting. Of 200 programs surveyed, 111 responded (56 %). Of 111 program directors 47 (42 %) indicated that cerebral angioplasty was being performed at their center. The greatest experience is currently for angioplasty of post-subarachnoid hemorrhage vasospasm (mean 16 procedures performed) and the least experience for dilation of basilar artery atherosclerosis (mean five procedures performed). The reported stroke and/or death rate in centers performing angioplasty of the extracranial carotid system is 1.5 %. Comparisons with other medical specialties (e. g., cardiologists, neurologists, neurosurgeons) are necessary to determine the full scope of extracranial neurovascular procedures being performed and the corresponding complication rates. (orig.)

  15. Immediate and Short-term Follow-Up of Aortic Coarctation Balloon Angioplasty and Stenting

    Directory of Open Access Journals (Sweden)

    Hasan Mottaghi Moghadam

    2017-12-01

    Full Text Available Background Aortic Coarcatation (CoA is one of the congenital heart diseases with the rate of 5-8% of Coronary heart diseases(CHDs. Balloon angioplasty is now one of the effective way of treatment for CoA, native or Re-coarctation (Re-CoA. We aimed to assess the immediate, and short term response to angioplasty and stenting, and also complications. Materials and Methods Balloon angioplasty with our without stenting was performed for 53 patients with native or Re-coarcatation angioplasty (39 balloon angioplasty alone, and 14 balloon and stenting. Pressure gradient across the CoA segment was measured initially by Echo and pre, and Post procedure. Echocardiography was also used for follow up assessment during 24 hours, one and 6 months afterward. Results Among 53 patients, 52.8% were male. There were 98.2% native and 3.8% Re-CoA. The mean age of patients was 8.65 ± 8.37 years, and the mean weight was 25.82±20.73 kg. The mean pressure gradient acrossthe CoA site before angioplasty was 24.88±12.32, and post procedure gradient was 4.77±6.42 (p

  16. Evaluation of workforce and organizational issues in establishing primary angioplasty in England.

    Science.gov (United States)

    Carter, Angela; Wood, Stephen; Goodacre, Steve; Sampson, Fiona; Stables, Rod

    2010-01-01

    To assess workforce and organizational issues in establishing a primary angioplasty service in England. Staff associated with the heart attack pathway at seven acute hospitals participating in the National Infarct Angioplasty Project (NIAP) completed a questionnaire, participated in focus groups and interviews, and observations were undertaken in catheter laboratories. All seven hospitals implemented primary angioplasty though not all provided a 24-hour service. Hospitals varied in size, number of staff involved in the delivery of angioplasty and the volume of cases. Hospitals that developed the service by incremental expansion encountered more problems than hospitals that planned for a full service at the outset. Simple, direct access to a catheter laboratory reduced delays and could be facilitated by an angioplasty gatekeeper. Little attention was paid to later cardiac rehabilitation. Multiskilling and the ability to work across traditional professional boundaries appeared to provide substantial advantages. Building relationships with key staff and auditing the heart attack pathway were critical to successful service development. Differences in remuneration and rest for staff undertaking out-of-hours working threatened sustainability. Primary angioplasty was feasible in varied settings and generally supported by staff. However, the participating hospitals were selected enthusiasts, only some implemented a 24-hour service and activity levels were relatively low. Organizational and workforce issues need to be addressed to achieve an efficient and sustainable service.

  17. Lessons learnt from an international intercomparison of national network systems used to provide early warning of a nuclear accident

    DEFF Research Database (Denmark)

    Saez-Vergara, J.C.; Thompson, I.M.G.; Funck, E.

    2003-01-01

    and at the Underground Laboratory for Dosimetry and Spectrometry (UDO) of the Physikalisch-Technische Bundesanstalt (PTB) in Germany. The network systems are used continuously to monitor radiation levels throughout a country in order to give early warning of nuclear accidents having transboundary implications...... in order to be consistent with the preliminary report. In addition, in some cases the results are also given in terms of the quantity measured by each national network system. The experience gained from this intercomparison is used to help organise a follow-up intercomparison to be held at the PTB...

  18. Lessons learnt from an international intercomparison of national network systems used to provide early warning of a nuclear accident

    International Nuclear Information System (INIS)

    Saez-Vergara, J.C.; Thompson, I.M.G.; Funck, E.; Andersen, C.E.; Neumaier, S.; Botter-Jensen, L.

    2003-01-01

    As part of the European Research Council's Fourth Framework Programme, the EURADOS Action Group on Monitoring of External Exposures held an intercomparison of national network systems. This took place during May/June 1999 at the Riso Natural Environmental Radiation Measurement Station in Denmark and at the Underground Laboratory for Dosimetry and Spectrometry of the Physikalisch-Technische Bundesanstalt in Germany. The network systems are used continuously to monitor radiation levels throughout a country in order to give early warning of nuclear accidents having transboundary implications. The radiation levels measured are used to estimate the radiation risks to people arising from the accident. Seven European countries participated in the intercomparison with detector systems used in their national network systems as well as with detectors being developed for future use. Since different radiation quantities were measured by the systems (namely exposure, air kerma and ambient dose equivalent), the initial analysis of the intercomparison results was made in terms of the quantity air kerma rate. This report completes the analysis of the results and these are given in terms of air kerma rate in order to be consistent with the preliminary report. In addition, in some cases the results are also given in terms of the quantity measured by each national network system. The experience gained from this intercomparison is used to help organise a follow-up intercomparison to be held at the PTB Braunschweig in September 2002 and in which a further seven or eight countries from Europe will participate. (author)

  19. Establishing and Scaling-Up Clinical Social Franchise Networks: Lessons Learned From Marie Stopes International and Population Services International

    OpenAIRE

    Thurston, Sarah; Chakraborty, Nirali M; Hayes, Brendan; Mackay, Anna; Moon, Pierre

    2015-01-01

    In many low- and middle-income countries, a majority of people seek health care from the private sector. However, fragmentation, poor economies of scale, inadequate financing, political opposition, a bias toward curative services, and weak regulatory and quality control systems pose serious challenges for the private sector. Social franchising addresses a number of these challenges by organizing small, independent health care businesses into quality-assured networks. Global franchisors Marie ...

  20. [Coronary angioplasty with the Monorail system via 6 French diagnostic catheters].

    Science.gov (United States)

    Villavicencio, R; González, H; López, J; Zavala, E; Ban Hayashi, E B; Gaspar, J; Gil, M; Martínez Ríos, M A

    1994-01-01

    We studied the use of "Monorail" system with Express (Scimed) balloon catheters for coronary angioplasty through 6 French (F) "high-flow" diagnostic catheters (Novoste, USCI). Prospectively, from July 1992 to January 1993, angioplasty of 31 lesions in 24 patients was attempted (1.3 lesions/procedure). Twenty procedures were of a single lesion and four were multi-vessel angioplasty. Fourteen lesions were in the left anterior descending or in its branches, 10 in the left circumflex or in its branches, 6 in the right coronary artery, and one in the distal anastomosis of an internal mammary artery graft. Thirteen lesions (42%) were type A, 17 (55%) type B and one (3%) type C. Balloon sizes varied between 2.0 and 3.5 mm. Twenty-nine lesions could be successfully dilated (93.5%); two cases were unsuccessful due to an acute occlusion in one and residual stenosis of more than 50% in the other. For only one case, another balloon catheter different from the "Monorail" system was necessary to complete a multi-vessel angioplasty. Coronary visualization and manipulation of the balloon through the tip of the diagnostic catheter were satisfactory in all cases, except with the 3.5 mm balloon catheter. Coronary angioplasty with "Monorail" system balloon catheters through 6 F "high-flow" diagnostic catheters is feasible and provides a high success rate in simple and moderately complex selected lesions, including multivessel angioplasty with advantages of smaller artery punction and the feasibility of performing coronary angioplasty with the same catheter used for diagnostic angiography.

  1. Application of conjugated heparin-albumin microparticles with laser-balloon angioplasty: a potential method for reducing adverse biologic reactivity after angioplasty

    Science.gov (United States)

    Kundu, Sourav K.; McMath, Linda P.; Zaidan, Jonathan T.; Spears, J. Richard

    1991-05-01

    Laser-balloon angioplasty (LBA) may potentially be used for local application of pharmacologically active agents which will reduce thrombogenic and proliferative responses after the angioplasty. In this study, the feasibility of applying covalently conjugated heparin- albumin microparticles onto arterial luminal surface was demonstrated. The covalent linkages were formed by reaction with 1-ethyl-3-dimethyl-aminopropyl-carbodiimide (EDC), and the resultant conjugates were used for preparation of microparticles by employing standard emulsification and heat-crosslinking techniques. The heparin release rate from the microparticles was found to be dependent upon the degree of crosslinking. When a thin coagulum of a suspension of microparticles was formed with heat on a glass surface, the treated surface demonstrated resistance to clot formation in contact with non-anticoagulated blood. A suspension of the microparticles applied during laser-balloon angioplasty onto the luminal surface of dog carotid and femoral arteries showed persistence for up to one week without thrombus formation or occlusion of the vessel. Since the rate of biodegradation is primarily dictated by the extent of crosslinking, an optimal degree of thermal denaturation will permit longer persistence of the carrier while allowing adequate release of the entrapped pharmacologic agent. A variety of antithrombotic and antiinflammatory agents are being considered as candidate bioprotective materials for local application after angioplasty.

  2. Radar subpixel-scale rainfall variability and uncertainty: lessons learned from observations of a dense rain-gauge network

    Directory of Open Access Journals (Sweden)

    N. Peleg

    2013-06-01

    Full Text Available Runoff and flash flood generation are very sensitive to rainfall's spatial and temporal variability. The increasing use of radar and satellite data in hydrological applications, due to the sparse distribution of rain gauges over most catchments worldwide, requires furthering our knowledge of the uncertainties of these data. In 2011, a new super-dense network of rain gauges containing 14 stations, each with two side-by-side gauges, was installed within a 4 km2 study area near Kibbutz Galed in northern Israel. This network was established for a detailed exploration of the uncertainties and errors regarding rainfall variability within a common pixel size of data obtained from remote sensing systems for timescales of 1 min to daily. In this paper, we present the analysis of the first year's record collected from this network and from the Shacham weather radar, located 63 km from the study area. The gauge–rainfall spatial correlation and uncertainty were examined along with the estimated radar error. The nugget parameter of the inter-gauge rainfall correlations was high (0.92 on the 1 min scale and increased as the timescale increased. The variance reduction factor (VRF, representing the uncertainty from averaging a number of rain stations per pixel, ranged from 1.6% for the 1 min timescale to 0.07% for the daily scale. It was also found that at least three rain stations are needed to adequately represent the rainfall (VRF < 5% on a typical radar pixel scale. The difference between radar and rain gauge rainfall was mainly attributed to radar estimation errors, while the gauge sampling error contributed up to 20% to the total difference. The ratio of radar rainfall to gauge-areal-averaged rainfall, expressed by the error distribution scatter parameter, decreased from 5.27 dB for 3 min timescale to 3.21 dB for the daily scale. The analysis of the radar errors and uncertainties suggest that a temporal scale of at least 10 min should be used for

  3. Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

    Energy Technology Data Exchange (ETDEWEB)

    Song, Jang Hyeon; Lee, Seung Jin; Jung, Hye Doo; Lim, Jae Hoon; Chang, Nam Kyu; Yim, Nam Yeol; Kim, Jae Kyu [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Lee, Keun Bae [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2011-09-15

    To assess the efficacy of percutaneous transluminal angioplasty (PTA) in patients with infrapopliteal arterial disease, and to determine the influencing factor for prognosis. A total of 55 patients (60 limbs) with infrapopliteal arterial stenosis or occlusion underwent PTA. Atherosclerotic risk factors, clinical symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and vascular wall calcification were evaluated before PTA. The number of patent infrapopliteal arteries was estimated, and the outcome was evaluated by symptom relief and limb salvage. Technical success was achieved in 53/60 limbs (88.3%) and 81/93 arteries (87.1%), TASC classification (p = 0.038) and vascular calcification (p = 0.002) influenced on technical failure. During follow-up, 26 of 55 limbs (47%) achieved symptom relief and 42/55 limbs (76%) underwent limb salvage. Non-diabetic patients (9/12, 75%) were superior to diabetic patients (17/43, 40%) in terms of symptom relief (p = 0.024). TASC classification and vascular wall calcification influenced on symptom relief and limb salvage. The number of patent infrapopliteal arteries after PTA influenced symptom relief (p < 0.001) and limb amputation (p = 0.003). PTA in patients with chronic critical limb ischemia is worthwhile as a primary treatment. The influence factors should be considered before PTA, and PTA should be performed in as many involved arteries as possible.

  4. Learning curve for intracranial angioplasty and stenting in single center.

    Science.gov (United States)

    Cai, Qiankun; Li, Yongkun; Xu, Gelin; Sun, Wen; Xiong, Yunyun; Sun, Wenshan; Bao, Yuanfei; Huang, Xianjun; Zhang, Yao; Zhou, Lulu; Zhu, Wusheng; Liu, Xinfeng

    2014-01-01

    To identify the specific caseload to overcome learning curve effect based on data from consecutive patients treated with Intracranial Angioplasty and Stenting (IAS) in our center. The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis trial was prematurely terminated owing to the high rate of periprocedural complications in the endovascular arm. To date, there are no data available for determining the essential caseload sufficient to overcome the learning effect and perform IAS with an acceptable level of complications. Between March 2004 and May 2012, 188 consecutive patients with 194 lesions who underwent IAS were analyzed retrospectively. The outcome variables used to assess the learning curve were periprocedural complications (included transient ischemic attack, ischemic stroke, vessel rupture, cerebral hyperperfusion syndrome, and vessel perforation). Multivariable logistic regression analysis was employed to illustrate the existence of learning curve effect on IAS. A risk-adjusted cumulative sum chart was performed to identify the specific caseload to overcome learning curve effect. The overall rate of 30-days periprocedural complications was 12.4% (24/194). After adjusting for case-mix, multivariate logistic regression analysis showed that operator experience was an independent predictor for periprocedural complications. The learning curve of IAS to overcome complications in a risk-adjusted manner was 21 cases. Operator's level of experience significantly affected the outcome of IAS. Moreover, we observed that the amount of experience sufficient for performing IAS in our center was 21 cases. Copyright © 2013 Wiley Periodicals, Inc.

  5. Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

    International Nuclear Information System (INIS)

    Song, Jang Hyeon; Lee, Seung Jin; Jung, Hye Doo; Lim, Jae Hoon; Chang, Nam Kyu; Yim, Nam Yeol; Kim, Jae Kyu; Lee, Keun Bae

    2011-01-01

    To assess the efficacy of percutaneous transluminal angioplasty (PTA) in patients with infrapopliteal arterial disease, and to determine the influencing factor for prognosis. A total of 55 patients (60 limbs) with infrapopliteal arterial stenosis or occlusion underwent PTA. Atherosclerotic risk factors, clinical symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and vascular wall calcification were evaluated before PTA. The number of patent infrapopliteal arteries was estimated, and the outcome was evaluated by symptom relief and limb salvage. Technical success was achieved in 53/60 limbs (88.3%) and 81/93 arteries (87.1%), TASC classification (p = 0.038) and vascular calcification (p = 0.002) influenced on technical failure. During follow-up, 26 of 55 limbs (47%) achieved symptom relief and 42/55 limbs (76%) underwent limb salvage. Non-diabetic patients (9/12, 75%) were superior to diabetic patients (17/43, 40%) in terms of symptom relief (p = 0.024). TASC classification and vascular wall calcification influenced on symptom relief and limb salvage. The number of patent infrapopliteal arteries after PTA influenced symptom relief (p < 0.001) and limb amputation (p = 0.003). PTA in patients with chronic critical limb ischemia is worthwhile as a primary treatment. The influence factors should be considered before PTA, and PTA should be performed in as many involved arteries as possible.

  6. Early outcomes after carotid angioplasty with stenting performed by neurologists

    Directory of Open Access Journals (Sweden)

    Bathala Lokesh

    2010-01-01

    Full Text Available Aims: To evaluate the results of carotid artery angioplasty and stenting (CAS in treating extracranial carotid artery stenosis performed by neurologists in our center and compare the results with other large published series. Materials and Methods: Data for all patients who underwent CAS from January 2003 through November 2007, was retrieved from the Nanjing Stroke Registry. Perioperative and post-procedural complications within 30 days following stenting were analyzed and compared with that from other series. A total number of 75 patients were enrolled, with a mean age of 65.9 ± 8.8 years, and 64 (85.3% of them were male. Results: Procedural success was achieved in 74 patients (98.7%. Pre-treatment stenosis was 73.8 ± 14.9 and post-treatment residual stenosis was less than 10%. Thirty-four patients (45.3% had bilateral carotid artery disease and seven (9.3% had tandem stenosis. The neurological complication rate was 3.9% (one major and two minor strokes. Bradycardia in four (5.3% and hypotension in 13 (17.3% were observed during procedures. Using the Fischer′s exact t test, the complication rate compared with the large published series did not reveal any statistically significant difference (P > 0.05. Conclusions: We conclude that neurologists, with adequate training, can develop and add this technical skill to the existing cognitive skill of vascular neurology and safely perform stenting.

  7. [Experimental ultrasound angioplasty: in vitro resolution of thrombi].

    Science.gov (United States)

    Stähr, P; Erbel, R; Weber, W; Fischer, H; Meyer, J

    1995-05-01

    A new ultrasonic angioplasty ablation catheter connected to a 19.5 kHz. 25 W transducer was tested in vitro for its ability to disrupt 12-h. 24-h, and 5-day-old whole blood thrombi (n = 45.697 mg +/- 223 mg) and fibrin thrombi (n = 45.338 mg +/- 133 mg), as well as 5-day-old cadaver thrombi (n = 8.270 mg +/- 71 mg) within 10 min. Five of each age were used as control thrombi in which the catheter was moved back and forth without ultrasound emission. The size of ablated thrombus particles was measured by a laser device. The power output at the end of the catheter was assessed calorimetrically. The loss of weight of whole blood thrombi was between 429 (74%) and 524 mg (91%) (p power output at the catheter tip was 5.9 W compared to the power output of 25 W at the ultrasound generator.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Carotid angioplasty and stenting under protection. Techniques, results and limitations.

    Science.gov (United States)

    Henry, M; Polydorou, A; Henry, I; Anagnostopoulou, I S; Polydorou, I A; Hugel, M

    2006-10-01

    A carotid stenosis is responsible for about 30% of strokes occurring. Carotid endarterectomy (CEA) is considered to be the gold standard treatment of a carotid stenosis. Carotid angioplasty and stenting (CAS) is emerging as a new alternative treatment for a carotid artery stenosis, but the risk of neurological complications and brain embolism remains the major drawback to this procedure. Therefore, in order to reduce the risks, we need: 1) good indications, good patient and lesion selection; 2) correct techniques; 3) brain protection devices (cerebral protection devices should be routinely used and are mandatory for any procedure); 4) 3 types of protection devices are available, but filters are the most commonly used (all protection devices have limitations and cannot prevent from all embolic events; however, neurological complications can be reduced by 60%); 5) a good choice of the stent and correct implantation (all stents are not equivalent and have different geometrical effects); 6) pharmacological adjuncts; 7) a good team. Recent studies have shown that CAS has superior short-term outcomes than CEA in high surgical risk patients, but there are enough reported data to conclude that CAS is also not inferior to CEA in low-risk patients. CAS under protection is the standard of care and is maybe becoming the gold standard treatment of a carotid stenosis at least in some subgroups of patients.

  9. Clinical experience with the Monorail balloon catheter for coronary angioplasty.

    Science.gov (United States)

    Finci, L; Meier, B; Roy, P; Steffenino, G; Rutishauser, W

    1988-01-01

    The Monorail balloon catheter is distinctly different from other current balloon catheters: the guidewire passes through the balloon itself, exits the catheter proximal to the balloon, and runs alongside its small shaft (3 French) through the guiding catheter. Monorail coronary angioplasty was attempted in 61 patients on 73 lesions with balloons from 2.0 to 3.7 mm. Angiographic success was obtained in 66 lesions (90%). For 15 lesions, balloon exchanges were needed. In three lesions, the Monorail balloon failed to cross the lesion, while a standard balloon succeeded; two lesions could not be crossed with any balloon. Vessel occlusion occurred in four patients: two had emergency surgery without infarct (one died suddenly 4 days later and one had a stroke 1 day later), one was recanalized with a standard balloon, and one had a myocardial infarct. Continuous infusion of urokinase was used until patient 3 in whom problems with the delivery system led to cardiocerebral air embolization (with complete recovery). No thrombotic complications were observed in the subsequent 58 patients with only a bolus of 10,000 U of heparin. The Monorail balloon facilitates contrast injections and balloon exchanges but appears more difficult to pass through tight lesions. Omission of the previously recommended infusion with a thrombolytic agent proved safe.

  10. Occupational contact urticaria: lessons from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P).

    Science.gov (United States)

    Bensefa-Colas, L; Telle-Lamberton, M; Faye, S; Bourrain, J-L; Crépy, M-N; Lasfargues, G; Choudat, D; Momas, I

    2015-12-01

    Occupational contact urticaria (OCU) is an occupational contact dermatitis that can cause serious health consequences and disability at work. To describe OCU and its temporal trends by the main causal agents and activity sectors in a nationwide scheme in France. Using data from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P), we described OCU reported during the period 2001-10 and analysed the temporal trends of OCU and OCU attributed to the most frequent agents over the study period. Trends analyses were supported by reporting odds ratios using a logistic regression model with reference to 2001, or with time as a continuous variable. During the study period, 251 cases of OCU were reported in RNV3P, half of which were due to natural rubber latex, in particular in the health and social work activity sector (HSW). The number of these cases declined significantly over the study period (19% per year), and particularly after 2006. Conversely, the other causes of OCU did not decrease. Using surveillance data from a French national network, this study has found that there was a significant decline in OCU due to natural rubber latex, particularly in the HSW, when powdered latex gloves were banned from French hospitals. Our results show the effectiveness of this preventive measure, and suggest that this practice should be extended to other sectors. © 2015 British Association of Dermatologists.

  11. Lessons Learned from the First Two Years of Nature's Notebook, the USA National Phenology Network's Plant and Animal Observation Program

    Science.gov (United States)

    Crimmins, T. M.; Rosemartin, A.; Denny, E. G.; Weltzin, J. F.; Marsh, L.

    2010-12-01

    Nature’s Notebook is the USA National Phenology Network’s (USA-NPN) national-scale plant and animal phenology observation program. The program was launched in March 2009 focusing only on plants; 2010 saw the addition of animals and the name and identity “Nature’s Notebook.” Over these two years, we have learned much about how to effectively recruit, train, and retain participants. We have engaged several thousand participants and can report a retention rate, reflected in the number of registered individuals that report observations, of approximately 25%. In 2009, participants reported observations on 133 species of plants on an average of nine days of the year, resulting in over 151,000 records in the USA-NPN phenology database. Results for the 2010 growing season are still being reported. Some of our most valuable lessons learned have been gleaned from communications with our observers. Through an informal survey, participants indicated that they would like to see more regular and consistent communications from USA-NPN program staff; clear, concise, and readily available training materials; mechanisms to keep them engaged and continuing to participate; and quick turn-around on data summaries. We are using this feedback to shape our program into the future. Another key observation we’ve made about our program is the value of locally and regionally-based efforts to implement Nature’s Notebook; some of our most committed observers are participating through partner programs such as the University of California-Santa Barbara Phenology Stewardship Program, Arbor Day Foundation, and the Great Sunflower Project. Future plans include reaching out to more partner organizations and improving our support for locally-based implementations of the Nature’s Notebook program. We have also recognized that the means for reaching and retaining potential participants in Nature’s Notebook vary greatly across generations. As the majority of our participants to

  12. Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial.

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2009-10-01

    Endovascular treatment (angioplasty with or without stenting) is an alternative to carotid endarterectomy for carotid artery stenosis but there are scarce long-term efficacy data showing that it prevents stroke. We therefore report the long-term results of the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS).

  13. Use of Reactor-Produced Radioisotopes for Prevention Restenosis After Angioplasty

    International Nuclear Information System (INIS)

    Knapp, F.F.; Pipes, D.W.

    1999-01-01

    Coronary heart disease leads to myocardial infarction and is a major cause of death in the US. Myocardial infarctions result from atherosclerotic plaque deposits in the coronary arteries, reducing blood flow through these arteries which supply oxygen and nutrients to the heart muscle. The two major approaches for restoring adequate blood flow are coronary bypass graft surgery and coronary angioplasty. Angioplasty is a routinely used clinical procedure, where a deflated balloon attached to the end of a long catheter is inserted into an artery in the leg and then advanced through the aorta into the blocked regions of the coronary arteries. After positioning in the occluded region of the artery, the balloon is inflated with a pressurized saline solution which opens the artery restoring blood flow by pressing the atherosclerotic plaque into the vessel wall. Angioplasty is a widely performed procedure with the coronary arteries and is a much less expensive alternative to coronary bypass surgery. The best patients for angioplasty are those with single occlusions and this method is preferred over bypass grafting because of the significantly reduced expense. The reformation of plaque deposits in arteries (restenosis) following angioplasty, however, is a major clinical problem encountered in as high as 40 percent of patients. Because reduction of health care costs is a major national priority, development of effective new preventative methods for restenoses is an important national priority

  14. Establishing and Scaling-Up Clinical Social Franchise Networks: Lessons Learned From Marie Stopes International and Population Services International

    Science.gov (United States)

    Thurston, Sarah; Chakraborty, Nirali M; Hayes, Brendan; Mackay, Anna; Moon, Pierre

    2015-01-01

    In many low- and middle-income countries, a majority of people seek health care from the private sector. However, fragmentation, poor economies of scale, inadequate financing, political opposition, a bias toward curative services, and weak regulatory and quality control systems pose serious challenges for the private sector. Social franchising addresses a number of these challenges by organizing small, independent health care businesses into quality-assured networks. Global franchisors Marie Stopes International (MSI) and Population Services International (PSI) have rapidly scaled their family planning social franchising programs in recent years, jointly delivering over 10.8 million couple-years of protection (CYPs) in 2014—up 26% from 8.6 million CYPs just 1 year prior. Drawing on experience across MSI’s 17 and PSI’s 25 social franchise networks across Africa, Asia, and Latin America and the Caribbean, this article documents the organizations’ operational approaches, challenges faced, and solutions implemented. The organizations provide intensive capacity building and support for private-sector providers, including clinical training, branding, monitoring quality of franchised services, and commodity support. In addition, franchising programs engage providers and clients through behavior change communication (BCC) and demand generation activities to raise awareness and to attract clients, and they implement initiatives to ensure services are affordable for the lowest-income clients. Social franchise programs offer the private sector a collective platform to better engage government in health policy advocacy and for integrating into new public health care financing and procurement mechanisms. The future of social franchising will require developing approaches to scale-up and sustain the model cost-effectively, selectively integrating other health services into the franchise package, and being responsive to evolving health care financing approaches with the

  15. Lessons for successful study enrollment from the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study.

    Science.gov (United States)

    Crowley, Susan T; Chertow, Glenn M; Vitale, Joseph; O'Connor, Theresa; Zhang, Jane; Schein, Roland M H; Choudhury, Devasmita; Finkel, Kevin; Vijayan, Anitha; Paganini, Emil; Palevsky, Paul M

    2008-07-01

    Design elements of clinical trials can introduce recruitment bias and reduce study efficiency. Trials involving the critically ill may be particularly prone to design-related inefficiencies. Enrollment into the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study was systematically monitored. Reasons for nonenrollment into this study comparing strategies of renal replacement therapy in critically ill patients with acute kidney injury were categorized as modifiable or nonmodifiable. 4339 patients were screened; 2744 fulfilled inclusion criteria. Of these, 1034 were ineligible by exclusion criteria. Of the remaining 1710 patients, 1124 (65.7%) enrolled. Impediments to informed consent excluded 21.4% of potentially eligible patients. Delayed identification of potential patients, physician refusal, and involvement in competing trials accounted for 4.4, 2.7, and 2.3% of exclusions. Comfort measures only status, chronic illness, chronic kidney disease, and obesity excluded 11.8, 7.8, 7.6, and 5.9% of potential patients. Modification of an enrollment window reduced the loss of patients from 6.6 to 2.3%. The Acute Renal Failure Trial Network Study's enrollment efficiency compared favorably with previous intensive care unit intervention trials and supports the representativeness of its enrolled population. Impediments to informed consent highlight the need for nontraditional acquisition methods. Restrictive enrollment windows may hamper recruitment but can be effectively modified. The low rate of physician refusal acknowledges clinical equipoise in the study design. Underlying comorbidities are important design considerations for future trials that involve the critically ill with acute kidney injury.

  16. Applying Collaborative Learning and Quality Improvement to Public Health: Lessons from the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality.

    Science.gov (United States)

    Ghandour, Reem M; Flaherty, Katherine; Hirai, Ashley; Lee, Vanessa; Walker, Deborah Klein; Lu, Michael C

    2017-06-01

    Infant mortality remains a significant public health problem in the U.S. The Collaborative Improvement & Innovation Network (CoIIN) model is an innovative approach, using the science of quality improvement and collaborative learning, which was applied across 13 Southern states in Public Health Regions IV and VI to reduce infant mortality and improve birth outcomes. We provide an in-depth discussion of the history, development, implementation, and adaptation of the model based on the experience of the original CoIIN organizers and participants. In addition to the political genesis and functional components of the initiative, 8 key lessons related to staffing, planning, and implementing future CoIINs are described in detail. This paper reports the findings from a process evaluation of the model. Data on the states' progress toward reducing infant mortality and improving birth outcomes were collected through a survey in the final months of a 24-month implementation period, as well as through ongoing team communications. The peer-to-peer exchange and platform for collaborative learning, as well as the sharing of data across the states, were major strengths and form the foundation for future CoIIN efforts. A lasting legacy of the initiative is the unique application and sharing of provisional "real time" data to inform "real time" decision-making. The CoIIN model of collaborative learning, QI, and innovation offers a promising approach to strengthening partnerships within and across states, bolstering data systems to inform and track progress more rapidly, and ultimately accelerating improvement toward healthier communities, States, and the Nation as a whole.

  17. Post-angioplasty far infrared radiation therapy improves 1-year angioplasty-free hemodialysis access patency of recurrent obstructive lesions.

    Science.gov (United States)

    Lai, C-C; Fang, H-C; Mar, G-Y; Liou, J-C; Tseng, C-J; Liu, C-P

    2013-12-01

    To explore the role of far infrared (FIR) radiation therapy for hemodialysis (HD) access maintenance after percutaneous transluminal angioplasties (PTA). This was a prospective observational study. Eligible patients were those who received repeated PTA with the last PTA successfully performed within 1 week before the study enrollments. Consecutively enrolled patients undergoing successful HD treatments after PTA were randomly assigned to the FIR-radiated group or control group without radiation. FIR-radiated therapy meaning 40-minute radiation at the major lesion site or anastomosed site three times a week was continued until an end-point defined as dysfunction-driven re-PTA or the study end was reached. Of 216 participants analyzed, including 97 with arteriovenous grafts (AVG) (49 FIR-radiated participants and 48 control participants) and 119 with arteriovenous fistulas (AVF) (69 FIR-radiated participants and 50 control participants), the FIR-radiated therapy compared with free-radiated usual therapy significantly enhanced PTA-unassisted patency at 1 year in the AVG subgroup (16.3% vs. 2.1%; p radiated therapy improves PTA-unassisted patency in patients with AVG who have undergone previous PTA. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  18. Percutaneous transluminal angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child after liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Yussim, Ethan; Belenky, Alexander; Atar, Eli [Department of Diagnostic Radiology, Rabin Medical Center, Vascular and Interventional Radiology Unit, Petah Tikva (Israel); Shapiro, Rivka [Schneider Children' s Medical Center, Institute of Pediatric Gastroenterology and Nutrition, Petah Tikva (Israel); Mor, Eytan [Rabin Medical Center, Department of Organ Transplantation, Petah Tikva (Israel)

    2005-07-01

    Percutaneous transluminal angioplasty is increasingly used in children. We present a case of successful balloon angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child who underwent liver transplantation because of biliary atresia. Percutaneous reopening of the shunt is a relatively safe procedure that may spare patients of surgical intervention. (orig.)

  19. Percutaneous transluminal angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child after liver transplantation

    International Nuclear Information System (INIS)

    Yussim, Ethan; Belenky, Alexander; Atar, Eli; Shapiro, Rivka; Mor, Eytan

    2005-01-01

    Percutaneous transluminal angioplasty is increasingly used in children. We present a case of successful balloon angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child who underwent liver transplantation because of biliary atresia. Percutaneous reopening of the shunt is a relatively safe procedure that may spare patients of surgical intervention. (orig.)

  20. Safety and efficacy of recombinant hirudin (CGP 39 393) versus heparin in patients with stable angina undergoing coronary angioplasty

    NARCIS (Netherlands)

    van den Bos, A. A.; Deckers, J. W.; Heyndrickx, G. R.; Laarman, G. J.; Suryapranata, H.; Zijlstra, F.; Close, P.; Rijnierse, J. J.; Buller, H. R.; Serruys, P. W.

    1993-01-01

    Enhanced thrombin activity has been associated with acute and long-term complications following balloon angioplasty (percutaneous transluminal coronary angioplasty (PTCA). We evaluated, in a 2-to-1 randomized, double-blind trial, the effects of recombinant hirudin, CGP 39 393, relative to

  1. Safety and efficacy of recombinant Hirudin (CGP 39 393) versus Heparin in patients with stable angina undergoing coronary angioplasty

    NARCIS (Netherlands)

    A.A. van den Bos (Arjan); G.R. Heyndrickx (Guy); G-J. Laarman (GertJan); H. Suryapranata (Harry); F. Zijlstra (Felix); P. Close (Philip); J.J.M.M. Rijnierse (Joep); H.R. Büller (Harry); P.W.J.C. Serruys (Patrick); J.W. Deckers (Jaap)

    1993-01-01

    textabstractBACKGROUND. Enhanced thrombin activity has been associated with acute and long-term complications following balloon angioplasty (percutaneous transluminal coronary angioplasty (PTCA). We evaluated, in a 2-to-1 randomized, double-blind trial, the effects of recombinant hirudin, CGP 39

  2. Establishing and Scaling-Up Clinical Social Franchise Networks: Lessons Learned From Marie Stopes International and Population Services International.

    Science.gov (United States)

    Thurston, Sarah; Chakraborty, Nirali M; Hayes, Brendan; Mackay, Anna; Moon, Pierre

    2015-06-17

    In many low- and middle-income countries, a majority of people seek health care from the private sector. However, fragmentation, poor economies of scale, inadequate financing, political opposition, a bias toward curative services, and weak regulatory and quality control systems pose serious challenges for the private sector. Social franchising addresses a number of these challenges by organizing small, independent health care businesses into quality-assured networks. Global franchisors Marie Stopes International (MSI) and Population Services International (PSI) have rapidly scaled their family planning social franchising programs in recent years, jointly delivering over 10.8 million couple-years of protection (CYPs) in 2014-up 26% from 8.6 million CYPs just 1 year prior. Drawing on experience across MSI's 17 and PSI's 25 social franchise networks across Africa, Asia, and Latin America and the Caribbean, this article documents the organizations' operational approaches, challenges faced, and solutions implemented. The organizations provide intensive capacity building and support for private-sector providers, including clinical training, branding, monitoring quality of franchised services, and commodity support. In addition, franchising programs engage providers and clients through behavior change communication (BCC) and demand generation activities to raise awareness and to attract clients, and they implement initiatives to ensure services are affordable for the lowest-income clients. Social franchise programs offer the private sector a collective platform to better engage government in health policy advocacy and for integrating into new public health care financing and procurement mechanisms. The future of social franchising will require developing approaches to scale-up and sustain the model cost-effectively, selectively integrating other health services into the franchise package, and being responsive to evolving health care financing approaches with the potential

  3. Exercise radionuclide ventriculography to detect restenosis following coronary angioplasty

    International Nuclear Information System (INIS)

    De Puey, E.G.; Leatherman, L.L.; Dear, W.E.; Leachman, R.D.; Massin, E.K.; Mathur, V.S.; Burdine, J.A.

    1984-01-01

    Forty one patients (pts) underwent semiupright exercise gated radionuclide ventriculography (EGRNV) before, within 3 d after single vessel transluminal coronary angioplasty (TCA), and 4 to 12 mos later, at which time follow-up cardiac catheterization was also performed. Prior to TCA 76% of pts had abnormal EGRNV, as defined by a failure to increase ejection fraction (EF) by 5 points or the development of a new regional wall motion abnormality. Stenosis was reduced from 90 +- 7% to 18 +- 17%. Early after TCA, exercise duration and maximum double product increased (p's 20% but <50%; Group III (n=8): ≥ 50%] Pts with abnormal EGRNV early after TCA were demonstrated to have a greater percent increase in stenosis at late follow-up than pts with normal EGRNV (41 +- 30% vs 19 +- 25%, p<.001). Early after TCA EGRNV was abnormal in 5% of Group I pts vs 75% in Group III (p<.01), and EF increased to a greater degree during exercise in Group I pts (+11.3 +- 7.5 vs +3.5 +- 6.5 points, p<.01). At 4-12 mos EGRNV was abnormal in 27% of Group I vs 88% of Group III (p<.01), and during exercise EF increased in Group I pts (+11.8 +- 7.8 points) but decreased in Group III (-1.9 +- 8.7 points) (p<.0005). The accuracy of abnormal EGRNV in predicting ≥ 50% restenosis was 73% early post-TCA and 77% at 4-12 mos. The authors conclude that EGRNV is a valuable test to verify the success of TCA and to detect subsequent restenosis

  4. Retrograde vs. Antegrade Puncture for Infra-Inguinal Angioplasty

    International Nuclear Information System (INIS)

    Nice, C.; Timmons, G.; Bartholemew, P.; Uberoi, R.

    2003-01-01

    This study was done to compare antegrade punctures with a retrograde puncture technique for infrainguinal angioplasty. A group of 100 consecutive patients (71 men, 29 women) were randomized for antegrade puncture or retrograde puncture of the common femoral artery. Following retrograde puncture the guidewire was 'turned' and placed into the superficial femoral artery. The time for gaining access, screening time, radiation dose, patient height, weight and complications were recorded. All patients were reviewed the day after the procedure and within 3 months. Data from 46 patients (34 males and 12 females) in the retrograde group and 44 (28 males and 16 females) in the antegrade group were available for analysis. Mean procedure time,screening time, radiation dose, height and weight were 8.3 minutes(range 3-22), 2.1 minutes (0.3-6.5), 7950 mGy cm -2 (820-71250), 169 cm (149-204) and 79 kg (32-108) for retrograde puncture and 8 min (2-60), 0.7 min (0.0-3.2), 1069 mGycm -2 (0-15400), 169 cm (152-186) and 75 kg (39-125) for antegrade punctures, respectively. An average of 1.2 (1-2) punctures was required for retrograde and 1.75 (1-8) for antegrade. Seven small hematomas occurred with antegrade and three for retrograde puncture.Retrograde puncture is technically easier with a tendency to fewer complications but results in a higher radiation dose. This technique should be used in difficult patients at high risk of haematoma formation

  5. Usefulness of percutaneous transluminal coronary angioplasty in silent myocardial ischemia

    International Nuclear Information System (INIS)

    Hou, Mami

    1996-01-01

    The usefulness of percutaneous transluminal coronary angioplasty (PTCA) was assessed in patients with exercise-induced asymptomatic myocardial ischemia (silent ischemia) and compared with exercise-induced symptomatic myocardial ischemia (symptomatic ischemia). Patients with single vessel coronary artery disease (51 with angina pectoris, 40 with old myocardial infarction) and evidence of stress-induced ischemia on thallium-201 single photon emission computed tomography (SPECT) underwent successful PTCA. Thirty-seven percent of angina patients and 60% of infarction patients showed asymptomatic exercise-induced ischemia. There was no significant difference in population characteristics between silent and symptomatic patients. Patients with silent angina had significantly higher percentage thallium uptake and washout rate than symptomatic patients. After PTCA, both percentage diameter stenosis and percentage thallium uptake were improved in all patients with angina irrespective of the presence or absence of symptoms. There were no significant differences in percentage thallium uptake and washout rate between patients with silent and symptomatic infarction. After PTCA, percentage diameter stenosis, percentage thallium uptake, and washout rate improved in all infarction patients irrespective of the symptoms. Zero percent of silent angina patients, 12% of symptomatic angina patients, 12% of silent infarction patients, 19% of symptomatic infarction patients had cardiac events during about 4.5 years after PTCA. The incidence of cardiac events did not significantly differ in any patient group. PTCA improved myocardial perfusion in all patients, and the incidence of cardiac events did not differ between the silent and symptomatic groups. Revascularization with PTCA is suitable for patients with silent as well as symptomatic ischemia. (author)

  6. Endovascular Revascularization of Symptomatic Infrapopliteal Arteriosclerotic Occlusive Disease: Comparison of Atherectomy and Angioplasty

    Science.gov (United States)

    Tan, Tze-Woei; Semaan, Elie; Nasr, Wael; Eberhardt, Robert T.; Hamburg, Naomi; Doros, Gheorghe; Rybin, Denis; Shaw, Palma M.; Farber, Alik

    2011-01-01

    The preferred method for revascularization of symptomatic infrapopliteal arterial occlusive disease (IPAD) has traditionally been open vascular bypass. Endovascular techniques have been increasingly applied to treat tibial disease with mixed results. We evaluated the short-term outcome of percutaneous infrapopliteal intervention and compared the different techniques used. A retrospective analysis of consecutive patients undergoing endovascular treatment for infrapopliteal arterial occlusive lesions between 2003 and 2007 in a tertiary teaching hospital was performed. Patient demographic data, indication for intervention, and periprocedural complications were recorded. Periprocedural and short-term outcomes were measured and compared. Forty-nine infrapopliteal arteries in 35 patients were treated. Twenty vessels (15 patients) underwent angioplasty and 29 vessels (20 patients) were treated with atherectomy. Demographic and angiographic characteristics were similar between the groups. Twenty-six patients had concurrent femoral and/or popliteal artery interventions. Overall, technical success was 90% and similar between angioplasty and atherectomy groups (85% versus 93%, p = NS). The vessel-specific complication rate was 10% and was similar between both groups (angioplasty 5% versus atherectomy 14%, p = NS). One dissection occurred in the angioplasty group; one perforation and three thromboembolic events occurred in the atherectomy group. Limb salvage and freedom from reintervention at 6 months were 81% and 68%, respectively, and were not significantly different between the angioplasty and atherectomy groups. Endovascular intervention for IPAD had acceptable periprocedural and short-term success rates in our high-risk patient population. Both atherectomy and angioplasty can be used successfully to treat symptomatic IPAD. PMID:22532766

  7. Predictors for adverse outcome after iliac angioplasty and stenting for limb-threatening ischemia.

    Science.gov (United States)

    Timaran, Carlos H; Stevens, Scott L; Freeman, Michael B; Goldman, Mitchell H

    2002-09-01

    The role of iliac artery angioplasty and stenting (IAS) for the treatment of limb-threatening ischemia is not defined. IAS has been used primarily for patients with disabling claudication. Because poorer results have been shown in patients with critical ischemia after iliac artery angioplasty, the purpose of this study was to estimate the influence of risk factors on the outcome of iliac angioplasty and stent placement in patients with limb-threatening ischemia. During a 5-year period (from 1996 to 2001), 85 iliac angioplasty and stent placement procedures (107 stents) were performed in 31 women and 43 men with limb-threatening ischemia. Patients with claudication were specifically excluded. The criteria prepared by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery) were followed to define the variables. The TransAtlantic InterSociety Consensus classification was used to characterize the type of iliac lesions. Both univariate (Kaplan-Meier [KM]) and multivariate analyses (Cox proportional hazards model) were used to determine the association between variables, cumulative patency, limb salvage, and survival. Indications for iliac angioplasty with stenting were ischemic rest pain (56%) and tissue loss (44%). Primary stenting was performed in 36 patients (42%). Stents were placed selectively after iliac angioplasty mainly for residual stenosis or pressure gradient (43%). Overall, primary stent patency rate was 90% at 1 year, 74% at 3 years, and 69% at 5 years. Primary stent patency rate was significantly reduced in women compared with men (KM, log-rank test, P 1.6 mg/dL; KM, log-rank test, P IAS. Limb salvage, as shown in this study, is not affected by previous iliac stent failure.

  8. Myocardial damage in successful vessel coronary angioplasty as assessed by creatinine kinase and its myocardium band isoenzyme levels

    International Nuclear Information System (INIS)

    Abbas, S.; Samor, N.A.; Kayani, A.M.

    2008-01-01

    To determine the frequency of myocardial damage in elective, successful, single vessel percutaneous coronary angioplasty by assessing myocardial band (MB), creatinine kinase levels and to find out the association of common modifiable risk factors with myocardial damage in patients undergoing single vessel coronary angioplasty. Fifty patients undergoing elective and successful single vessel percutaneous coronary angioplasty were evaluated with creatinine kinase and creatinine kinase MB levels before and after 8 hours and 1st day following coronary angioplasty. Studied variables included the length of stent deployed, maximum deployment pressure and total balloon inflation time, apart from hypertension, cholesterol level, smoking and diabetes mellitus. Out of 50 patients, 9 had raised creatinine kinase at 8 hours (18%) and 10 had raised creatinine kinase (20%) on 1st day following coronary angioplasty, 7 (14%) patients and 8 (16%) patients had raised creatinine kinase MB levels at 8 hours and 1st day following coronary angioplasty respectively. The rise of either was equal to or more than 3 times the normal limits. Modifiable risk factors, significantly associated with myocardial damage, were diabetes mellitus (p=0.006) and LDL levels (p=0.009) in patients undergoing single vessel coronary angioplasty. Successful elective, uncomplicated, single vessel coronary angioplasty resulted in some myocardial damage evident by mild rise in cardiac enzymes but rise of creatinine kinase MB above 3 times of normal, which signifies percutaneous coronary angioplasty-related myocardial infarction, was not seen. There was a significant association between diabetes mellitus, LDL levels and myocardial damage in patients undergoing coronary angioplasty but no significant association was found between hypertension, smoking and myocardial damage. (author)

  9. Pulmonary balloon angioplasty of chronic thromboembolic pulmonary hypertension (CTEPH) in surgically inaccessible cases

    International Nuclear Information System (INIS)

    Pitton, M.B.; Herber, S.; Thelen, M.; Mayer, E.

    2003-01-01

    The clinical course of patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH) depends on the distribution pattern of the thromboembolic material. In patients with thromboembolic findings in the central pulmonary segments pulmonary thrombendarterectomy (PTE) has excellent results and acceptable operative risk. This paper presents two surgically inaccessable cases that were successfully treated with balloon pulmonary angioplasty. Balloon angioplasty improved parenchymal perfusion, increased cardiac index (ΔCI + 19.2% [Case 1], and + 15.4% [2]), reduced pulmonary vascular resistance during follow-up (ΔPVRI - 25.0% [1] and - 15.9% [2]), and is discussed as an alternative treatment option for cases not suited for surgery. (orig.) [de

  10. Cost-effectiveness analysis of orbital atherectomy plus balloon angioplasty vs balloon angioplasty alone in subjects with calcified femoropopliteal lesions

    Science.gov (United States)

    Weinstock, Barry; Dattilo, Raymond; Diage, Tiffini

    2014-01-01

    Introduction As cost considerations become increasingly critical when selecting optimal endovascular treatment strategies, a cost-benefit analysis was conducted comparing the Diamondback 360°® Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc., St Paul, MN, USA) and balloon angioplasty (BA) vs BA alone for treatment of calcified femoropopliteal lesions. Patients and methods The clinical outcomes from COMPLIANCE 360°, a prospective, multicenter, randomized study comparing OAS+BA vs BA alone for treatment of calcified femoropopliteal lesions, were correlated with cost data and previously published quality of life data. Site of service, hospital charges, and associated medical resource utilization were obtained from Uniform Billing statements for index treatments and associated revascularizations out to 1 year. Hospital costs were estimated using hospital-specific, procedure-specific cost-to-charge ratios. Length of stay and procedural data were collected from participating study sites. Results Twenty-five subjects with 38 lesions and 25 subjects with 27 lesions were randomized to the OAS+BA and BA-alone groups, respectively. Mean hospital charges (US$51,755 vs US$39,922) and estimated hospital costs (US$15,100 vs US$11,016) were higher for OAS+BA compared with BA alone (not statistically significant). Stent utilization was statistically significantly higher with BA-alone treatment for all subjects (1.1 vs 0.1, P=0.001) and in the subset of subjects with one lesion (1.0 vs 0.1, Patherectomy for treatment of calcified femoropopliteal lesions, a longstanding challenge for peripheral artery disease interventionalists. PMID:24672251

  11. Percutaneous lower-extremity arterial interventions with primary balloon angioplasty versus Silverhawk atherectomy and adjunctive balloon angioplasty: randomized trial.

    Science.gov (United States)

    Shammas, Nicolas W; Coiner, Denise; Shammas, Gail A; Dippel, Eric J; Christensen, Lori; Jerin, Michael

    2011-09-01

    Target lesion revascularization (TLR) with primary percutaneous transluminal angioplasty (PTA) versus SilverHawk atherectomy and adjunctive PTA of de novo infrainguinal disease has not been well defined. This study was conducted to compare the two approaches. In this prospective, two-center randomized trial of PTA versus atherectomy of infrainguinal vessels, the primary endpoint of TLR was evaluated at 1 year. Secondary endpoints included the rate of "bailout" stent placement for suboptimal acute angiographic results and the rate of target vessel revascularization (TVR). Fifty-eight patients were included in the study. Of these, 29 (36 vessels) were randomized to the atherectomy arm and 29 (48 vessels) to the PTA arm. Final acute angiographic success rates were 100% in the PTA arm and 97.2% in the atherectomy arm (P value not significant). There was no statistical difference in TLR (16.7% vs 11.1%) or TVR (21.4% vs 11.1%) between the PTA and atherectomy groups, respectively. Bailout stent placement was performed in 18 of 29 patients (62.1%) in the PTA arm and eight of 29 patients (27.6%) in the atherectomy arm (P = .017). Major adverse events were similar between the PTA and atherectomy arms. Finally, when embolic filter protection was used, distal macroembolization occurred in 11 of 17 patients (64.7%) treated with atherectomy versus none of 10 in the PTA group (P atherectomy and primary PTA. Atherectomy reduced the need for bailout stent placement compared with primary PTA. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  12. Cutting-Balloon Angioplasty Versus Balloon Angioplasty as Treatment for Short Atherosclerotic Lesions in the Superficial Femoral Artery: Randomized Controlled Trial

    Energy Technology Data Exchange (ETDEWEB)

    Poncyljusz, Wojciech, E-mail: wponcyl@poczta.onet.pl; Falkowski, Aleksander, E-mail: bakhis@hot.pl [Pomeranian Medical University, Department of Interventional Radiology (Poland); Safranow, Krzysztof, E-mail: chrissaf@mp.pl; Rac, Monika, E-mail: carmon@pum.edu.pl [Pomeranian Medical University, Department of Biochemistry and Medical Chemistry (Poland); Zawierucha, Dariusz, E-mail: dariusz13@yahoo.com [Interventional Radiology, Sacred Heart Medical Center, River Bend (United States)

    2013-12-15

    Purpose: To evaluate the treatments of a short-segment atherosclerotic stenosis in the superficial femoral arteries with the cutting balloon angioplasty (CBA) versus conventional balloon angioplasty [percutaneous transluminal angioplasty (PTA)] in a randomized controlled trial. Material and Methods: The study group comprised 60 patients (33 men, 27 women; average age 64 years) with a short ({<=}5 cm) focal SFA de novo atherosclerotic stenosis associated with a history of intermittent claudication or rest pain. The primary end point of this study was the rate of binary restenosis in the treated segment 12 months after the intervention. All patients were evenly randomized to either the PTA or CBA treatment arms. Follow-up angiograms and ankle-brachial index (ABI) measurements were performed after 12 months. The evaluation of the restenosis rates and factors influencing its occurrence were calculated by logistic regression analysis. Results: In the intention-to-treat analysis, restenosis rates after 2-month follow-up were 9 of 30 (30 %) in the PTA group and 4 of 30 (13 %) in the CBA group (p = 0.117). In the actual treatment analysis, after exclusion of patients who required nitinol stent placement for a suboptimal result after angioplasty alone (5 patients in the PTA group and none in the CBA group), restenosis rates were 9 of 25 (36 %) and 4 of 30 (13 %), respectively (p = 0.049). In the intention-to-treat analysis there were also significant differences in ABI values between the PTA and CBA groups at 0.77 {+-} 0.11 versus 0.82 {+-} 0.12, respectively (p = 0.039), at 12 months. Conclusion: Based on the presented results of the trial, CBA seems to be a safer and more effective than PTA for treatment of short atherosclerotic lesions in the superior femoral artery.

  13. Percutaneous common femoral artery interventions using angioplasty, atherectomy, and stenting.

    Science.gov (United States)

    Mehta, Manish; Zhou, Yi; Paty, Philip S K; Teymouri, Medhi; Jafree, Kamran; Bakhtawar, Humayun; Hnath, Jeffrey; Feustel, Paul

    2016-08-01

    This study evaluated the feasibility, safety, and effectiveness of endovascular interventions for common femoral artery (CFA) occlusive disease. Using a prospectively maintained multicenter database, we analyzed outcomes in 167 consecutive patients who underwent percutaneous CFA interventions for Rutherford class 3 to class 6 (R3-R6) disease. The standardized treatment approach included primary percutaneous transluminal angioplasty (PTA) only, atherectomy + PTA, and provisional stenting. Outcomes included technical failure rate, recurrence, complications, and major or minor amputation rate. Data were analyzed using multivariate regression analysis. During a 7-year period, 167 patients with R3 (n = 91 [54.5%]) and R4 to R6 (n = 76 [45.5%]) disease underwent CFA interventions that included PTA only (n = 114 [68.2%]), atherectomy ± PTA (n = 38 [22.8%]), and provisional stenting (n = 15 [9.0%]) for failed atherectomy ± PTA. Procedure-related complications included pseudoaneurysm (n = 1 [0.6%]), thrombosis (n = 1 [0.6%]), distal embolization (n = 1 [0.6%]), and death (R6, n = 1 [0.06%]). CFA restenosis was observed in 34 (20.4%) patents; these underwent further percutaneous (n = 18 [10.8%]) or surgical (n = 17 [10.2%]) revascularization that included CFA endarterectomy ± femoral distal bypass. Major or minor amputations were observed in none of the R3 patients and in only three (3.9%) and five (6.5%) of the R4 to R6 patients, respectively. Compared with the atherectomy + PTA group, patients in the PTA-only group had a significantly lower patency. Furthermore, during long-term mean follow-up of 42.5 months, the CFA provisional stent group had a 100% primary patency, which was significantly better than the primary patency in the CFA nonstent groups combined (77.0%; P = .0424). Data from this study to date would suggest that percutaneous CFA interventions in select patients are relatively safe and effective. In the long term, CFA stenting has

  14. Prevention of subsequent exercise-induced periinfarct ischemia by emergency coronary angioplasty in acute myocardial infarction: comparison with intracoronary streptokinase

    International Nuclear Information System (INIS)

    Fung, A.Y.; Lai, P.; Juni, J.E.; Bourdillon, P.D.; Walton, J.A. Jr.; Laufer, N.; Buda, A.J.; Pitt, B.; O'Neill, W.W.

    1986-01-01

    To compare the efficacy of emergency percutaneous transluminal coronary angioplasty and intracoronary streptokinase in preventing exercise-induced periinfarct ischemia, 28 patients presenting within 12 hours of the onset of symptoms of acute myocardial infarction were prospectively randomized. Of these, 14 patients were treated with emergency angioplasty and 14 patients received intracoronary streptokinase. Recatheterization and submaximal exercise thallium-201 single photon emission computed tomography were performed before hospital discharge. Periinfarct ischemia was defined as a reversible thallium defect adjacent to a fixed defect assessed qualitatively. Successful reperfusion was achieved in 86% of patients treated with emergency angioplasty and 86% of patients treated with intracoronary streptokinase (p = NS). Residual stenosis of the infarct-related coronary artery shown at predischarge angiography was 43.8 +/- 31.4% for the angioplasty group and 75.0 +/- 15.6% for the streptokinase group (p less than 0.05). Of the angioplasty group, 9% developed exercise-induced periinfarct ischemia compared with 60% of the streptokinase group (p less than 0.05). Thus, patients with acute myocardial infarction treated with emergency angioplasty had significantly less severe residual coronary stenosis and exercise-induced periinfarct ischemia than did those treated with intracoronary streptokinase. These results suggest further application of coronary angioplasty in the management of acute myocardial infarction

  15. Renal artery blood flow assessed by video dilution technique before and after percutaneous transluminal angioplasty

    International Nuclear Information System (INIS)

    Lantz, B.M.T.; Link, D.P.; Lewis, E.L.; Foerster, J.M.; Lee, G.

    1981-01-01

    Successful percutaneous transluminal angioplasty was performed in 3 cases of renal artery stenosis where the effect upon renal blood flow was quantified by video dilution technique. This technique adds important information to pressure gradients and renin assays obtained during the dilatation procedure. (Auth.)

  16. Venous Sinus Stent-Assisted Angioplasty for Refractory Benign Intracranial Hypertension

    OpenAIRE

    Zhongrong, M.; Feng, L.; Shengmao, L.; Fengshui, Z.

    2003-01-01

    Two patients with dural sinus stenosis of different causes presenting with refractory benign intracranial hypertension were confirmed by angiogram. Stent-assistant angioplasty was used to dilate the stenosed sinusesand led to prompt clinical improvement. Relative long-term follow-up showed good patency of the stented sinuses.

  17. The prognostic importance of heart failure and age in patients treated with primary angioplasty

    NARCIS (Netherlands)

    Henriques, Jose P. S.; Zijlstra, Felix; de Boer, Menko-Jan; van 't Hof, Arnoud W. J.; Gosselink, A. T. Marcel; Dambrink, Jan-Henk E.; Suryapranata, Harry; Hoorntje, Jan C. A.

    2003-01-01

    Effective risk stratification is essential in the management of patients with acute myocardial infarction. Available models have not yet been studied and validated in patients treated with primary angioplasty for acute myocardial infarction. The prognostic value of heart failure defined by Killip

  18. Postpartum cerebral angiopathy: atypical features and treatment with intracranial balloon angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Song, J.K. [Center for Endovascular Surgery, Hyman-Newman Inst. for Neurology and Neurosurgery, New York, NY (United States); Cacayorin, E.D. [Interventional Neuroradiology, Dept. of Radiology, Univ. of Texas Medical School, Houston, TX (United States); Fisher, S.; Seifert, T.D.; Alexandrov, A.V.; Malkoff, M.D.; Grotta, J.C.; Campbell, M.S. [Div. of Stroke Neurology, Dept. of Neurology, Univ. of Texas Medical School, Houston, TX (United States)

    2004-12-01

    Postpartum cerebral angiopathy (PCA) is an uncommon cause of ischemic and hemorrhagic stroke in young women. It is usually clinically benign and not relapsing. We describe a patient with non-hemorrhagic PCA who had an atypical progressive neurological deficit from bilateral hemisphere watershed ischemia despite treatment with aggressive medical therapy and intracranial balloon angioplasty. (orig.)

  19. The design and rationale of the primary angioplasty registry of Kerala

    Directory of Open Access Journals (Sweden)

    Jabir A

    2017-11-01

    Conclusions: The primary angioplasty registry of Kerala would help analyze the quality and outcomes of primary PCI services in Kerala, thereby yielding insights that can help limit unacceptable procedural variations in the performance of primary PCI. Identifying deviations from guideline based therapies can form the basis of quality improvement programs, which in turn will enable hospitals to achieve better patient outcomes.

  20. Stent angioplasty for the treatment of symptomatic stenosis of middle cerebral artery

    International Nuclear Information System (INIS)

    Lu Huisheng; Niu Huiming; Chao Yuanxiang; Li Xiaoning; Wu Dingfeng; Zhang Chenhong; Yang Jie; Zhang Liang

    2010-01-01

    Objective: To investigate the safety and feasibility of endovascular stent angioplasty in treating symptomatic stenosis of middle cerebral artery. Methods: Endovascular angioplasty with coronary stents was performed in 27 patients with symptomatic stenosis of middle cerebral artery. The clinical results were reviewed and analyzed. Results: Of the total 27 patients, successful placement of the coronary stents was achieved in 24. Angiography immediately after the procedure showed that the stenotic degree of the diseased artery was markedly decreased from preoperative (80 ± 19)% to postoperative (8 ±4)%, the improvement was very obvious. Percutaneous transcatheter angioplasty had to be employed in two cases because of the failure of stent placement. A mean follow-up period of 18 months was carried out. During the following up period no transient cerebral ischemia attack occurred in 25 patients and no newly-developed cerebral infarction in region fed by the responsible vessels occurred either.Re-irrigation cerebral hemorrhage was seen in one patient, which occurred three hours after the placement of the stent. In one case the placed stent fell off and immigrated into the siphon of internal carotid artery, and the displaced stent was took out later with a catching apparatus. In another case re-stenosis occurred six months after the stenting. Conclusion: Percutaneous endovascular stent angioplasty is a safe and effective treatment for symptomatic stenosis of middle cerebral artery, although its long-term results need to be further evaluated. (authors)

  1. HEMOPERFUSION DURING CORONARY ANGIOPLASTY - 1ST EUROPEAN EXPERIENCE WITH A NEW HEMOPERFUSION PUMP

    NARCIS (Netherlands)

    DEMUINCK, ED; MEEDER, J; MAGIELSE, C; BOM, VJJ; VANDIJK, RB; VERKERKE, GJ; LIE, KI

    Hemolysis tests with fresh human blood were performed in vitro with a new 5 ml, piston-type hemoperfusion pump, designed to prevent myocardial ischemia during coronary angioplasty. Despite driving pressures greater than 3 atmospheres, shear stress greater than 200 Pa, turbulent pump flow, and the

  2. Femoral artery recanalisation with percutaneous angioplasty and segmentally enclosed plasminogen activator

    DEFF Research Database (Denmark)

    Jørgensen, B; Tønnesen, K H; Bülow, J

    1989-01-01

    To establish whether re-occlusion of the femoral artery could be prevented, in 6 consecutive patients undergoing percutaneous transluminal angioplasty (PTA) for superficial femoral artery occlusion the recanalised segment was isolated, with a 7-French double-balloon catheter. 5 mg recombined huma...

  3. Postpartum cerebral angiopathy: atypical features and treatment with intracranial balloon angioplasty

    International Nuclear Information System (INIS)

    Song, J.K.; Cacayorin, E.D.; Fisher, S.; Seifert, T.D.; Alexandrov, A.V.; Malkoff, M.D.; Grotta, J.C.; Campbell, M.S.

    2004-01-01

    Postpartum cerebral angiopathy (PCA) is an uncommon cause of ischemic and hemorrhagic stroke in young women. It is usually clinically benign and not relapsing. We describe a patient with non-hemorrhagic PCA who had an atypical progressive neurological deficit from bilateral hemisphere watershed ischemia despite treatment with aggressive medical therapy and intracranial balloon angioplasty. (orig.)

  4. Subintimal angioplasty for the treatment of long segment occlusion of superficial femoral artery: the midterm results

    International Nuclear Information System (INIS)

    Lou Wensheng; Gu Jianping; He Xu; Chen Liang; Chen Guoping; Su Haobo; Song Jinhua; Wang Tao; Xu Ke

    2011-01-01

    Objective: To discuss the clinical value of subintimal angioplasty in treating long segment occlusion of superficial femoral artery and to observe its midterm results. Methods: Subintimal angioplasty was performed in 45 patients with long segment occlusion of superficial femoral artery, whose clinical presentation was intermittent claudication or critical limb ischemia. The primary patency, limb salvage and factors influencing long-term patency were observed, and the clinical data were analyzed. Results: Of the total 45 cases, the subintimal angioplasty was successfully accomplished in 43. The success rate of antegrade approach technique via the superficial femoral artery was 80% (n=36), the occlusion was recanalized by using retrograde approach technique via ipsilateral popliteal artery in 7 case. The total technical success rate was 95.6%. The primary patency in 43 successful cases at 6, 12, 24 and 36 months was 85.7%, 69.0% 57.3% and 50.9%, respectively. No statistically significant difference in primary patency existed between the group of intermittent claudication and the group of critical limb ischemia (P>0.05). Statistically significant prediction factors for primary patency included the number of the run off vessels below the knee and the length of the occlusion (P<0.05). Conclusion: Subintimal angioplasty is an effective procedure for the treatment of long segment occlusions of superficial femoral artery with satisfactory mid-term results. (authors)

  5. Experimental and numerical investigation of wire waveguides for therapeutic ultrasound angioplasty

    OpenAIRE

    Noone, Declan J.

    2008-01-01

    Therapeutic ultrasound angioplasty is an emerging minimally invasive cardiovascular procedure for disrupting atherosclerotic lesions using small diameter wire waveguides. The lesions are damaged through a combination of direct ablation, pressure waves, cavitation and acoustic streaming caused by distal-tip displacements at ultrasonic frequencies. Numerical and experimental methods are used to investigate the outputs of the wire waveguides during ultrasonic activation. A commercially avail...

  6. Retrospective study of rapid-exchange monorail versus over-the-wire technique for femoropopliteal angioplasty.

    Science.gov (United States)

    Jahnke, Thomas; Schäfer, Jost Philipp; Bolte, Hendrik; Schäfer, Fritz; Michalek, Jens; Charalambous, Nicholas; Sapoval, Marc; Müller-Hülsbeck, Stefan

    2008-01-01

    The purpose of this study was to compare procedural outcome of rapid-exchange (RX) monorail versus conventional over-the-wire (OTW) technique for femoropopliteal angioplasty. Demographic data, procedure details, angioplasty success, and complications of 328 consecutive percutaneous transluminal angioplasties (PTAs) were collected from a prospective database and retrospectively analyzed. Procedure details included duration of fluoroscopy, area-dose product, amount of contrast agent, sheath sizes, access route, length of stenosis, presence of total occlusion, technical and anatomical success (residual stenosis or = 6 Fr = 82.5% for OTW) but showed only a tendency toward lower overall complication rates (16.6% [17/102] in the RX group versus 19.9% [45/226] in the OTW group; p = 0.09). There was no effect on length of hospitalization. RX monorail systems were not associated with higher procedural costs when compared to conventional OTW technique. We conclude that RX monorail systems seem to enhance the technical success of femoropopliteal angioplasty. Although smaller sheath sizes can be used due to the lower profile of the RX systems, there is only a tendency toward lower complication rates.

  7. Iliac artery myointimal hyperplasia in rabbits submitted to angioplasty and treated with Moringa oleifera.

    Science.gov (United States)

    Rolim, Jânio Cipriano; Nogueira, Manoel Ricardo Sena; Lima, Paulo Roberto da Silva; Bandeira, Francisco Chavier Vieira; Pordeus, Mizael Armando Abrantes; Castro, Aldemar Araújo; Pitta, Guilherme Benjamin; Diniz, Margareth de Fátima Formiga Melo; Pereira, Adamastor Humberto

    2016-02-01

    to assess post-angioplasty myointimal hyperplasia in iliac artery of rabbits treated with extract of Moringa oleifera leaves. we conducted a randomized trial in laboratory animals for five weeks of follow-up, developed in the Vivarium of Pharmaceutical Technology Laboratory of the Universidade Federal da Paraíba. We used rabbits from the New Zealand breed, subjected to a hypercholesterolemic diet and angioplasty of the external iliac artery, randomized into two groups: M200 Group (n=10) - rabbits treated with 200mg/kg/day of Moringa oleifera leaves extract orally; SF group (n=10) - rabbits treated with 0.9% saline orally. After five weeks, the animals were euthanized and the iliac arteries prepared for histology. Histological sections were analyzed by digital morphometry. Statistical analysis was performed using the Student's t test. The significance level was 0.05. there was no significant difference in myointimal hyperplasia between M200 and SF groups when comparing the iliac arteries submitted to angioplasty. there was no difference of myointimal hyperplasia between groups treated with saline and Moringa oleifera after angioplasty.

  8. Iliac artery myointimal hyperplasia in rabbits submitted to angioplasty and treated with Moringa oleifera

    Directory of Open Access Journals (Sweden)

    Jânio Cipriano Rolim

    Full Text Available Objective: to assess post-angioplasty myointimal hyperplasia in iliac artery of rabbits treated with extract of Moringa oleifera leaves. Methods : we conducted a randomized trial in laboratory animals for five weeks of follow-up, developed in the Vivarium of Pharmaceutical Technology Laboratory of the Universidade Federal da Paraíba. We used rabbits from the New Zealand breed, subjected to a hypercholesterolemic diet and angioplasty of the external iliac artery, randomized into two groups: M200 Group (n=10 - rabbits treated with 200mg/kg/day of Moringa oleifera leaves extract orally; SF group (n=10 - rabbits treated with 0.9% saline orally. After five weeks, the animals were euthanized and the iliac arteries prepared for histology. Histological sections were analyzed by digital morphometry. Statistical analysis was performed using the Student's t test. The significance level was 0.05. Results : there was no significant difference in myointimal hyperplasia between M200 and SF groups when comparing the iliac arteries submitted to angioplasty. Conclusion : there was no difference of myointimal hyperplasia between groups treated with saline and Moringa oleifera after angioplasty.

  9. Drug therapy or coronary angioplasty for the treatment of coronary artery disease : New insights

    NARCIS (Netherlands)

    Amoroso, G; Van Boven, AJ; Crijns, HJGM

    Background In the last decade percutaneous transluminal coronary angioplasty has become a very popular strategy For the treatment of coronary artery disease, although its efficacy in reducing ischemic events and the subsequent need for revascularization has yet to be proved. Methods We reviewed the

  10. Percutaneous angioplasty of portal vein stenosis that complicated liver transplantation: the mid-term therapeutic results

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kwang Bo; Choo, Sung Wook; Do, Young Soo; Shin, Sung Wook; Cho, Sung Gi; Choo, In Wook [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2005-09-15

    We wanted to valuate the mid-term therapeutic results of percutaneous transhepatic balloon angioplasty for portal vein stenosis after liver transplantation. From May 1996 to Feb 2005, 420 patients underwent liver transplantation. Percutaneous transhepatic angioplasty of the portal vein was attempted in six patients. The patients presented with the clinical signs and symptoms of portal venous hypertension or they were identified by surveillance doppler ultrasonography. The preangioplasty and postangioplasty pressure gradients were recorded. The therapeutic results were monitored by the follow up of the clinical symptoms, the laboratory values, CT and ultrasonography. The overall technical success rate was 100%. The clinical success rate was 83% (5/6). A total of eight sessions of balloon angioplasty were performed in six patients. The mean pressure gradient decreased from 14.5 mmHg to 2.8 mmHg before and after treatment, respectively. The follow up periods ranged from three months to 64 months (mean period; 32 months). Portal venous patency was maintained in all six patients until the final follow up. Combined hepatic venous stenosis was seen in one patient who was treated with stent placement. One patient showed puncture tract bleeding, and this patient was treated with coil embolization of the right portal puncture tract via the left transhepatic portal venous approach. Percutaneous transhepatic balloon angioplasty is an effective treatment for the portal vein stenosis that occurs after liver transplantation, and our results showed good mid-term patency with using this technique.

  11. Preserved endothelium-dependent vasodilation in coronary segments previously treated with balloon angioplasty and intracoronary irradiation

    NARCIS (Netherlands)

    M. Sabaté (Manel); A.J. Wardeh (Alexander); I.P. Kay (Ian Patrick); A. Cequier (Angel); J.M.R. Ligthart (Jürgen); J.A. Gómez-Hospital (Joan Antoni); S.G. Carlier (Stephan); V.L.M.A. Coen (Veronique); J.P. Marijnissen (Johannes); P.W.J.C. Serruys (Patrick); P.C. Levendag (Peter); W.J. van der Giessen (Wim)

    1999-01-01

    textabstractBACKGROUND: Abnormal endothelium-dependent coronary vasomotion has been reported after balloon angioplasty (BA), as well as after intracoronary radiation. However, the long-term effect on coronary vasomotion is not known. The aim of this study was to evaluate the

  12. Value of Duplex scanning in the selection of patients for percutaneous transluminal angioplasty

    NARCIS (Netherlands)

    van der Heijden, F. H.; Legemate, D. A.; van Leeuwen, M. S.; Mali, W. P.; Eikelboom, B. C.

    1993-01-01

    Duplex scanning is becoming increasingly important in the diagnosis and follow-up of arterial lesions, though most surgeons and radiologists currently still prefer diagnostic angiography prior to percutaneous transluminal angioplasty (PTA). We performed PTA based on Duplex scanning alone in 31

  13. The role of the adventitia in the arterial response to angioplasty: the effect of intravascular radiation

    International Nuclear Information System (INIS)

    Wilcox, Josiah N.; Waksman, Ron; King, Spencer B.; Scott, Neal A.

    1996-01-01

    Purpose: In the current series of experiments we have characterized cell proliferation leading to vascular lesion formation in a porcine model for post-angioplasty restenosis and examined the mechanism of action of intravascular beta irradiation in the prevention of lesion formation in this model. Methods and Materials: Juvenile male pigs were subjected to balloon overstretch injury of the left anterior descending and circumflex coronary arteries using clinical angioplasty catheters. Proliferating cells were labelled by injections of 50 mg/kg of bromo-deoxyuridine (BrDU) 24, 16 and 8 hrs prior to sacrifice and were detected by immunohistochemistry using a specific antibody to BrDU. In some cases, BrDU was given as a pulse 3 days after angioplasty and the animals sacrificed on day 14 to follow the migration of the cells which had proliferated earlier. Characterization of the proliferating cells was performed by immunohistochemistry using antibodies to specific cytoskeletal proteins specific for smooth muscle cells and myofibroblasts. Some vessels were treated at the time of angioplasty with 14 or 28 Gy (to a depth of 2 mm) intravascular irradiation using a flexible catheter with a pure beta emitter 90 SR/Y and the effect on cell proliferation and terminal transferase-mediated UTP nick-end labelling (TUNEL) examined 3 or 7 days later. Results: The first major site of cell proliferation between 2-3 days after angioplasty is the adventitia and not the medial wall. Seven days after angioplasty cell proliferation is predominant in the neointima and is reduced in the media and adventitia. Differential staining with antibodies directed against smooth muscle alpha actin and other cytoskeletal proteins indicates that the proliferating adventitial cells are myofibroblasts. Pulse label studies with BrDU indicates that the proliferating adventitial myofibroblasts migrate into the neointima and contribute to the mass of the restenosis lesion. Fourteen days after angioplasty the

  14. Endovascular brachytherapy to prevent restenosis after angioplasty; Endovaskulaere Brachytherapie in der Restenoseprophylaxe nach Angioplastie und Stentimplantation: Eine Uebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Wohlgemuth, W.A.; Bohndorf, K. [Klinikum Augsburg (Germany). Klinik fuer Diagnostische Radiologie und Neuroradiologie

    2003-02-01

    Endovascular radiotherapy is the first effective prophylaxis of restenosis after percutaneous transluminal angioplasty (PTA) and stenting. The FDA recently approved two devices for the delivery of intracoronary radiation following coronary artery stenting. Published multicenter, double-blind, randomized trials of intracoronary radiation therapy report good results for preventing in-stent restenosis, while the data for the peripheral circulation are still inconclusive. Beta-emitters are easier applicable and probably also safer, whereas gamma-emitters have been more extensively evaluated clinically so far. Primary indication for endovascular brachytherapy are patients at high risk for restenosis, such as previous restenoses, in-stent hyperplasia, long stented segment, long PTA lesion, narrow residual vascular lumen and diabetes. Data from coronary circulation suggest a safety margin of at least 4 to 10 mm at both ends of the angioplastic segment to avoid edge restenosis. To prevent late thrombosis of the treated coronary segment, antiplatelet therapy with clopidogrel and aspirin are recommended for at least 6 months after PTA and for 12 months after a newly implanted stent. An established medication regimen after radiotherapy of peripheral arteries is still lacking. (orig.) [German] Die endovaskulaere Radiotherapie stellt das erste erfolgreiche Therapiekonzept in der Restenoseprophylaxe nach PTA und Stentimplantation dar. Am 3.11.2000 hat die amerikanische Food and Drug Administration erstmalig zwei Brachytherapiegeraete zur Restenoseprophylaxe nach Koronararterien-Stenting zugelassen. Grosse multizentrische, kontrollierte Studien wurden fuer das koronare Stromgebiet mit positiven Ergebnissen publiziert, die Datenlage im peripheren Stromgebiet ist noch ungenuegend. Beta-Strahler bieten Vorteile in der Anwendung, moeglicherweise auch in der Sicherheit, Gamma-Strahler dagegen sind besser klinisch evaluiert. Die primaere Indikation zur endovaskulaeren Brachytherapie

  15. Cost-effectiveness analysis of orbital atherectomy plus balloon angioplasty vs balloon angioplasty alone in subjects with calcified femoropopliteal lesions.

    Science.gov (United States)

    Weinstock, Barry; Dattilo, Raymond; Diage, Tiffini

    2014-01-01

    As cost considerations become increasingly critical when selecting optimal endovascular treatment strategies, a cost-benefit analysis was conducted comparing the Diamondback 360°® Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc., St Paul, MN, USA) and balloon angioplasty (BA) vs BA alone for treatment of calcified femoropopliteal lesions. The clinical outcomes from COMPLIANCE 360°, a prospective, multicenter, randomized study comparing OAS+BA vs BA alone for treatment of calcified femoropopliteal lesions, were correlated with cost data and previously published quality of life data. Site of service, hospital charges, and associated medical resource utilization were obtained from Uniform Billing statements for index treatments and associated revascularizations out to 1 year. Hospital costs were estimated using hospital-specific, procedure-specific cost-to-charge ratios. Length of stay and procedural data were collected from participating study sites. Twenty-five subjects with 38 lesions and 25 subjects with 27 lesions were randomized to the OAS+BA and BA-alone groups, respectively. Mean hospital charges (US$51,755 vs US$39,922) and estimated hospital costs (US$15,100 vs US$11,016) were higher for OAS+BA compared with BA alone (not statistically significant). Stent utilization was statistically significantly higher with BA-alone treatment for all subjects (1.1 vs 0.1, P=0.001) and in the subset of subjects with one lesion (1.0 vs 0.1, Pcost for single-lesion versus multiple-lesion treatment. Using costs and quality-adjusted life years (QALYs) for the single-lesion cohort, the 1-year incremental cost of OAS+BA vs BA alone was US$549, and incremental QALY was 0.16. This results in an incremental cost-effectiveness ratio of US$3,441, well below the US$50,000 threshold. One-year index procedure cost and cost-effectiveness were comparable for OAS+BA vs BA alone. This study provides compelling cost-effectiveness data for using atherectomy for treatment of

  16. Cost-effectiveness analysis of orbital atherectomy plus balloon angioplasty vs balloon angioplasty alone in subjects with calcified femoropopliteal lesions

    Directory of Open Access Journals (Sweden)

    Weinstock B

    2014-03-01

    Full Text Available Barry Weinstock,1 Raymond Dattilo,2 Tiffini Diage3 1Orlando Health Heart Institute, Mid-Florida Cardiology Specialists, Orlando, FL, USA; 2Department of Cardiology, St Francis Health Center, Topeka, KS, USA; 3North American Science Association (NAMSA, Sunnyvale, CA, USA Introduction: As cost considerations become increasingly critical when selecting optimal endovascular treatment strategies, a cost-benefit analysis was conducted comparing the Diamondback 360°® Orbital Atherectomy System (OAS (Cardiovascular Systems, Inc., St Paul, MN, USA and balloon angioplasty (BA vs BA alone for treatment of calcified femoropopliteal lesions. Patients and methods: The clinical outcomes from COMPLIANCE 360°, a prospective, multicenter, randomized study comparing OAS+BA vs BA alone for treatment of calcified femoropopliteal lesions, were correlated with cost data and previously published quality of life data. Site of service, hospital charges, and associated medical resource utilization were obtained from Uniform Billing statements for index treatments and associated revascularizations out to 1 year. Hospital costs were estimated using hospital-specific, procedure-specific cost-to-charge ratios. Length of stay and procedural data were collected from participating study sites. Results: Twenty-five subjects with 38 lesions and 25 subjects with 27 lesions were randomized to the OAS+BA and BA-alone groups, respectively. Mean hospital charges (US$51,755 vs US$39,922 and estimated hospital costs (US$15,100 vs US$11,016 were higher for OAS+BA compared with BA alone (not statistically significant. Stent utilization was statistically significantly higher with BA-alone treatment for all subjects (1.1 vs 0.1, P=0.001 and in the subset of subjects with one lesion (1.0 vs 0.1, P<0.00001. There was a significant difference in cost for single-lesion versus multiple-lesion treatment. Using costs and quality-adjusted life years (QALYs for the single-lesion cohort, the 1-year

  17. Clinical observation of intraluminal stent angioplasty in the treatment of renal arterial stenoses

    International Nuclear Information System (INIS)

    Lu Yanwen; Zhang Jian; Huang Xianglong

    2002-01-01

    Objective: To evaluate the clinical application of intraluminal stent angioplasty (PTRAS) in the treatment of renal arterial stenoses. Methods: A retrospective study was done in 28 patients with renal arterial stenoses. Primary renal artery stenting was performed in 28 consecutive patients (36 renal arteries). Blood pressure, serum creating, the number of anti-hypertensive medications were recorded at 1, 6, 12 month post stent angioplasty respectively. Arterial angiography was also taken 1 year later to evaluate the incidence of restenosis. Results: Technical success rate was 100% achieving in all patients without serious complications. Primary successful patently rate reached 82% (renal artery 86%), secondary successful rate was 89% (renal artery 90%). Systolic and diastolic blood pressure were reduced significantly (P<0.01) at 1,6,12 month after stent angioplasty comparing with baseline and clinical improvement (cured + improved) of hypertension reached 100%, 92.9%, 89.3% respectively. There were no significant differences between serum creatine level and the number of anti-hypertensive medications before and after stent angioplasty. One year later, 14.3% of all patients showed improvement of renal function, 64.3% remained in stabilization and 21.4% fell into deterioration. Angiographic restenosis was found in 3 cases one year after stent angioplasty. Complications included 1 hematoma at puncture site and 3 transient azotaemia. Conclusions: PTRAS can be performed safely with high technical success and beneficial to the majority of patients with hypertension or renal insufficiency and therefore it should be the first choice in treating renal arterial stenoses

  18. Retrospective Study of Rapid-Exchange Monorail Versus Over-the-Wire Technique for Femoropopliteal Angioplasty

    International Nuclear Information System (INIS)

    Jahnke, Thomas; Schaefer, Jost Philipp; Bolte, Hendrik; Schaefer, Fritz; Michalek, Jens; Charalambous, Nicholas; Sapoval, Marc; Mueller-Huelsbeck, Stefan

    2008-01-01

    PurposeThe purpose of this study was to compare procedural outcome of rapid-exchange (RX) monorail versus conventional over-the-wire (OTW) technique for femoropopliteal angioplasty.Materials and MethodsDemographic data, procedure details, angioplasty success, and complications of 328 consecutive percutaneous transluminal angioplasties (PTAs) were collected from a prospective database and retrospectively analyzed. Procedure details included duration of fluoroscopy, area-dose product, amount of contrast agent, sheath sizes, access route, length of stenosis, presence of total occlusion, technical and anatomical success (residual stenosis <30% in the absence of complications), need for bail-out stenting, and periprocedural complications. The RX technique alone was used in 102 of 328 cases (31%); the OTW technique, in 226 of 328 of cases (68%).ResultsTechnical success was 98% for the RX versus 95.4% for the OTW technique (p = 0.2). A significantly greater number of stents had to be implanted due to angioplasty failure when the OTW technique was used (RX, 5.9%; OTW, 13.7%; p = 0.04). There were no significant differences in fluorocopy time, dose-area product, or amount of contrast medium used. The RX system facilitated the use of smaller sheath sizes (5 Fr = 38% and 6 Fr = 59% for RX versus 5 Fr = 16.8% and ≥6 Fr = 82.5% for OTW) but showed only a tendency toward lower overall complication rates (16.6% [17/102] in the RX group versus 19.9% [45/226] in the OTW group; p = 0.09). There was no effect on length of hospitalization. RX monorail systems were not associated with higher procedural costs when compared to conventional OTW technique.ConclusionWe conclude that RX monorail systems seem to enhance the technical success of femoropopliteal angioplasty. Although smaller sheath sizes can be used due to the lower profile of the RX systems, there is only a tendency toward lower complication rates.

  19. Endovascular brachytherapy prevents restenosis after femoropopliteal angioplasty: results of the Vienna-3 randomised multicenter study

    International Nuclear Information System (INIS)

    Pokrajac, Boris; Poetter, Richard; Wolfram, Roswitha M.; Budinsky, Alexandra C.; Kirisits, Christian; Lileg, Brigitte; Mendel, Helmuth; Sabeti, Schila; Schmid, Rainer; Minar, Erich

    2005-01-01

    Background and purpose: The aim of the trial was to investigate the effect of Iridium-192 gamma endovascular brachytherapy on reduction of restenosis after femoropopliteal angioplasty. Patients and methods: Between Oct, 1998 and Jul, 2001 a total of 134 patients have been randomized after successful angioplasty to brachytherapy or sham irradiation in a prospective, randomized, multicenter, double blind controlled trial. Patients with de novo lesion of at least 5 cm or recurrent lesion of any length after prior angioplasty have been enrolled. Brachytherapy was performed with 7 F centering catheter. Mean lesion length was 9.1 cm (1.5-25 cm) and mean intervention length 13.6 cm (4-27.5 cm) in brachytherapy cohort. Results: In placebo cohort mean lesion length was 10.3 cm (2-25 cm) and mean intervention length 14.1 cm (2-29 cm). A dose of 18 Gy was prescribed 2 mm from the surface of centering balloons. Analyzed (based on angiography) on intention to treat basis the binary restenosis rate at 12 months was 41.7% (28/67) in brachytherapy cohort and 67.1% (45/67) in placebo cohort (χ 2 test, P 30% residual stenosis after angioplasty) have been 23.4% in the brachytherapy and 53.3% in the placebo group (P<0.05), respectively. The cumulative patency rates after 24 months on intention to treat analysis were 54% in the brachytherapy and 27% in the placebo group (P<0.005). Corresponding data for as treated analysis were 77% in the brachytherapy and 39% in the placebo group (P<0.001). Late thrombosis was not seen. Conclusions: Significant reduction of restenosis rate was obtained with endovascular gamma brachytherapy after femoropopliteal angioplasty

  20. A New Approach: Regional Nerve Blockade for Angioplasty of the Lower Limb

    International Nuclear Information System (INIS)

    Marcus, A.J.; Lotzof, K.; Kamath, B.S.K.; Shanthakumar, R.E.; Munir, N.; Loh, A.; Bird, R.; Howard, A.

    2006-01-01

    Purpose. An audit study investigated the pilot use of regional nerve block analgesia (as an alternative to sedative/opiate, general or central neuraxial anesthesia) performed by radiologists with the assistance of imaging techniques during complex prolonged angiography. Methods. Radiologists were trained by anesthetic consultants to administer and use lower limb peripheral nerve block for difficult prolonged angioplasty procedures for patients with severe lower limb rest pain who were unable to lie in the supine position. In a pilot study 25 patients with limb-threatening ischemia received sciatic and femoral nerve blockade for angioplasty. The technique was developed and perfected in 12 patients and in a subsequent 13 patients the details of the angiography procedures, peripheral anesthesia, supplementary analgesia, complications, and pain assessment scores were recorded. Pain scores were also recorded in 11 patients prior to epidural/spinal anesthesia for critical ischemic leg angioplasty. Results. All patients with peripheral nerve blockade experienced a reduction in their ischemic rest pain to a level that permitted angioplasty techniques to be performed without spinal, epidural or general analgesia. In patients undergoing complex angioplasty intervention, the mean pain score by visual analogue scale was 3.7, out of a maximum score of 10. Conclusions. The successful use of peripheral nerve blocks was safe and effective as an alternative to sedative/opiate, epidural or general anesthesia in patients undergoing complex angiography and has optimized the use of radiological and anesthetic department resources. This has permitted the frequent radiological treatment of patients with limb-threatening ischemia and reduced delays caused by the difficulty in enlisting the help of anesthetists, often at short notice, from the busy operating lists

  1. Instability of Reference Diameter in the Evaluation of Stenosis After Coronary Angioplasty: Percent Diameter Stenosis Overestimates Dilative Effects Due to Reference Diameter Reduction

    International Nuclear Information System (INIS)

    Hirami, Ryouichi; Iwasaki, Kohichiro; Kusachi, Shozo; Murakami, Takashi; Hina, Kazuyoshi; Matano, Shigeru; Murakami, Masaaki; Kita, Toshimasa; Sakakibara, Noburu; Tsuji, Takao

    2000-01-01

    Purpose: To examine changes in the reference segment luminal diameter after coronary angioplasty.Methods: Sixty-one patients with stable angina pectoris or old myocardial infarction were examined. Coronary angiograms were recorded before coronary angioplasty (pre-angioplasty) and immediately after (post-angioplasty), as well as 3 months after. Artery diameters were measured on cine-film using quantitative coronary angiographic analysis.Results: The diameters of the proximal segment not involved in the balloon inflation and segments in the other artery did not change significantly after angioplasty, but the reference segment diameter significantly decreased (4.7%). More than 10% luminal reduction was observed in seven patients (11%) and more than 5% reduction was observed in 25 patients (41%). More than 5% underestimation of the stenosis was observed in 22 patients (36%) when the post-angioplasty reference diameter was used as the reference diameter, compared with when the pre-angioplasty measurement was used and more than 10% underestimation was observed in five patients (8%).Conclusion: This study indicated that evaluation by percent diameter stenosis, with the reference diameter from immediately after angioplasty, overestimates the dilative effects of coronary angioplasty, and that it is thus better to evaluate the efficacy of angioplasty using the absolute diameter in addition to percent luminal stenosis

  2. Influence of a history of smoking on short term (six month) clinical and angiographic outcome after successful coronary angioplasty

    NARCIS (Netherlands)

    A.G. Violaris (Andonis); A. Thury (Attila); R. Melkert (Rein); P.W.J.C. Serruys (Patrick); E.S. Regar (Eveline)

    2000-01-01

    textabstractOBJECTIVES: To assess the influence of smoking on restenosis after coronary angioplasty. DESIGN AND PATIENTS: The incidence of smoking on restenosis was investigated in 2948 patients. They were prospectively enrolled in four major restenosis trials in which quantitative

  3. Usefulness of repeat coronary angiography 24 hours after balloon angioplasty to evaluate early lminal deterioration and facilitate quantitative analysis

    NARCIS (Netherlands)

    G.R. Heyndrickx (Guy); G-J. Laarman (GertJan); H. Suryapranata (Harry); F. Zijlstra (Felix); P.W.J.C. Serruys (Patrick); D.P. Foley (David); A.A. van den Bos (Arjan); J.W. Deckers (Jaap)

    1993-01-01

    textabstractBecause of the unavoidable occurrence of vessel disruption after successful coronary balloon angioplasty, the reliability of quantitative angiographic analysis in that setting has been questioned. For this reason and the suggested occurrence of delayed elastic recoil, repeat angiography

  4. Shear-stress and wall-stress regulation of vascular remodeling after balloon angioplasty: effect of matrix metalloproteinase inhibition

    NARCIS (Netherlands)

    C.J. Slager (Cornelis); J. Kloet (Jeroen); J.A.F. Oomen; J.C.H. Schuurbiers (Johan); B.J. de Smet; M.J. Post (Mark); D.P.V. de Kleijn (Dominique); G. Pasterkamp (Gerard); R. Krams (Rob); C. Borst (Cornelius); J.J. Wentzel (Jolanda); I. Andhyiswara (Ivan)

    2001-01-01

    textabstractBACKGROUND: Constrictive vascular remodeling (VR) is the most significant component of restenosis after balloon angioplasty (PTA). Whereas in physiological conditions VR is associated with normalization of shear stress (SS) and wall stress (WS), after PTA

  5. Videodensitometric quantitative angiography after coronary balloon angioplasty, compared to edge-detection quantitative angiography and intracoronary ultrasound imaging

    NARCIS (Netherlands)

    Peters, R. J.; Kok, W. E.; Pasterkamp, G.; von Birgelen, C.; Prins, M. [=Martin H.; Serruys, P. W.

    2000-01-01

    AIMS: To assess the value of videodensitometric quantification of the coronary lumen after angioplasty by comparison to two other techniques of coronary artery lumen quantification. METHODS AND RESULTS: Videodensitometric quantitative angiography, edge detection quantitative angiography and 30 MHz

  6. A Systematic Review of Outcomes Following Percutaneous Transluminal Angioplasty and Stenting in the Treatment of Transplant Renal Artery Stenosis

    NARCIS (Netherlands)

    Ngo, A. T.; Markar, S. R.; de Lijster, M. S.; Duncan, N.; Taube, D.; Hamady, M. S.

    2015-01-01

    To evaluate outcomes following treatment of transplant renal artery stenosis by percutaneous transluminal angioplasty and stent insertion. A literature search was performed using Pubmed, MEDLINE, Embase, Wiley Interscience and the Cochrane Library databases. Outcome measures were glomerular

  7. Lesson Learning at JPL

    Science.gov (United States)

    Oberhettinger, David

    2011-01-01

    A lessons learned system is a hallmark of a mature engineering organization A formal lessons learned process can help assure that valuable lessons get written and published, that they are well-written, and that the essential information is "infused" into institutional practice. Requires high-level institutional commitment, and everyone's participation in gathering, disseminating, and using the lessons

  8. Comparative study of conducting iliac angioplasties with digital subtraction and conventional angiography. Incidence on true (consumable) costs

    International Nuclear Information System (INIS)

    Brenot, P.; Raynaud, A.; Pernes, J.M.; Parola, J.L.; Gaux, J.C.

    1986-01-01

    Differences in time and cost were evaluated between the performance of iliac angioplasty with conventional (AC) and digital subtraction (AN) angiography, after a total of 27 angioplasties (13 with AC and 14 with AN). Excluding amortization of material and personnel costs, findings confirmed a certain number of advantages for AN: gain in time of about 34%, decrease of about 14% in charges, and notably of 83% in expenditure on films and 50% on contrast media [fr

  9. Long term results of endovascular treatment in renal arterial stenosis from Takayasu arteritis: Angioplasty versus stent placement

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hong Suk, E-mail: hongsukpark@gmail.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Do, Young Soo, E-mail: ysdo@skku.edu [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Park, Kwang Bo, E-mail: kbjh.park@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Kim, Duk-Kyung, E-mail: dukkyung.kim@samsung.com [Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Choo, Sung Wook, E-mail: sw.choo@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Shin, Sung Wook, E-mail: sw88.shin@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Cho, Sung Ki, E-mail: sungkismc@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Hyun, Dongho, E-mail: mesentery.hyun@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Choo, In Wook, E-mail: inwook.choo@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of)

    2013-11-01

    Purpose: To retrospectively evaluate and compare the long term patency and antihypertensive effect of angioplasty and stent insertion in renal artery stenosis caused by Takayasu arteritis, with CT angiography and clinical follow-up. Materials and methods: We retrospectively analyzed and compared effects on hypertension and patency of renal artery in 16 patients (age ranging from 16 to 58 years, mean: 32.1 years) with renovascular hypertension caused by Takayasu arteritis who underwent endovascular treatment including angioplasty (n = 13) and stent placement (n = 9) for 22 stenotic renal arteries. Results: Technical success was 95% (21/22) without major complications. In the last follow-up CT angiogram (mean 85 ± 41 months), restenosis was 8% (1/12) in angioplasty and 66% (6/9) in stent. Patency rates of angioplasty were 100%, 91.7%, 91.7% and primary unassisted and primary assisted patency rates of stent placement were 55.6%, 33.3%, 33.3% and 88.9%, 66.7%, 55.6% at 1-, 3- and 5-years, respectively. In clinical follow-up (mean 120 ± 37.8 months, range 48–183 months), beneficial effects on hypertension were obtained in 87% of patients (13/15) and there was no significant difference between the patients who were treated by only angioplasty and the patients who received stent placement in at least one renal artery, regardless of whether or not angioplasty had been performed in the other renal artery. Conclusion: Compared with stent placement, angioplasty demonstrated better long term patency and similar clinical benefit on renovascular hypertension in renal artery stenosis of Takayasu arteritis. We suggest that stent placement should be reserved for obvious angioplasty failure.

  10. Balloon Angioplasty - The Legacy of Andreas Grüntzig, M.D. (1939-1985).

    Science.gov (United States)

    Barton, Matthias; Grüntzig, Johannes; Husmann, Marc; Rösch, Josef

    2014-01-01

    In 1974, at the Medical Policlinic of the University of Zürich, German-born physician-scientist Andreas Grüntzig (1939-1985) for the first time applied a balloon-tipped catheter to re-open a severely stenosed femoral artery, a procedure, which he initially called "percutaneous transluminal dilatation". Balloon angioplasty as a therapy of atherosclerotic vascular disease, for which Grüntzig and Charles T. Dotter (1920-1985) received a nomination for the Nobel Prize in Physiology or Medicine in 1978, became one of the most successful examples of translational medicine in the twentieth century. Known today as percutaneous transluminal angioplasty (PTA) in peripheral arteries or percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) in coronary arteries, balloon angioplasty has become the method of choice to treat patients with acute myocardial infarction or occluded leg arteries. On the occasion of the 40(th) anniversary of balloon angioplasty, we summarize Grüntzig's life and career in Germany, Switzerland, and the United States and also review the developments in vascular medicine from the 1890s to the 1980s, including Dotter's first accidental angioplasty in 1963. The work of pioneers of catheterization, including Pedro L. Fariñas in Cuba, André F. Cournand in France, Werner Forssmann, Werner Porstmann and Eberhard Zeitler in Germany, António Egas Moniz and Reynaldo dos Santos in Portugal, Sven-Ivar Seldinger in Sweden, and Barney Brooks, Thomas J. Fogarty, Melvin P. Judkins, Richard K. Myler, Dickinson W. Richards, and F. Mason Sones in the United States, is discussed. We also present quotes by Grüntzig and excerpts from his unfinished autobiography, statements of Grüntzig's former colleagues and contemporary witnesses, and have included hitherto unpublished historic photographs and links to archive recordings and historic materials. This year, on June 25, 2014, Andreas Grüntzig would have celebrated his 75(th

  11. Basic Lessons in *ORA and Automap 2009

    Science.gov (United States)

    2009-06-01

    screen capture showing the visualization of the agent x event graph from the Stargate Summit Meta-Network. The visualization displays the connections...for the Stargate dataset. 25.2 lessons - 201-207 A step by step run through of creating the Meta-Network from working with Excel, exporting data to...For the purpose of creating the Stargate MetaNetwork the two-episode story arc (Summit / Last Stand) was choosen as the basis for all the nodes

  12. Nuclear Techniques for Coronary Heart Disease Therapy after Percutaneous Transluminal Coronary Angioplasty

    International Nuclear Information System (INIS)

    Nurlaila-Z

    2005-01-01

    Nuclear techniques studies of the heart represent one of the fastest growing areas of research. Several years ago, nuclear medicine cardiac studies were limited for the evaluation and diagnosis of myocardial infarction. Development in radiopharmaceutical-chemistry and instrumentation have made possible advances in nuclear medicine for restenosis cardiovascular therapy after percutaneous transluminal coronary angioplasty.The radionuclide as radiation source can be delivered to the target basically by two techniques, those are catheter-based systems and radioactive stents. For this purpose,it can be use the γ and β emitter radionuclides, in which the β emitter radionuclides is an ideal radionuclide for endovascular therapy. Restenosis after percutaneous transluminal coronary angioplasty can be prevented by using the radioactive stent. This review discusses several techniques which could be used for restenosis cardiovascular therapy. Furthermore, several types of radiopharmaceutical and kinds of radionuclides as well as doses of the compounds for this purpose are also reviewed. (author)

  13. Evidence level of nursing care technologies in angioplasty of the lower limbs

    Directory of Open Access Journals (Sweden)

    Viviane Soares

    2016-12-01

    Full Text Available The objective of this study was to describe the scientific work on nursing care technologies to adult patients undergoing angioplasty of the lower limbs. Systematic review of the literature followed the electronic databases: LILACS, PubMed, Web of Science, SciELO, and Google Scholar. Twelve articles were analyzed and classified according to the levels of evidence. All qualitative studies were classified with a low degree of recommendation, and as for the quantitative studies only one showed a high degree of recommendation. The research showed studies with the lowest level of scientific evidence, aside from a lack of research and poor scientific background in which nursing preoperative care to patients undergoing angioplasty of the lower limbs have been developed. Consequently, there is a lack of information and hence poor training, culminating in unpreparedness in providing care to patients, and in understanding and leading this high complexity service according to the safety principles of patient care.

  14. Amputation-Free Survival after Crural Percutaneous Transluminal Angioplasty for Critical Limb Ischemia

    DEFF Research Database (Denmark)

    Strøm, M; Konge, L; Lönn, L

    2016-01-01

    BACKGROUND AND AIM: To evaluate the amputation-free survival after below the knee percutaneous transluminal angioplasty in a consecutive group of patients with critical ischemia of the lower extremity. MATERIALS AND METHODS: A total of 70 consecutive patients with critical ischemia were treated......-up clinical examinations were performed within 6 weeks and after 1 year. All medical records were crosschecked with the national vascular registry ensuring a valid 1-year status in 97% of the patients. RESULTS: A total of 15 major amputations were performed during follow-up, with 11 amputations performed...... within the first year. Complications after percutaneous transluminal angioplasty were rare. Cumulative mortality after 1 and 2 years was 22% and 34%, respectively. Amputation-free survival at 1 and 2 years of follow-up was 68% and 58%, respectively. There were no association between known risk factors...

  15. Spontaneous Coronary Dissection: “Live Flash” Optical Coherence Tomography Guided Angioplasty

    Science.gov (United States)

    Bento, Angela Pimenta; Fernandes, Renato Gil dos Santos Pinto; Neves, David Cintra Henriques Silva; Patrício, Lino Manuel Ribeiro; de Aguiar, José Eduardo Chambel

    2016-01-01

    Optical Coherence tomography (OCT) is a light-based imaging modality which shows tremendous potential in the setting of coronary imaging. Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS). The diagnosis of SCAD is made mainly with invasive coronary angiography, although adjunctive imaging modalities such as computed tomography angiography, IVUS, and OCT may increase the diagnostic yield. The authors describe a clinical case of a young woman admitted with the diagnosis of ACS. The ACS was caused by SCAD detected in the coronary angiography and the angioplasty was guided by OCT. OCT use in the setting of SCAD has been already described and the true innovation in this case was this unique use of OCT. The guidance of angioplasty with live and short images was very useful as it allowed clearly identifying the position of the guidewires at any given moment without the use of prohibitive amounts of contrast. PMID:26989520

  16. Successful Venous Angioplasty of Superior Vena Cava Syndrome after Heart Transplantation

    Directory of Open Access Journals (Sweden)

    Thomas Strecker

    2014-01-01

    Full Text Available Introduction. For patients with terminal heart failure, heart transplantation (HTX has become an established therapy. Before transplantation there are many repeated measurements with a pulmonary artery catheter (PAC via the superior vena cava (SVC necessary. After transplantation, endomyocardial biopsy (EMB is recommended for routine surveillance of heart transplant rejection again through the SVC. Case Presentation. In this report, we present a HTX patient who developed a SVC syndrome as a possible complication of all these procedures via the SVC. This 35-year-old Caucasian male could be successfully treated by balloon dilatation/angioplasty. Conclusion. The SVC syndrome can lead to pressure increase in the venous system such as edema in the head and the upper part of the body and further serious complications like cerebral bleeding and ischemia, or respiratory problems. Balloon angioplasty and stent implantation are valid methods to treat stenoses of the SVC successfully.

  17. Monorail Piccolino catheter: a new rapid exchange/ultralow profile coronary angioplasty system.

    Science.gov (United States)

    Mooney, M R; Douglas, J S; Mooney, J F; Madison, J D; Brandenburg, R O; Fernald, R; Van Tassel, R A

    1990-06-01

    The Monorail Piccolino coronary angioplasty balloon catheter (MBC) was evaluated on 118 patients at two centers. Technical success was achieved in 110 patients (93%). Time for catheter exchange and total fluoroscopy time were significantly lower for the Monorail catheter than with standard equipment (exchange time 97 vs. 170 seconds P less than .05 and fluoroscopy time 17 vs. 88 seconds P less than .001). The advantages of rapid exchange and the ability of utilize 2 Monorail balloon catheters through one 9F guiding catheter for simultaneous inflations allowed for maximal flexibility in treating patients with bifurcation lesions. The double wire approach utilizing one Monorail balloon catheter with a 7F guiding catheter was also technically successful. The Monorail Piccolino balloon catheter has unique features that allow for greater ease of operator use, rapid catheter exchange, and optimal angiographic visualization. It is felt that this catheter design provides distinct advantages over standard angioplasty equipment.

  18. Use of a wire extender during neuroprotected vertebral artery angioplasty and stenting.

    Science.gov (United States)

    Lesley, Walter S; Kumar, Ravi; Rangaswamy, Rajesh

    2010-09-01

    The off-label use of an extender wire during vertebral artery stenting and angioplasty with or with neuroprotection has not been previously reported. Retrospective, single-patient, technical report. After monorail balloon angioplasty was performed on a proximal left vertebral artery stenosis, the 190 cm long Accunet neuroprotection filter device was not long enough for delivery of an over-the-wire stent. After mating a 145 cm long, 0.014 inch extension wire to the filter device, a balloon-mounted Liberté stent was implanted with good angiographic and clinical results. The off-label use of an extender wire permits successful over-the-wire stenting on a monorail neuroprotection device for vertebral artery endosurgery.

  19. Clinical effectiveness of percutaneous angioplasty for acute and chronic mesenteric ischemia: a six case series.

    Science.gov (United States)

    Jung, Yu Min; Jo, Yun Ju; Ahn, Sang Bong; Son, Byoung Kwan; Kim, Seong Hwan; Park, Young Sook; Bae, June Ho; Cho, Young Kwon

    2011-04-01

    Intestinal ischemia is divided into three categories, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), and colonic ischemia. AMI can result from arterial or venous thrombi, emboli, and vasoconstriction secondary to low-flow states. It is an urgent condition which can result in high mortality rate. The predominant causative factor of CMI is stenosis or occlusion of the mesenteric arterial circulation, and it is characterized by postprandial abdominal pain and weight loss. Surgery is the treatment of choice for intestinal ischemia. However, it has been recently reported that percutaneous transluminal angioplasty with stent placement and/or thrombolysis is an effective therapy in various types of mesenteric ischemia. We report six cases of mesenteric ischemia which were successfully treated by percutaneous angioplasty, and review the literature from South Korea.

  20. Ultrasound-Guided Angioplasty of Dysfunctional Vascular Access for Haemodialysis. The Pros and Cons

    Energy Technology Data Exchange (ETDEWEB)

    García-Medina, J., E-mail: josegmedina57@gmail.com [“Reina Sofia” University Hospital, Vascular and Interventional Radiology Unit, Department of Radiology (Spain); García-Alfonso, J. J., E-mail: juanjozarandieta@gmail.com [University of Murcia, Faculty of Medicine (Spain)

    2017-05-15

    PurposeTo describe the benefits and the disadvantages of angioplasty in dialysis fistulas using only ultrasound guidance.Materials and MethodsThis is a prospective study in 132 failing or non-maturing arteriovenous accesses that underwent 189 ultrasound-guided balloon angioplasties. The technical success was defined as non-use of X-ray fluoroscopy during the procedure.Results127 procedures (67%) were successfully completed without fluoroscopy. Most failures were due to difficulty to traverse aneurismal segments, as well as anastomotic stenoses. Including initial failures, the primary patency rates at 6, 12 months and 2 years were 75 ± 3, 41 ± 3 and 14 ± 2%, respectively.ConclusionEndovascular repair of the dysfunctional vascular access for haemodialysis under ultrasound guidance is feasible and safe in roughly two-thirds of cases.

  1. Autogenic training reduces anxiety after coronary angioplasty: a randomized clinical trial.

    Science.gov (United States)

    Kanji, N; White, A R; Ernst, E

    2004-03-01

    Autogenic training (AT) is a method of autosuggestion with some potential for reducing anxiety. This study tests whether AT lowers anxiety levels experienced by patients undergoing coronary angioplasty. Fifty-nine patients were randomly assigned to receive regular AT or no such therapy as an adjunct to standard care for 5 months. The primary outcome measure was State Anxiety at 2 months. Qualitative information was generated by face-to-face interviews. State Anxiety showed a significant intergroup difference both at 2 and 5 months. This finding was corroborated by secondary outcome measures, for example, quality of life, and by qualitative information about patients' experiences. The results do not allow us to determine whether the observed effects are specific to AT or of a nonspecific nature. Our results suggest that AT may have a role in reducing anxiety of patients undergoing coronary angioplasty.

  2. “Transcollateral” Renal Angioplasty for a Completely Occluded Renal Artery

    International Nuclear Information System (INIS)

    Chandra, Subash; Chadha, Davinder S.; Swamy, Ajay

    2011-01-01

    Percutaneous transluminal renal angioplasty with stenting has been effective in the control of hypertension, renal function, and pulmonary edema caused by atherosclerotic renal artery stenosis. However, the role of the procedure has not been fully established in the context of chronic total occlusion of renal artery. We report the successful use of this procedure in 57-year-old male patient who reported for evaluation of a recent episode of accelerated hypertension. A renal angiogram in this patient showed ostial stenosis of the right renal artery, which was filling by way of the collateral artery. Renal angioplasty for chronic total occlusion of right renal artery was successfully performed in a retrograde fashion through a collateral artery, thereby leading to improvement of renal function and blood pressure control.

  3. Case report: renovascular hypertension following radiotherapy and chemotherapy treated by transluminal angioplasty

    International Nuclear Information System (INIS)

    Minton, M.J.; McIvor, J.; Cappuccio, F.P.; MacGregor, G.A.; Newlands, E.S.

    1986-01-01

    A man aged 33 with poorly controlled hypertension who had been treated with radiotherapy and combination chemotherapy for testicular teratoma 8 years earlier was found on arteriography to have 75% stenosis of the left renal artery and occlusion of the right renal artery. The stenosis was dilated by transluminal angioplasty and the hypertension adequately controlled. Patients who develop high blood pressure after abdominal radiotherapy with or without chemotherapy should be investigated for renal artery stenosis. (author)

  4. Long-Term Follow-Up of Percutaneous Balloon Angioplasty in Adult Aortic Coarctation

    International Nuclear Information System (INIS)

    Paddon, Alex J.; Nicholson, Anthony A.; Ettles, Duncan F.; Travis, Simon J.; Dyet, John F.

    2000-01-01

    Purpose: To assess long-term outcomes following percutaneous transluminal angioplasty (PTA) of congenital aortic coarctation in adults.Methods: Seventeen patients underwent PTA for symptomatic adult coarctation of the aorta. Sixteen patients, with a mean age of 28 years (range 15-60 years), were reviewed at a mean interval after angioplasty of 7.3 years (range 1.5-11 years). Assessment included magnetic resonance imaging (MRI), Doppler echocardiography, and clinical examination. Current clinical measurements were compared with pre- and immediate post-angioplasty measurements.Results: At follow-up 16 patients were alive and well. The patient not included in follow-up had undergone surgical repair and excision of the coarctation segment following PTA. Mean brachial systolic blood pressure for the group decreased from 174 mmHg before angioplasty to 130 mmHg at follow-up (p 0.0001). The mean gradient had fallen significantly from 50.9 to 17.8 at follow-up (p = 0.001). The average number of antihypertensive drugs required per patient decreased from 0.56 to 0.31 (p = 0.234). No significant residual stenoses or restenoses were seen at MRI. Small but clinically insignificant residual pressure gradients were recorded in all patients using Doppler echocardiography. Complications included one transient ischemic attack at 5 days, one external iliac dissection requiring stent insertion, and a further patient who developed a false aneurysm close to the coarctation site at 12 months which subsequently required surgical excision.Conclusion: PTA of adult coarctation is safe and effective in the long term. Although primary stenting has recently been advocated in the treatment of this condition, our results suggest that PTA remains the treatment of choice

  5. Popliteal artery thrombosis in a patient with Cogan syndrome: Treatment with thrombolysis and percutaneous transluminal angioplasty

    International Nuclear Information System (INIS)

    Bastug, Demir E.; Dominic, Anthony; Ortiz, Orlando; DiBartolomeo, Anthony G.; Kotzan, Jeffrey M.; Abraham, F. Matthew

    1997-01-01

    A 31-year-old woman with Cogan syndrome (a rare form of systemic vasculitis) was evaluated for a cold, painful left foot with diminished pulses. Arteriography demonstrated thrombosis of the left popliteal artery with evidence of vasculitis. Thrombolytic therapy was begun with initial success but eventual rethrombosis. After reinitiating thrombolytic therapy combined with intraarterial vasodilator therapy, successful angioplasty was performed with sustained results, at 6-month follow-up

  6. Ureteric angioplasty balloon placement to increase localised dosage of BCG for renal pelvis TCC.

    LENUS (Irish Health Repository)

    Forde, J C

    2012-03-01

    Endoscopic percutaneous resection of a renal pelvis transitional cell carcinoma (TCC) is a viable treatment option in those who would be rendered dialysis dependent following a nephroureterectomy. We report endoscopic percutaneous resection of an upper tract TCC recurrence in a single functioning kidney followed by antegrade renal pelvis BCG instillation with novel placement of inflated angioplasty balloon in the ureter to help localise its effect.

  7. Investigating the effect of collaborative care on depression, anxiety, and stress of patients after coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Parastoo Rezapour

    2016-02-01

    Full Text Available Background: Coronary artery disease and its associated treatment interventions such as angioplasty can lead to emotional problems, including depression, anxiety, and stress, in patients and might have adverse effects on the recovery process. This study aimed to evaluate the effect of collaborative care model on depression, anxiety, and stress in patients after coronary angioplasty. Methods: This clinical trial was conducted on 50 patients undergoing coronary angioplasty, who were referred to intensive care unit and surgical ward of one of the hospitals of Isfahan, Iran, in 2015. Samples were selected through randomized convenience sampling and were divided into intervention and control group (n=25 for each group. Collaborative care model, consisting of four stages of motivation, preparation, engagement, and evaluation, was implemented for the intervention group through five 45-60 minute sessions and a three-month telephone follow-up. Data was collected using depression, anxiety, and stress scale (DASS-42 before and one month after the intervention from both groups. Data were analyzed using descriptive statistics, Chi-square, as well as independent and paired t-tests in SPSS, version 18. Results: In this study, mean score of depression was significantly decreased in the intervention group after the implementation of collaborative model (from 31.6±3.7 to 6.3±5.03 (P<0.001, and mean anxiety and stress scores were reduced from 32.6±3.04 and 32.2±3.3 to 6.2±4.1 and 8.5±4.8, respectively (P<0.001. In this regard, a significant difference was observed between the intervention and control groups (P<0.001. Conclusion: Implementation of collaborative care could be associated with lower depression, anxiety, and stress in patients after coronary angioplasty. Therefore, its application is recommended as an effective method for such patients.

  8. Pravastatin and endothelium dependent vasomotion after coronary angioplasty: the PREFACE trial.

    Science.gov (United States)

    Mulder, H J; Schalij, M J; Kauer, B; Visser, R F; van Dijkman, P R; Jukema, J W; Zwinderman, A H; Bruschke, A V

    2001-11-01

    To test the hypothesis that the 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitor pravastatin ameliorates endothelium mediated responses of dilated coronary segments: the PREFACE (pravastatin related effects following angioplasty on coronary endothelium) trial. A double blind, randomised, placebo controlled, multicentre study. Four hospitals in the Netherlands. 63 non-smoking, non-hypercholesterolaemic patients scheduled for elective balloon angioplasty (pravastatin 34, placebo 29). The effects of three months of pravastatin treatment (40 mg daily) on endothelium dependent vasomotor function were studied. Balloon angioplasty was undertaken one month after randomisation, and coronary vasomotor function tests using acetylcholine were performed two months after balloon angioplasty. The angiograms were analysed quantitatively. The efficacy measure was the acetylcholine induced change in mean arterial diameter, determined in the dilated segment and in an angiographically normal segment of an adjacent non-manipulated coronary artery. Increasing acetylcholine doses produced vasoconstriction in the dilated segments (p = 0.004) but not in the normal segments. Pravastatin did not affect the vascular response to acetylcholine in either the dilated segments (p = 0.09) or the non-dilated sites. Endothelium dependent vasomotion in normal segments was correlated with that in dilated segments (r = 0.47, p < 0.001). There were fewer procedure related events in the pravastatin group than in the placebo group (p < 0.05). Endothelium dependent vasomotion in normal segments is correlated with that in dilated segments. A significant beneficial effect of pravastatin on endothelial function could not be shown, but in the dilated segments there was a trend towards a beneficial treatment effect in the pravastatin group.

  9. Successful Retrieval of an Embolized Vascular Closure Device (Angio-Seal{sup ®}) After Peripheral Angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Jud, Philipp, E-mail: philipp.jud@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria); Portugaller, Rupert; Bohlsen, Dennis [Medical University of Graz, Division of Vascular and Interventional Radiology, Department of Radiology (Austria); Gary, Thomas; Brodmann, Marianne [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria); Hackl, Gerald [Medical University of Graz, Division of Intensive Care, Department of Internal Medicine (Austria); Hafner, Franz [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria)

    2017-06-15

    A 55-year-old male with peripheral arterial disease underwent angioplasty of the right lower limb arteries via antegrade femoral access. Angio-Seal{sup ®} closure device was used to treat the puncture site, whereby the intravascular sealing anchor accidentally embolized into the malleolar region of the right posterior tibial artery. Successful retrieval of the anchor was accomplished by a SpiderFX embolic protection device. This technique may be a useful approach to retrieve embolized foreign bodies via endovascular access.

  10. Acute occlusion of the coronary artery after transluminal balloon coronary angioplasty

    International Nuclear Information System (INIS)

    Savchenko, A.P.; Matchin, Yu.G.; Lyakishev, A.A.

    1995-01-01

    The research was aimed at elucidation of the relationship of the clinical and angiographic factors, on the one hand, and development of acute occlusion following transluminal balloon coronary angioplasty TBCA, on the other. TBCA was carried out in 162 patients. Eight (4.9 %) patients developed acute occlusion of the coronary artery, which was complicated by acute myocardial infarction in 50 % cases. 35 refs.; 4 tabs

  11. Fibrin Sheath Angioplasty: A Technique to Prevent Superior Vena Cava Stenosis Secondary to Dialysis Catheters

    Science.gov (United States)

    Hacker, Robert I.; Garcia, Lorena De Marco; Chawla, Ankur; Panetta, Thomas F.

    2012-01-01

    Fibrin sheaths are a heterogeneous matrix of cells and debris that form around catheters and are a known cause of central venous stenosis and catheter failure. A total of 50 cases of central venous catheter fibrin sheath angioplasty (FSA) after catheter removal or exchange are presented. A retrospective review of an outpatient office database identified 70 eligible patients over a 19-month period. After informed consent was obtained, the dialysis catheter exiting the skin was clamped, amputated, and a wire was inserted. The catheter was then removed and a 9-French sheath was inserted into the superior vena cava, a venogram was performed. If a fibrin sheath was present, angioplasty was performed using an 8 × 4 or 10 × 4 balloon along the entire length of the fibrin sheath. A completion venogram was performed to document obliteration of the sheath. During the study, 50 patients were diagnosed with a fibrin sheath, and 43 had no pre-existing central venous stenosis. After FSA, 39 of the 43 patient's (91%) central systems remained patent without the need for subsequent interventions; 3 patients (7%) developed subclavian stenoses requiring repeat angioplasty and stenting; 1 patent (2.3%) developed an occlusion requiring a reintervention. Seven patients with prior central stenosis required multiple angioplasties; five required stenting of their central lesions. Every patient had follow-up fistulograms to document long-term patency. We propose that FSA is a prudent and safe procedure that may help reduce the risk of central venous stenosis from fibrin sheaths due to central venous catheters. PMID:23997555

  12. Cutting Balloon Angioplasty in the Treatment of Short Infrapopliteal Bifurcation Disease.

    Science.gov (United States)

    Iezzi, Roberto; Posa, Alessandro; Santoro, Marco; Nestola, Massimiliano; Contegiacomo, Andrea; Tinelli, Giovanni; Paolini, Alessandra; Flex, Andrea; Pitocco, Dario; Snider, Francesco; Bonomo, Lorenzo

    2015-08-01

    To evaluate the safety, feasibility, and effectiveness of cutting balloon angioplasty in the management of infrapopliteal bifurcation disease. Between November 2010 and March 2013, 23 patients (mean age 69.6±9.01 years, range 56-89; 16 men) suffering from critical limb ischemia were treated using cutting balloon angioplasty (single cutting balloon, T-shaped double cutting balloon, or double kissing cutting balloon technique) for 47 infrapopliteal artery bifurcation lesions (16 popliteal bifurcation and 9 tibioperoneal bifurcation) in 25 limbs. Follow-up consisted of clinical examination and duplex ultrasonography at 1 month and every 3 months thereafter. All treatments were technically successful. No 30-day death or adverse events needing treatment were registered. No flow-limiting dissection was observed, so no stent implantation was necessary. The mean postprocedure minimum lumen diameter and acute gain were 0.28±0.04 and 0.20±0.06 cm, respectively, with a residual stenosis of 0.04±0.02 cm. Primary and secondary patency rates were estimated as 89.3% and 93.5% at 6 months and 77.7% and 88.8% at 12 months, respectively; 1-year primary and secondary patency rates of the treated bifurcation were 74.2% and 87.0%, respectively. The survival rate estimated by Kaplan-Meier analysis was 82.5% at 1 year. Cutting balloon angioplasty seems to be a safe and effective tool in the routine treatment of short/ostial infrapopliteal bifurcation lesions, avoiding procedure-related complications, overcoming the limitations of conventional angioplasty, and improving the outcome of catheter-based therapy. © The Author(s) 2015.

  13. Matrix metalloproteinase 9 level as an indicator for restenosis following cervical and intracranial angioplasty and stenting

    Directory of Open Access Journals (Sweden)

    Jun-peng Liu

    2015-01-01

    Full Text Available Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study investigated serum level of matrix metalloproteinase 9 as a predictor of restenosis after 40 patients underwent cervical and/or intracranial angioplasty and stenting. Results showed that restenosis occurred in 30% (3/10 of patients when the serum level of matrix metalloproteinase 9 at 3 days after surgery was 2.5 times higher than preoperative level. No restenosis occurred when the serum level of matrix metalloproteinase 9 at 3 days after surgery was not 2.5 times higher than preoperative level. Restenosis occurred in 12% (2/17 of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for more than 30 days after surgery, but only occurred in 4% (1/23 of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for less than 30 days after surgery. However, the differences observed were not statistically significant (P > 0.05. Experimental findings indicate that when the serum level of matrix metalloproteinase 9 is 2.5 times higher than preoperative level at 3 days after cervical and intracranial angioplasty and stenting, it may serve as a predictor of in-stent restenosis.

  14. [Effect of compound Danshen dripping pills combined with atorvastatin on restenosis after angioplasty in rabbits].

    Science.gov (United States)

    Song, Jieli; Zeng, Jinpei; Zhang, Yongxia; Li, Pengfei; Zhang, Lihong; Chen, Cibin

    2014-08-01

    To study the effect of compound Danshen dripping pills and atorvastatin on restenosis after abdominal aorta angioplasty in rabbits. Rabbit models of abdominal aorta restenosis after angioplasty were established and treated with saline (group A), compound Danshen dripping pills (group B), atorvastatin (group C), or compound Danshen dripping pills plus atorvastatin (group D). HE staining was used to determine the thickness of arterial intimal hyperplasia and assess the morphological changes of the narrowed artery. Immunohistochemistry was employed to detect the expression of nuclear factor-κB (NF-κB) and monocyte chemoattractant protein-1 (MCP-1). Compared with group A, the 3 treatment groups showed significant increased vascular cavity area and reduced intimal area and percentage of intimal hyperplasia (Ppills combined with atorvastatin produces better effects than the drugs used alone in inhibiting vascular smooth muscle cell proliferation in rabbits after abdominal aorta angioplasty possibly due to a decreased expression of MCP-1 as a result of NF-κB inhibition.

  15. [Synchronized anterograde perfusion during percutaneous transluminal coronary angioplasty: preliminary clinical study].

    Science.gov (United States)

    Farcot, J C; Berland, J; Derumeaux, G; Letac, B; Bourdarias, J P

    1995-03-01

    A new circulatory system, "physiologic anteroperfusion system", has been developed and tested in 6 patients with significant proximal coronary artery stenosis. Prolonged and safe balloon inflation was possible without any ischemic signs. The system consists of an electronic cardiac synchroperfusor which, by activating a pulsatile unit, permits increased diastolic anteroperfusion of autologous blood under physiologic pressure through low-profile standard angioplasty catheters. This study reports the results obtained in 6 patients during proximal prolonged percutaneous transluminal coronary angioplasty. Four men and two women suffering from severe exertional angina pectoris, with normal resting left ventricular function, no collaterals and excellent apical two-dimensional four-chamber echocardiographic views were studied. After a 90 +/- 10 seconds of control occlusion under continuous monitoring of hemodynamics, electrocardiograms (3 to 4 leads), two-dimensional echo and chest pain grading, a second balloon inflation protected by the physiologic anteroperfusion system at a flow rate of 44 +/- 12 ml/min was performed for fifteen minutes. The ischemic signs present in the myocardium depending on the occluded artery were totally abolished during prolonged inflation protected by physiologic anteroperfusion system. All the patients were successfully dilated and were discharged from hospital the following morning without cardiac enzyme elevation or signs of central or peripheral hemolysis. Conclusion, in 6 patients with severe proximal coronary artery stenosis, safe prolonged proximal angioplasty without signs of ischemia was performed using a new simple physiologic anteroperfusion system, which allows active diastolic flow-pressure controlled autologous arterial blood perfusion, through standard low profile catheters.

  16. Cool excimer laser-assisted angioplasty (CELA) and tibial balloon angioplasty (TBA) in management of infragenicular arterial occlusion in critical lower limb ischemia (CLI).

    Science.gov (United States)

    Sultan, Sherif; Tawfick, Wael; Hynes, Niamh

    2013-04-01

    We aim to compare cool excimer laser-assisted angioplasty (CELA) versus tibial balloon angioplasty (TBA) in patients with critical limb ischemia (CLI) with tibial artery occlusive disease. The primary end point is sustained clinical improvement (SCI) and amputation-free survival (AFS). The secondary end points are binary restenosis, target extremity revascularization (TER), and cost-effectiveness. From June 2005 to October 2010, 1506 patients were referred with peripheral vascular disease and 572 with CLI. A total of 80 patients underwent 89 endovascular revascularizations (EVRs) for tibial occlusions, 47 using TBA and 42 using CELA. All patients were Rutherford category 4 to 6. Three-year SCI was enhanced with CELA (81%) compared to TBA (63.8%; P = .013). Three-year AFS significantly improved with CELA (95.2%) versus TBA (89.4%; P = .0165). Three-year freedom from TER was significantly improved with CELA (92.9%) versus 78.7% TBA (P = .026). Three-year freedom from MACE was comparable in both the groups (P = .455). Patients with CELA had significantly improved quality time without symptoms of disease or toxicity of treatment (Q-TWiST) at 3 years (10.5 months; P = .048) with incremental cost of €2073.19 per quality-adjusted life year gained. Tibial EVR provides exceptional outcome in CLI. The CELA has superior SCI, AFS, and freedom from TER, with improved Q-TWiST and cost-effectiveness.

  17. Long-term results after primary infrapopliteal angioplasty for limb ischemia

    International Nuclear Information System (INIS)

    Alfke, H.; Marburg Univ.; Vannucchi, A.; Froelich, J.J.; Klinikum Bad Hersfeld; El-Sheik, M.; Wagner, H.J.; Vivantes-Klinikum im Friedrichshain

    2007-01-01

    Purpose: To evaluate the technical success rate, procedure-related complications, and clinical long-term results for patients who underwent infrapopliteal angioplasty. Materials and Methods: We retrospectively evaluated all patients who underwent infrapopliteal angioplasty to treat critical chronic limb ischemia or severe claudication from 1/1997 to 12/1999. We excluded patients with acute (< 2 weeks) limb ischemia. Procedure-related data were prospectively documented in a database and analyzed with a focus on the technical success rate and procedure-related complications. In addition all clinical documents were analyzed, and a follow-up examination was performed or telephone interviews were conducted with patients, relatives and referring doctors for follow-up. The primary end points were the limb salvage rate and patient survival rate. The secondary end points included the complication rate, technical success rate, and walking distance. Results: 112 patients with a mean age of 72 years (41 women, 71 men) underwent crural angioplasty on 121 limbs. Four patients suffered from severe claudication (Rutherford category 3) and all others had critical chronic limb ischemia (category 4 to 6). The complication rate was 2.7 %. The technical success rate was 92 %. The ankle brachial index increased from 0.59 to 0.88. The mean walking distance increased significantly from 52 ± 66 to 284 ± 346 meters at the time of follow-up. The limb salvage rate was 83.6 % after one year and 81.1 % after three years. The mean survival rate according to Kaplan-Meier was 79.4 %, 69.2 %, and 54.2 % at 1, 2, and 3 years, respectively. Patients with at least one patent run-off vessel after angioplasty had a significantly better limb salvage rate. Diabetes was not a risk factor for limb salvage. Conclusion: Infrapopliteal angioplasty shows a high technical success rate with an acceptable complication rate. The clinical long-term success seems favorable if a least one open run-off vessel was

  18. Long-term results after primary infrapopliteal angioplasty for limb ischemia; Langzeitergebnisse nach Ballonangioplastie kruraler Arterien

    Energy Technology Data Exchange (ETDEWEB)

    Alfke, H. [Klinikum Luedenscheid (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Marburg Univ. (Germany). Klinik fuer Strahlendiagnostik; Vannucchi, A. [Marburg Univ. (Germany). Klinik fuer Strahlendiagnostik; Froelich, J.J. [Marburg Univ. (Germany). Klinik fuer Strahlendiagnostik; Klinikum Bad Hersfeld (Germany). Klinik fuer Radiologie und Nuklearmedizin; El-Sheik, M.; Wagner, H.J. [Marburg Univ. (Germany). Klinik fuer Strahlendiagnostik; Vivantes-Klinikum im Friedrichshain (Germany). Inst. fuer Radiologie und Interventionelle Therapie

    2007-08-15

    Purpose: To evaluate the technical success rate, procedure-related complications, and clinical long-term results for patients who underwent infrapopliteal angioplasty. Materials and Methods: We retrospectively evaluated all patients who underwent infrapopliteal angioplasty to treat critical chronic limb ischemia or severe claudication from 1/1997 to 12/1999. We excluded patients with acute (< 2 weeks) limb ischemia. Procedure-related data were prospectively documented in a database and analyzed with a focus on the technical success rate and procedure-related complications. In addition all clinical documents were analyzed, and a follow-up examination was performed or telephone interviews were conducted with patients, relatives and referring doctors for follow-up. The primary end points were the limb salvage rate and patient survival rate. The secondary end points included the complication rate, technical success rate, and walking distance. Results: 112 patients with a mean age of 72 years (41 women, 71 men) underwent crural angioplasty on 121 limbs. Four patients suffered from severe claudication (Rutherford category 3) and all others had critical chronic limb ischemia (category 4 to 6). The complication rate was 2.7 %. The technical success rate was 92 %. The ankle brachial index increased from 0.59 to 0.88. The mean walking distance increased significantly from 52 {+-} 66 to 284 {+-} 346 meters at the time of follow-up. The limb salvage rate was 83.6 % after one year and 81.1 % after three years. The mean survival rate according to Kaplan-Meier was 79.4 %, 69.2 %, and 54.2 % at 1, 2, and 3 years, respectively. Patients with at least one patent run-off vessel after angioplasty had a significantly better limb salvage rate. Diabetes was not a risk factor for limb salvage. Conclusion: Infrapopliteal angioplasty shows a high technical success rate with an acceptable complication rate. The clinical long-term success seems favorable if a least one open run-off vessel was

  19. Network workshop

    DEFF Research Database (Denmark)

    Bruun, Jesper; Evans, Robert Harry

    2014-01-01

    This paper describes the background for, realisation of and author reflections on a network workshop held at ESERA2013. As a new research area in science education, networks offer a unique opportunity to visualise and find patterns and relationships in complicated social or academic network data....... These include student relations and interactions and epistemic and linguistic networks of words, concepts and actions. Network methodology has already found use in science education research. However, while networks hold the potential for new insights, they have not yet found wide use in the science education...... research community. With this workshop, participants were offered a way into network science based on authentic educational research data. The workshop was constructed as an inquiry lesson with emphasis on user autonomy. Learning activities had participants choose to work with one of two cases of networks...

  20. Networking

    OpenAIRE

    Rauno Lindholm, Daniel; Boisen Devantier, Lykke; Nyborg, Karoline Lykke; Høgsbro, Andreas; Fries, de; Skovlund, Louise

    2016-01-01

    The purpose of this project was to examine what influencing factor that has had an impact on the presumed increasement of the use of networking among academics on the labour market and how it is expressed. On the basis of the influence from globalization on the labour market it can be concluded that the globalization has transformed the labour market into a market based on the organization of networks. In this new organization there is a greater emphasis on employees having social qualificati...

  1. Lessons Learned

    Directory of Open Access Journals (Sweden)

    Amanda Phelan BNS, MSc, PhD

    2015-03-01

    Full Text Available The public health nurses’ scope of practice explicitly includes child protection within their role, which places them in a prime position to identify child protection concerns. This role compliments that of other professions and voluntary agenices who work with children. Public health nurses are in a privileged position as they form a relationship with the child’s parent(s/guardian(s and are able to see the child in its own environment, which many professionals cannot. Child protection in Ireland, while influenced by other countries, has progressed through a distinct pathway that streamlined protocols and procedures. However, despite the above serious failures have occurred in the Irish system, and inquiries over the past 20 years persistently present similar contributing factors, namely, the lack of standardized and comprehensive service responses. Moreover, poor practice is compounded by the lack of recognition of the various interactional processes taking place within and between the different agencies of child protection, leading to psychological barriers in communication. This article will explore the lessons learned for public health nurses practice in safeguarding children in the Republic of Ireland.

  2. Highlights and Lessons from the EU CCS Demonstration Project Network: 13th International Conference on Greenhouse Gas Control Technologies, GHGT 2016. 14 November 2016 through 18 November 2016

    NARCIS (Netherlands)

    Kapetaki, Z.; Hetland, J.; Guenan, T. le; Mikunda, T.; Scowcroft, J.

    2017-01-01

    The European Carbon Capture and Storage (CCS) Demonstration Project Network (the “Network”) is currently composed of projects located in the Netherlands, Norway, Spain, and the UK. The goal of the Network is to accelerate deployment of CCS by sharing project development experiences about technology

  3. Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula

    Energy Technology Data Exchange (ETDEWEB)

    Tercan, Fahri, E-mail: ftercan@yahoo.com; Koçyiğit, Ali, E-mail: alkoc@yahoo.com [Pamukkale University, Department of Radiology, School of Medicine (Turkey); Güney, Bünyamin [Muğla Sıtkı Kocman University, Department of Radiology, School of Medicine (Turkey)

    2016-09-15

    PurposeThe present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses.MethodThe cases referred to our interventional radiology unit with symptoms and physical examination findings suggestive of ischemic steal syndrome were retrospectively evaluated first by Doppler ultrasonography, and then by angiography. Cases with proximal artery stenosis were applied angioplasty, and those with steal syndrome underwent coil embolization to distal radial artery.ResultsOf 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (range 41–78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery.ConclusionIn palmar arch steal syndrome affecting forearm fistulae, combined distal radial embolization and angioplasty is also an effective treatment method in the presence of proximal radial and ulnar arterial stenoses and occlusions.

  4. The Knitting Lesson.

    Science.gov (United States)

    Smith, Pamela

    1987-01-01

    Based on Jean-Francois Millet's 1869 painting, "The Knitting Lesson," this lesson's goal is to introduce students in grades seven through nine to genre (everyday life) painting the nineteenth century. The lesson is also designed to show that some aspects of genre may be timeless. (BSR)

  5. Is Angiosome-Targeted Angioplasty Effective for Limb Salvage and Wound Healing in Diabetic Foot? : A Meta-Analysis.

    Science.gov (United States)

    Chae, Kum Ju; Shin, Jin Yong

    2016-01-01

    Given that the efficacy of employing angiosome-targeted angioplasty in the treatment of diabetic foot remains controversial, this study was conducted to examine its efficacy. We performed a systematic literature review and meta-analysis using core databases, extracting the treatment modality of angiosome-targeted angioplasty as the predictor variable, and limb salvage, wound healing, and revision rate as the outcome variables. We used the Newcastle-Ottawa Scale to assess the study quality, along with the Cochrane Risk of Bias Tool. We evaluated publication bias using a funnel plot. The search strategy identified 518 publications. After screening these, we selected four articles for review. The meta-analysis revealed that overall limb salvage and wound healing rates were significantly higher (Odds ratio = 2.209, 3.290, p = 0.001, pdiabetic foot was more effective than nonangiosome-targeted angioplasty with respect to wound healing and limb salvage.

  6. Balloon angioplasty of popliteal and crural arteries in elderly with critical chronic limb ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Atar, Eli; Siegel, Yoel; Avrahami, Ram; Bartal, Gabriel; Bachar, Gil N.; Belenky, Alexander

    2005-02-01

    Objective: Elderly patients with extensive infrainguinal peripheral vascular disease and critical chronic limb ischemia (CCLI) are poor surgical candidates. Our purpose was to evaluate angiographic and clinical results of popliteal, infrapopliteal, and multi-level disease percutaneous transluminal angioplasty (PTA) in such patients. Design: Retrospective study of angiographic and clinical files in selected group. Materials and methods: Between 1996 and 2002, 38 elderly patients aged 80-94 years old (mean age 83.3) with critical leg ischemia were treated with PTA. All patients were at high surgical risk. 31/38 (81.5%) patients had chronic non-healing wounds, and 14/38 (37%) had multi-level disease of superficial femoral, popliteal and crural arteries. One hundred and two lesions were treated by angioplasty. Immediate angiographic and 1 year clinical results were retrospectively analyzed. Results: The overall procedural success rate was 32/38 (84.2%). There were three major complications (7.9%), but no deaths, and three technical failures, all were of infrapopliteal lesions. After 1 year, 27 patients could be followed, five patients died during the first year of unrelated causes. Twenty-three patients (85.2%), were clinically re-occluded within 1 year, but complete and partial wound healing was achieved in 80% (16/20) and rest pain improvement in 57% (4/7), so that overall limb salvage was 74% (20/27). Conclusions: Elderly patients with multi-level CCLI have a short patency term following angioplasty of 14.8% after 1 year. Nevertheless, this temporary vascular patency enables wound healing or improvement in 74% of these patients, thus such endovascular interventions are recommended in this age group.

  7. Balloon angioplasty of popliteal and crural arteries in elderly with critical chronic limb ischemia

    International Nuclear Information System (INIS)

    Atar, Eli; Siegel, Yoel; Avrahami, Ram; Bartal, Gabriel; Bachar, Gil N.; Belenky, Alexander

    2005-01-01

    Objective: Elderly patients with extensive infrainguinal peripheral vascular disease and critical chronic limb ischemia (CCLI) are poor surgical candidates. Our purpose was to evaluate angiographic and clinical results of popliteal, infrapopliteal, and multi-level disease percutaneous transluminal angioplasty (PTA) in such patients. Design: Retrospective study of angiographic and clinical files in selected group. Materials and methods: Between 1996 and 2002, 38 elderly patients aged 80-94 years old (mean age 83.3) with critical leg ischemia were treated with PTA. All patients were at high surgical risk. 31/38 (81.5%) patients had chronic non-healing wounds, and 14/38 (37%) had multi-level disease of superficial femoral, popliteal and crural arteries. One hundred and two lesions were treated by angioplasty. Immediate angiographic and 1 year clinical results were retrospectively analyzed. Results: The overall procedural success rate was 32/38 (84.2%). There were three major complications (7.9%), but no deaths, and three technical failures, all were of infrapopliteal lesions. After 1 year, 27 patients could be followed, five patients died during the first year of unrelated causes. Twenty-three patients (85.2%), were clinically re-occluded within 1 year, but complete and partial wound healing was achieved in 80% (16/20) and rest pain improvement in 57% (4/7), so that overall limb salvage was 74% (20/27). Conclusions: Elderly patients with multi-level CCLI have a short patency term following angioplasty of 14.8% after 1 year. Nevertheless, this temporary vascular patency enables wound healing or improvement in 74% of these patients, thus such endovascular interventions are recommended in this age group

  8. Drug-coated balloon angioplasty after directional atherectomy improves outcome in restenotic femoropopliteal arteries.

    Science.gov (United States)

    Sixt, Sebastian; Carpio Cancino, Oscar Gerardo; Treszl, András; Beschorner, Ulrich; Macharzina, Roland; Rastan, Aljoscha; Krankenberg, Hans; Neumann, Franz-Josef; Zeller, Thomas

    2013-09-01

    Restenosis remains an unresolved problem despite different treatment modalities and new stent technology in femoropopliteal arteries. No standard therapy has proven to provide acceptable outcome data for this entity. Directional atherectomy alone did not result in satisfactory long-term patency rates. The outcome might be improved in conjunction with drug-coated balloon angioplasty. In this retrospective study, restenotic lesions of the femoropopliteal arteries were treated with directed atherectomy in 89 lesions of consecutive patients (58% male; mean age, 69 ± 11 years). All patients received adjunctive treatment with conventional balloon percutaneous angioplasty (PTA; n = 60) or drug-coated balloon angioplasty (DCB; n = 29). Lesion location was in the stent (DCB [n = 27] vs PTA [n = 36]) and in native restenotic vessels (DCB [n = 2] vs PTA [n = 25]). The 1-year Kaplan-Meier freedom from restenosis estimates (95% confidence intervals) in the DCB and PTA groups were 84.7% (70.9%-98.5%) and 43.8% (30.5%-57.1%), respectively. In a multivariable Cox model for restenosis, DCB treatment had a hazard ratio (95% confidence interval) of 0.28 (0.12-0.66; P = .0036) compared with the PTA group. In the multivariable model for procedural success, the effect of treatment did not differ between PTA and DCB (P = .134). The combination of directed atherectomy with adjunctive DCB is associated with a better event-free survival at 12 months of follow-up compared with PTA after directed atherectomy. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  9. A clinical study on perforator stroke resulting from Wingspan stent angioplasty for symptomatic intracranial artery stenosis

    International Nuclear Information System (INIS)

    Wang Ziliang; Xu Haowen; Li Tianxiao; Zhu Liangfu; Li Zhaoshuo; Xue Jiangyu; Bai Weixing; Li Li; Guan Sheng

    2011-01-01

    Objective: To evaluate the incidence, potential hazards and effective countermeasure for perforator stroke (PS) resulting from stent angioplasty of symptomatic intracranial artery stenosis. Methods: Peri-operation PS complications of 258 patients receiving Gateway balloon-Wingspan stenting for severe symptomatic intracranial stenosis were analyzed. The incidence, clinical course, and prognosis of PS resulting from stenting were recorded. Special attention was given to the anatomical features, clinical manifestation and video materials of patients with PS. χ 2 test was used for statistics. Results: Two hundred and fifty-five patients received stent angioplasty successfully and 7 patients had PS (incidence rate 2.7%). The patients with basilar artery stenosis had a higher incidence of PS resulting from intracranial stenting (6.1%, 4/66) than patients with middle cerebral artery stenosis (2.5%, 3/118) (χ 2 =2.320, P= 0.025). The potential hazards for PS included preoperative perforator stroke adjacent to the stenotic segment and prominent dissection during operation. Six patients presented symptoms after awake from general anaesthesia and one had symptoms 3 hours after stenting. One deteriorated gradually and the others reached the maximum deficit almost at once. At the follow-up of 3 months, 3 patients were disabled and scored one, two, two by mRS respectively. Conclusion: The incidence of PS resulting from intracranial stenting was low and the prognosis was not disastrous. Stenosis at basilar artery and preoperative perforator stroke adjacent to the stenotic segment were potential risk factors for PS complication. Proper maneuver of angioplasty may decrease the incidence of PS and improve the prognosis. (authors)

  10. Lessons learned bulletin

    International Nuclear Information System (INIS)

    1994-05-01

    During the past four years, the Department of Energy -- Savannah River Operations Office and the Westinghouse Savannah River Company (WSRC) Environmental Restoration (ER) Program completed various activities ranging from waste site investigations to closure and post closure projects. Critiques for lessons learned regarding project activities are performed at the completion of each project milestone, and this critique interval allows for frequent recognition of lessons learned. In addition to project related lessons learned, ER also performs lessons learned critiques. T'he Savannah River Site (SRS) also obtains lessons learned information from general industry, commercial nuclear industry, naval nuclear programs, and other DOE sites within the complex. Procedures are approved to administer the lessons learned program, and a database is available to catalog applicable lessons learned regarding environmental remediation, restoration, and administrative activities. ER will continue to use this database as a source of information available to SRS personnel

  11. Short term results of percutaneous transluminal coronary angioplasty with the monorail technique: experience in the first 1000 patients.

    Science.gov (United States)

    de Feyter, P J; Serruys, P W; van den Brand, M; Suryapranata, H; Beatt, K

    1990-04-01

    The monorail technique allows monitoring of all steps of the coronary angioplasty procedure by high quality coronary angiography; easy, rapid, and safe recrossing and redilatation of the lesion if necessary; and stepwise dilatation of a stenosis with sequential increase of size of balloons. Transstenotic pressure differences cannot, however, be measured through the narrow shaft of the standard monorail balloon catheter. The monorail technique was used in 1014 patients (820 men, 194 women; mean age 57.8 years (range 24 to 84]. The indication for coronary angioplasty was stable angina in 52%, unstable angina in 40%, and acute myocardial infarction in 8%. Single vessel coronary angioplasty was attempted in 78%, multilesion coronary angioplasty in 11%, and multivessel coronary angioplasty in 11%. Angiographic success (reduction of stenosis to less than 50% of the luminal diameter) of all attempted lesions was achieved in 93%. The technique was clinically successful--that is, angiographic success of all attempted lesions, no occurrence of a major complication (death, myocardial infarction, acute bypass surgery), and improvement of symptoms--in 92% and partially successful in 1.3%. The clinical success rates were similar for stable angina (91%) and unstable angina (94%), but were somewhat lower for acute myocardial infarction (88%). Failure without major complication occurred in 3.4% of the patients. Failure with a major complication occurred in 3.3% (death 0.3%, myocardial infarction 2.4%, and acute bypass surgery 2.3%). The total major complication rate was higher in unstable angina (4.2%) than in stable angina (3.0%). These results indicate that the monorail technique can be applied safely and effectively for coronary angioplasty of patients with stable angina, unstable angina, and acute myocardial infarction.

  12. Economic appraisal of the angioplasty procedures performed in 2004 in a high-volume diagnostic and interventional cardiology unit.

    Science.gov (United States)

    Manari, Antonio; Costa, Elena; Scivales, Alessandro; Ponzi, Patrizia; Di Stasi, Francesca; Guiducci, Vincenzo; Pignatelli, Gianluca; Giacometti, Paola

    2007-10-01

    Growing interest in the use of drug-eluting stents (DESs) in coronary angioplasty has prompted the Healthcare Agency of the Emilia Romagna Region to draw up recommendations for their appropriate clinical use in high-risk patients. Since the adoption of any new technology necessitates economic appraisal, we analysed the resource consumption of the various types of angioplasty procedures and the impact on the budget of a cardiology department. A retrospective economic appraisal was carried out on the coronary angioplasty procedures performed in 2004 in the Department of Interventional Cardiology of Reggio Emilia. On the basis of the principles of activity-based costing, detailed hospital costs were estimated for each procedure and compared with the relevant diagnosis-related group (DRG) reimbursement. In 2004, the Reggio Emilia hospital performed 806 angioplasty procedures for a total expenditure of euro 5,176,268. These were 93 plain old balloon angioplasty procedures (euro 487,329), 401 procedures with bare-metal stents (euro 2,380,071), 249 procedures with DESs (euro 1,827,386) and 63 mixed procedures (euro 481,480). Reimbursements amounted to euro 5,816,748 (11% from plain old balloon angioplasty, 50% from bare-metal stent, 31% from DES and 8% from mixed procedures) with a positive margin of about euro 680,480 between costs incurred and reimbursements obtained, even if the reimbursement for DES and mixed procedures was not covering all the incurred costs. Analysis of the case-mix of procedures revealed that an overall positive margin between costs and DRG reimbursements was achieved. It therefore emerges that adherence to the indications of the Healthcare Agency of the Emilia Romagna Region for the appropriate clinical use of DESs is economically sustainable from the hospital enterprise point of view, although the DRG reimbursements are not able to differentiate among resource consumptions owing to the adoption of innovative technologies.

  13. The SABRE Trial (Sirolimus Angioplasty Balloon for Coronary In-Stent Restenosis)

    DEFF Research Database (Denmark)

    Verheye, Stefan; Vrolix, Mathias; Kumsars, Indulis

    2017-01-01

    centers, 50 ISR patients were treated with the Virtue balloon. Angiographic measurements at 6 months are reported, along with 12-month clinical follow-up. RESULTS Procedural success in the intention-to-treat population was 100 The primary safety endpoint was target lesion failure (TLF) (cardiac death...... and 14.3% MACE and for the per-protocol population were 2.8% TLF and 2.8% MACE. CONCLUSIONS This first-in-human study showed excellent procedural success for the Virtue sirolimus-eluting angioplasty balloon, 6-month LLL rates in line with current stent-free ISR treatment options, and clinical outcomes...

  14. Morphological differences in coronary arteries following rotational atherectomy versus balloon angioplasty: ultrasound and angioscopic observations

    Science.gov (United States)

    Bass, Theodore A.; Gilmore, Paul S.; White, Christopher J.; Chami, Youssef G.; Kircher, Barbara J.; Conetta, Donald A.

    1993-09-01

    Percutaneous transluminal coronary rotational atherectomy (PTCRA) is an exciting new device to recannulate obstructed coronary arteries. This device works as a high speed `drill,' selectively cutting hard atherosclerotic plaque while preferentially sparing the softer, less diseased vascular luminal surface. At speeds as high as 200,000 rpm the plaque is pulverized into small particles easily handled by the circulatory system with no untoward clinical sequela. Balloon angioplasty does not remove atherosclerotic plaque. It dilates the vessel by mechanically stretching, compressing and splitting the plaque and vessel lining. We compare morphological and surface luminal characteristics of vessels post PTCRA to vessels post PTCA.

  15. Balloon pulmonary angioplasty: a treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Aiko eOgawa

    2015-02-01

    Full Text Available In chronic thromboembolic pulmonary hypertension, stenoses or obstructions of the pulmonary arteries due to organized thrombi can cause an elevation in pulmonary artery resistance, which in turn can result in pulmonary hypertension. Chronic thromboembolic pulmonary hypertension can be cured surgically by pulmonary endarterectomy; however, patients deemed unsuitable for pulmonary endarterectomy due to lesion, advanced age, or comorbidities have a poor prognosis and limited treatment options. Recently, advances have been made in balloon pulmonary angioplasty for these patients, and this review highlights this recent progress.

  16. Nuclear medical control of the efficiency of transluminal coronary angioplasty (TCA)

    International Nuclear Information System (INIS)

    Klepzig, H. Jr.; Scherer, D.; Kober, G.; Maul, F.D.; Kanemoto, N.; Standke, R.; Hoer, G.; Kaltenbach, M.; Frankfurt Univ.

    1982-01-01

    To assess the results of transluminal coronary angioplasty 48 patients with coronary heart disease were investigated at rest and during exercise with the ECG (46 patients), thallium-201 myocardial scintigraphy (26 patients), and equilibrium radionuclide ventriculography (38 patients). Exercise stress test was quantified by means of an ischemia score, myocardial scintigraphy by an vitality index and by corresponding redistribution factors, and radionuclide ventriculography by ejection fraction and maximum systolic volume change as a fraction of enddiastolic volume. This, the results show, that in selected cases, TCA can achieve improved left ventricular function and perfusion comparable to that of aortocoronary bypass surgery. (orig./MG) [de

  17. Angioplasty treatment and stent implant vs. surgical treatment in patients with stenosis of the cervical carotid artery

    International Nuclear Information System (INIS)

    Hamdan, Nabil; Castro, Pablo; Calderon, Luis I; Gomez, German; Estrada, Gilberto; Hurtado, Edgar; Echeverria, Rene

    2006-01-01

    Angioplasty with stent implant is a less invasive procedure than surgical intervention in the treatment of significant stenosis of the common cervical carotid artery (common and internal) (5). Currently the major published studies, in which angioplasty and surgical treatment are compared, show similar results in the major events, as cerebrovascular accidents and mortality, but a greater significant difference in the apparition of acute myocardial infarction, during surgical intervention (5,11). The objective of this study is to compare in both treatment methods the major and minor clinical events, like cerebrovascular accident, acute myocardial infarction, death, bradycardia, hypotension and encephalopathy during the intervention, the hospitalization and the follow-up year, as well as the re-intervention, the time of hospital stay and the complications of the surgical incision. Materials and methods: in this study of historical cohort, 46 patients with significant stenosis of the cervical carotid arteries, who were subjected to intervention from January 1st 2001 to December 31st 2003, were included. 21 patients were treated with angioplasty and stent implant and 25 with surgery (endarterectomy) Results: 1 (4.8%) major cerebrovascular accident occurred during angioplasty, whereas none occurred in the patients treated with surgery. 1 (4%) acute myocardial infarction occurred during intervention in the group of patients treated with surgery, and none in the patients treated with angioplasty. No deaths occurred in any of the groups during intervention, hospitalization and the follow-up year. After 8 months 1 (4%) patient treated with surgery was intervened again with angioplasty and stent implant. There were no statistically significant differences between both groups during hospitalization, and in the apparition of minor complications as bradycardia and hypotension. 2 (8%) complications related to the incision of the neck compromising cranial nerves, occurred in the

  18. Contribution of inhibitory receptor glycoprotein iib / iiia in coronary angioplasty and acute coronary syndrome, about 152 patients

    International Nuclear Information System (INIS)

    Sellami, Walid

    2007-01-01

    The aim of our study was to evaluate the immediate results and long-term intake of anti-GP IIb / IIIa inhibitors for patients with acute coronary syndrome treated with coronary angioplasty. The use of anti-GP IIb / IIIa is a valid therapeutic option in patients with acute coronary syndrome with signs of severity and for patients undergoing complex angioplasty. Adverse effects of anti-GP IIb / IIIa can be seen to encourage vigilance and careful monitoring during the administration of these molecules and perfect knowledge of their pharmacological properties for appropriate use.

  19. Clinical effectiveness and cost-effectiveness of immediate angioplasty for acute myocardial infarction: systematic review and economic evaluation.

    Science.gov (United States)

    Hartwell, D; Colquitt, J; Loveman, E; Clegg, A J; Brodin, H; Waugh, N; Royle, P; Davidson, P; Vale, L; MacKenzie, L

    2005-05-01

    To review the clinical evidence comparing immediate angioplasty with thrombolysis, and to consider whether it would be cost-effective. Electronic databases. Experts in the field. For clinical effectiveness, a comprehensive review of randomised control trials (RCTs) was used for efficacy, and a selection of observational studies such as case series or audit data used for effectiveness in routine practice. RCTs of thrombolysis were used to assess the relative value of prehospital and hospital thrombolysis. Observational studies were used to assess the representativeness of patients in the RCTs, and to determine whether different groups have different capacity to benefit. Clinical effectiveness was synthesised through a narrative review with full tabulation of results of all included studies and a meta-analysis to provide a precise estimate of absolute clinical benefit. Consideration was given to the effect of the growing use of stents. The economic modelling adopted an NHS perspective to develop a decision-analytical model of cost-effectiveness focusing on opportunity costs over the short term (6 months). The results were consistent in showing an advantage of immediate angioplasty over hospital thrombolysis. The updated meta-analysis showed that mortality is reduced by about one-third, from 7.6% to 4.9% in the first 6 months, and by about the same in studies of up to 24 months. Reinfarction is reduced by over half, from 7.6% to 3.1%. Stroke is reduced by about two-thirds, from 2.3% with thrombolysis to 0.7% with percutaneous coronary intervention (PCI), with the difference being due to haemorrhagic stroke. The need for coronary artery bypass graft is reduced by about one-third, from 13.2% to 8.4%. Caution is needed in interpreting some of the older trials, as changes such as an increase in stenting and the use of the glycoprotein IIb/IIa inhibitors may improve the results of PCI. There is little evidence comparing prehospital thrombolysis with immediate PCI. Research

  20. Percutaneous transluminal angioplasty with stenting for treatment of superior vena cava obstructive syndrome

    International Nuclear Information System (INIS)

    Chen Shiwei; Qiao Delin

    2004-01-01

    Objective: To evaluate the clinical value of percutaneous transluminal angioplasty with stenting (PTAS) for the treatment of superior vana cava obstructive syndrome (SVCOS). Methods: 15 cases of SVCOS including 10 cases of lung cancer with mediastinal lymphatic metastasis, 3 cases as malignant lymphoma and 2 cases of esophageal cancer with mediastinal lymphadenopathy, were undergone right subclavian vein or elbow vein catheterization for pressure measurement and DSA imaging of SVC with displaying the obstructive characteristics. A self-expanding stent was then implanted through right femoral vein catheterization. Results: 15 cases were all successfully under-taken angioplasty and stenting, except 1 case with a long stricture over 10 cm requiring 2 stents. After successful stent placement, DSA revealed smooth flow of contrast with almost normal diameter of SVC lumen, together with disappearance or relief of SVCOS. The SVC pressure decreased from 30.5±2.3 cmH 2 O down to 8.8 ± 1.5 cmH 2 O after recanalization, with a significant difference in statistics (P<0.01). All the patients were followed up for 6 months and obstructive symptom did not reappear except one case complicated with thrombosis which was treated by regional thrombolysis and balloon dilation leading to obviously improved symptom. Conclusion: PTAS for the treatment of SVCOS is effective, safe, simple and of less complications. (authors)

  1. Renal angioplasty for atherosclerotic renal artery stenosis: Cardiologist′s perspective

    Directory of Open Access Journals (Sweden)

    A S Gulati

    2013-01-01

    Full Text Available Atherosclerotic renal artery stenosis (ARAS is frequently associated with concomitant coronary and peripheral arterial disease with a significant impact on cardiovascular morbidity and mortality. Renal angioplasty of ARAS is more challenging because of increased incidence of technical failures, complications, and restenosis; while there is barely perceptible control of hypertension and only marginal improvement in renal function. This is because most of the patient population in recent randomized trials had unmanifested or clinically silent renovascular disease. Manifestations of RAS should be looked for and incorporated in the management plan particularly before deciding for revascularization. In the absence of clinical manifestation like renovascular hypertension, ischemic nephropathy, left ventricular failure, or unstable coronary syndromes; mere presence of RAS is analogous to presence of concomitant peripheral arterial disease which increases risk of adverse coronary events. Dormant-RAS in the absence of any manifestations can be managed with masterly inactivity. Chronological sequence of events and clinical condition of the patient help in decision making by identifying progressive renovascular disease. Selecting patients for renal artery stenting who actually will benefit from revascularization shall also decrease the unnecessary complications inherent with any interventional procedure. The present review is an attempt to analyze the current view on the diagnostic and management issues more specifically about the need and rationale behind angioplasty.

  2. [The usefullness of percutaneous transluminal balloon angioplasty in the management of budd-Chiari syndrome].

    Science.gov (United States)

    Kim, Se Hwan; Yu, Kyung Sool; Baek, Seung Min; Lee, Seung Yup; Kim, Hyun Su; Tak, Won Young; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan; Chung, Joon Mo

    2002-06-01

    Membranous obstruction is the most common cause of Budd-Chiari syndrome in Orientals. Recently, percutaneous transluminal balloon angioplasty (PTBA) has been successfully applied as a treatment of membranous obstruction. We evaluated etiologies and clinical manifestations in our cases and the usefulness of PTBA. Twelve cases of Budd-Chiari syndrome were analyzed. 50.3 years was the average age of the cases (ranging from 37 to 67 years). Major symptoms or signs were superficial collateral vessels on the chest or the abdomen in 6 cases, ascites in 3, abdominal pain in 4, hepatomegaly in 4, splenomegaly in 3, melena or hematemesis in 2, and leg edema in 2. Upper gastrointestinal endoscopy showed esophageal varices in 6 cases and two of these 6 cases had gastric varices. Of 8 cases with liver cirrhosis, 4 were classified as Child-Pugh class A and 4 as B. Four patients with cirrhosis had concurrent hepatocellular carcinoma including 1 patient who was HBs Ag positive. Etiologies were membranous obstruction in 11 cases and protein C deficiency in 1 case. The main site of obstruction was IVC in 8 and hepatic vein in 4. PTBA was successfully performed in 8 cases of membranous obstruction. During the mean follow-up period of 27.6 months (12-40 months), there were no reobstructions except in 2 cases. The most common cause of Budd-Chiari syndrome in our cases was membranous obstruction of IVC. Percutaneous transluminal balloon angioplasty is a very useful treatment method.

  3. Platelet deposition at angioplasty sites and its relation to restenosis in human iliac and femoropopliteal arteries

    International Nuclear Information System (INIS)

    Minar, E.; Ehringer, H.; Ahmadi, R.; Dudczak, R.; Leitha, T.; Koppensteiner, R.; Jung, M.; Stuempflen, A.

    1989-01-01

    The amount and time course of platelet accumulation at angioplasty sites and influence of these platelets on restenosis after percutaneous transluminal angioplasty (PTA) in peripheral arteries were determined in 92 patients, who received either a high or low dose of aspirin. Platelet deposition was quantitated by means of dual-radiotracer scintigraphy and calculation of a platelet accumulation index (PAI). The PAI was higher (P less than .05) 4-6 hours after PTA compared with that on subsequent days. There was a trend toward greater platelet accumulation in vessels with extensive dissection. Platelet accumulation at the PTA site occurred with both doses of aspirin, with no differences between the two dosage groups. Twenty-one of 67 patients who underwent PTA in the femoropopliteal segment developed restenosis during a median follow-up of 14 months. The median PAI at 4-6 and 22-24 hours after PTA was significantly less in these 21 patients than in the 46 without restenosis. The data suggest that use of antiplatelet agents to prevent platelet deposition after PTA may not be useful for prevention of restenosis

  4. Assessment of percutaneous transluminal coronary angioplasty with 123IODO-heptadecanoic acid

    International Nuclear Information System (INIS)

    Stoddart, P.G.P.; Wilde, P.; Papouchado, M.; Jones, J.V.

    1987-01-01

    Ten patients underwent myocardial scintigraphy with 123 I-iodo-heptadecanoic acid (HDA), which was injected in the last minute of maximal exercise testing. Six of the patients were rescanned following percutaneous transluminal coronary angioplasty. All ten patients underwent full coronary angiography. There were visible perfusion defects on the static images in 74% of the myocardial areas which were supplied by an artery with a stenosis greater than 75%. The mean half life recorded from areas distal to an arterial stenosis of at least 90% (35.69 min±41.25 min), was longer than the expected normal mean (18.85 min±3.35 min). However, the difference was not statistically significant. The static images changed in some patients following angioplasty, however there was no consistent alteration in the half-lives. It was concluded that HDA is a suitable agent for investigating myocardial perfusion, but that the half life cannot be measured adequately for clinical purposes with a planar imaging sytsem. (orig.)

  5. [Effect of nattokinase on restenosis after percutaneous transluminal angioplasty of the abdominal artery in rabbits].

    Science.gov (United States)

    Gong, Min; Lin, Huan-bing; Wang, Qian; Xu, Jiang-ping

    2008-08-01

    To investigate the effect of nattokinase on intimal hyperplasia in rabbit abdominal artery after balloon injury and explore a novel strategy for the preventing restenosis after percutaneous transluminal angioplasty. Fifty-six New Zealand rabbits were randomly divided into 7 groups, namely the solvent control group, model group, natto extract lavage group, refined nattokinse lavage group, intravenous refined nattokinse injection group, clopidogrel group and clopidogrel-aspirin group. Balloon injury was induced by inserting the catheter through the femoral artery into the thoracic aorta of the rabbits. The platelet counts were notad and platelet aggregation was observed, and the abdominal artery was taken for pathological analysis. The expressions of MMP-2 and -9 in the abdominal artery were detected immunohistochemically. There was no significant difference in the platelet counts, platelet aggregation rate or MMP-2 and -9 expression between the model group and the nattokinse-treated groups (P>0.05). The stenosis index in each nattokinse-treated group was significantly greater and the neointimal proliferation index smaller than that of the model group (P<0.01 or 0.05). Nattokinse can inhibit restenosis of rabbit abdominal artery after percutaneous transluminal angioplasty, which is independent of its actions on the platelet or MMP-2 and -9 expressions.

  6. Improved left ventricular function and perfusion at rest after successful transluminal coronary angioplasty

    International Nuclear Information System (INIS)

    Klepzig, H.; Kaltenbach, M.; Standke, R.; Maul, F.D.; Hoer, G.

    1991-01-01

    The purpose of this study was to evaluate left ventricular function and perfusion at rest before and after percutaneous transluminal coronary angioplasty. In consecutive 69 patients in whom coronary stenoses were dilated, the radionuclide left ventricular ejection fraction at rest increased significantly. In 26 of these patients, the ejection fraction increased by at least 4%. In these patients, exercise-induced ischemic ST depression had been more pronounced than in the others. 36 other patients underwent 201 Tl myocardial scintigraphy before and after angioplasty. Twelve patients in whom pre-PTCA images had revealed regions with irreversible 201 Tl uptake defects, showed normal 201 Tl distribution patterns on post-PTCA scintigrams. Post-exercise 201 Tl uptake (representing myocardial perfusion and metabolic activity) during pre-PTCA exercise stress tests was significantly lower in these cases. It is concluded that PTCA can improve left ventricular function and perfusion at rest. This improvement is most obvious in patients with pronounced exercise-induced myocardial ischemia as diagnosed by typical ST segment depression and reduced thallium uptake. (orig.) [de

  7. Treatment of Chronic Thromboembolic Pulmonary Hypertension: The Role of Medical Therapy and Balloon Pulmonary Angioplasty.

    Science.gov (United States)

    Fernandes, Timothy M; Poch, David S; Auger, William R

    2016-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable disease when treated with pulmonary thromboendarterectomy (PTE). However, even at experienced surgical centers, nearly one-third of patients with CTEPH will be deemed inoperable for reasons including distal disease, comorbidities, or out-of-proportion pulmonary hypertension. It is in these patients with inoperable CTEPH that pulmonary hypertension (PH)-targeted medical therapy and balloon pulmonary angioplasty have potential therapeutic value. Previous unblinded cohort trials have assessed PH-targeted medical therapy in various subpopulations of CTEPH patients using epoprostenol, treprostinil, sildenafil, bosentan, and iloprost, each demonstrating measurable pulmonary hemodynamic effects. However, riociguat, a soluble guanylate cyclase stimulator, is the first FDA-approved therapy for inoperable CTEPH to demonstrate both an improvement in functional capabilities (6-minute walk time) as well as significant gains in secondary pulmonary hemodynamic end points in a large placebo-controlled trial. Balloon pulmonary angioplasty is an interventional procedure using telescoping catheters placed in the pulmonary arteries, through which wires and balloons are used to mechanically disrupt chronic clot material and relieve pulmonary vascular obstruction. Contemporary case series from multiple centers worldwide have demonstrated pulmonary hemodynamic improvement with this approach. As a result of these advances, patients with inoperable CTEPH who had few options as recently as 5 years ago now have alternatives with emerging evidence of therapeutic efficacy.

  8. Percutaneous transluminal angioplasty and stent placement for iliofemoral arterial atherosclerotic occlusive disease

    International Nuclear Information System (INIS)

    Zheng Yanbo; Jiang Wenjin; Liu Sheng; Song Xuepeng; Sheng Qirui

    2006-01-01

    Objectives: To assess the safety and efficacy of percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of iliofemoral arterial atherosclerotic occlusive diseases. Methods From April 1999 to August 2004, 13 cases of iliofemoral arterial occlusions were recanalized with contact thrombolytic therapy combined with guide wire mechanical recanalization method, followed by angioplasty and stent placement. A total of 25 self-expanding Wallstents were deployed. All patients were followed up by means of duplex ultrasound, angiography, or both. Results: All 13 cases were successfully recanalized, with technical successful rate of 100%. Available follow-up for all patients from 8 months-5 years (mean 26.2 months) included one patient undergoing again with successful contact thrombolysis because of early thrombosis; another patient with recurrent symptoms at 19 month after operation undertaking surgical bypass because of later reocclusion; all of the rest stents showing patency by the end of the study. Conclusions: Contact thrombolysis combined with guide wire mechanical recanalization for iliofemoral arterial occlusion is safe and effective, whereas PTA and stent placement would have the nearly same efficacy for the disease with mild injury and low restenosis. (authors)

  9. The Legal Implications of Student Use of Social Networking Sites in the UK and US: Current Concerns and Lessons for the Future

    Science.gov (United States)

    Davies, Mark R.; Lee, Barbara A.

    2008-01-01

    This paper provides a comparative snapshot of the current state of the law in the US and UK with respect to potential liability of university and college students for use (and misuse) of social networking sites. It reviews the limited case law on this topic, highlights the differences in the two nations' laws of defamation and the various possible…

  10. Comparison of orbital atherectomy plus balloon angioplasty vs. balloon angioplasty alone in patients with critical limb ischemia: results of the CALCIUM 360 randomized pilot trial.

    Science.gov (United States)

    Shammas, Nicolas W; Lam, Russell; Mustapha, Jihad; Ellichman, Jonathan; Aggarwala, Gaurav; Rivera, Ernesto; Niazi, Khusrow; Balar, Nilesh

    2012-08-01

    To evaluate the role of orbital atherectomy in calcified infrapopliteal arteries in patients with critical limb ischemia compared to balloon angioplasty (BA) alone. A randomized multicenter study was undertaken to evaluate short and 1-year outcomes in 50 patients (32 men; mean age 71 years, range 40-90) with confirmed calcified lesions using 1∶1 randomization to the Diamondback 360° Orbital Atherectomy System followed by BA vs. BA alone. All patients had severe (≥50% stenosis) peripheral artery disease (Rutherford classification 4-6) in the popliteal, tibial, and/or peroneal arteries. The primary endpoint was defined as restoration of a normal lumen (residual stenosis ≤30%) with no bailout stenting or dissection types C through F. Scheduled follow-up visits were conducted according to a common protocol at 1, 6, and 12 months. Procedural success was 93.1% (27/29 lesions) for atherectomy + BA patients and 82.4% (28/34 lesions) for BA alone (p = 0.27). Bailout stenting was needed in 2 (6.9%) of the 29 atherectomy + BA lesions and in 5 (14.3%) of the 35 BA-treated lesions (p = 0.44). At 1 year, there were no amputations in either group related to the index procedure. Estimates for freedom from target vessel revascularization and all-cause mortality were 93.3% and 100% in the atherectomy + BA group vs. 80.0% (p = 0.14) and 68.4% (p = 0.01) in the BA group, respectively. Proportional hazard models evaluating survival time vs. status of residual stenosis determined a hazard ratio for major adverse events of 5.6 for patients with an acute post-procedure residual stenosis >30% (p = 0.01). Debulking with orbital atherectomy appeared to increase the chance of reaching a desirable angioplasty result, with less acute need for bailout stenting and a higher procedure success. A negative association between procedure success and risk of serious adverse outcomes should encourage larger confirmatory studies.

  11. Systemic Hypertension and Transient Ischemic Attack in a 6-Year-Old Girl with Fibromuscular Dysplasia Treated with Percutaneous Angioplasty

    International Nuclear Information System (INIS)

    Foa-Torres, Gustavo; Ganame, Javier; Juaneda, Ernesto; Peirone, Alejandro; Barcudi, Maria Silvina; Achaval, Alberto

    2010-01-01

    We describe a 6-year-old girl with arterial hypertension secondary to fibromuscular dysplasia with stenoses of both renal arteries and transient ischemic attack due to extracranial right internal carotid artery subtotal occlusion as well as left internal carotid artery stenosis. She was treated with percutaneous angioplasty of both renal and both carotid arteries.

  12. Successful intestinal ischemia treatment by percutaneus transluminal angioplasty of visceral arteries in a patient with abdominal angina

    Directory of Open Access Journals (Sweden)

    Nenezić Dragoslav

    2011-01-01

    Full Text Available Introduction. Abdominal angina, also known as chronic mesenteric ischemia or intestinal angina, is a rare disease caused by intestinal flow reduction due to stenosis or occlusion of mesenteric arteries. A case of successful treatment of a patient with abdominal angina by percutaneous transuliminal angioplasty of high-grade superior mesenteric artery and coeliac trunk stenosis was presented. Case Outline. A 77-year-old male patient was admitted at our Clinic for severe postprandial abdominal pains followed by frequent diarrhoeas. Extensive gastrointestinal investigations were performed and all results were normal. Multislice computerized (MSCT arteriography was indicated which revealed ostial celiac trunk and superior mesenteric artery subocclusion. Percutaneous transluminal angioplasty of the superior mesenteric artery and coeliac trunk was done with two stents implantation. Just a few hours following the intervention, after food ingestion, there were no abdominal pains. Six months later, the patient described a significant feeling of relief after food ingestion and no arduousness at all. Conclusion. High-grade visceral arteries stenoses in patients with intestinal ischemia symptoms can be treated by either surgical procedures or percutaneus transluminal angioplasty. In cases when a low operative risk is anticipated, surgical treatment is recommended due to a better anatomical outcome, while percutaneus angioplasty is advised to elderly patients in whom increased operative risks can be expected.

  13. Short-, medium-, and long-term follow-up after percutaneous transluminal coronary angioplasty for stable and unstable angina pectoris

    NARCIS (Netherlands)

    O. Kamp (Otto); K.J. Beatt (Kevin); P.J. de Feyter (Pim); M.J.B.M. van den Brand (Marcel); H. Suryapranata (Harry); H.E. Luijten; P.W.J.C. Serruys (Patrick)

    1989-01-01

    textabstractThe first 840 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA) performed in the same institution were retrospectively assessed at an average follow-up period of 25 months after the initial procedure. The study population consisted of 506 patients

  14. Primary Cutting Balloon Angioplasty for Treatment of Venous Stenoses in Native Hemodialysis Fistulas: Long-Term Results from Three Centers

    International Nuclear Information System (INIS)

    Bhat, Rajesh; McBride, Kieran; Chakraverty, Sam; Vikram, Raghunandan; Severn, Alison

    2007-01-01

    Aim. To evaluate the technical success and patency rates following primary cutting balloon angioplasty for venous stenoses in native dialysis fistulas. Methods. Forty-one patients (26 men, 15 women; age range 26-82 years, average age 59 years) underwent 50 (repeat procedures in 9 patients) primary cutting balloon (PCB) angioplasty procedures in three institutions by three primary operators. The indication was primary stenosis in 21 patients, recurrent lesions in 15, and immature fistulas in 5. A PCB was used alone in 17 cases, but was followed by a larger standard balloon in 33 cases. Follow-up included ultrasound, flow analysis and urea reduction ratio, and ranged from 2 to 30 months (mean 14 months). Results. The technical success rate was 98%. All procedures were relatively painless. Two PCBs burst and 4 leaked, but without causing any morbidity. Nineteen fistulas were still working at last follow-up. Primary patency rates at 6, 12, and 24 months using Kaplan-Meier analysis were 88%, 73%, and 34%, respectively, and the primary assisted patencies were 90%, 75%, and 50%, respectively. Conclusion. PCB angioplasty has high technical success and low complication rates. The long-term patency rates are favorable for PCB angioplasty and compare favorably with other series

  15. 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...

  16. Comparison of costs of percutaneous transluminal coronary angioplasty and coronary bypass surgery for patients with angina pectoris

    NARCIS (Netherlands)

    C. van Halem; F. van den Brink; P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); H. Suryapranata (Harry); K.J. Meeter; E. Bos (Egbert); F.J. van Dalen (Frederik); M.J.B.M. van den Brand (Marcel)

    1990-01-01

    textabstractTo determine the costs of a procedure, the total costs of the department that provides the service must be considered and, in addition, the direct cost of the specific procedure. Applying this principle to the cost accounting of angioplasty and bypass surgery results in a direct, i.e.

  17. Efficacy of beta radiation in prevention of post-angioplasty restenosis : An interim report from the beta energy restenosis trial

    NARCIS (Netherlands)

    D. Meerkin; R. Bonan (Raoul); I.R. Crocker; A. Arsenault (André); P. Chougule; V.L.M.A. Coen (Veronique); D.O. Williams (David); P.W.J.C. Serruys (Patrick); S.B. King 3rd (Spencer)

    1998-01-01

    textabstractRestenosis remains a major limitation of coronary angioplasty in spite of major advances in techniques and technology. Recent studies have demonstrated that ionizing radiation may limit the degree of this problem. Gamma radiation has been shown to be effective in reducing in stent

  18. Cardiac troponin T and CK-MB mass release after visually successful percutaneous transluminal coronary angioplasty in stable angina pectoris

    DEFF Research Database (Denmark)

    Ravkilde, J; Nissen, H; Mickley, H

    1994-01-01

    The incidence of cardiac troponin T (Tn-T) and creatine kinase (CK) isoenzyme MB mass release was studied in 23 patients with stable angina pectoris undergoing visually successful percutaneous transluminal coronary angioplasty (PTCA). Serial blood samples were drawn for measurement of serum Tn...

  19. The Canadian Pediatric Surgery Network (CAPSNet): Lessons Learned from a National Registry Devoted to the Study of Congenital Diaphragmatic Hernia and Gastroschisis.

    Science.gov (United States)

    Butler, Alison E; Puligandla, Pramod S; Skarsgard, Erik D

    2015-12-01

    The Canadian Pediatric Surgery Network (CAPSNet) was created in 2005 by a geographically representative, multidisciplinary group of clinicians and researchers with the intent of establishing a national research registry for gastroschisis (GS) and congenital diaphragmatic hernia (CDH). Since then, CAPSNet has used this registry and its 16-center network to make contributions to the knowledge base informing best practices for GS and CDH care. More recently, CAPSNet has expanded its focus to include quality assurance and improvement at each of its sites, by issuing a benchmarked outcomes "report card" with its annual report. Finally, a major objective of CAPSNet has been to establish and adopt standardized, evidence-based practice guidelines for GS and CDH across all Canadian perinatal centers. Georg Thieme Verlag KG Stuttgart · New York.

  20. Strengthening and sustainability of national immunization technical advisory groups (NITAGs) globally: Lessons and recommendations from the founding meeting of the global NITAG network.

    Science.gov (United States)

    Adjagba, Alex; MacDonald, Noni E; Ortega-Pérez, Inmaculada; Duclos, Philippe

    2017-05-25

    National Immunization Technical Advisory Groups (NITAGs) provide independent, evidence-informed advice to assist their governments in immunization policy formation. However, many NITAGs face challenges in fulfilling their roles. Hence the many requests for formation of a network linking NITAGs together so they can learn from each other. To address this request, the Health Policy and Institutional Development (HPID) Center (a WHO Collaborating Center at the Agence de Médecine Préventive - AMP), in collaboration with WHO, organized a meeting in Veyrier-du-Lac, France, on 11 and 12 May 2016, to establish a Global NITAG Network (GNN). The meeting focused on two areas: the requirements for (a) the establishment of a global NITAG collaborative network; and (b) the global assessment/evaluation of the performance of NITAGs. 35 participants from 26 countries reviewed the proposed GNN framework documents and NITAG performance evaluation. Participants recommended that a GNN should be established, agreed on its governance, function, scope and a proposed work plan as well as setting a framework for NITAG evaluation. Copyright © 2017.

  1. What A Long Strange Trip It's Been: Lessons Learned From NASA EOS, LTER, NEON, CZO And On To The Future With Sustainable Research Networks

    Science.gov (United States)

    Williams, M. W.

    2014-12-01

    The traditional, small-scale, incremental approach to environmental science is changing as researchers embrace a more integrated and multi-disciplinary approach to understanding how our natural systems work today and how they may respond in the future to forcings such as climate change. In situ networks are evolving in response to these challenges so as to provide the appropriate measurements to develop high-resolution spatial and temporal data sets across a wide range of platforms from microbial measurements to remote sensing. These large programs provide a unique set of challenges when compared to more traditional programs. Here I provide insights learned from my participation in a number of large programs, including NASA EOS, LTER, CZO, NEON, and WSC and how those experiences in environmental science can help us move forward towards more applied applications of environmental science, including sustainability initiatives. I'll chat about the importance of managerial and management skills, which most of us scientists prefer to avoid. I'll also chat about making decisions about what long-term measurements to make and when to stop. Data management is still the weakest part of environmental networks; what needs to be done. We have learned that these networks provide an important knowledge base that can lead to informed decisions leading to environmental, energy, social and cultural sustainability.

  2. Percutaneous Transluminal Angioplasty and Enclosed Thrombolysis Versus Percutaneous Transluminal Angioplasty in the Treatment of Femoropopliteal Occlusions: Results of a Prospective Randomized Trial

    International Nuclear Information System (INIS)

    Nicholson, Tony

    1998-01-01

    Purpose: To determine whether percutaneous transluminal angioplasty (PTA) and enclosed thrombolysis (ET) is superior to PTA alone in the treatment of femoropopliteal occlusions. Methods: Twenty-five patients with 5-15-cm-long occlusions in the femoropopliteal segments, with otherwise normal run-in arteries and at least one normal tibioperoneal artery to the foot, were randomized to ET/PTA or PTA alone. Ankle brachial systolic index (ABI) was measured before the procedure and at 24 hr and 12 months after the procedure, when a duplex scan was also carried out. End points in the study were patency at, or repeat intervention before, 12 months. Results: Procedures were successful in 23 of 25 patients. There was one immediate occlusion of tibioperoneal arteries, and one early reocclusion of a reopened segment in the ET/PTA group. There was one early reocclusion in the PTA group. At 12 months patency was 70% and 69.2% in the ET/PTA and PTA groups respectively. Covariant analysis showed no significant difference in ABI between the two groups at any of the three measurement times. Conclusion: This trial demonstrated no difference between ET/PTA and PTA alone in femoropopliteal occlusions associated with normal proximal arteries and at least one normal tibioperoneal artery

  3. Decreased expression of vitamin D receptors in neointimal lesions following coronary artery angioplasty in atherosclerotic swine.

    Directory of Open Access Journals (Sweden)

    Gaurav K Gupta

    Full Text Available Inflammatory cytokines, such as TNF-α, play a key role in the pathogenesis of occlusive vascular diseases. Activation of vitamin D receptors (VDR elicits both growth-inhibitory and anti-inflammatory effects. Here, we investigated the expression of TNF-α and VDR in post-angioplasty coronary artery neointimal lesions of hypercholesterolemic swine and examined the effect of vitamin D deficiency on the development of coronary restenosis. We also examined the effect of calcitriol on cell proliferation and effect of TNF-α on VDR activity and expression in porcine coronary artery smooth muscle cells (PCASMCs in-vitro.Expression of VDR and TNF-α and the effect of vitamin D deficiency in post-angioplasty coronary arteries were analyzed by immunohistochemistry and histomorphometry. Cell proliferation was examined by thymidine and BrdU incorporation assays in cultured PCASMCs. Effect of TNF-α-stimulation on the activity and expression of VDR was analyzed by luciferase assay, immunoblotting and immunocytochemistry. In-vivo, morphometric analysis of the tissues revealed typical lesions with significant neointimal proliferation. Histological evaluation showed expression of smooth muscle α-actin and significantly increased expression of TNF-α in neointimal lesions. Interestingly, there was significantly decreased expression of VDR in PCASMCs of neointimal region compared to normal media. Indeed, post-balloon angioplasty restenosis was significantly higher in vitamin D-deficient hypercholesterolemic swine compared to vitamin D-sufficient group. In-vitro, calcitriol inhibited both serum- and PDGF-BB-induced proliferation in PCASMCs and TNF-α-stimulation significantly decreased the expression and activity of VDR in PCASMCs.These data suggest that significant downregulation of VDR in proliferating smooth muscle cells in neointimal lesions could be due to atherogenic cytokines, including TNF-α. Vitamin D deficiency potentiates the development of coronary

  4. Angiography for renal artery stenosis: no additional impairment of renal function by angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Lufft, Volkmar; Fels, Lueder M.; Egbeyong-Baiyee, Daniel; Olbricht, Christoph J. [Abteilung Nephrologie, Medizinische Hochschule Hannover (Germany); Hoogestraat-Lufft, Linda; Galanski, Michael [Abteilung Diagnostische Radiologie, Medizinische Hochschule Hannover (Germany)

    2002-04-01

    The aim of this study was to compare renal function between patients with renal angiography and patients with renal angiography and angioplasty (AP) for renal artery stenosis (RAS). Forty-seven patients with suspected RAS were prospectively investigated by digital subtraction angiography (DSA) using non-ionic low osmolar contrast media (CM). In 22 patients RAS was detected and in 16 cases an angioplasty was performed in the same session. The following parameters were determined 1 day prior to and after the DSA, respectively: serum creatinine (S-Crea, {mu}mol/l) and single-shot inulin clearance (In-Cl, ml/min) for the evaluation of renal function; and urine alpha 1-microglobuline (AMG, {mu}g/g Crea) and beta-N-acetyl-glucoseaminidase (beta-NAG, U/g Crea) as markers of tubular toxicity. Serum creatinine was measured additionally 2 days after CM had been injected. In both groups with and without AP 174{+-}65 and 104{+-}56 ml of CM (p<0.0005) were used, respectively. There were no differences with regard to renal function or risk factors for CM nephrotoxicity between both groups. In the group with AP S-Crea and In-Cl (each: mean{+-}SD) did not change significantly (before DSA: 171{+-}158 and 61{+-}24, after DSA: 189{+-}177 and 61{+-}25, respectively), beta-NAG (median) rose from 4 to 14 (p<0.05) and AMG from 8 to 55 (n.s., because of high SD). In the group without AP S-Crea increased from 134{+-}109 to 141{+-}113 (p<0.01), In-Cl dropped from 65{+-}26 to 62{+-}26 (p<0,01), beta NAG (median) rose from 4 to 8 (p=0.01), and AMG from 7 to 10 (n.s.). A rise in baseline S-Crea by more than 25% or 44 {mu}mol/l occurred in 4 and 2 patients in the group with and without AP, respectively. Creatinine increase was reversible in all cases within 7 days. In this study using sensitive methods to detect changes of renal function and tubular toxicity no additional renal function impairment in DSA with angioplasty for RAS compared with DSA alone could be demonstrated. Our data suggest

  5. Angiography for renal artery stenosis: no additional impairment of renal function by angioplasty

    International Nuclear Information System (INIS)

    Lufft, Volkmar; Fels, Lueder M.; Egbeyong-Baiyee, Daniel; Olbricht, Christoph J.; Hoogestraat-Lufft, Linda; Galanski, Michael

    2002-01-01

    The aim of this study was to compare renal function between patients with renal angiography and patients with renal angiography and angioplasty (AP) for renal artery stenosis (RAS). Forty-seven patients with suspected RAS were prospectively investigated by digital subtraction angiography (DSA) using non-ionic low osmolar contrast media (CM). In 22 patients RAS was detected and in 16 cases an angioplasty was performed in the same session. The following parameters were determined 1 day prior to and after the DSA, respectively: serum creatinine (S-Crea, μmol/l) and single-shot inulin clearance (In-Cl, ml/min) for the evaluation of renal function; and urine alpha 1-microglobuline (AMG, μg/g Crea) and beta-N-acetyl-glucoseaminidase (beta-NAG, U/g Crea) as markers of tubular toxicity. Serum creatinine was measured additionally 2 days after CM had been injected. In both groups with and without AP 174±65 and 104±56 ml of CM (p<0.0005) were used, respectively. There were no differences with regard to renal function or risk factors for CM nephrotoxicity between both groups. In the group with AP S-Crea and In-Cl (each: mean±SD) did not change significantly (before DSA: 171±158 and 61±24, after DSA: 189±177 and 61±25, respectively), beta-NAG (median) rose from 4 to 14 (p<0.05) and AMG from 8 to 55 (n.s., because of high SD). In the group without AP S-Crea increased from 134±109 to 141±113 (p<0.01), In-Cl dropped from 65±26 to 62±26 (p<0,01), beta NAG (median) rose from 4 to 8 (p=0.01), and AMG from 7 to 10 (n.s.). A rise in baseline S-Crea by more than 25% or 44 μmol/l occurred in 4 and 2 patients in the group with and without AP, respectively. Creatinine increase was reversible in all cases within 7 days. In this study using sensitive methods to detect changes of renal function and tubular toxicity no additional renal function impairment in DSA with angioplasty for RAS compared with DSA alone could be demonstrated. Our data suggest that AP performed for RAS has

  6. An assessment of PKI and networked electronic patient record system: lessons learned from real patient data exchange at the platform of OCHIS (Osaka Community Healthcare Information System).

    Science.gov (United States)

    Takeda, Hiroshi; Matsumura, Yasushi; Kuwata, Shigeki; Nakano, Hirohiko; Shanmai, Ji; Qiyan, Zhang; Yufen, Chen; Kusuoka, Hideo; Matsuoka, Masaki

    2004-03-31

    To enhance medical cooperation between the hospitals and clinics around Osaka local area, the healthcare network system, named Osaka Community Healthcare Information System (OCHIS), was established with support of a supplementary budget from the Japanese government in fiscal year 2002. Although the system has been based on healthcare public key infrastructure (PKI), there remain security issues to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority in contract with the Japanese Medical Information Systems Organization (MEDIS) in 2003. This paper describes the experimental design and the results of the study concerning message security.

  7. Lesson study i Danmark?

    DEFF Research Database (Denmark)

    Mogensen, Arne

    2009-01-01

    Der beskrives et japansk lesson study forløb, og det diskuteres i hvilket omfang, de gode japanske erfaringer kan overføres til dansk matematikundervisning.......Der beskrives et japansk lesson study forløb, og det diskuteres i hvilket omfang, de gode japanske erfaringer kan overføres til dansk matematikundervisning....

  8. "Frankenstein." [Lesson Plan].

    Science.gov (United States)

    Simon, Melanie

    Based on Mary Shelley's novel "Frankenstein," this lesson plan presents activities designed to help students understand that active readers interpret a novel (its characters, plot, setting, and theme) in different ways; and the great literature can be and has been adapted in many ways over time. The main activity of the lesson involves students…

  9. Rupture of the Renal Artery After Cutting Balloon Angioplasty in a Young Woman With Fibromuscular Dysplasia

    International Nuclear Information System (INIS)

    Oguzkurt, Levent; Tercan, Fahri; Gulcan, Oner; Turkoz, Riza

    2005-01-01

    A 24-year-old woman with uncontrollable high blood pressure for 3 months had significant stenosis of the left renal artery caused by fibromuscular dysplasia (FMD). The lesion was resistant to percutaneous transluminal angioplasty at 18 atm with a semicompliant balloon. Angioplasy with a 6 x 10 mm cutting balloon (CB) caused rupture of the artery. Low-pressure balloon inflation decreased but did not stop the leak. An attempt to place a stent-graft (Jostent; Jomed, Rangendingen, Germany) failed, and a bare, 6-mm balloon-expandable stent (Express SD; Boston Scientific, MN) was deployed to seal the leak, which had decreased considerably after long-duration balloon inflation. The bleeding continued, and the patient underwent emergent surgical revascularization of the renal artery with successful placement of a 6-mm polytetrafluoroethylene bypass graft. CBs should be used very carefully in the treatment of renal artery stenosis, particularly in patients with FMD

  10. Duplex evaluation following femoropopliteal angioplasty and stenting: criteria and utility of surveillance.

    Science.gov (United States)

    Baril, Donald T; Marone, Luke K

    2012-07-01

    Surveillance following lower extremity bypass, carotid endarterectomy, and endovascular aortic aneurysm repair has become the standard of care at most institutions. Conversely, surveillance following lower extremity endovascular interventions is performed somewhat sporadically in part because the duplex criteria for recurrent stenoses have been ill defined. It appears that duplex surveillance after peripheral endovascular interventions, as with conventional bypass, is beneficial in identifying recurrent lesions which may preclude failure and occlusion. In-stent stenosis following superficial femoral artery angioplasty and stenting can be predicted by both peak systolic velocity and velocity ratio data as measured by duplex ultrasound. Duplex criteria have been defined to determine both ≥50% in-stent stenosis and ≥80% in-stent stenosis. Although not yet well studied, it appears that applying these criteria during routine surveillance may assist in preventing failure of endovascular interventions.

  11. Iatrogenic Subtotal Stenosis of the Right Subclavian Artery Treated With Percutaneous Transluminal Angioplasty

    International Nuclear Information System (INIS)

    Smeenk, Robert M.; Kock, Mark C. J. M.; Elgersma, Otto E. H.; Schnater, Marco J.

    2011-01-01

    This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA.

  12. Longitudinal outcomes after tibioperoneal angioplasty alone compared to tibial stenting and atherectomy for critical limb ischemia.

    Science.gov (United States)

    Reynolds, Shaun; Galiñanes, Edgar Luis; Dombrovskiy, Viktor Y; Vogel, Todd R

    2013-10-01

    There are limited data available evaluating longitudinal outcomes after tibioperoneal angioplasty (TA) alone compared to adjunctive tibial procedures including stenting and atherectomy. Using the Centers for Medicare & Medicaid Services inpatient claims (2005-2007), patients evaluated TA only, TA plus stent placement (TA + S), and TA plus atherectomy (TA + A). A total of 2080 patients with critical limb ischemia underwent percutaneous tibioperoneal intervention for the indication of ulceration. Procedures included TA (56.3%), TA + S (16.2%), and TA + A (27.5%). Rates of amputation were not statistically different between the groups at 30, 90, and 365 days after the intervention. Mean total hospital charges were TA ($35,867), TA + A ($41,698; P = .0004), and TA + S ($51,040; P atherectomy for ulceration demonstrated no improvement in limb salvage. Future analysis of adjunctive tibioperoneal interventions is essential to temper cost, as they fail to improve long-term limb salvage.

  13. Percutaneous transluminal angioplasty in the region of the renal artery: indications, technique and results

    Energy Technology Data Exchange (ETDEWEB)

    Olbert, F; Ogris, E; Muzika, N; Schlegl, A; Vacariu, O; Diez, W

    1985-01-01

    The paper reports the results obtained by percutaneous transluminal angioplasty (PTA) in the treatment of renal artery stenosis in 25 patients with secondary hypertension and discusses indications and the technique used. The follow-up period ranged from 0.5 to 12 months. All interventions were performed with the Olbert catheter system. Following PTA a significant decrease in systolic, diastolic and mean arterial pressure was observed in nearly all patients. The response of the plasma renin activity (PRA) to orthostatic stimulation and pharmacological stimulation by furosemide was determined in a subset of 15 patients before and after PTA. A significant decrease in both basal and stimulated PRA values was observed subsequent to PTA. The decrease in PRA values after successful PTA did not, however, correlate with the extent of the blood pressure changes. (Author).

  14. Percutaneous transluminal angioplasty in the region of the renal artery: indications, technique and results

    International Nuclear Information System (INIS)

    Olbert, F.; Ogris, E.; Muzika, N.; Schlegl, A.; Vacariu, O.; Diez, W.

    1985-01-01

    The paper reports the results obtained by percutaneous transluminal angioplasty (PTA) in the treatment of renal artery stenosis in 25 patients with secondary hypertension and discusses indications and the technique used. The follow-up period ranged from 0.5 to 12 months. All interventions were performed with the Olbert catheter system. Following PTA a significant decrease in systolic, diastolic and mean arterial pressure was observed in nearly all patients. The response of the plasma renin activity (PRA) to orthostatic stimulation and pharmacological stimulation by furosemide was determined in a subset of 15 patients before and after PTA. A significant decrease in both basal and stimulated PRA values was observed subsequent to PTA. The decrease in PRA values after successful PTA did not, however, correlate with the extent of the blood pressure changes. (Author)

  15. After the Dawn - Balloon Pulmonary Angioplasty for Patients With Chronic Thromboembolic Pulmonary Hypertension.

    Science.gov (United States)

    Ogawa, Aiko; Matsubara, Hiromi

    2018-04-25

    In the past 5 years, balloon pulmonary angioplasty (BPA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are deemed inoperable has undergone significant refinement. As a result, the procedure is now used worldwide and has become a promising therapeutic option for those patients. However, pulmonary endarterectomy remains the gold standard treatment for patients with CTEPH because the techniques and strategies for BPA are not yet unified. The best therapeutic option for each patient should be determined based on discussion among a multidisciplinary team of experts. For BPA to become an established treatment for CTEPH, further data are needed. This review summarizes the techniques and strategies of BPA at present and discusses the future development of the procedure.

  16. Comparison of angiography and intravascular ultrasound before and after balloon angioplasty of the femoropopliteal artery

    International Nuclear Information System (INIS)

    Lankeren, Winnifred van; Gussenhoven, Elma J.; Pieterman, Herman; Sambeek, Marc R. H. M. van; Lugt, Aad van der

    1998-01-01

    Purpose: To compare angiographic and intravascular ultrasound (IVUS) data before and after balloon angioplasty (PTA) of the femoropopliteal artery.Methods: Qualitative and quantitative analyses were performed on corresponding angiographic and IVUS levels obtained from 135 patients.Results: IVUS detected more lesions, calcified lesions, and vascular damage than angiography. Sensitivity of angiography was good for the presence of a lesion (84%), moderate for eccentric lesions (53%) and for vascular damage (52%), and poor for calcified lesions (30%). The increase in angiographic diameter stenosis was associated with a decrease in lumen area and increase in percentage area stenosis on IVUS.Conclusions: Angiography is less sensitive than IVUS for detecting lesion eccentricity, calcified lesions, and vascular damage. Presence of a lesion and amount of plaque were underestimated angiographically. Only before PTA was good agreement found between angiographic diameter stenosis and lumen size on IVUS.

  17. Percutaneous transluminal angioplasty of renal artery: therapeutic experience of 31 patients

    International Nuclear Information System (INIS)

    Kim, Seung Cheol; Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Kim, Hong Dae; Jeong, Yoong Ki; Kim, Seung Hoon; Yeon, Kyung Mo

    1995-01-01

    The purpose of this study is to introduce the experience of 31 patients who had renovascular hypertension and underwent percutaneous transluminal angioplasty of renal artery (PTA). The subjects were 31 patients with hypertension and stenotic renal artery or arteries on angiography. The criteria of stenosis is more than 50% narrowing of the artery. The technical results were considered to be successful if residual stenosis is less than 50%. The clinical results were classified as cure, improvement and fail. And clinical results were analyzed according to the follow-up duration, short term (≤6 mo) and long term (> 6 mo). Technical success rate was 90.2% (37/41) and clinical success rate were 82.8% (24/29) on short term follow-up and 84.2% (16/19) on long term follow-up. Recurred cases were 7 cases. PTA is a safe and effective therapeutic modality on renovascular hypertension

  18. MYOCARDIAL PERFUSION ASSESSMENT IN FORECASTING EFFECT OF CORONARY ANGIOPLASTY IN PATIENTS WITH ISCHEMIC CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. B. Mironkov

    2015-01-01

    Full Text Available Aim. To define influence of the left ventricle (LV perfusion defects on the clinical status dynamics after coronary angioplasty in patients with the expressed myocardium dysfunction of ischemic etiology. Materials and methods. Examined 86 patients (81 men and 5 women aged from 46 to 73 years before and in 2–3 days after percutaneous coronary intervention with diagnosis: CAD, CHF with NYHA class III–IV, echocardiography parameters of LV: ejection fraction less than 40%, end-diastolic volume is more than 200 ml. Perfusion defects of myocardium estimated with use of ECG-gated single photon emission computed tomography. Predictors were defined: perfusion defects on LV apex (in score, perfusion defects in the area of LAD, LCx and RCA (%, the LV global perfusion defects (in score and %. Results. In 42% of cases 6-minute walk test increased to 3 times; The NYHA class decreased by 2 classes (group 1. In 28 cases 6-minute walk test increased to 2 times and the NYHA class decreased on 1 class. In 22 patients 6-minute walk test increased less than 50% of reference values and there was no dynamics NYHA class (50 patients of the group 2. Initial extent of LV global perfusion defects in group 1 – 41,2 ± 4,0%, in group 2 – 58,3 ± 2,4% (р = 0,0004. Similar values are received for perfusion indicators in the area of LAD and the LV apex. Prevalence of myocardial perfusion defects at rest reflects prevalence of a cardiosclerosis in a cardiac muscle. Conclusion. Degree of LV myocardial perfusion defects in patients with the expressed heart failure of ischemic etiology is the key indicator influencing clinical efficiency of coronary angioplasty. Critical size for definition of the favorable forecast of revascularization are 60% and more perfusion defects testifying that in a cardiac muscle the focal cardiosclerosis prevails over the functioning myocardium. 

  19. Impact of the Intracoronary Rendezvous technique on coronary angioplasty for chronic total occlusion.

    Science.gov (United States)

    Nihei, Taro; Yamamoto, Yoshito; Kudo, Shun; Hanawa, Kenichiro; Hasebe, Yuhi; Takagi, Yusuke; Minatoya, Yutaka; Sugi, Masafumi; Shimokawa, Hiroaki

    2017-10-01

    The Rendezvous technique, which requires bidirectional wiring, is one of the useful methods for improving the success rate of recanalization for chronic total occlusion (CTO) in the field of peripheral intervention. Recently, advanced new devices for percutaneous coronary intervention have enabled us to perform the Rendezvous technique for peripheral as well as for coronary CTO lesions. We used the Intracoronary Rendezvous technique to perform angioplasty for coronary CTO. "Intracoronary Rendezvous" means that Rendezvous was achieved within the CTO lesion. From March 2009 to November 2015, 189 patients underwent CTO angioplasty at our institute, and we treated 10 patients with the Intracoronary Rendezvous technique. This technique involves crossing the Gaia series guidewire to the contralateral Corsair microcatheter located inside the plaque of CTO lesions. The majority of the CTO sites examined were in the proximal RCA (60 %). Lesion length of the occlusion was relatively long (64.4 ± 12.2 mm). Using the biplane imaging system, we were able to control the Gaia guidewires in a specific direction. Furthermore, if the antegrade and retrograde wires can be advanced into contiguous space inside the CTO lesion, we intentionally entered either wire into the contralateral Corsair microcatheter, followed by successful CTO crossing. CTO recanalization was completed for all patients without controlled antegrade retrograde subintimal tracking (CART) or reverse CART. No major complications occurred during hospitalization. These results indicate that the Rendezvous technique, assisted by new devices and a biplane imaging system, represents one of the primary options to achieve successful coronary CTO recanalization.

  20. Critical appraisal of paclitaxel balloon angioplasty for femoral-popliteal arterial disease.

    Science.gov (United States)

    Herten, Monika; Torsello, Giovanni B; Schönefeld, Eva; Stahlhoff, Stefan

    2016-01-01

    Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB) concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis. This article reviews the results of DCB treatments of femoropopliteal and infrapopliteal lesions in comparison to standard angioplasty with uncoated balloons. A systematic literature search was performed in 1) medical journals (ie, MEDLINE), 2) international registers for clinical studies (ie, www.clinicaltrials.gov), and 3) abstracts of scientific sessions. Several controlled randomized trials with follow-up periods of up to 5 years demonstrated the efficacy of paclitaxel -DCB technology. However, calcified lesions seem to affect the efficacy of DCB. Combinations of preconditioning methods with DCBs showed promising results. Although the mechanical abrasion of calcium via atherectomy or laser ablation showed favorable periprocedural results, the long-term impact on restenosis and clinical outcome has to be demonstrated. Major advantages of the DCBs are the rapid delivery of drug at uniform concentrations with a single dose, their efficacy in areas wherein stents have been contraindicated until now (ie, bifurcation, ostial lesions), and in leaving no stent scaffold behind. Reinterventions are easier to perform because DCBs leave no metal behind. Various combinations of DCBs with other treatment modalities may prove to be viable options in future. The follow-up results of clinical studies will evaluate the long-term impact

  1. Percutaneous transluminal angioplasty combining intraarterial drug perfusion for the treatment of chronic lower limb ischemia

    International Nuclear Information System (INIS)

    Liu Yuan; He Chunshui; Liao Huaqiang; Zeng Wei; Zhang Hongwei; Liu Yang; Mu Yan; Liao Huaqiang; Guan Yongsong

    2008-01-01

    Objective: To evaluate the clinical effects of balloon angioplasty in combination with intraarterial perfusion of vasoactive drugs in the treatment of chronic lower limb ischemia. Methods: A total of 21 patients were treated with percutaneous transfemoral or transaxillary approach of balloon dilatation of the occlusive arterial segments, and then followed by perfusion of urokinase, Lipo prostaglandin E 1 and ginkgo leaf injection, respectively, into the responsible arteries via the catheter. Postoperatively, some of the patients with tibioperoneal arteries occlusion were perfused with the same drugs into their diseased arterial segments, one time per day altogether 5-7 times, through the ipsilateral femoral arterial sheath reserved temporarily, and then followed by observation for improvement of ischemia, superficial ulceration and gangrenous change. Results: Of the 21 patients, 20 were successfully treated with percutaneous transluminal balloon dilation and arterial perfusion with a technical successful rate of 95.2% (20/21). Five of the total 20 were additionally treated with the same drugs perfusion 5-7 days through the retained sheath, showing well patency. No serious complications occurred and ischemic symptoms of limbs improved, such as rest pain, claudication and dermo temperature. During 2-7 months follow-up, healing of skin ulcer occurred in 4 patients and breakoff of necrotic digits in 2 with the surface wound healed. Necrotic toes in all patients were dehydrated with stopping of necrosis and without any amputation. Conclusions: Percutaneous transluminal angioplasty combining intraarterial drug perfusion is safe and effective for promoting blood circulation with healing of ulceration and ceasing the development of lesions; with furthermore of maintaining the arterial patency through the retained vascular sheath for sustaining the drug plerfusion. (authors)

  2. Angioplasty and stent placement in the treatment of radiation-induced arterial injury

    International Nuclear Information System (INIS)

    Liu Pengcheng; Pierre, P.; Philippe, O.; Danial, C.; Jean-Paul, B.; Cyril, B.; Jean-Pierre, C.; Denis, K.; Helve, R.; Francis, J.

    1999-01-01

    Objective: Evaluation of therapeutic efficacy and longterm patency of angioplasty and stent for the treatment of radiation induced arterial disease. Methods: PTA was attempted in 18 arterial lesions following irradiation in 14 patients. Thirteen stents were placed in 8 patients to treat occlusion (n = 3), aneurysm (n = 1), residual stenosis (n =2), multiple stenoses (n = 1), and delayed restenosis after previous balloon angioplasty (n = 1). The stents were readily visualized and patency of the stent and the target artery determined with Doppler US and (or) CT in all patients. Results: Interventional procedure was successful in 14 patients of which 8 underwent stent placement for their arterial lesions. Eleven of these patients demonstrated primary patency with relief of clinical symptoms with a mean follow-up of 2 years (range, 8 months -60 months). Clinical improvement was noted for the other patients. Eleven patients underwent PTA once or twice. One patient had PTA four times and three stents were installed, two of which were in the area of the aortic bifurcation, and one in the celiac trunk. another patient also had PTA four times and two stents were placed in the superior mesenteric artery. A stent was implanted in one patient because of PTA induced dissection and occlusion, and the arterial lesion was considered to be cured clinically after a follow-up of 5 years. Conclusions: The results suggested that PTA with single or multiple techniques may be effective immediately in the treatment of arterial lesions caused by radiation and can be considered the first therapeutic option in these cases

  3. Percutaneous Transluminal Angioplasty of Renal Artery Fibromuscular Dysplasia: Mid-term Results

    International Nuclear Information System (INIS)

    Kim, Hyo Jin; Do, Young Soo; Shin, Sung Wook; Park, Kwang Bo; Cho, Sung Ki; Choe, Yeon Hyeon; Choo, Sung Wook; Choo, In Wook; Kim, Duk Kyung

    2008-01-01

    To evaluate mid-term imaging, clinical follow-up, and restenosis rates from patients that had undergone percutaneous transluminal renal artery angioplasty (PTRA) for symptomatic renal artery fibromuscular dysplasia (FMD). Between March 1999 and July 2006, 16 consecutive renal artery FMD patients underwent PTRA for poorly controlled hypertension. The patients were enrolled into this retrospective study after receiving 19 primary and four secondary PTRAs in 19 renal artery segments. Follow-up monitoring of blood pressure, use of antihypertensive medication, and the serum creatinine level after PTRA were assessed at 1, 3, 6, 9, 12 months, and each following year. The degree of restenosis was evaluated with computed tomographic angiography (CTA) after PTRA at 6, 12 months, and every year if possible. Technical and clinical success rates for the treatment of FMD, and restenosis rates for the renal artery were evaluated. The technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19). Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months. There was a cumulative 22% (4/18) restenosis rate during the follow-up period. All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA. Percutaneous transluminal renal artery angioplasty for clinically symptomatic renal FMD is technically and clinically successful and safe to perform. For all patients with restenosis, there was a good response after undergoing a second PTRA

  4. Patient Experience, Pain, and Quality of Life after Lower Limb Angioplasty: A Multisite Prospective Cohort Study

    Energy Technology Data Exchange (ETDEWEB)

    Culverwell, A. D., E-mail: adamculverwell@doctors.net.uk [Leeds General Infirmary (United Kingdom); Tapping, C. R.; Ettles, D. F. [Hull Royal Infirmary (United Kingdom); Kessel, D. [Leeds General Infirmary (United Kingdom)

    2012-08-15

    Purpose: To explore the experience of patients undergoing endovascular lower limb angioplasty and evaluate the improvements in quality of life and disease-related symptoms after the procedure. Methods: Patients completed a questionnaire before treatment and three questionnaires after the procedure (immediately after the procedure, and again 4 weeks and 3 months later). Anxiety, patient understanding, procedure-related pain, and disease-related pain were assessed by a visual analog score (VAS). Complications, analgesic requirements, and satisfaction were recorded. Changes to quality of life were assessed by the validated SF36 questionnaire. Results: A total of 88 patients (41%) responded. Overall, disease-related pain decreased over 3 months after the procedure. Smokers had more pain both before and after the procedure (P < 0.05). Explanation was considered better if provided by radiologist (P < 0.05). Sixty-nine percent of patients found the procedures less painful (mean VAS 2.5) than they had anticipated (VAS 5.5). Fifty percent of patients experienced adverse effects related to their puncture site, but this was highest among patients who had undergone the procedure before and smokers. The greatest quality-of-life improvements were in emotional and general health. Higher levels of disease-related pain were associated with worse general, emotional, and physical health (P < 0.05). Conclusion: Lower limb angioplasty provides symptomatic and quality-of-life improvements. Implementation of simple measures could improve patient satisfaction-for example, treatment should be explained by the radiologist in advance. Routine prescription of analgesics with particular attention to smokers and those undergoing repeat interventions is suggested.

  5. Outpatient angioplasty and stenting facilitated by percutaneous arterial suture closure devices

    International Nuclear Information System (INIS)

    Wilde, N.T.; Bungay, P.; Johnson, L.; Asquith, J.; Butterfield, J.S.; Ashleigh, R.J.

    2006-01-01

    Aim: To review our practice of outpatient percutaneous vascular interventions facilitated by an arterial suture device. Materials and methods: A retrospective review of all patients attending this tertiary centre for iliac or femoral intervention was undertaken between February 2001 and December 2004. All patients who underwent angioplasty or stenting had their puncture sites closed using a Perclose suture. Patients were kept flat for 15 min and allowed to fully mobilize at 60 min. Puncture sites were scored for visible bruising, haematoma and pain at discharge and on outpatient follow-up. Patient preference for future outpatient treatment was assessed. Results: Fifty-seven outpatients underwent 81 punctures. Forty-eight (84%) patients underwent iliac angioplasty; of those 42% underwent stent placement. Six patients (10%) required inpatient admission, five secondary to failed suture deployment. One patient had a non-closer-related puncture site intimal flap occlusion successfully repaired at surgery. Fifty-one (90%) patients discharged with a mean time of 157 min (60-280 min). Forty-six (92%) patients had no visible bruising or palpable haematoma on discharge. No patient had a haematoma greater than 2.5 cm. No discharged patient required readmission. Thirty percent reported a moderate to severe groin pain score (2-5/5) at discharge, increasing to 40% at follow-up. Forty-seven (98%) of the 48 patients, who expressed a preference, would be happy to undergo outpatient treatment again. Conclusion: Outpatient treatment is feasible, well tolerated and preferable to patients, but 10% will require inpatient admission. A planned post-procedure analgesia regimen or advice should be considered

  6. Outpatient angioplasty and stenting facilitated by percutaneous arterial suture closure devices

    Energy Technology Data Exchange (ETDEWEB)

    Wilde, N.T. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Bungay, P. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Johnson, L. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Asquith, J. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Butterfield, J.S. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Ashleigh, R.J. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom)]. E-mail: Ray.Ashleigh@smuht.nhs.uk

    2006-12-15

    Aim: To review our practice of outpatient percutaneous vascular interventions facilitated by an arterial suture device. Materials and methods: A retrospective review of all patients attending this tertiary centre for iliac or femoral intervention was undertaken between February 2001 and December 2004. All patients who underwent angioplasty or stenting had their puncture sites closed using a Perclose suture. Patients were kept flat for 15 min and allowed to fully mobilize at 60 min. Puncture sites were scored for visible bruising, haematoma and pain at discharge and on outpatient follow-up. Patient preference for future outpatient treatment was assessed. Results: Fifty-seven outpatients underwent 81 punctures. Forty-eight (84%) patients underwent iliac angioplasty; of those 42% underwent stent placement. Six patients (10%) required inpatient admission, five secondary to failed suture deployment. One patient had a non-closer-related puncture site intimal flap occlusion successfully repaired at surgery. Fifty-one (90%) patients discharged with a mean time of 157 min (60-280 min). Forty-six (92%) patients had no visible bruising or palpable haematoma on discharge. No patient had a haematoma greater than 2.5 cm. No discharged patient required readmission. Thirty percent reported a moderate to severe groin pain score (2-5/5) at discharge, increasing to 40% at follow-up. Forty-seven (98%) of the 48 patients, who expressed a preference, would be happy to undergo outpatient treatment again. Conclusion: Outpatient treatment is feasible, well tolerated and preferable to patients, but 10% will require inpatient admission. A planned post-procedure analgesia regimen or advice should be considered.

  7. Patient Experience, Pain, and Quality of Life after Lower Limb Angioplasty: A Multisite Prospective Cohort Study

    International Nuclear Information System (INIS)

    Culverwell, A. D.; Tapping, C. R.; Ettles, D. F.; Kessel, D.

    2012-01-01

    Purpose: To explore the experience of patients undergoing endovascular lower limb angioplasty and evaluate the improvements in quality of life and disease-related symptoms after the procedure. Methods: Patients completed a questionnaire before treatment and three questionnaires after the procedure (immediately after the procedure, and again 4 weeks and 3 months later). Anxiety, patient understanding, procedure-related pain, and disease-related pain were assessed by a visual analog score (VAS). Complications, analgesic requirements, and satisfaction were recorded. Changes to quality of life were assessed by the validated SF36 questionnaire. Results: A total of 88 patients (41%) responded. Overall, disease-related pain decreased over 3 months after the procedure. Smokers had more pain both before and after the procedure (P < 0.05). Explanation was considered better if provided by radiologist (P < 0.05). Sixty-nine percent of patients found the procedures less painful (mean VAS 2.5) than they had anticipated (VAS 5.5). Fifty percent of patients experienced adverse effects related to their puncture site, but this was highest among patients who had undergone the procedure before and smokers. The greatest quality-of-life improvements were in emotional and general health. Higher levels of disease-related pain were associated with worse general, emotional, and physical health (P < 0.05). Conclusion: Lower limb angioplasty provides symptomatic and quality-of-life improvements. Implementation of simple measures could improve patient satisfaction—for example, treatment should be explained by the radiologist in advance. Routine prescription of analgesics with particular attention to smokers and those undergoing repeat interventions is suggested.

  8. Self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty

    International Nuclear Information System (INIS)

    Tepe, Gunnar; Heller, Stephan; Wiskirchen, Jakub; Fischmann, Arne; Claussen, Claus D.; Zeller, Thomas; Coerper, Stephan; Beckert, Stefan; Balletshofer, Bernd

    2007-01-01

    The feasibility of self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty was assessed. Options for lower limb percutaneous revascularization are limited, especially for complex vessel obstruction. Depending on the lesion and the experience of the interventionalist, the failure rate of balloon angioplasty (PTA) ranges between 10 and 40%. Until recently, no self-expanding stent for the use in the infragenicular arteries was available. This is the first report of the results for 18 consecutive patients who received 4F sheath compatible self-expanding nitinol stents following unsuccessful PTA or early restenosis. Twenty-four stents were implanted in 21 lesions for various indications residual stenosis >50% due to heavy calcification, flow-limiting dissection, occluding thrombus resistant to thrombolyis, thrombaspiration, and PTA, and early restenosis after previous PTA. Stent implantation was feasible in all cases. No complications occurred. After the stent implantation, all primarily unsuccessful interventions could be transformed into successful procedures with no residual stenosis >30% in any case. After 6 ± 2 months, two of the 18 patients died, and 14 of the 16 remaining patients improved clinically. At follow-up, the patency could be assessed in 14 stented arteries. Three stents were occluded, one stent showed some neointimal hyperplasia (50-70% restenosis), the remaining ten stents showed no restenosis (0-30%). The use of self-expanding nitinol stents in tibioperoneal and popliteal arteries is a safe and feasible option for the treatment of unsuccessful PTA. The 6-months patency is high. (orig.)

  9. Percutaneous Transluminal Angioplasty for Complete Membranous Obstruction of Suprahepatic Inferior Vena Cava: Long-Term Results

    Energy Technology Data Exchange (ETDEWEB)

    Kucukay, Fahrettin, E-mail: fkucukay@hotmail.com [Turkiye Yuksek Ihtisas Hospital, Department of Interventional Radiology (Turkey); Akdogan, Meral, E-mail: akdmeral@yahoo.com [Turkiye Yuksek Ihtisas Hospital, Department of Gastroenterology (Turkey); Bostanci, Erdal Birol, E-mail: ebbostanci@yahoo.com [Turkiye Yuksek Ihtisas Hospital, Department of Gastrointestinal Surgery (Turkey); Ulus, Ahmet Tulga, E-mail: uluss@yahoo.com [Hacettepe University, Department of Cardiovascular Surgery (Turkey); Kucukay, Murat Bulent, E-mail: dr-mbk@hotmail.com [Lokman Hekim Hospital, Department of Internal Medicine (Turkey)

    2016-10-15

    PurposeTo determine the long-term results of percutaneous transluminal angioplasty (PTA) for a complete membranous obstruction of the suprahepatic inferior vena cava.MethodsPatients (n = 65) who were referred to the interventional unit for PTA for a complete membranous obstruction of the suprahepatic inferior vena cava between January 2006 and October 2014 were included in the study. Thirty-two patients (18 males, 14 females, mean age 35 ± 10.7, range 20–42 years) were treated. The patients presented with symptoms of ascites (88 %), pleural effusion (53 %), varicose veins (94 %), hepatomegaly (97 %), abdominal pain (84 %), and splenomegaly (40 %). Transjugular liver access set and re-entry catheter were used to puncture and traverse the obstruction from the jugular side. PTA balloon dilations were performed. The mean follow-up period was 65.6 ± 24.5 months. The objective was to evaluate technical success, complications, primary patency, and clinical improvement in the symptoms of the patients.ResultsThe technical success rate was 94 %. In two patients, obstruction could not be traversed. These patients underwent cavoatrial graft bypass surgery. There were no procedure-related complications. Clinical improvements were achieved in all patients within 3 months. The primary patency rate at 4 years was 90 %. There was no primary assisted patency. There was no need for metallic stent deployment in the cohort. The secondary patency rate at 4 years was 100 %.ConclusionsPercutaneous transluminal angioplasty for a complete membranous obstruction of the suprahepatic inferior vena cava is safe and effective, and the long-term results are excellent.

  10. Is the Watanabe heritable hyperlipidemic rabbit a suitable experimental model for percutaneous transluminal coronary angioplasty in humans? A light microscopic, immunohistochemical and ultrastructural study

    NARCIS (Netherlands)

    Wanibuchi, H.; Dingemans, K. P.; Becker, A. E.; Ueda, M.; Naruko, T.; Tanizawa, S.; Nakamura, K.

    1993-01-01

    This study was designed to assess an experimental model for the study of mechanisms that underlie restenosis after percutaneous transluminal coronary angioplasty. The Watanabe heritable hyperlipidemic (WHHL) rabbit lacks the receptor for low density lipoproteins, produces atherosclerotic lesions

  11. Systematic Review of Randomized Controlled Trials of Patch Angioplasty Versus Primary Closure and Different Types of Patch Materials During Carotid Endarterectomy

    Directory of Open Access Journals (Sweden)

    Kittipan Rerkasem

    2011-01-01

    Conclusion: Meta-analysis of relatively small RCTs suggests that carotid patch angioplasty reduces the combined perioperative and long-term risk of stroke and the risk of restenosis. More data are needed.

  12. The history of a lesson

    DEFF Research Database (Denmark)

    Rasmussen, Mikkel Vedby

    2003-01-01

    and emphasises the need to study the history of lessons rather than the lessons of history. This approach shows that Munich is the end point of a constitutive history that begins in the failure of the Versailles treaty to create a durable European order following the First World War. The Munich lesson is thus......The article investigates the concept of lessons in IR. By means of a constructivist critique of the 'lessons literature', the article analyses one of the most important of IR lessons: that of Munich. Examining how the Munich lesson came about, the article shows the praxeological nature of lessons...... one element of the lesson of Versailles, which is a praxeology that defines how the West is to make peace, and against whom peace must be defended. The lesson of Versailles has been, at least in part, constitutive of the outbreak of the Cold War, and it continues to define the Western conception...

  13. 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 st...... angioplasty and stent implantation included in the Drug-Eluting Stent in Primary Angioplasty (DESERT) Cooperation database. Age was significantly associated with female gender (p...

  14. Transient right-sided heart failure after percutaneous transluminal angioplasty (PTA) of Membranous obstruction of inferior vena cava: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Bin [College of Medicine, University of Ulsan, Ulsan (Korea, Republic of); Lee, Deok hee; Kim, Yeon Suk; Jung, Seung Mun; Ryu, Dae Sik; Park, Man Soo [Kangnung Hospital, Kangnung (Korea, Republic of)

    2000-09-01

    We experienced a case of transient right-sided heart failure after angioplasty of membranous obstruction of the inferior vena cava confirmed by sonography and an inferior vena cavogram. Angioplasty involved the use of a self-expandable metallic stent, but after successful recanalization of the obstruction, the patient became dyspneic. Chest radiography revealed mild cardiomegaly with pulmonary congestion, but this was resolved spontaneously. For the prevention of serious heart failure, we recommend preprocedural evaluation of cardiac function. (author)

  15. Balloon Angioplasty – The Legacy of Andreas Grüntzig, M.D. (1939–1985)

    Science.gov (United States)

    Barton, Matthias; Grüntzig, Johannes; Husmann, Marc; Rösch, Josef

    2014-01-01

    In 1974, at the Medical Policlinic of the University of Zürich, German-born physician-scientist Andreas Grüntzig (1939–1985) for the first time applied a balloon-tipped catheter to re-open a severely stenosed femoral artery, a procedure, which he initially called “percutaneous transluminal dilatation”. Balloon angioplasty as a therapy of atherosclerotic vascular disease, for which Grüntzig and Charles T. Dotter (1920–1985) received a nomination for the Nobel Prize in Physiology or Medicine in 1978, became one of the most successful examples of translational medicine in the twentieth century. Known today as percutaneous transluminal angioplasty (PTA) in peripheral arteries or percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) in coronary arteries, balloon angioplasty has become the method of choice to treat patients with acute myocardial infarction or occluded leg arteries. On the occasion of the 40th anniversary of balloon angioplasty, we summarize Grüntzig’s life and career in Germany, Switzerland, and the United States and also review the developments in vascular medicine from the 1890s to the 1980s, including Dotter’s first accidental angioplasty in 1963. The work of pioneers of catheterization, including Pedro L. Fariñas in Cuba, André F. Cournand in France, Werner Forssmann, Werner Porstmann and Eberhard Zeitler in Germany, António Egas Moniz and Reynaldo dos Santos in Portugal, Sven-Ivar Seldinger in Sweden, and Barney Brooks, Thomas J. Fogarty, Melvin P. Judkins, Richard K. Myler, Dickinson W. Richards, and F. Mason Sones in the United States, is discussed. We also present quotes by Grüntzig and excerpts from his unfinished autobiography, statements of Grüntzig’s former colleagues and contemporary witnesses, and have included hitherto unpublished historic photographs and links to archive recordings and historic materials. This year, on June 25, 2014, Andreas Grüntzig would have celebrated

  16. Basic Lessons in ORA and AutoMap 2012

    Science.gov (United States)

    2012-06-11

    legend also appears. Below is a screen capture showing the visualization of the agent x event graph from the Stargate Summit Meta-Network. 4 The...visualization displays the connections between all items in the Stargate Summit Meta-Network. The red circles represent the agents, the green...examples I used for the Stargate dataset. 5 lessons - 201-207 A step by step run through of creating the Meta-Network from working with Excel

  17. Basic Lessons in ORA and AutoMap 2011

    Science.gov (United States)

    2011-06-13

    A small legend also appears. Below is a screen capture showing the visualization of the agent x event graph from the Stargate Summit Meta-Network...4 The visualization displays the connections between all items in the Stargate Summit Meta-Network. The red circles represent the agents, the...It takes the examples I used for the Stargate dataset. 5 lessons - 201-207 A step by step run through of creating the Meta-Network from

  18. Emergency coronary angioplasty with stenting using Cordis® diagnostic coronary catheters when there is difficulty in engaging guide catheters and bench evaluation of diagnostic and guide catheters.

    Science.gov (United States)

    Arokiaraj, Mark Christopher

    2018-02-01

    Difficulty in engaging with guide catheters is not uncommon in acute emergencies. We aimed to evaluate the use of Cordis ® INFINITI diagnostic catheters to perform angioplasty in patients in whom the coronaries cannot be engaged using standard guide catheters. In 34 cases of acute coronary syndrome, when difficulty in engagement with two standard guide catheters was encountered with reasonable manipulations, angioplasty was performed using diagnostic catheters. In total, 40 stents were placed by this technique. Pushability and trackability, distal tip flexion and three-point bending tests were performed to evaluate the performance of the guide and diagnostic catheters. Angioplasty was performed easily in a setting where it would have been very difficult to perform. Coronary dissection occurred in one patient, treated by a stent. The stent and dilatation balloons were easily passed through the diagnostic catheters. Pressure tracings were clearly preserved with certain stent delivery systems, and at angioplasty, although there was slightly reduced opacification of the respective artery, the coronary anatomy was sufficiently visualized to perform angioplasty. No periprocedural target lesion complications were seen in any cases. Pushability and trackability tests showed good force transmission along a tortuous path with diagnostic catheters, and balanced force-displacement curves from three-point bending tests and distal tip softness tests. Angioplasty with stenting can be performed safely through 6F Cordis ® infiniti diagnostic catheters when difficulty in engaging guide catheters is encountered. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Comparative Efficacy of Pulse-Spray Thrombolysis and Angioplasty Versus Surgical Salvage Procedures for Treatment of Recurrent Occlusion of PTFE Dialysis Access Grafts

    International Nuclear Information System (INIS)

    Polak, Joseph F.; Berger, Markus F.; Pagan-Marin, Heriberto; Aruny, John E.; Meyerovitz, Michael F.

    1998-01-01

    Purpose: To compare the efficacy of surgery versus pulse-spray thrombolysis and angioplasty in patients with recurrent thrombosis of polytetrafluoroethylene (PTFE) dialysis access grafts. Methods: We analyzed 96 consecutive interventions for thrombosed PTFE dialysis access grafts in 18 patients. Primary patency after thrombolysis and angioplasty (n= 25) was compared with primary patency following thrombectomy alone (n= 50) or thrombectomy followed by graft revision (n= 21) using life-table analysis. A Cox proportional hazards model that accounted for graft age and number of previous interventions was used to generate the relative risk for recurrent occlusion following therapy. Results: Life-table analysis showed that patency after thrombolysis and angioplasty was greater than that following thrombectomy alone (p= 0.02). After accounting for the age of the graft and the number of previous interventions (average six per patient), the relative risk for recurrent occlusion [3.0; 95% confidence intervals (CI): 1.5, 6.4] was greater for thrombectomy alone than for thrombolysis/angioplasty [0.6; CI = 0.3, 1.3]. The relative risks of repeat occlusion following thrombolysis/angioplasty [0.6; CI = 0.3, 1.3] and thrombectomy/surgical revision [1.0; CI = 0.5, 1.7] were similar. Conclusion: Outcome data from our retrospective study on recurrent thrombosis of PTFE dialysis access grafts suggest that thrombolysis/angioplasty is superior to thrombectomy alone, and equivalent to thrombectomy/surgical revision

  20. Long-term outcome of primary angioplasty compared with fibrinolysis across age groups: a Danish Multicenter Randomized Study on Fibrinolytic Therapy Versus Acute Coronary Angioplasty in Acute Myocardial Infarction (DANAMI-2) substudy

    DEFF Research Database (Denmark)

    Fosbøl, Emil Loldrup; Thune, Jens Jakob; Kelbaek, Henning

    2008-01-01

    of angioplasty versus fibrinolysis was investigated in 1,572 patients from the DANAMI-2 study across age groups. End points were total mortality and a composite end point of death, reinfarction, or disabling stroke. Follow-up was 3 years. RESULTS: Increasing age was associated with mortality (adjusted hazard...... ratio [HR] 2.45 per 10 year increment, 95% confidence interval [CI] 1.78-3.37, P age: patients aged ... 0.73, CI 0.41-1.31); 56 to 65 years (HR 0.83, CI 0.52-1.33); 66 to 75 years (HR 0.71, CI 0.48-1.04); and >75 years (HR 0.83, CI 0.59-1.17) (P = .006 for overall treatment effect and P = .5 for interaction between age and treatment). There was no long-term effect of angioplasty versus fibrinolysis...

  1. Sustained intra- and inter-jurisdictional transmission of tuberculosis within a mobile, multi-ethnic social network: lessons for tuberculosis elimination.

    Science.gov (United States)

    Aspler, Anne; Chong, Huey; Kunimoto, Dennis; Chui, Linda; Der, Evelina; Boffa, Jody; Long, Richard

    2010-01-01

    A context-specific, spatial-temporal understanding of a chain of tuberculosis (TB) transmission can inform TB elimination strategy. Clinical, public health and molecular epidemiologic data were used to: 1) identify and describe a complex cluster of TB cases in Alberta, 2) elucidate transmission sequences, and 3) assess case-patient mobility. Socio-economic indicators in loci of transmission and the province at large were described. Factors seen to be fostering or hampering TB elimination were identified. Over a 15-year period, 18 TB cases in Alberta and multiple cases in the Northwest Territories were determined to be due to the same strain. One patient was diagnosed at death; all others completed directly-observed therapy (DOT). Case-level analysis revealed that patients were highly mobile with transmission of the strain over 26,569 km2, an average of 2.8 different places of residence per patient during treatment, and contacts of sputum smear-positive cases spanning 9 of 17 regional health authorities. The majority of the contacts (57%) were attached to a single infectious case living in a homeless shelter. The three loci of transmission in Alberta were separated geographically but similar in terms of median incomes, rates of unemployment, levels of post-secondary education, and rates of population mobility (p network analysis, engineering controls in shelters and better determinants of health in loci of transmission were seen as hampering TB elimination.

  2. Ten-years trends in renal replacement therapy for end-stage renal disease in mainland France: Lessons from the French Renal Epidemiology and Information Network (REIN) registry.

    Science.gov (United States)

    Vigneau, Cécile; Kolko, Anne; Stengel, Bénédicte; Jacquelinet, Christian; Landais, Paul; Rieu, Philippe; Bayat, Sahar; Couchoud, Cécile

    2017-06-01

    The incidence rate of renal replacement therapy (RRT) for end-stage renal disease (ESRD) is decreasing in several countries, but not in France. We studied the RRT trends in mainland France from 2005 to 2014 to understand the reasons for this discrepancy and determine the effects of ESRD management changes. Data were extracted from the French Renal Epidemiology and Information Network registry. Time trends of RRT incidence and prevalence rates, patients' clinical and treatment characteristics were analysed using the Joinpoint regression program and annual percentage changes. Survival within the first year of RRT was analysed using Kaplan-Meier estimates for 4 periods of time. The overall age- and gender-adjusted RRT incidence rate increased from 144 to 159 individuals per million inhabitants (pmi) (+0.8% per year; 95% CI: 0.5-1.2) and the prevalence from 903 to 1141 pmi (+2.4% per year; 95% CI: 2.2-2.7). This increase concerned exclusively ESRD associated with type 2 diabetes (+4.0%; 3.4-4.6) and mostly elderly men. Despite patient aging and increasing comorbidity burden and a persistent 30% rate of emergency dialysis start, the one-year survival rate slightly improved from 82.1% (81.4-82.8) to 83.8% (83.3-84.4). Pre-emptive wait listing for renal transplantation and the percentage of wait-listed patients within one year after dialysis start strongly increased (from 5.6% to 15.5% and from 29% to 39%, respectively). Kidney transplantation and survival significantly improved despite the heavier patient burden. However, the rise in type 2 diabetes-related ESRD and the stable high rate of emergency dialysis start remain major issues. Copyright © 2016 Association Société de néphrologie. Published by Elsevier Masson SAS. All rights reserved.

  3. How transformational learning promotes caring, consultation and creativity, and ultimately contributes to sustainable development: Lessons from the Partnership for Education and Research about Responsible Living (PERL) network

    Science.gov (United States)

    Thoresen, Victoria Wyszynski

    2017-12-01

    Oases of learning which are transformative and lead to significant behavioural change can be found around the globe. Transformational learning has helped learners not only to understand what they have been taught but also to re-conceptualise and re-apply this understanding to their daily lives. Unfortunately, as many global reports indicate, inspirational transformational learning approaches for sustainable development are rare and have yet to become the norm - despite calls for such approaches by several outstanding educators and organisations. This article examines three learning approaches developed by the network of the Partnership for Education and Research about Responsible Living (PERL). These approaches are structured around core elements of transformative learning for sustainable development, yet focus particularly on the ability to care, consult with others and be creative. They seem to depend on the learners' ability to articulate their perceptions of sustainable development in relation to their own values and to identify how these are actualised in their daily life. Together with other core elements of transformative learning, an almost magical (not precisely measurable) synergy then emerges. The intensity of this synergy appears to be directly related to the individual learner's understanding of the contradictions, interlinkages and interdependencies of modern society. The impact of this synergy seems to be concurrent with the extent to which the learner engages in a continual learning process with those with whom he/she has contact. The findings of this study suggest that mainstreaming transformational learning for sustainable development in ways that release the "magic synergy of creative caring" can result in the emergence of individuals who are willing and able to move from "business as usual" towards more socially just, economically equitable, and environmentally sensitive behaviour.

  4. Real world implementation lessons and outcomes from the Worker Interactive Networking (WIN) project: workplace-based online caregiver support and remote monitoring of elders at home.

    Science.gov (United States)

    Mahoney, Diane M F; Mutschler, Phyllis H; Tarlow, Barbara; Liss, Ellen

    2008-04-01

    The objective of this research was to determine the feasibility of and receptivity to the first computerized workplace-based direct caregiver intervention and to assess the effects on businesses, working family caregivers, and their elderly relatives. Working family caregivers, with at least one health and/or safety concern related to an elder residing alone at home during the workday, were recruited from five companies (n = 27). Caregivers received free computer access to the Worker Interactive Networking (WIN) Internet online caregiver support group and a remote elder monitoring system at home for 6 months. The remote monitoring system provided Web-based status reports and e-mail/pager alerts when individualized parameters were exceeded. Motion sensor signals were transmitted to a transponder that uploaded via wireless cellular communications to the project server, thereby not interfering with elders' telephone use. Formative qualitative analyses clarified acceptance and implementation issues. Summative quantitative evaluation determined pilot intervention effects and was conducted by external evaluators. Despite interoperability and cellular reception issues, the system was successfully deployed across four states to a variety of businesses and housing types. Positive results occurred on worker morale, productivity, and reduction of caregiver stress. Participants found it easy to learn and use. Elders did not find the technology "intrusive" or "isolating." Contrary to their expectations, managers reported no abuse of Internet access. Workers expressed a willingness to pay for a similar system in the future ranging from $10 to $130, depending on the features. They would pay the most for the option involving a geriatric nurse coach. The WIN system innovatively tailored to users' wants, and provided users customized control and personalized support. Use of the system was associated with positive outcomes. Enrollment response suggests a specific niche market for

  5. Percutaneous transluminal angioplasty of brachiocephalic arteries: Indications and long-term success in a series of 25 patients

    International Nuclear Information System (INIS)

    Burke, D.R.; Gordon, R.; Mishkin, J.D.; Meranze, S.G.; McLean, G.K.

    1986-01-01

    The clinical records and procedural details of 28 angioplasty procedures performed on 25 patients were reviewed. Long-term follow-up was conducted by examining the referring physicians' records and by direct telephone contact with the patient. Nine patients had neurologic symptoms only, eight patients had arm claudication symptoms only, seven patients had both neurologic and arm symptoms, and two patients underwent dilation procedures to provide graft inflow. Procedural complications were a stroke in the contralateral carotid distribution during follow-up thoracic aortography, and an embolus to the fifth digit (of no clinical significance). Long-term success of the angioplasty procedure did not correlate with initial symptoms, degree of stenosis, lesion length, or postangioplasty appearance. All patients with arm and neurologic symptoms and who were followed up for 3 years, with the exception of the patient who suffered a periprocedural stroke

  6. Evaluation of the effect of collaborative care on depression, anxiety and stress of patients after coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Rezapour Parastoo

    2016-08-01

    Full Text Available Background and Objective: Coronary artery disease and its associated treatment interventions such as angioplasty can lead to emotional problems, including depression, anxiety, and stress, in patients and might have adverse effects on the recovery process. This study aimed to evaluate the effect of collaborative care model on depression, anxiety, and stress in patients after coronary angioplasty. Materials and Methods: This clinical trial was conducted on 50 patients undergoing coronary angioplasty, who were referred to intensive care unit and surgical ward of one of the hospitals of Isfahan, Iran, in 2015. Samples were selected through randomized convenience sampling and were divided into intervention and control group (n=25 for each group. Collaborative care model, consisting of four stages of motivation, preparation, engagement, and evaluation, was implemented for the intervention group through five 45-60 minute sessions and a three-month telephone follow-up. Data was collected using depression, anxiety, and stress scale (DASS-42 before and one month after the intervention from both groups. Data were analyzed using descriptive statistics, Chi-square, as well as independent and paired t-tests in SPSS, version 18. Results: In this study, mean score of depression was significantly decreased in the intervention group after the implementation of collaborative model (from 31.6±3.7 to 6.3±5.03 (P <0.001, and mean anxiety and stress scores were reduced from 32.6±3.04 and 32.2±3.3 to 6.2±4.1 and 8.5±4.8, respectively (P<0.001. In this regard, a significant difference was observed between the intervention and control groups (P<0.001. Conclusion: Implementation of collaborative care could be associated with lower depression, anxiety, and stress in patients after coronary angioplasty. Therefore, its application is recommended as an effective method for such patients.

  7. Randomized Trial of the SMART Stent versus Balloon Angioplasty in Long Superficial Femoral Artery Lesions: The SUPER Study

    International Nuclear Information System (INIS)

    Chalmers, Nicholas; Walker, Paul T.; Belli, Anna-Maria; Thorpe, Anthony P.; Sidhu, Paul S.; Robinson, Graham; Ransbeeck, Mariella van; Fearn, Steven A.

    2013-01-01

    To determine whether primary stenting reduces the rate of restenosis compared with balloon angioplasty alone in the endovascular treatment of long superficial femoral artery lesions; and to assess the effect of treatment on quality of life. A total of 150 patients with superior femoral artery occlusion or severe stenosis of 5–22 cm length from 17 UK centers were randomized to either primary stenting with the SMART stent or balloon angioplasty (i.e., percutaneous transluminal angioplasty, PTA). Bailout stent placement was permitted in case of inadequate result from PTA. The primary end point was restenosis measured by duplex ultrasound at 1 year. Quality-of-life assessments were performed by the EuroQol (EQ)-5D questionnaire. Mean lesion length was 123.0 mm in the stent group and 116.8 mm in the PTA group. A total of 140 (93.3 %) of 150 had total occlusions. At 12 months’ follow-up, restenosis measured by Duplex ultrasound was not significantly different between the stent and PTA groups by intention-to-treat or as-treated analyses: 47.2 versus 43.5 % (p = 0.84) and 40.8 versus 46.7 % (p = 0.68), respectively. There were fewer target lesion revascularizations in patients randomized to stenting, but this did not reach statistical significance (12.5 vs. 20.8 %, p = 0.26). There was no difference in the rate of amputation. Patients in both groups reported improved quality of life. Primary stenting of long lesions in predominantly occluded superficial femoral arteries does not reduce the rate of binary restenosis compared with balloon angioplasty and bailout stenting. Both treatment strategies conferred a meaningful and sustained improvement to the quality of life of patients with severe superficial femoral artery disease.

  8. The exposure of radiologists and patients to radiation during coronary angiography and percutaneous transluminal coronary angioplasty (PTCA)

    International Nuclear Information System (INIS)

    Karppinen, J.; Parviainen, T.

    1993-03-01

    The exposure of radiologists and patients to radiation during coronary angiography and percutaneous transluminal coronary angioplasty (PTCA) in Finland was studied using phantom measurements. Additional tests were made concerning the performance of TV fluoroscopy systems, cine fluorographic units and film processing. These tests include sensitometric quality control of film processing, automatic exposure control in fluoroscopy and cinefluorography, and contrast and resolution in a cine frame and TV image

  9. Flow motion waves with high and low frequency in severe ischaemia before and after percutaneous transluminal angioplasty

    OpenAIRE

    Hoffmann, Ulrich; Schneider, Ernst; Bollinger, Alfred

    2017-01-01

    Study of objective - The aim was to evaluate skin flux and prevalence of low and high frequency flow motion waves in patients with severe ischaemia due to peripheral arterial occlusive disease before and after percutaneous transluminal angioplasty (PTA) with and without local thrombolysis. Design - Flow motion was recorded by the laser Doppler technique at the dorsum of the foot before, one day, and one month after PTA. The results were separately analysed in patients with successful and unsu...

  10. Below-the-ankle Angioplasty and Stenting for Limb Salvage: Anatomical Considerations and Long-term Outcomes

    International Nuclear Information System (INIS)

    Katsanos, Konstantinos; Diamantopoulos, Athanasios; Spiliopoulos, Stavros; Karnabatidis, Dimitris; Siablis, Dimitris

    2013-01-01

    PurposeTo report the long-term angiographic and clinical results in a series of below-the-ankle (BTA) angioplasty procedures and to present some biomechanical issues related to the unique anatomical geometry of the ankle.MethodsWe performed a retrospective analysis of BTA angioplasty procedures. Clinical end points included technical success, patient mortality, salvage of the treated foot, and repeat target lesion revascularization. Imaging end points included primary patency, binary restenosis of the target lesion at the 50 % threshold, and stent integrity (stent fracture, deformation, or collapse). Univariate subgroup analysis was performed.ResultsIn total, 40 limbs in 37 patients (age 73.5 ± 8.2 years) with critical limb ischemia were included and 42 inframalleolar lesions (4.2 ± 1.4 cm) were analyzed. Technical success was achieved in 95.2 % (40 of 42). Provisional stent placement was performed in 45.2 % (19 of 42). Two patients died, and two major amputations occurred up to 3 years. At 1 year, overall primary vessel patency was 50.4 ± 9.1 %, lesion binary restenosis rate was 64.1 ± 8.3 %, and repeat intervention-free survival was 93.6 ± 4.3 % according to life table analysis of all treated lesions. Pairwise subgroup analysis showed that BTA self-expanding stents were associated with significantly higher restenosis and poorer primary patency compared to plain balloon angioplasty or sirolimus-eluting balloon-expandable stents. Significant deformation and/or fracture of balloon-expandable stents placed BTA were identified in five of 11. Dynamic imaging showed that the dorsalis pedis artery is kinked during foot dorsiflexion, whereas the distal posterior tibial artery is kinked during plantar flexion of the foot.ConclusionBTA angioplasty for critical limb ischemia treatment is safe and feasible with satisfactory long-term results. BTA stent placement must be reserved for bailout indications

  11. Below-the-ankle Angioplasty and Stenting for Limb Salvage: Anatomical Considerations and Long-term Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Diamantopoulos, Athanasios; Spiliopoulos, Stavros; Karnabatidis, Dimitris; Siablis, Dimitris [School of Medicine, Patras University Hospital, Department of Interventional Radiology (Greece)

    2013-08-01

    PurposeTo report the long-term angiographic and clinical results in a series of below-the-ankle (BTA) angioplasty procedures and to present some biomechanical issues related to the unique anatomical geometry of the ankle.MethodsWe performed a retrospective analysis of BTA angioplasty procedures. Clinical end points included technical success, patient mortality, salvage of the treated foot, and repeat target lesion revascularization. Imaging end points included primary patency, binary restenosis of the target lesion at the 50 % threshold, and stent integrity (stent fracture, deformation, or collapse). Univariate subgroup analysis was performed.ResultsIn total, 40 limbs in 37 patients (age 73.5 {+-} 8.2 years) with critical limb ischemia were included and 42 inframalleolar lesions (4.2 {+-} 1.4 cm) were analyzed. Technical success was achieved in 95.2 % (40 of 42). Provisional stent placement was performed in 45.2 % (19 of 42). Two patients died, and two major amputations occurred up to 3 years. At 1 year, overall primary vessel patency was 50.4 {+-} 9.1 %, lesion binary restenosis rate was 64.1 {+-} 8.3 %, and repeat intervention-free survival was 93.6 {+-} 4.3 % according to life table analysis of all treated lesions. Pairwise subgroup analysis showed that BTA self-expanding stents were associated with significantly higher restenosis and poorer primary patency compared to plain balloon angioplasty or sirolimus-eluting balloon-expandable stents. Significant deformation and/or fracture of balloon-expandable stents placed BTA were identified in five of 11. Dynamic imaging showed that the dorsalis pedis artery is kinked during foot dorsiflexion, whereas the distal posterior tibial artery is kinked during plantar flexion of the foot.ConclusionBTA angioplasty for critical limb ischemia treatment is safe and feasible with satisfactory long-term results. BTA stent placement must be reserved for bailout indications.

  12. A new approach to investigate an eruptive paroxysmal sequence using camera and strainmeter networks: Lessons from the 3-5 December 2015 activity at Etna volcano

    Science.gov (United States)

    Bonaccorso, A.; Calvari, S.

    2017-10-01

    Explosive sequences are quite common at basaltic and andesitic volcanoes worldwide. Studies aimed at short-term forecasting are usually based on seismic and ground deformation measurements, which can be used to constrain the source region and quantify the magma volume involved in the eruptive process. However, during single episodes of explosive sequences, integration of camera remote sensing and geophysical data are scant in literature, and the total volume of pyroclastic products is not determined. In this study, we calculate eruption parameters for four powerful lava fountains occurring at the main and oldest Mt. Etna summit crater, Voragine, between 3 and 5 December 2015. These episodes produced impressive eruptive columns and plume clouds, causing lapilli and ash fallout to more than 100 km away. We analyse these paroxysmal events by integrating the images recorded by a network of monitoring cameras and the signals from three high-precision borehole strainmeters. From the camera images we calculated the total erupted volume of fluids (gas plus pyroclastics), inferring amounts from 1.9 ×109 m3 (first event) to 0.86 ×109 m3 (third event). Strain changes recorded during the first and most powerful event were used to constrain the depth of the source. The ratios of strain changes recorded at two stations during the four lava fountains were used to constrain the pyroclastic fraction for each eruptive event. The results revealed that the explosive sequence was characterized by a decreasing trend of erupted pyroclastics with time, going from 41% (first event) to 13% (fourth event) of the total erupted pyroclastic volume. Moreover, the volume ratio fluid/pyroclastic decreased markedly in the fourth and last event. To the best of our knowledge, this is the first time ever that erupted volumes of both fluid and pyroclastics have been estimated for an explosive sequence from a monitoring system using permanent cameras and high precision strainmeters. During future

  13. Rendezvous technique for recanalization of long-segmental chronic total occlusion above the knee following unsuccessful standard angioplasty.

    Science.gov (United States)

    Cao, Jun; Lu, Hai-Tao; Wei, Li-Ming; Zhao, Jun-Gong; Zhu, Yue-Qi

    2016-04-01

    To assess the technical feasibility and efficacy of the rendezvous technique, a type of subintimal retrograde wiring, for the treatment of long-segmental chronic total occlusions above the knee following unsuccessful standard angioplasty. The rendezvous technique was attempted in eight limbs of eight patients with chronic total occlusions above the knee after standard angioplasty failed. The clinical symptoms and ankle-brachial index were compared before and after the procedure. At follow-up, pain relief, wound healing, limb salvage, and the presence of restenosis of the target vessels were evaluated. The rendezvous technique was performed successfully in seven patients (87.5%) and failed in one patient (12.5%). Foot pain improved in all seven patients who underwent successful treatment, with ankle-brachial indexes improving from 0.23 ± 0.13 before to 0.71 ± 0.09 after the procedure (P rendezvous technique is a feasible and effective treatment for chronic total occlusions above the knee when standard angioplasty fails. © The Author(s) 2015.

  14. Predictive value of elevated neutrophil to lymphocyte ratio in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Ergelen, Mehmet; Uyarel, Huseyin; Altay, Servet; Kul, Şeref; Ayhan, Erkan; Isık, Turgay; Kemaloğlu, Tuba; Gül, Mehmet; Sönmez, Osman; Erdoğan, Ercan; Turfan, Murat

    2014-05-01

    The neutrophil to lymphocyte ratio (NLR) has been investigated as a new predictor for cardiovascular risk. Admission NLR would be predictive of adverse outcomes after primary angioplasty for ST-segment elevation myocardial infarction (STEMI). A total of 2410 patients with STEMI undergoing primary angioplasty were retrospectively enrolled. The study population was divided into tertiles based on the NLR values. A high NLR (n = 803) was defined as a value in the third tertile (>6.97), and a low NLR (n = 1607) was defined as a value in the lower 2 tertiles (≤6.97). High NLR group had higher incidence of inhospital and long-term cardiovascular mortality (5% vs 1.4%, P 6.97) was found as an independent predictor of inhospital cardiovascular mortality (odds ratio: 2.8, 95% confidence interval: 1.37-5.74, P = .005). High NLR level is associated with increased inhospital and long-term cardiovascular mortality in patients with STEMI undergoing primary angioplasty.

  15. [CLINICAL STUDIES ON EFFECT OF ARTHROSCOPIC INTERCONDYLAR FOSSA ANGIOPLASTY ON ABILITY OF NEUROMUSCULAR CONTROL IN ELDERLY PATIENTS WITH KNEE OSTEOARTHRITIS].

    Science.gov (United States)

    Huang, Jingmin; Wang, Haijiao; Wu, Jiang; Li, Dongchao; Li, Yuhong

    2015-08-01

    To study the effect of arthroscopic intercondylar fossa angioplasty on the ability of neuromuscular control of the knee joint in elderly patients with knee osteoarthritis (KOA). Between June 2012 and March 2013, 20 elderly patients with KOA and in accordance with inclusion and exclusion criteria underwent arthroscopic intercondylar fossa angioplasty (operation group), and 20 healthy elderly people served as control group. There was no significant difference in age, height, weight, and body mass index between 2 groups (P > 0.05). The proprioception capability (using passive regeneration test at measurement angles of 15, 30, and 60°) and quadriceps mobilization [including maximum voluntary contraction (MVC), central activation ratio (CAR), and activation deficit (AD)] were measured to avaluate the neuromuscular control of the knee; the Lysholm score was used to evaluate knee function. The above indexes were measured to assess the knee neuromuscular control and recovery of joint function in patients of operation group at 3, 6, and 9 months after operation. Compared with the control group, MVC, CAR, and Lysholm scores were significantly decreased, and the AD and passive knee angle difference were significantly increased in operation group (P 0.05). Arthroscopic intercondylar fossa angioplasty can relieve ACL pressure, abrasion, and impact, which will recover the ability of neuromuscular control, increase proprioception and quadriceps mobilization capacity, and improve the joint function.

  16. Early intervention in acute myocardial infarction: significance for myocardial salvage of immediate intravenous streptokinase therapy followed by coronary angioplasty

    International Nuclear Information System (INIS)

    Miller, H.I.; Almagor, Y.; Keren, G.

    1987-01-01

    Sixteen patients with acute myocardial infarction underwent treatment with streptokinase up to 3 hours after the onset of chest pain. Nine patients (group I) received streptokinase within 1 hour of the onset of pain, and seven patients (group II) received it within 2 to 3 hours. All underwent multigated radionuclide ventriculography after streptokinase therapy and 1 week later. Percutaneous transluminal coronary angioplasty of the infarct artery was performed within 24 hours in all patients. An effort-limited treadmill stress test was performed before discharge. There was no mortality or serious complication. Mean peak total creatine kinase was 521 +/- 289 mU/ml in group I, and 1,614 +/- 709 mU/ml in group II (p less than 0.05). The mean initial left ventricular ejection fraction was 47 +/- 11% in group I and 37 +/- 10% in group II. After early angioplasty (within 24 hours) and at 1 week recovery, left ventricular ejection fraction increased to 53 +/- 9% in group I (p less than 0.05) and to 40 +/- 7% in group II (p = NS). Seven of the nine patients in group I had normal radionuclide ventriculograms at discharge compared with none of the seven patients in group II. Thrombolytic therapy administered less than 1 hour after the onset of symptoms of acute myocardial infarction followed by angioplasty of the infarct artery results in preservation of left ventricular function, whereas therapy given after 2 hours has only a limited effect

  17. Safety and efficacy of angioplasty with intracoronary stenting in patients with unstable coronary syndromes. Comparison with stable coronary syndromes

    Directory of Open Access Journals (Sweden)

    Luís C. L. Correia

    2000-06-01

    Full Text Available OBJECTIVE: To assess safety and efficacy of coronary angioplasty with stent implantation in unstable coronary syndromes. METHODS: Retrospective analysis of in-hospital and late evolution of 74 patients with unstable coronary syndromes (unstable angina or infarction without elevation of the ST segment undergoing coronary angioplasty with stent placement. These 74 patients were compared with 31 patients with stable coronary syndromes (stable angina or stable silent ischemia undergoing the same procedure. RESULTS: No death and no need for revascularization of the culprit artery occurred in the in-hospital phase. The incidences of acute non-Q-wave myocardial infarction were 1.4% and 3.2% (p=0.6 in the unstable and stable coronary syndrome groups, respectively. In the late follow-up (11.2±7.5 months, the incidences of these events combined were 5.7% in the unstable coronary syndrome group and 6.9% (p=0.8 in the stable coronary syndrome group. In the multivariate analysis, the only variable with a tendency to significance as an event predictor was diabetes mellitus (p=0.07; OR=5.2; 95% CI=0.9-29.9. CONCLUSION: The in-hospital and late evolutions of patients with unstable coronary syndrome undergoing angioplasty with intracoronary stent implantation are similar to those of the stable coronary syndrome group, suggesting that this procedure is safe and efficacious when performed in unstable coronary syndrome patients.

  18. Critical appraisal of paclitaxel balloon angioplasty for femoral–popliteal arterial disease

    Directory of Open Access Journals (Sweden)

    Herten M

    2016-08-01

    Full Text Available Monika Herten,1 Giovanni B Torsello,1,2 Eva Schönefeld,3 Stefan Stahlhoff2 1Department of Vascular and Endovascular Surgery, University Hospital Münster, 2Department of Vascular Surgery, St Franziskus Hospital, Münster, 3Institute for Education and Student Affairs, University Hospital Münster, Münster, Germany Abstract: Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis. This article reviews the results of DCB treatments of femoropopliteal and infrapopliteal lesions in comparison to standard angioplasty with uncoated balloons. A systematic literature search was performed in 1 medical journals (ie, MEDLINE, 2 international registers for clinical studies (ie, www.clinicaltrials.gov, and 3 abstracts of scientific sessions. Several controlled randomized trials with follow-up periods of up to 5 years demonstrated the efficacy of paclitaxel –DCB technology. However, calcified lesions seem to affect the efficacy of DCB. Combinations of preconditioning methods with DCBs showed promising results. Although the mechanical abrasion of calcium via atherectomy or laser ablation showed favorable periprocedural results, the long-term impact on restenosis and clinical outcome has to be demonstrated. Major advantages of the DCBs are the rapid delivery of drug at uniform concentrations with a single dose, their efficacy in areas wherein stents have been

  19. Atherectomy offers no benefits over balloon angioplasty in tibial interventions for critical limb ischemia.

    Science.gov (United States)

    Todd, Kevin E; Ahanchi, Sadaf S; Maurer, Christian A; Kim, Jung H; Chipman, Candice R; Panneton, Jean M

    2013-10-01

    Endovascular adjuncts, like atherectomy, were developed to improve outcomes of endovascular arterial interventions. The true impact of atherectomy on endovascular outcomes remains to be determined, and little data exist on the influence of atherectomy on tibial interventions. Our study compares early and late outcomes of tibial intervention with angioplasty vs atherectomy-assisted interventions. We completed a retrospective review of all tibial interventions between 2008 and 2010. Outcomes were analyzed using single and multivariate analysis, Cox regression, and Kaplan-Meier curves. Primary outcomes were primary, primary assisted, and secondary patency rates, as well as limb salvage and survival rates. Over a 2-year period, 480 tibial interventions were completed for 421 patients. Eighty-seven percent (n = 418) of interventions were performed for critical limb ischemia (CLI) and 13% (n = 62) for claudication. The CLI cohort of 418 interventions was analyzed. These patients had a mean age of 71 years with a mean follow-up time of 16 ± 15 months (range, 0-59 months). Of the 418 interventions, 339 underwent percutaneous transluminal angioplasty (PTA): 333 PTA alone, six PTA + stent. The remaining 79 interventions received atherectomy: 33 laser, 13 directional, and 33 orbital either alone or in conjunction with PTA (11 atherectomy only, 68 atherectomy + PTA). The groups did not differ significantly in terms of demographics, risk factors, or technical success. The atherectomy group had more TASC B lesions (54% vs 38%; P = .013), while the PTA-alone group had more TASC D lesions (25% vs 13%; P = .004). TASC A and C lesions did not differ significantly between the groups. No significant differences existed with respect to the early (30-day) outcomes of loss of patency (11% vs 13%; P = .699), complications (8% vs 13%; P = .292), or major amputation (17% vs 13%; P = .344) in the PTA-alone group vs the atherectomy-assisted group. Kaplan-Meier analysis revealed no difference

  20. Inferior knee arterial endoluminal angioplasty in treating severe lower limb ischemia though the DEEP balloon catheter

    International Nuclear Information System (INIS)

    Li Shaoqin; Jiang Guomin; Zhao Jinwei; Chen Yaxian; Tian Feng; Wang Yun; Huang Wenhua; Ni Caifang

    2008-01-01

    Objective: To evaluate the efficacy of inferior knee arterial endoluminal angioplasty for treating severe lower limb ischemia with the use of the DEEP balloon catheter. Methods: Eleven patients (17 limbs) with severe ischemia of lower extremities from August 2007 to April 2008 were retrospectively studied. All involved limbs suffered from rest pain including 6 limbs (6/17)complicated with ulcer, 2 (2/17) with toe gangrene or 3 (3/17)with both of the complaints. ABI (Ankle bxancial index) were 0.2-0.5 and 0.51-0.7 in 12 limbs and 5 limbs respectively, with average value 0.47. Results: The success rate of operation was 100% (17/17). Pain relieved obviously in 13 limbs (13/17) and reduced in 2 limbs (2/17). 2 limbs (2/17) still suffered from pain and underwent upper-knee amputation and other 2 with ulcerations(2/ 17)were healed. 3 (3/17) with toe gangrene underwent partial foot amputation, 1 with dried gangrene remained unchanged and the other was lost. Another one showed ulcer healed and toe was lost. Increase of ABI was more than 0.5 in 10 limbs(10/17) and 0.3-0.5 in 5 limbs(5/17) with average value of 0.83. 10 patients with sixteen limbs were followed up in an average period of 4.3 months (1-9 months). Of the 15 immediate pain-relieved limbs, 12(12/15) limbs remained free of pain and pain recurred in 3 other limbs; and 2 of them with pain-reduced after PTA again; the other 1 underwent amputation, Average value of ABI was 0.70. Conclusions: Inferior arterial endoluminal angioplasty for the treatment of severe limb ischemia with application of the DEEP balloon catheter show high successful rate and short-term encouraging clinical results but mid-term and long-terms follow up should be undertaken for further investigation. (authors)

  1. Safety analysis of Wingspan stent angioplasty for symptomatic intracranial arterial stenosis: A report of 109 cases

    Directory of Open Access Journals (Sweden)

    Jian-ping DENG

    2011-12-01

    Full Text Available Objective The present study aims to probe into the feasibility and safety of larger balloons in the self-expandable stent Wingspan system when treating symptomatic intracranial arterial stenosis.Methods The clinical data of 109 symptomatic intracranial arterial stenosis patients,consisting of 68 males and 41 females,were analyzed.These patients were treated via angioplasty using the Wingspan system from March 2007 to June 2010.The ages of the patients ranged from 36 years to 79 years,with an average of 62.4.The patients were divided into two groups according to the sizes of the Gateway balloons they used.The balloon diameter for group A(n=31 was based on 80% of the diameter of the normal blood vessels on both sides of the arterial vessel.Meanwhile,the balloon diameter for group B was based on the average diameter of the vessels on both sides of the arterial vessel.The effects of the treatment and the occurrence of complications in both groups were analyzed and compared.Results The degree of arteriostenosis before operation for group A was 56.0% to 87.8%,with an average of 71.8%,residual stenosis after operation was 0% to 45%,with an average of 24.9%.The degree of ateriostenosis before operation for group B was 68.9% to 98.0%,with an average of 76.0%,residual stenosis after operation was 0% to 21%,with an average of 10.2%.Group A had four cases(12.9% of durability neurological dysfunction.One case was a visual-field defect.In group B,six patients(7.7% experienced complications.The differences were not statistically significant,and no deaths occurred in both groups.Conclusions Wingspan stent angioplasty is a safe and effective treatment for intracranial arterial stenosis,and even the use of larger balloons does not increase the risk in patients.

  2. Evaluation of radiation dose during the percutaneous angioplasty for arteriovenous shunt assembling

    Science.gov (United States)

    Ting, Chien-Yi; Wu, Wen-Shiann; Tang, Kuo-Ting; Wang, Hsin-Ell; Lin, Chun-Chih

    2017-11-01

    Percutaneous angioplasty (PTA) for dysfunctional hemodialysis is usually performed by radiologists, but not cardiologists, in Taiwan, so that the radiation dose in patients and physicians are usually unknown and related studies are rare. In this study, we are pioneering an investigation into the radiation dose in percutaneous angioplasty for arteriovenous shunt assembling and the effect of RADPAD device, a lead-free surgical drape containing Bi and Ba, on the decrease of a radiation dose in the non-targeted organs of the patient and also the operator. The radiation dose in a typical digital subtraction angiography (DSA) by the PTA protocol under a fixed field of view (FOV), was measured with optically simulated luminescent dosimeters arranged in a PIXY RS-102 anthropomorphic phantom. The results indicate that there is a significant dose reduction at the hands (0.022±0.002 mGy before treatment vs. 0.014±0.001 mGy after treatment; P=0.021), but not at the lens (0.027±0.003 mGy before treatment vs. 0.018±0.001 mGy after treatment; P=0.058), and the gonads (0.026±0.003 mGy before treatment vs. 0.020±0.001 mGy after treatment; P=0.058), of the cardiologist/operator after treatment with the RADPAD drape. At the patient's abdomen, the dose significantly decreased from 1.597±0.104 mGy to 0.031±0.002 mGy (PRADPAD shield. For the chest, lens and thyroid in the patient, the doses were respectively 0.154±0.100 mGy (compared to 0.049±0.001 mGy after treated with the RADPAD drape; P=0.0002), 0.066±0.001 mGy (compared to 0.021±0.001 mGy after the RADPAD treatment; P=0.009), and 0.208±0.002 mGy (compared to 0.042±0.003 mGy after shielded with the RADPAD drape; PRADPAD drape significantly reduced radiation exposure to the patient during the PTA for the arteriovenous shunt assembling, which is suggested should be applied to the current cardiac catheterization.

  3. Breathing Life into Engineering: A Lesson Study Life Science Lesson

    Science.gov (United States)

    Lawrence, Maria; Yang, Li-Ling; Briggs, May; Hession, Alicia; Koussa, Anita; Wagoner, Lisa

    2016-01-01

    A fifth grade life science lesson was implemented through a lesson study approach in two fifth grade classrooms. The research lesson was designed by a team of four elementary school teachers with the goal of emphasizing engineering practices consistent with the "Next Generation Science Standards" (NGSS) (Achieve Inc. 2013). The fifth…

  4. On the Creation, Utility and Sustaining of Rare Diseases Research Networks: Lessons learned from the Urea Cycle Disorders Consortium, the Japanese Urea Cycle Disorders Consortium and the European Registry and Network for Intoxication Type Metabolic Diseases.

    Science.gov (United States)

    Summar, Marshall L; Endo, Fumio; Kölker, Stefan

    2014-01-01

    The past two decades has seen a rapid expansion in the scientific and public interest in rare diseases and their treatment. One consequence of this has been the formation of registries/longitudinal natural history studies for these disorders. Given the expense and effort needed to develop and maintain such programs, we describe our experience with three linked registries on the same disease group, urea cycle disorders. The Urea Cycle Disorders Consortium (UCDC) was formed in the U.S. in 2003 in response to a request for application from the National Institutes of Health (NIH); the European Registry and Network for Intoxication Type Metabolic Diseases (E-IMD) was formed in 2011 in response to a request for applications from the Directorate-General for Health and Consumers (DG SANCO) of the EU; and the Japanese Urea Cycle Disorders Consortium (JUCDC) was founded in 2012 as a sister organization to the UCDC and E-IMD. The functions of these groups are to collect natural history data, educate the professional and lay population, develop and test new treatments, and establish networks of excellence for the care for these disorders. The UCDC and JUCDC focus exclusively on urea cycle disorders while the E-IMD includes patients with urea cycle disorders and organic acidurias. More than 1400 patients have been enrolled in the three consortia, and numerous projects have been developed and joint meetings held including an international UCDC/E-IMD/JUCDC Urea Cycle meeting in Barcelona in 2013. This article summarizes some of the experiences from the three groups regarding formation, funding, and models for sustainability. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Effect of percutaneous transluminal angioplasty on the stenosis of autogenous radiocephalic ateriovenous fistula for hemodialysis

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Sun Min; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin MMo; Choi, Sang Tae; Kim, Jong Woo; Kim, Hyung Sik; Choi, Hye Young [Gachon University Gil Medical Center, Incheon (Korea, Republic of); Park, Jae Hyung [Dept. of Radiology, Seonam University College of Medicine, Myongji Hospital, Goyang (Korea, Republic of)

    2016-02-15

    The purpose of this study was to evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) on stenosis of autogenous radiocephalic arteriovenous fistula (RCF) for hemodialysis and to determine the factors influencing patency. This retrospective study included 136 patients referred for PTA of RCF stenosis between March 2005 and July 2014. The technical success rate, complications, and patency rate were evaluated. The following factors were analyzed as they might influence patency: age, gender, site and duration of arteriovenous fistula, underlying disease, body mass index, hypercholesterolemia, smoking, peripheral artery or coronary artery occlusive disease, stenosis length/grade, cutting balloon, and balloon size. The initial technical success rate was 91.9% (125/136). Complications included vessel rupture (n = 2) and vessel dissection (n = 2). The patency rates at 6, 12, 24, and 48 months after PTA were 81.9, 67.1, 52.7, and 42.3%, respectively. The patency rate was higher in cases with longer (> 3 cm) stenosis (p = 0.04). Use of cutting balloon and larger size of balloon catheter made the patency longer, but this difference was not statistically significant (p = 0.637, 0.258). PTA is a safe and effective way to manage stenosis in RCF. The length of stenosis was the only factor which affected the patency rate in this study.

  6. Dialysis Arteriovenous Fistula Failure and Angioplasty: Intimal Hyperplasia and Other Causes of Access Failure

    Science.gov (United States)

    Duque, Juan C.; Tabbara, Marwan; Martinez, Laisel; Cardona, Jose; Vazquez-Padron, Roberto I; Salman, Loay H

    2016-01-01

    Arteriovenous fistula (AVF) is the preferred hemodialysis access type because it has better patency rates and fewer complications than other access types. However, primary failure remains a common problem impeding AVF maturation and adding to patients’ morbidity and mortality. Juxta-anastomotic (or inflow) stenosis is the most common reason leading to primary failure, and percutaneous transluminal angioplasty (PTA) continues to be the gold standard treatment with excellent success rates. Intimal hyperplasia (IH) has been traditionally blamed as the main pathophysiologic culprit, but new evidence raises doubts regarding the contribution of IH alone to primary failure. We report a 64-year-old man with a two-stage brachio-basilic AVF that was complicated by failure four months after creation. Angiogram showed multiple juxta-anastomotic and mid-fistula stenotic lesions. PTA was successful in assisting maturation and subsequently cannulating AVF for hemodialysis treatment. We failed to identify the underlying cause of stenosis as biopsy specimens from fistula tissue obtained at the time of transposition revealed no occlusive IH. This case emphasizes the need for additional research on factors contributing to AVF failure besides IH, and highlights the need for more therapeutic options to reduce AVF failure rate. PMID:28084215

  7. Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Nozomu; Tanasawa, Toshihiko; Okada, Takeshi; Endo, Otone; Yamamoto, Naohito [Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Department of Neurosurgery, Aichi (Japan); Miyachi, Shigeru; Hattori, Kenichi [Nagoya University Graduate School of Medicine, Department of Neurosurgery, Nagoya (Japan)

    2006-11-15

    Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed. (orig.)

  8. Below knee angioplasty in elderly patients: predictors of major adverse clinical outcomes.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2012-02-01

    AIM: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). MATERIALS AND METHODS: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. RESULTS: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). CONCLUSION: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  9. Efficacy of 24-Hour Blood Pressure Monitoring in Evaluating Response to Percutaneous Transluminal Renal Angioplasty.

    Science.gov (United States)

    Jujo, Kentaro; Saito, Katsumi; Ishida, Issei; Furuki, Yuho; Ouchi, Taisuke; Kim, Ahsung; Suzuki, Yuki; Sekiguchi, Haruki; Yamaguchi, Junichi; Ogawa, Hiroshi; Hagiwara, Nobuhisa

    2016-08-25

    Percutaneous transluminal renal angioplasty (PTRA) improves patency in atherosclerotic renal artery stenosis (ARAS), but improvement in clinic blood pressure (BP) is seen in only 20-40% of patients who undergo PTRA. This study investigated the effects of PTRA on BP lowering, assessed on 24-h ambulatory BP monitoring (ABPM), and identified preoperative features predictive of satisfactory BP improvement after PTRA. Of 1,753 consecutive patients undergoing coronary angiography, 31 patients with angiographically significant ARAS and translesional pressure gradient (TLPG) >20 mmHg underwent PTRA. ABPM was performed before, at 1 month and at 1 year after PTRA; patients with average systolic ABPM-BP decrease >10 mmHg at 1 month from baseline were categorized as responders. There was no obvious relationship between clinic BP and ABPM-BP at baseline. ABPM-BP was significantly higher in responders at baseline (SBP: 148 vs. 126 mmHg, PABPM-BP achieved a larger decrease in ABPM-BP, but the severity of stenosis reflected by TLPG; renal duplex findings; and neurohumoral parameters other than baseline renal function, did not differ between the groups. Clinic BP does not represent daily hemodynamic status, whereas high ABPM-BP is a potent predictor of satisfactory BP response to PTRA. (Circ J 2016; 80: 1922-1930).

  10. [Successful correction with stent-graft of coronary artery rupture after angioplasty].

    Science.gov (United States)

    Demin, V V

    2003-01-01

    Rupture and perforation of coronary arteries complicate in average 0.5% of radiosurgical coronary interventions and often are accompanied by serious consequences and high mortality. According to-type of coronary perforation different methods of correction are used, ranging from conservative measures to urgent cardiosurgical interventions. Coronary stent-grafts with 'sandwich' type of construction ore composed from two metal stents and PTFE layer between them. Development of such stents enabled effective radioguided endovascular repair of coronary ruptures. The paper presents the first Russian experience of stout-graft implantation for coronary artery rupture occurred during direct stenting of proximal anterior descending artery and balloon angioplasty in distal segment. The rupture occurred probably because of wall fragility between affected segment and muscular bridge. Stent-graft JoStent 16 mm in length connected with 3-mm balloon was implanted with subsequent complete restitution of blood flow, resolution of pain syndrome and ECG normalization. Echocardiography in operative theatre and one day after surgery showed no intrapericardial fluid. Stent-graft devices for urgent implantation in cases of coronary rupture must be included into obligatory equipment of radiosurgical facilities.

  11. Transluminal Angioplasty of Peroneal Artery Branches in Diabetics: Initial Technical Experience

    International Nuclear Information System (INIS)

    Graziani, Lanfroi; Silvestro, Antonio; Monge, Luca; Boffano, Gian Mario; Kokaly, Francesco; Casadidio, Ilaria; Giannini, Francesco

    2008-01-01

    The present study aimed to report the technical feasibility of percutaneous transluminal angioplasty (PTA) of obstructed or insufficient collateral branches (anterior and posterior perforating branches) from distal peroneal to foot arteries in diabetic patients with chronic critical limb ischemia (CLI) and chronic noncrossable occlusion of the anterior and posterior tibial arteries. Twenty-four diabetic CLI patients (age, 67 ± 8 years; 87% males) undergoing collateral PTA were included. Baseline clinical angiographic and follow-up data were retrospectively reviewed. Collateral PTA was associated with a concomitant PTA of other sites in 21 (83%) cases. In 15 cases the treated collateral linked the peroneal with the plantaris communis; in 9 cases, the peroneal with the dorsalis pedis. Angiographic results of collateral PTA were good in 13 cases (<30% residual stenosis), whereas the result was considered moderate (30%-49% residual stenosis) in the remaining cases. Neither perforation nor acute occlusion of the treated collaterals or other relevant complications were observed. Mean follow-up was 32 ± 17 months. Major amputation was necessary for two (8.3%) patients. Cumulative limb salvage rates at 2 and 4 years were 96% and 87%, respectively. In conclusion, this initial experience shows that PTA of the collateral branches from distal peroneal to foot arteries is a feasible technique. Future studies are required to define the clinical role of this novel approach

  12. Optimization and audit of radiation dose during percutaneous transluminal coronary angioplasty

    International Nuclear Information System (INIS)

    Livingstone, Roshan S.; Timothy Peace, B.S.; Chandy, Sunil; Gorge, Paul V.; Pati, Purendra

    2007-01-01

    The percutaneous transluminal coronary angioplasty (PTCA) is one of the interventional procedures which impart high radiation doses to patients compared to the other cardiologic procedures. This study intends to audit and optimize radiation dose imparted to patients undergoing PTCA. Forty-four patients who underwent PTCA involving single or multiple stent placement guided under cardiovascular X-ray machine were included in the study. Radiation doses were measured using dose area product (DAP) meter for patients undergoing single and multiple stent placements during PTCA. A dose reduction of 27-47% was achieved using copper filters and optimal exposure parameters. The mean DAP values before optimization were 66.16 and 122.68 Gy cm 2 for single and multiple stent placement respectively. These values were 48.67 and 65.44 Gy cm 2 respectively after optimization. In the present scenario, due to the increase in the number of PTCAs performed and the associated risk from radiation, periodical audit of radiation doses for interventional procedures are recommended. (author)

  13. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Keeling, Aoife N.; Khalidi, Karim; Leong, Sum [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland); Wang, Tim T. [Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary' s Hospital, London W2 1NY (United Kingdom); Ayyoub, Alaa S.; McGrath, Frank P. [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland); Athanasiou, Thanos [Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary' s Hospital, London W2 1NY (United Kingdom); Lee, Michael J., E-mail: mlee@rcsi.ie [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland)

    2011-03-15

    Aim: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). Materials and methods: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. Results: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). Conclusion: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  14. Intravascular Ultrasound Imaging of Peripheral Arteries as an Adjunct to Balloon Angioplasty and Atherectomy

    International Nuclear Information System (INIS)

    Korogi, Yukunori; Hirai, Toshinori; Takahashi, Mutsumasa

    1996-01-01

    This article reviews many of the applications of intravascular ultrasound (US) imaging for peripheral arterial diseases. In vitro studies demonstrate an excellent correlation between ultrasound measurements of lumen and plaque crossectional area compared with histologic sections. In vivo clinical studies reveal the enhanced diagnostic capabilities of this technology compared with angiography. Intravascular US imaging can provide valuable information on the degree, eccentricity, and histologic type of stenosis before intervention, and on the morphological changes in the arterial wall and the extent of excision after intervention. Intravascular US may also serve as a superior index for gauging the diameter of balloon, stent, laser probe, and/or atherectomy catheter appropriate for a proposed intervention. Significant new insights into the mechanisms of balloon angioplasty and atherectomy have been established by intravascular US findings. Intravascular US imaging has been shown to be a more accurate method than angiography for determining the cross-sectional area of the arterial lumen, and for assessing severity of stenosis. Quantitative assessment of the luminal cross-sectional area after the balloon dilatation should be more accurate than angiography as intimal tears or dissections produced by the dilatation may not be accurately evaluated with angiography. At the present time, intravascular US is still a controversial imaging technique. Outcome studies are currently being organized to assess the clinical value and cost effectiveness of intravascular ultrasound in the context of these interventional procedures

  15. Ruptured Splenic Abscess following Percutaneous Transluminal Angioplasty in a 40-Year-Old Man

    Directory of Open Access Journals (Sweden)

    C. Rajasekharan

    2012-05-01

    Full Text Available The incidence of splenic abscesses is currently 0.14–0.7% with a reported mortality of 0–47%. The diagnosis of splenic abscess which has ruptured into the abdomen is often overlooked because of its rarity and its misleading clinical presentations. Percutaneous coronary interventions (PCIs and coronary stenting procedures increased from 184,000 to 885,000 (from 335 to 1,550 and from 3,000 to 770,000 (from 5 to 1,350 per one million inhabitants, respectively. A 40-year-old Asian male presented to our emergency department with upper abdominal pain 5 days after a percutaneous transluminal coronary angioplasty. Clinical examination raised the possibilities of acute pancreatitis and intraabdominal sepsis. An initial ultrasound of the abdomen and blood tests were negative. A computed tomography scan of the abdomen revealed a splenic abscess that had ruptured into the abdomen. Pus culture revealed a multidrug-resistant strain of Klebsiella pneumoniae that was sensitive to meropenem. The patient recovered quickly after open surgical drainage and antibiotic therapy. As this is the second case of splenic abscess and the first case report of a ruptured splenic abscess following a PCI, it will be rational to administer a short course of antibiotic prophylaxis for high-risk immunocompromised patients who are undergoing percutaneous transluminal coronary intervention.

  16. Milrinone infusion: A therapeutic option in coronary vasospasm after primary percutaneous transluminal coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Singh Amarpal

    2009-01-01

    Full Text Available A 42-year-old male presented to the emergency department with acute chest pain. The electrocardiogram revealed inferior wall myocardial infarction. Emergency coronary angiography revealed total occlusion of the distal right coronary artery with thrombus. Patient was taken up for primary percutaneous coronary angioplasty with stenting of distal right coronary artery. Six hours following the procedure, the patient developed re-elevation of ST-segment in inferior leads of electrocardiogram and subsequent haemodynamic instability. Repeat coronary angiography revealed patent stent and coronary artery spasm in proximal part, which was relieved by intracoronary injection of nitroglycerine. After an hour, the patient re-developed symptoms of chest pain along with bradycardia, hypotension and ST segment elevation. Intravenous infusion of nitroglycerine did not improve the condition but produced persistent hypotension. Infusion of milrinone was then started. Over time, normalisation of electrocardiogram occurred. The patient was discharged in stable condition. This case suggests that milrinone may be effective in alleviating coronary artery spasm when the use of other agents fails

  17. Balloon pulmonary angioplasty: applicability of C-Arm CT for procedure guidance

    Energy Technology Data Exchange (ETDEWEB)

    Hinrichs, Jan B. [Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany); Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover (Germany); Renne, Julius; Wacker, Frank K.; Meyer, Bernhard C. [Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany); Hoeper, Marius M.; Olsson, Karen M. [Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany)

    2016-11-15

    To investigate the feasibility of and compare two C-Arm CT (CACT) guidance methods during balloon pulmonary angioplasty (BPA). Forty-two BPAs [27 CTEPH patients (nine males, 70 ± 14y)] targeting 143 pulmonary arteries were included. Twenty-two BPAs were guided by contrast-enhanced CACT acquired immediately before BPA (G3D). In another 20 BPAs (G2D), two orthogonal fluoroscopy images of the chest where acquired to compute a registration of a previously acquired CACT. Volume rendering-based graphic representations (VRT guidance) were generated indicating the origin and course of the vessels. Based on VRT guidance, the intervention was planned. Procedure durations and radiation exposure data were compared between the two groups (Wilcoxon test). The overall intervention time was approximately 2 h in both groups (p = 0.31). BPA was successfully performed in G3D 91 % and G2D 94 %. No significant difference was found concerning the mean dose area product (DAP) related to fluoroscopy (p = 0.38), while DAP related to DSA was slightly higher in G3D (p = 0.048). Overall, DAP was significantly higher in G3D (p = 0.002). The use of CACT for procedure guidance in patients undergoing BPA is feasible and accurate. Image fusion of a pre-acquired CACT can be used to decrease radiation exposure due to multiple BPA sessions. (orig.)

  18. Cerebral protection devices for use during carotid artery angioplasty with stenting: a health technology assessment.

    Science.gov (United States)

    Menon, Devidas; Stafinski, Tania

    2006-01-01

    This study sought to examine the safety, efficacy, and economic implications of the use of cerebral protection devices during carotid artery angioplasty and stenting (CAS) in high-risk patients with severe carotid artery disease (CAD). A comprehensive search for peer- and non-peer-reviewed studies that compared carotid endarterectomy (CEA) or CAS without cerebral protection to CAS with cerebral protection and appeared in the English language literature between January 1990 and January 2005 was completed. Information from studies identified was extracted using a common data abstraction form and then critically appraised against published quality assessment criteria. Of the eight studies found, six provided information on technical or procedural success rates, with values ranging from 95.6 percent to 100 percent. Three of the four studies comparing groups of patients who received CAS with cerebral protection with those who received only CAS reported a non-statistically significantly higher 30-day incidence of death and stroke (major or minor) in the latter group. None of the three studies comparing CAS with cerebral protection to CEA demonstrated a statistically significant difference in the 30-day incidence of death, major stroke, or myocardial infarction between treatment groups. No economic analyses were found. In high-risk patients with severe CAD, the evidence suggests that CAS with cerebral protection may offer a safe and efficacious alternative to CEA, reducing the risk of embolic peri-procedural complications associated with CAS to acceptable levels.

  19. Efficacy of stent angioplasty for symptomatic stenoses of the proximal vertebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Weber, W. [Department of Radiology and Neuroradiology, Alfried Krupp Hospital, Essen (Germany); Mayer, T.E. [Department of Neuroradiology, Klinikum Grosshadern, University of Munich (Germany); Henkes, H. [Department of Radiology and Neuroradiology, Alfried Krupp Hospital, Essen (Germany); Kis, B. [Department of Neurology, Alfried Krupp Hospital, Essen (Germany) and Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, Virchow Street 174, D-45147 Essen (Germany)]. E-mail: bernhard.kis@uni-duisburg-essen.de; Hamann, G.F. [Department of Neurology, Klinikum Grosshadern, University of Munich (Germany); Holtmannspoetter, M. [Department of Neuroradiology, Klinikum Grosshadern, University of Munich (Germany); Brueckmann, H. [Department of Neuroradiology, Klinikum Grosshadern, University of Munich (Germany); Kuehne, D. [Department of Radiology and Neuroradiology, Alfried Krupp Hospital, Essen (Germany)

    2005-11-01

    Background: To evaluate the safety and efficacy of stent angioplasty in the treatment of symptomatic arteriosclerotic stenoses of the proximal vertebral artery (VA). Methods: Thirty-eight symptomatic stenoses of the vertebral origin were treated with flexible balloon-expandable coronary stents. Angiographic and clinical follow-up examinations were obtained in 26 patients at a mean of 11 months. Results: The immediate post-procedural angiographic results showed no residual stenosis in 33 vessels and mild residual stenoses in five vessels. Periprocedurally, there were two asymptomatic technical complications and one TIA. During follow-up re-stenosis could be detected in 10 cases (36%), and vessel occlusions in two patients. Two stents were broken. One of the restenosis caused a TIA within the follow-up period. Conclusions: Flexible balloon-expandable coronary stents proved to be save and effective in preventing vertebrobasilar stroke but were incapable to preserve the proximal vertebral artery lumen. For the VA origine an adequate stent, self-expanding, bioresorbable, or drug-eluting has to be found.

  20. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes

    International Nuclear Information System (INIS)

    Keeling, Aoife N.; Khalidi, Karim; Leong, Sum; Wang, Tim T.; Ayyoub, Alaa S.; McGrath, Frank P.; Athanasiou, Thanos; Lee, Michael J.

    2011-01-01

    Aim: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). Materials and methods: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. Results: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). Conclusion: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  1. Clinical, angiographic, hemodynamic, perfusional and functional changes after one-vessel left anterior descending coronary angioplasty

    International Nuclear Information System (INIS)

    Okada, R.D.; Lim, Y.L.; Boucher, C.A.; Pohost, G.M.; Chesler, D.A.; Block, P.C.

    1985-01-01

    Percutaneous transluminal coronary angioplasty (PTCA) was successfully performed in 20 patients with 1-vessel left anterior descending (LAD) coronary artery disease. Exercise capacity in terms of peak workload, heart rate and systolic blood pressure all increased significantly 1 week after PTCA. All patients had some decrease in stenosis size and gradient. All patients except 1 had an improvement in functional class. Eight of 12 patients with abnormal exercise electrocardiograms before PTCA had normal electrocardiograms after the procedure. Exercise thallium-201 (TI-201) myocardial perfusion images obtained in all 20 patients before and 1 week after PTCA were analyzed using a new computer method designed to quantitate regional myocardial TI-201 distribution, redistribution and clearance rate. Significant improvement in TI-201 activity was present in the anterior and septal segments of the left ventricle 1 week after PTCA. This increase in TI-201 uptake was associated with a significant reduction in the amount of TI-201 redistribution between initial and delayed postexercise images in the same regions. TI-201 clearance rate in the segments supplied by the dilated vessel also improved significantly. Abnormal TI-201 lung uptake was seen in 17 patients before and in 4 patients after PTCA. Exercise ejection fraction response and septal wall motion also improved after PTCA of the LAD stenosis in all 17 patients who had exercise radionuclide ventriculography

  2. Patients' feelings and experiences during and after peripheral percutaneous transluminal angioplasty

    International Nuclear Information System (INIS)

    Lundén, Maud; Lundgren, Solveig M.; Persson, Lars-Olof; Lepp, Margret

    2015-01-01

    Background: Peripheral Arterial Disease (PAD) often caused by atherosclerosis is a major health care issue worldwide. Percutaneous Transluminal Angioplasty (PTA) on the lower limb is a common procedure used to enhance peripheral circulation. With an increasing number of individuals acquiring peripheral PTA treatment and with an increased focus on patient centred care, there is a need to find out more about patients' feelings and thoughts of undergoing PTA. Aim: The aim was to identify patients who are predominantly anxious or calm during and after peripheral PTA and to explore reasons for these feelings. Method: The study includes 51 patients who received PTA treatment in western Sweden. Findings: Seventy-eight percent of the patients rated themselves as calm after the PTA. The analysed interviews resulted in two themes: reasons for feelings of calmness and reasons for feelings of anxiety. Conclusion: In order to feel calm during and after the PTA, information given prior to the PTA needs to be comprehensive and consistent with the actual situation at the angiography suite. The dialogue with the physician and the radiographers was considered valuable, as was the ability to follow the procedure on the image screen. It is concluded that a thorough dialogue with the physician in a calm setting after the PTA is important for the patients' ability to foresee and plan for the future. Moreover, there is a need to find ways to improve analgesic routines regarding assessment and evaluation in connection with PTA treatment as pain is shown to increase anxiety

  3. Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note

    International Nuclear Information System (INIS)

    Kobayashi, Nozomu; Tanasawa, Toshihiko; Okada, Takeshi; Endo, Otone; Yamamoto, Naohito; Miyachi, Shigeru; Hattori, Kenichi

    2006-01-01

    Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed. (orig.)

  4. Clinical utility and problem of thallium myocardial imaging after coronary angioplasty

    International Nuclear Information System (INIS)

    Konishi, Tokuji; Tamai, Takuya; Nakamura, Mashio; Miyahara, Masatoshi; Isaka, Naoki; Nakano, Takeshi.

    1995-01-01

    The purpose of this study was twofold: (1) to assess the value and limits of stress thallium myocardial imaging in the diagnosis of reclosure after percutaneous transluminal coronary angioplasty (PTCA) and (2) to determine how myocardial viability, as determined on thallium imaging, influenced the therapeutic option. In study 1, 117 segments, which were treated with PTCA, were examined. Of 52 segments that showed thallium defects, 27 were treated with repeated PTCA. Of the other 25 segments, 12 were found to be reclosed. On the other hand, 65 other segments showed redistribution on thallium imaging, and 60 of these had no reclosure. The remaining 5 segments that were reclosed reflected no evidence of myocardial viability. These findings suggest that coronary arteriography may omitted when redistribution is seen on stress thallium imaging after PTCA. The population in Study 2 included 39 patients who were diagnosed as having myocardial necrosis on thallium imaging. In 22 of these patients, thallium findings ruled out coronary revascularization. One other patient did not undergo coronary revascularization because of technical problems. Thus, the remaining 16 patients were treated with coronary revascularization combined with bypass surgery for necrotic zones (n=10) or with PTCA for preserved collateral circulation (n=6). For necrotic zones evidenced on thallium imaging, factors other than necrosis were considered in determining coronary revascularization. (N.K.)

  5. [Aortic dissection spread to the renal arteries: role of renal volumetry after angioplasty].

    Science.gov (United States)

    Vautrin, E; Thony, F; Chavanon, O; Hannachi, I; Barone-Rochette, G; Pierre, H; Baguet, J-P

    2012-06-01

    Type A or B aortic dissection can extend to renal arteries, causing a renal ischemia which treatment is usually endovascular. The aim of our study is to show the interest of the renal volumetry in the follow-up of these patients. Twenty-two patients (16 men, mean age 63.4±11.8years, BMI 25.2±3.4kg/m(2)) with a type A or B aortic dissection spread to one or to both renal arteries and followed at Grenoble university hospital were consecutively included. All patients underwent renal angiography with aorto-renal pressure gradients measurements and follow-up by renal volumetry (scanner Siemens(®)). A renal ischemia was defined by a decrease of 20% or more of the volumetry. Sixteen patients (73%) were hypertensive before the aortic dissection among which ten (62%) were treated. Eight patients (36%) have a significant renal pressure gradient among which five (62%) underwent renal endovascular therapy. The renal volumetry of these five patients remained unchanged while six of 17 patients (36%) without angioplasty have a decreasing volumetry. Renal volumetry appeared an effective and attractive option for the follow-up of the patients with aortic dissection spread to the renal arteries. These results should be taken into account to put the indication of an endovascular treatment. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  6. Selection of patients with infrainguinal arterial occlusive disease for percutaneous transluminal angioplasty with duplex scanning

    International Nuclear Information System (INIS)

    Bostroem Ardin, A.; Hellberg, A.; Ljungman, C.; Logason, K.; Karacagil, S.; Loefberg, A.M.; Andren, B.

    2002-01-01

    Aim: To evaluate the role of duplex scanning in the selection of patients with infrainguinal arterial occlusive disease for percutaneous transluminal angioplasty (PTA). Material and Methods: From January 1995 through May 2000, 702 patients (952 limbs), with chronic lower extremity ischemia due to infrainguinal atherosclerotic disease diagnosed by duplex scanning, were retrospectively studied. Diagnostic angiography (130 limbs) or infrainguinal PTA (108 limbs) was performed in 238 limbs. Two investigators retrospectively analyzed the duplex examinations and angiographies in a blinded manner and used similar criteria for the interpretation of lesions suitable or not suitable for PTA. Results: The superficial femoral, popliteal and crural artery lesions were correctly selected for PTA in 85%, 66% and 32%, respectively. The accuracy, sensitivity, specificity, negative predictive value and positive predictive value of duplex scanning to appropriately categorize femoropopliteal lesions as suitable or unsuitable for PTA were 89%, 83%, 92%, 94% and 78%, respectively. The accuracy of duplex scanning for predicting the performance of infrainguinal PTA was 83%. Conclusion: Duplex scanning has an important impact on the selection of treatment modalities in limbs with infrainguinal arterial occlusive disease. Femoropopliteal lesions can be reliably selected to PTA according to duplex scan findings

  7. Duplex-guided percutaneous transluminal angioplasty in iliac arterial occlusive disease.

    Science.gov (United States)

    Krasznai, A G; Sigterman, T A; Welten, R J; Heijboer, R; Sikkink, C J J M; van de Akker, L H J M; Bouwman, L H

    2013-11-01

    Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance. Duplex-guided infra-inguinal interventions and access-related interventions have been reported. Duplex-guided iliac interventions have not been performed to any extent because of the anatomic location. In our study we evaluated the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in iliac arteries. From June 2012 until February 2013, 31 patients (35 iliac lesions), underwent DuPTA. Indications ranged from Rutherford 3 to 5. Preoperative evaluation included Ankle Brachial Index (ABI), Duplex and MRA. Procedural success was defined as crossing the lesion with a guidewire and dilating or stenting the lesion. Clinical success was defined as 50% reduction in peak systolic velocity (PSV) or clinical improvement. PSV was evaluated after PTA, then at 2 weeks. Clinical results were assessed 2 weeks after the procedure. Procedural success was achieved in 94% of patients (33/35), all of whom also had clinical success. Post-procedural PSV reduction showed an average improvement of 63% (431 cm/s to 153 cm/s). Mean preoperative ABI was 0.72 and improved to 0.88 postoperatively. PTA using Duplex-guidance in significant iliac stenosis is a safe method with major advantages in patients at high risk for developing contrast-induced nephropathy. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  8. Clinical application of Inoue-balloon in percutaneous transluminal angioplasty for Budd-Chiari syndrome

    International Nuclear Information System (INIS)

    Mei Jian; Qu Jian; Zhu Yaoqing; Wang Lei; Liu Cheng

    2007-01-01

    Objective: To investigate the feasibility and effect of recanalization of inferior vena cava with percutaneous transluminal angioplasty(PTA)by Inoue-balloon. Methods: Eighty-nine patients with Budd-chiari syndrome (BCS )were treated with PTA by Inoue-balloon. Results: After PTA, the median (interquartile range)diameter of hepatic segment inferior vena cava increased from 0.00 (0.20-0.00) cm to 1.90 (2.00 1.47)cm; (P < 0.001), and the mean pressure of inferior vena cava reduced from (20.63 ± 7.22) mmHg to (12.13 ± 5.60) mmHg; (P < 0.001); with only less serious complications as rupture in two cases and without need of prior minor diameter balloon dilation in Inoue-balloon PTA. Conclusion: The advantages of Inoue- balloon PTA for BCS are more reliable and facile than those of polyethylene balloon, and may take the place in the foreseen future. (authors)

  9. Efficacy of stent angioplasty for symptomatic stenoses of the proximal vertebral artery

    International Nuclear Information System (INIS)

    Weber, W.; Mayer, T.E.; Henkes, H.; Kis, B.; Hamann, G.F.; Holtmannspoetter, M.; Brueckmann, H.; Kuehne, D.

    2005-01-01

    Background: To evaluate the safety and efficacy of stent angioplasty in the treatment of symptomatic arteriosclerotic stenoses of the proximal vertebral artery (VA). Methods: Thirty-eight symptomatic stenoses of the vertebral origin were treated with flexible balloon-expandable coronary stents. Angiographic and clinical follow-up examinations were obtained in 26 patients at a mean of 11 months. Results: The immediate post-procedural angiographic results showed no residual stenosis in 33 vessels and mild residual stenoses in five vessels. Periprocedurally, there were two asymptomatic technical complications and one TIA. During follow-up re-stenosis could be detected in 10 cases (36%), and vessel occlusions in two patients. Two stents were broken. One of the restenosis caused a TIA within the follow-up period. Conclusions: Flexible balloon-expandable coronary stents proved to be save and effective in preventing vertebrobasilar stroke but were incapable to preserve the proximal vertebral artery lumen. For the VA origine an adequate stent, self-expanding, bioresorbable, or drug-eluting has to be found

  10. Femoral versus Radial Access in Primary Angioplasty. Analysis of the ACCEPT Registry

    Directory of Open Access Journals (Sweden)

    Pedro Beraldo de Andrade

    2014-07-01

    Full Text Available Background: The radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Objective: To compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route. Methods: From August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure. Results: The mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used. Conclusions: The femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques.

  11. Femoral versus Radial Access in Primary Angioplasty. Analysis of the ACCEPT Registry

    International Nuclear Information System (INIS)

    Andrade, Pedro Beraldo de; Andrade, Mônica Vieira Athanazio de; Barbosa, Robson Alves; Labrunie, André; Hernandes, Mauro Esteves; Marino, Roberto Luiz; Precoma, Dalton Bertolim; Sá, Francisco Carleial Feijó de; Berwanger, Otávio; Mattos, Luiz Alberto Piva e

    2014-01-01

    The radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention. To compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route. From August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure. The mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used. The femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques

  12. Femoral versus Radial Access in Primary Angioplasty. Analysis of the ACCEPT Registry

    Energy Technology Data Exchange (ETDEWEB)

    Andrade, Pedro Beraldo de, E-mail: pedroberaldo@cardiol.br; Andrade, Mônica Vieira Athanazio de; Barbosa, Robson Alves; Labrunie, André [Santa Casa de Misericórdia de Marília, São Paulo -SP (Brazil); Hernandes, Mauro Esteves [Santa Casa de Votuporanga, São Paulo -SP (Brazil); Marino, Roberto Luiz [Hospital Madre Teresa, Belo Horizonte -MG (Brazil); Precoma, Dalton Bertolim [Sociedade Hospital Angelina Caron, Campina Grande do Sul -PR (Brazil); Sá, Francisco Carleial Feijó de [Hospital do Coração do Cariri, Barbalha -CE (Brazil); Berwanger, Otávio [Instituto de Ensino e Pesquisa do Hospital do Coração, São Paulo -SP (Brazil); Mattos, Luiz Alberto Piva e [Sociedade Brasileira de Cardiologia, São Paulo -SP (Brazil); Instituto Dante Pazzanese de Cardiologia, São Paulo -SP (Brazil); Unidades de Hemodinâmica e Intervenção Cardiovascular Rede D' Or / São Luiz, São Paulo, SP (Brazil)

    2014-06-15

    The radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention. To compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route. From August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure. The mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used. The femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques.

  13. Cryptography and the Internet: lessons and challenges

    Energy Technology Data Exchange (ETDEWEB)

    McCurley, K.S.

    1996-12-31

    The popularization of the Internet has brought fundamental changes to the world, because it allows a universal method of communication between computers. This carries enormous benefits with it, but also raises many security considerations. Cryptography is a fundamental technology used to provide security of computer networks, and there is currently a widespread engineering effort to incorporate cryptography into various aspects of the Internet. The system-level engineering required to provide security services for the Internet carries some important lessons for researchers whose study is focused on narrowly defined problems. It also offers challenges to the cryptographic research community by raising new questions not adequately addressed by the existing body of knowledge. This paper attempts to summarize some of these lessons and challenges for the cryptographic research community.

  14. Lessons for Teaching Art Criticism.

    Science.gov (United States)

    Barrett, Terry, Ed.; Clark, Gilbert, Ed.

    This collection of lessons is meant to be a practical guide to help teachers engage children in art criticism. The lessons generally follow a similar format. Most suggest an age group but may be modified for use with younger or older students. Several authors suggest variations and extensions for lessons that include studio activities. A broad…

  15. Lesson Planning the Kodaly Way.

    Science.gov (United States)

    Boshkoff, Ruth

    1991-01-01

    Discusses the contribution of Zoltan Kodaly to music lesson planning. Emphasizes preparation, presentation, and practice as the three important strategies in teaching concepts and skills to be included in a lesson plan. Includes a sample lesson plan covering a semester and advice on choosing song material. (DK)

  16. Emergent intracranial balloon angioplasty and bailout self-expandable stent placement in acute large vessel occlusion of the anterior circulation: Experience of a single institution

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Young Jin; Seo, Jung Hwa; Jeong, Hae Woong [Busan Paik Hospital, Inje University, Busan (Korea, Republic of)

    2017-06-15

    To evaluate the outcomes of angioplasty for recanalization after acute ischemic stroke (AIS). The study population was selected from 134 patients who underwent endovascular revascularization therapy (ERT) for AIS between October 2011 and May 2014. Of those 134 patients, 39 who underwent balloon angioplasty with or without stent insertion were included in this study. Balloon angioplasty was the primary treatment for nine patients and a rescue method for 30 patients. The revascularization rate at 7 days, procedure-related complications, and clinical outcomes at 3 months were analyzed. The occlusion sites were the middle cerebral artery (n = 26), intracranial internal carotid artery (n = 10), and middle cerebral artery branch (n = 3). Angioplasty achieved successful revascularization (Thrombolysis in Cerebral Ischemia grade 2b–3) in 76.9% of patients. Computed tomography angiography performed 7 days post-procedure revealed a maintained reperfusion in 82.8% of successful cases. Only two patients had symptomatic intracerebral hemorrhage. At the 3-month follow-up, 18 (48.6%) and 10 (27.0%) patients showed good and poor functional outcomes, respectively (modified Rankin Scale scores, 0–2 and 5–6). Emergent balloon angioplasty and bailout self-expandable stent placement may be safe and effective for achieving successful revascularization in acute large vessel occlusion of the anterior circulation. It could be a feasible rescue method as well as a primary method for ERT.

  17. Emergent intracranial balloon angioplasty and bailout self-expandable stent placement in acute large vessel occlusion of the anterior circulation: Experience of a single institution

    International Nuclear Information System (INIS)

    Heo, Young Jin; Seo, Jung Hwa; Jeong, Hae Woong

    2017-01-01

    To evaluate the outcomes of angioplasty for recanalization after acute ischemic stroke (AIS). The study population was selected from 134 patients who underwent endovascular revascularization therapy (ERT) for AIS between October 2011 and May 2014. Of those 134 patients, 39 who underwent balloon angioplasty with or without stent insertion were included in this study. Balloon angioplasty was the primary treatment for nine patients and a rescue method for 30 patients. The revascularization rate at 7 days, procedure-related complications, and clinical outcomes at 3 months were analyzed. The occlusion sites were the middle cerebral artery (n = 26), intracranial internal carotid artery (n = 10), and middle cerebral artery branch (n = 3). Angioplasty achieved successful revascularization (Thrombolysis in Cerebral Ischemia grade 2b–3) in 76.9% of patients. Computed tomography angiography performed 7 days post-procedure revealed a maintained reperfusion in 82.8% of successful cases. Only two patients had symptomatic intracerebral hemorrhage. At the 3-month follow-up, 18 (48.6%) and 10 (27.0%) patients showed good and poor functional outcomes, respectively (modified Rankin Scale scores, 0–2 and 5–6). Emergent balloon angioplasty and bailout self-expandable stent placement may be safe and effective for achieving successful revascularization in acute large vessel occlusion of the anterior circulation. It could be a feasible rescue method as well as a primary method for ERT

  18. Idiopathic infantile arterial calcification in a 12-year-old girl presenting as chronic mesenteric ischemia: imaging findings and angioplasty results

    International Nuclear Information System (INIS)

    Zhang, Edwin; Owen, Richard; Bruce, Garth; Wiebe, Sheldon

    2011-01-01

    We report an unusual case of chronic mesenteric ischemia presenting in a 12-year-old girl with idiopathic infantile arterial calcinosis (IIAC). This is the first reported case in the literature of chronic mesenteric ischemia in the setting of IIAC. The girl presented with a classical history of postprandial abdominal pain. Imaging demonstrated significant stenoses of the celiac axis, superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). Angioplasty of the celiac axis and SMA was attempted, with successful dilation of the SMA only. At 3-, 6- and 12-month follow-ups, the child's symptoms had almost resolved. This case report has three important ramifications: chronic mesenteric ischemia is a possible clinical presentation in children with IACC, pre-angioplasty imaging is important in guiding treatment approach, and angioplasty was effective in this case of chronic mesenteric ischemia and offers hope for other similarly affected children. (orig.)

  19. [Coronary angioplasty simultaneous with the "kissing" technique in a bifurcation lesion: use of a guidewire, and 2 monorail systems of rapid interchange].

    Science.gov (United States)

    Escudero, X

    1996-01-01

    Coronary branch occlusion complicating percutaneous coronary angioplasty has been recognized in certain bifurcation lesions. The utilization of double angioplasty systems simultaneously has been called "kissing" because the image of contact between balloons, and has been utilized as an alternative to protect the jeopardized branch or prevent snowplow lesion of the principal artery. The technological advance with the use of wide lumen catheters and low profile dilation balloons make the application of this technique possible in those type of lesions using a single guiding catheter. The present paper describes one case treated with this technique using conventional angioplasty systems in a complex bifurcating lesion of the circumflex artery. Some technical considerations about the procedure are made.

  20. Idiopathic infantile arterial calcification in a 12-year-old girl presenting as chronic mesenteric ischemia: imaging findings and angioplasty results

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Edwin; Owen, Richard [University of Alberta, Department of Radiology and Diagnostic Imaging, Edmonton (Canada); Bruce, Garth [University of Saskatchewan, Department of Pediatrics, Royal University Hospital, Saskatoon (Canada); Wiebe, Sheldon [University of Saskatchewan, Department of Medical Imaging, Royal University Hospital, Saskatoon (Canada)

    2011-11-15

    We report an unusual case of chronic mesenteric ischemia presenting in a 12-year-old girl with idiopathic infantile arterial calcinosis (IIAC). This is the first reported case in the literature of chronic mesenteric ischemia in the setting of IIAC. The girl presented with a classical history of postprandial abdominal pain. Imaging demonstrated significant stenoses of the celiac axis, superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). Angioplasty of the celiac axis and SMA was attempted, with successful dilation of the SMA only. At 3-, 6- and 12-month follow-ups, the child's symptoms had almost resolved. This case report has three important ramifications: chronic mesenteric ischemia is a possible clinical presentation in children with IACC, pre-angioplasty imaging is important in guiding treatment approach, and angioplasty was effective in this case of chronic mesenteric ischemia and offers hope for other similarly affected children. (orig.)

  1. The Timing and Frequency of Complications After Peripheral Percutaneous Transluminal Angioplasty and Iliac Stenting: Is a Change from Inpatient to Outpatient Therapy Feasible?

    International Nuclear Information System (INIS)

    Burns, Briony J.; Phillips, Andrea J.; Fox, Anthony; Boardman, Phillip; Phillips-Hughes, Jane

    2000-01-01

    Purpose: A prospective study was performed to assess the frequency and timing of complications after transluminal angioplasty and stent placement with a view to changing our practice and performing these procedures on an outpatient basis.Method: A total of 266 angioplasties and 51 stent deployments were attempted on 240 consecutive patients. Immediate complications were documented by the radiologists. The timing and nature of any complications during and beyond the first 24 hr were reported by the vascular surgeons.Results: There were 14 complications in 240 patients, giving a complication rate of 4.8% per vessel segment dilated. There were five major and nine minor complications. Eighty-six percent of complications were evident before the patient had left the angiography suite. All complications were evident within 4.5 hr of the procedure.Conclusion: The timing of complications suggests it would be reasonable to perform percutaneous transluminal angioplasties and iliac stenting on an outpatient basis in suitable patients

  2. Evaluation of radiation dose during the percutaneous angioplasty for arteriovenous shunt assembling

    International Nuclear Information System (INIS)

    Ting, Chien-Yi; Wu, Wen-Shiann; Tang, Kuo-Ting; Wang, Hsin-Ell; Lin, Chun-Chih

    2017-01-01

    Percutaneous angioplasty (PTA) for dysfunctional hemodialysis is usually performed by radiologists, but not cardiologists, in Taiwan, so that the radiation dose in patients and physicians are usually unknown and related studies are rare. In this study, we are pioneering an investigation into the radiation dose in percutaneous angioplasty for arteriovenous shunt assembling and the effect of RADPAD device, a lead-free surgical drape containing Bi and Ba, on the decrease of a radiation dose in the non-targeted organs of the patient and also the operator. The radiation dose in a typical digital subtraction angiography (DSA) by the PTA protocol under a fixed field of view (FOV), was measured with optically simulated luminescent dosimeters arranged in a PIXY RS-102 anthropomorphic phantom. The results indicate that there is a significant dose reduction at the hands (0.022±0.002 mGy before treatment vs. 0.014±0.001 mGy after treatment; P=0.021), but not at the lens (0.027±0.003 mGy before treatment vs. 0.018±0.001 mGy after treatment; P=0.058), and the gonads (0.026±0.003 mGy before treatment vs. 0.020±0.001 mGy after treatment; P=0.058), of the cardiologist/operator after treatment with the RADPAD drape. At the patient's abdomen, the dose significantly decreased from 1.597±0.104 mGy to 0.031±0.002 mGy (P<0.001) after treated with the RADPAD shield. For the chest, lens and thyroid in the patient, the doses were respectively 0.154±0.100 mGy (compared to 0.049±0.001 mGy after treated with the RADPAD drape; P=0.0002), 0.066±0.001 mGy (compared to 0.021±0.001 mGy after the RADPAD treatment; P=0.009), and 0.208±0.002 mGy (compared to 0.042±0.003 mGy after shielded with the RADPAD drape; P<0.0001), which represents an apparent reduction in dose. However, no significant difference was found in the dose-area product between before (179.9±0.1mGy.cm 2 ) and after (177.4±0.1mGy.cm 2 ) the treatment (P=0.38). In conclusion, the RADPAD drape significantly reduced

  3. TW-01, a piperazinedione-derived compound, inhibits Ras-mediated cell proliferation and angioplasty-induced vascular restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Chao-Feng [The Ph.D. Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan (China); Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (China); Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan (China); Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (China); Huang, Han-Li [The Ph.D. Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan (China); Peng, Chieh-Yu [Chinese Medicine Research and Development Center, China Medical University Hospital, Taichung 404, Taiwan (China); School of Pharmacy, College of Pharmacy, China Medical University, Taichung 404, Taiwan (China); Lee, Yu-Ching [The Center of Translational Medicine, Taipei Medical University, Taipei, Taiwan (China); Ph.D. Program for Biotechnology in Medicine, Taipei Medical University, Taipei, Taiwan (China); Wang, Hui-Po [College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan (China); Teng, Che-Ming [College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan (China); Pharmacological Institute, College of Medicine, National Taiwan University, Taipei 100, Taiwan (China); Pan, Shiow-Lin, E-mail: slpan@tmu.edu.tw [The Ph.D. Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan (China); Department of Pharmacology, College of Medicine, Taipei Medical University, Taipei 10031, Taiwan (China)

    2016-08-15

    Purpose: Vascular smooth muscle cell (VSMC) proliferation plays a critical role in the pathogenesis of atherosclerosis and restenosis. This study investigated piperazinedione derived compound TW-01-mediated inhibitory effects on VSMC proliferation and intimal hyperplasia. Methods: Cell proliferation was determined using [{sup 3}H]-thymidine incorporation and MTT assay; cell cycle distribution was measured using flow cytometry; proteins and mRNA expression were determined using western blotting and RT-PCR analyses; DNA binding activity of nuclear factor-κB (NF-κB), as measured using enzyme-linked immunosorbent assays (ELISA); in vivo effects of TW-01 were determined using balloon angioplasty in the rat. Results: TW-01 significantly inhibited cell proliferation. At the concentrations used, no cytotoxic effects were observed. Three predominant signaling pathways were inhibited by TW-01: (a) extracellular signal-regulated kinase (ERK)1/2 mitogen-activated protein kinase (MAPK) activation and its downstream effectors of c-fos, c-jun, and c-myc; (b) DNA binding activity of nuclear factor-κB (NF-κB); and, (c) Akt/protein kinase B (PKB) and cell cycle progression. Furthermore, TW-01 also inhibited Ras activation, a shared upstream event of each of these signaling cascades. In vascular injury studies, oral administration of TW-01 significantly suppressed intimal hyperplasia induced by balloon angioplasty. Conclusion: The present study suggests that TW-01 might be a potential candidate for atherosclerosis treatment. - Highlights: • TW-01significantly inhibits vascular smooth muscle cell proliferation. • TW-01 inhibits ERK, Akt and Ras pathway and DNA binding activity of NF-κB. • TW-01 significantly suppresses intimal hyperplasia induced by balloon angioplasty. • TW-01 might be a potential candidate for atherosclerosis treatment.

  4. Combined Directional Atherectomy and Drug-Eluting Balloon Angioplasty for Isolated Popliteal Artery Lesions in Patients With Peripheral Artery Disease.

    Science.gov (United States)

    Stavroulakis, Konstantinos; Bisdas, Theodosios; Torsello, Giovanni; Stachmann, Arne; Schwindt, Arne

    2015-12-01

    To evaluate the midterm results of combined directional atherectomy (DA) and drug-eluting balloon (DEB) angioplasty for atherosclerotic lesions of the popliteal artery. In a single-arm, prospective study, 21 patients (mean age 63±16 years; 16 men) with isolated popliteal artery lesions were enrolled and underwent treatment with combined DA and DEB angioplasty under filter protection between October 2009 and February 2014. The majority (18, 86%) presented with lifestyle-limiting intermittent claudication and 3 with critical limb ischemia. Fifteen (71%) target sites were de novo lesions; 4 were occlusions. The main outcome was primary patency; secondary outcomes were technical success, secondary patency, and early and midterm morbidity and mortality. The TurboHawk atherectomy device was used in 15 (71%) patients and the SilverHawk peripheral plaque excision system in the remaining 6 patients. The In.Pact Admiral/Pacific DEB was used in the majority of cases (15, 71%). The technical success rate was 90% (n=19). One flow-limiting dissection was treated with bailout stenting. Complications included a perforation of the popliteal artery and 2 puncture site hematomas; there was no distal embolic event. The mean follow-up was 18±12 months. Two restenoses were retreated successfully. Kaplan-Meier estimates of primary patency at 12 and 18 months were 95% and 90%, respectively; the secondary patency was 100%. One (5%) patient died in follow-up. None of the patients had an amputation. In this prospective single-arm study, the combined therapy of DA and DEB angioplasty for popliteal artery lesions showed promising midterm performance. The combination of DA and DEB may, in highly selected patients, overcome the challenges presented by the mobility of the knee joint. © The Author(s) 2015.

  5. TW-01, a piperazinedione-derived compound, inhibits Ras-mediated cell proliferation and angioplasty-induced vascular restenosis

    International Nuclear Information System (INIS)

    Lin, Chao-Feng; Huang, Han-Li; Peng, Chieh-Yu; Lee, Yu-Ching; Wang, Hui-Po; Teng, Che-Ming; Pan, Shiow-Lin

    2016-01-01

    Purpose: Vascular smooth muscle cell (VSMC) proliferation plays a critical role in the pathogenesis of atherosclerosis and restenosis. This study investigated piperazinedione derived compound TW-01-mediated inhibitory effects on VSMC proliferation and intimal hyperplasia. Methods: Cell proliferation was determined using [ 3 H]-thymidine incorporation and MTT assay; cell cycle distribution was measured using flow cytometry; proteins and mRNA expression were determined using western blotting and RT-PCR analyses; DNA binding activity of nuclear factor-κB (NF-κB), as measured using enzyme-linked immunosorbent assays (ELISA); in vivo effects of TW-01 were determined using balloon angioplasty in the rat. Results: TW-01 significantly inhibited cell proliferation. At the concentrations used, no cytotoxic effects were observed. Three predominant signaling pathways were inhibited by TW-01: (a) extracellular signal-regulated kinase (ERK)1/2 mitogen-activated protein kinase (MAPK) activation and its downstream effectors of c-fos, c-jun, and c-myc; (b) DNA binding activity of nuclear factor-κB (NF-κB); and, (c) Akt/protein kinase B (PKB) and cell cycle progression. Furthermore, TW-01 also inhibited Ras activation, a shared upstream event of each of these signaling cascades. In vascular injury studies, oral administration of TW-01 significantly suppressed intimal hyperplasia induced by balloon angioplasty. Conclusion: The present study suggests that TW-01 might be a potential candidate for atherosclerosis treatment. - Highlights: • TW-01significantly inhibits vascular smooth muscle cell proliferation. • TW-01 inhibits ERK, Akt and Ras pathway and DNA binding activity of NF-κB. • TW-01 significantly suppresses intimal hyperplasia induced by balloon angioplasty. • TW-01 might be a potential candidate for atherosclerosis treatment.

  6. Association Between Disruption of Fibrin Sheaths Using Percutaneous Transluminal Angioplasty Balloons and Late Onset of Central Venous Stenosis

    International Nuclear Information System (INIS)

    Ni, Nina; Mojibian, Hamid; Pollak, Jeffrey; Tal, Michael

    2011-01-01

    To compare the rates of central venous stenosis in patients undergoing hemodialysis who underwent disruption of fibrin sheath with percutaneous transluminal angioplasty balloons and those who underwent over-the-wire catheter exchange. This study is a retrospective review of 209 percutaneous transluminal angioplasty balloon disruption and 1304 over-the-wire catheter exchange procedures performed in 753 patients. Approval from the Human Investigations Committee was obtained for this study. Up to 10-year follow-up was performed. A χ 2 test was used to compare the rates of central venous stenosis after balloon disruption versus catheter exchange. A t-test was used to compare time to central venous stenosis development. Of the 753 patients in the study, 127 patients underwent balloon disruption of fibrin sheath and 626 had catheter exchange. Within the balloon disruption group, 18 (14.2%) of 127 patients subsequently developed central venous stenosis, compared with 44 (7.0%) of 626 in the catheter exchange group (P 2 test). Time to central venous stenosis development was approximately 3 years in both groups and not significantly different (1371 and 1010 days, P = 0.20). A total of 25.2% of patients in the balloon disruption group had four or more subsequent catheter exchanges, versus 12.6% in the catheter exchange group (P 2 test). In conclusions, there is a possible association between percutaneous transluminal angioplasty balloon disruption of fibrin sheath and late-onset central venous stenosis. Because venography was not routinely performed in catheter exchange patients, future randomized studies are necessary to confirm these findings.

  7. Angioplasty Guided by Intravascular Ultrasound: Meta-Analysis of Randomized Clinical Trials

    Energy Technology Data Exchange (ETDEWEB)

    Figueiredo, José Albuquerque Neto de, E-mail: jafneto@cardiol.br; Nogueira, Iara Antonia Lustosa [Universidade Federal do Maranhão, São Luiz, MA (Brazil); Figueiro, Mabel Fernandes; Buehler, Anna Maria; Berwanger, Otavio [Instituto de Ensino e Pesquisa do Hospital do Coração, São Paulo, SP (Brazil)

    2013-08-15

    The impact of intravascular ultrasound (IVUS) use on stenting has shown inconclusive results. Systematic review and meta-analysis of the impact of IVUS on stenting regarding the clinical and angiographic evolution. A search was performed in Medline/Pubmed, CENTRAL, Embase, Lilacs, Scopus and Web of Science databases. It included randomized clinical trials (RCTs) that evaluated the implantation of stents guided by IVUS, compared with those using angiography alone (ANGIO). The minimum follow-up duration was six months and the following outcomes were assessed: thrombosis, mortality, myocardial infarction, percutaneous and surgical revascularization, major adverse cardiovascular events (MACE) and restenosis. The binary outcomes were presented considering the number of events in each group; the estimates were generated by a random effects model, considering Mantel-Haenszel statistics as weighting agent and magnitude of effect for the relative risk (RR) with its respective 95% confidence interval (95%CI). Higgins I{sup 2} test was used to quantify the consistency between the results of each study. A total of 2,689 articles were evaluated, including 8 RCTs. There was a 27% reduction in angiographic restenosis (RR: 0.73, 95% CI: 0.54-0.97, I{sup 2} = 51%) and statistically significant reduction in the rates of percutaneous revascularization and overall (RR: 0.88; 95% CI: 0.51 to 1.53, I{sup 2} = 61%, RR: 0.73, 95% CI: 0.54 to 0.99, I{sup 2} = 55%), with no statistical difference in surgical revascularization (RR: 0.95, 95% CI: 0.52-1.74, I{sup 2} = 0%) in favor of IVUS vs. ANGIO. There were no differences regarding the other outcomes in the comparison between the two strategies. Angioplasty with stenting guided by IVUS decreases the rates of restenosis and revascularization, with no impact on MACE, acute myocardial infarction, mortality or thrombosis outcomes.

  8. The Appropriateness of Renal Angioplasty. The ANPARIA Software: A Multidisciplinary Expert Panel Approach

    International Nuclear Information System (INIS)

    Gerbaud, Laurent; Manhes, Geraud; Debourse, Juliette; Gouby, Gerald; Glanddier, Phyllis-Yvonne; Vader, John-Paul; Boyer, Louis; Deteix, Patrice

    2008-01-01

    Percutaneous transluminal renal angioplasty (PTRA) is an invasive technique that is costly and involves the risk of complications and renal failure. The ability of PTRA to reduce the administration of antihypertensive drugs has been demonstrated. A potentially greater benefit, which nevertheless remains to be proven, is the deferral of the need for chronic dialysis. The aim of the study (ANPARIA) was to assess the appropriateness of PTRA to impact on the evolution of renal function. A standardized expert panel method was used to assess the appropriateness of medical treatment alone or medical treatment with revascularization in various clinical situations. The choice of revascularization by either PTRA or surgery was examined for each clinical situation. Analysis was based on a detailed literature review and on systematically elicited expert opinion, which were obtained during a two-round modified Delphi process. The study provides detailed responses on the appropriateness of PTRA for 1848 distinct clinical scenarios. Depending on the major clinical presentation, appropriateness of revascularization varied from 32% to 75% for individual scenarios (overal 48%). Uncertainty as to revascularization was 41% overall. When revascularization was appropriate, PTRA was favored over surgery in 94% of the scenarios, except in certain cases of aortic atheroma where sugery was the preferred choice. Kidney size >7 cm, absence of coexisting disease, acute renal failure, a high degree of stenosis (≥70%), and absence of multiple arteries were identified as predictive variables of favorable appropriateness ratings. Situations such as cardiac failure with pulmonary edema or acute thrombosis of the renal artery were defined as indications for PTRA. This study identified clinical situations in which PTRA or surgery are appropriate for renal artery disease. We built a decision tree which can be used via Internet: the ANPARIA software (http://www

  9. Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency?

    Energy Technology Data Exchange (ETDEWEB)

    Sidhu, Arshdeep; Tan, Kong T.; Noel-Lamy, Maxime; Simons, Martin E.; Rajan, Dheeraj K., E-mail: dheeraj.rajan@uhn.ca [University Health Network, University of Toronto, Division of Vascular and Interventional Radiology, Peter Munk Cardiac Center (Canada)

    2016-10-15

    PurposeTo study if <30 % residual stenosis post angioplasty (PTA) correlates with primary access circuit patency, and if any variables predict technical success.Materials and MethodsA prospective observational study was performed between January 2009 and December 2012, wherein 76 patients underwent 154 PTA events in 56 prosthetic grafts (AVG) and 98 autogenous fistulas (AVF). Data collected included patient age, gender, lesion location and laterality, access type and location, number of prior interventions, and transonic flow rates pre- and postintervention. Impact of technical outcome on access patency was assessed. Univariate logistic regression was used to assess the impact of variables on technical success with significant factors assessed with a multiple variable model.ResultsTechnical success rates of PTA in AVFs and AVGs were 79.6 and 76.7 %, respectively. Technical failures of PTA were associated with an increased risk of patency loss among circuits with AVFs (p < 0.05), but not with AVGs (p = 0.7). In AVFs, primary access patency rates between technical successes and failures at three and 6 months were 74.4 versus 61.9 % (p = 0.3) and 53.8 versus 23.8 % (p < 0.05), respectively. In AVGs, primary access patency rates between technical successes and failures at three and six months were 72.1 versus 53.9 % (p = 0.5) and 33.6 versus 38.5 % (p = 0.8), respectively. Transonic flow rates did not significantly differ among technically successful or failed outcomes at one or three months.ConclusionTechnical failures of PTA had a significant impact on access patency among AVFs with a trend toward poorer access patency within AVGs.

  10. Medical Therapy Versus Balloon Angioplasty for CTEPH: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Phan, Kevin; Jo, Helen E; Xu, Joshua; Lau, Edmund M

    2018-01-01

    A significant number of chronic thromboembolic pulmonary hypertension (CTEPH) patients will have an inoperable disease. Medical therapy and balloon pulmonary angioplasty (BPA) have provided alternate therapeutic options for patients with inoperable CTEPH, although there are a limited number of published studies examining the outcomes. Thus, our study aims to evaluate and compare the efficacy of medical therapy and BPA in patients with inoperable CTEPH. An electronic search of six databases was performed and the search results were screened against established criteria for inclusion into this study. Data was extracted and meta-analytical techniques were used to analyse the data. Pooled data from RCTs revealed that medical therapy, compared with a placebo, was associated with a significant improvement of at least one functional class (p=0.038). With regards to pulmonary haemodynamics, medical therapy also resulted in a significant reduction in both mean pulmonary arterial pressure (mPAP) (p=0.002) and pulmonary vascular resistance (PVR) (pmedical therapy by an average of 22.8% (pmedical therapy for CTEPH (p=0.001). Pooled data from available observational studies of medical therapy or BPA all demonstrated significant improvements in mPAP and PVR for pre versus post intervention comparisons. The improvement in mPAP (p=0.002) and PVR (p=0.002) were significantly greater for BPA intervention when compared to medical therapy. High-quality evidence supports the use of targeted medical therapy in improving haemodynamics in patients with inoperable CTEPH. There is only moderate-quality evidence from observational studies supporting the efficacy of BPA in improving both haemodynamics and exercise capacity. Further RCTs and prospective observational studies comparing medical therapy and BPA in patients with inoperable CTEPH are required. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New

  11. Analysis of periinterventional complications of intracranial angioplasty and stenting: A single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Silber, Toni; Ziemann, Ulf [Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen (Germany); Ernemann, Ulrike [Department of Diagnostic and Interventional Neuroradiology, University of Tübingen (Germany); Bischof, Felix, E-mail: felix.bischof@uni-tuebingen.de [Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen (Germany)

    2014-12-15

    Highlights: • Periinterventional complications in 7.5% of patients with intracranial artery stenting. • 2.5% of periinterventional complications were perforator strokes. • 3.8% of patients developed a hemorrhagic stroke due to reperfusion injury. • Complications could be reduced by individualized measures to prevent perforator stroke or reperfusion injury. - Abstract: Background and purpose: Treatment of symptomatic intracranial atherosclerotic disease by angioplasty and stenting (PTAS) is limited by a high rate of periinterventional strokes. We performed a detailed analysis of these strokes at our center in order to identify strategies to reduce the risk of periinterventional complications. Methods: Case records and imaging data of 80 patients with a symptomatic 70–99% stenosis of a major intracranial artery treated with PTAS between July 2007 and December 2013 were reviewed. All patients had a sufficient response to aspirin and clopidogrel. Periinterventional strokes were categorized as either ischemic (perforator territory, distal embolic or delayed stent thrombosis) or hemorrhagic (intraparenchymal, subarachnoid). Results: Periinterventional complications occurred in 6/80 (7.5%) patients, consisting of 2 ischemic strokes (2.5%, both perforator territory), 3 hemorrhagic strokes (3.8%, 2 intraparenchymal due to reperfusion injury, 1 subarachnoid due to vessel rupture) and one death (1.3%) unrelated to stroke. All strokes occurred within 24 h after PTAS. Conclusion: Our retrospective data analysis suggests that the risk of periinterventional stroke after PTAS of symptomatic intracranial atherosclerotic disease might be reduced by sufficient antiplatelet therapy and optimized management of patients with high risk for reperfusion injury or perforator strokes, including selection of a stenting device adapted to individual vessel morphology.

  12. Serial High-Sensitivity Troponin T in Post-Primary Angioplasty Exercise Test

    Directory of Open Access Journals (Sweden)

    Humberto Andres Vaz

    2016-04-01

    Full Text Available Abstract Background: The kinetics of high-sensitivity troponin T (hscTnT release should be studied in different situations, including functional tests with transient ischemic abnormalities. Objective: To evaluate the release of hscTnT by serial measurements after exercise testing (ET, and to correlate hscTnT elevations with abnormalities suggestive of ischemia. Methods: Patients with acute ST-segment elevation myocardial infarction (STEMI undergoing primary angioplasty were referred for ET 3 months after infarction. Blood samples were collected to measure basal hscTnT immediately before (TnT0h, 2 (TnT2h, 5 (TnT5h, and 8 hours (TnT8h after ET. The outcomes were peak hscTnT, TnT5h/TnT0h ratio, and the area under the blood concentration-time curve (AUC for hscTnT levels. Log-transformation was performed on hscTnT values, and comparisons were assessed with the geometric mean ratio, along with their 95% confidence intervals. Statistical significance was assessed by analysis of covariance with no adjustment, and then, adjusted for TnT0h, age and sex, followed by additional variables (metabolic equivalents, maximum heart rate achieved, anterior wall STEMI, and creatinine clearance. Results: This study included 95 patients. The highest geometric means were observed at 5 hours (TnT5h. After adjustments, peak hscTnT, TnT5h/TnT0h and AUC were 59% (p = 0.002, 59% (p = 0.003 and 45% (p = 0.003 higher, respectively, in patients with an abnormal ET as compared to those with normal tests. Conclusion: Higher elevations of hscTnT may occur after an abnormal ET as compared to a normal ET in patients with STEMI.

  13. Serial High-Sensitivity Troponin T in Post-Primary Angioplasty Exercise Test

    Energy Technology Data Exchange (ETDEWEB)

    Vaz, Humberto Andres, E-mail: humbertovaz@cardiol.br; Vanz, Ana Paula; Castro, Iran [Instituto de Cardiologia - Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2016-04-15

    The kinetics of high-sensitivity troponin T (hscTnT) release should be studied in different situations, including functional tests with transient ischemic abnormalities. To evaluate the release of hscTnT by serial measurements after exercise testing (ET), and to correlate hscTnT elevations with abnormalities suggestive of ischemia. Patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty were referred for ET 3 months after infarction. Blood samples were collected to measure basal hscTnT immediately before (TnT{sub 0h}), 2 (TnT{sub 2h}), 5 (TnT{sub 5h}), and 8 hours (TnT{sub 8h}) after ET. The outcomes were peak hscTnT, TnT{sub 5h}/TnT{sub 0h} ratio, and the area under the blood concentration-time curve (AUC) for hscTnT levels. Log-transformation was performed on hscTnT values, and comparisons were assessed with the geometric mean ratio, along with their 95% confidence intervals. Statistical significance was assessed by analysis of covariance with no adjustment, and then, adjusted for TnT{sub 0h}, age and sex, followed by additional variables (metabolic equivalents, maximum heart rate achieved, anterior wall STEMI, and creatinine clearance). This study included 95 patients. The highest geometric means were observed at 5 hours (TnT{sub 5h}). After adjustments, peak hscTnT, TnT{sub 5h}/TnT{sub 0h} and AUC were 59% (p = 0.002), 59% (p = 0.003) and 45% (p = 0.003) higher, respectively, in patients with an abnormal ET as compared to those with normal tests. Higher elevations of hscTnT may occur after an abnormal ET as compared to a normal ET in patients with STEMI.

  14. Analysis of periinterventional complications of intracranial angioplasty and stenting: A single center experience

    International Nuclear Information System (INIS)

    Silber, Toni; Ziemann, Ulf; Ernemann, Ulrike; Bischof, Felix

    2014-01-01

    Highlights: • Periinterventional complications in 7.5% of patients with intracranial artery stenting. • 2.5% of periinterventional complications were perforator strokes. • 3.8% of patients developed a hemorrhagic stroke due to reperfusion injury. • Complications could be reduced by individualized measures to prevent perforator stroke or reperfusion injury. - Abstract: Background and purpose: Treatment of symptomatic intracranial atherosclerotic disease by angioplasty and stenting (PTAS) is limited by a high rate of periinterventional strokes. We performed a detailed analysis of these strokes at our center in order to identify strategies to reduce the risk of periinterventional complications. Methods: Case records and imaging data of 80 patients with a symptomatic 70–99% stenosis of a major intracranial artery treated with PTAS between July 2007 and December 2013 were reviewed. All patients had a sufficient response to aspirin and clopidogrel. Periinterventional strokes were categorized as either ischemic (perforator territory, distal embolic or delayed stent thrombosis) or hemorrhagic (intraparenchymal, subarachnoid). Results: Periinterventional complications occurred in 6/80 (7.5%) patients, consisting of 2 ischemic strokes (2.5%, both perforator territory), 3 hemorrhagic strokes (3.8%, 2 intraparenchymal due to reperfusion injury, 1 subarachnoid due to vessel rupture) and one death (1.3%) unrelated to stroke. All strokes occurred within 24 h after PTAS. Conclusion: Our retrospective data analysis suggests that the risk of periinterventional stroke after PTAS of symptomatic intracranial atherosclerotic disease might be reduced by sufficient antiplatelet therapy and optimized management of patients with high risk for reperfusion injury or perforator strokes, including selection of a stenting device adapted to individual vessel morphology

  15. Carotid Angioplasty In Octogenarians: A Mono-Arm Trial With Clinical And Angiographic Follow Up

    Directory of Open Access Journals (Sweden)

    Ehsan Sharifipour

    2017-02-01

    Full Text Available Background: Octogenarians account for a third of ischemic stroke (IS patients and they have higher morbidity and mortality rate among IS patients. The aim of this study was to evaluate the pri-procedural and long term clinical and angiographic statement of carotid artery angioplasty (CAA in octogenarians. Methods: In a mono-arm trial 102 patients>80 years old with symptomatic internal carotid artery (ICA stenosis presented by non-disabling IS or TIA underwent the CAA and were evaluated prospectively from January 2010 to July 2014. All patients had standard stroke care during the study follow up. The peri-procedural complications, cerebrovascular accidents, restenosis in target vessel and mortality rate were recorded to evaluate safety and durability of this secondary stroke prevention method in octogenarians. Results: 48 (47.06% males and 54 (52.9% females in a mean period of 24.5±14.1 (6-50 months were followed. For all patients mean age was 83.39 ±2.53 (range, 80-88 years. The success rate of CAA was 100%, whereas the peri-procedural complication rate was 5.8% (access-site local hematoma and bradycardia during CAA both in 2.94%.There was only one patient who had acute ischemic stroke during the procedure. Restenosis occurred in 3.9% after a mean of 21.5 months. The proportion of recurrent cerebrovascular accident was 9.8% while TIAs occurred in 3.9% and stroke in 1% of patients. Also 4.9% of patients experienced coronary artery disease and the proportion of fatal recurrent cerebrovascular accident was 2.9%.  The median patient event-free survival was 20 months. Conclusion: CAA seems to be a safe and durable IS secondary prevention method in octogenarians with symptomatic carotid artery stenosis.

  16. Angiographic Characteristics of Symptomatic Recurrent Disease After Infrainguinal Percutaneous Transluminal Angioplasty

    International Nuclear Information System (INIS)

    Soeder, Heini K.; Manninen, Hannu I.; Matsi, Pekka J.

    1999-01-01

    Purpose: To evaluate the angiographic patterns of clinically manifest recurrent disease after infrainguinal percutaneous transluminal angioplasty (PTA) of stenoses and total occlusions. Methods: Among 326 infrainguinal PTAs on 263 consecutive patients, selective angiography was performed on 61 limbs of 52 patients 1-60 months after the primary intervention because of clinically suspected recurrent disease. Lesion-specific and patient-related factors were analyzed for 75 angiographically confirmed recurrent lesions in 57 limbs of 48 patients. Results: Recurrent disease was more frequently a stenosis when the original target lesion was a stenosis (92%, 44/48) than when the original lesion was a total occlusion (59%, 16/27; p < 0.001). When the original target lesion was a stenosis, the total length of the recurrent disease was longer than that of the original lesion [3.9 ± 3.9 cm (mean ± standard deviation) vs 2.8 ± 2.7 cm; p= 0.03], while in the subgroup of original total occlusions the length of the recurrent lesion was shorter than that of the original occlusion (7.1 ± 5.0 cm vs 9.9 ± 6.9 cm; p0.02). Half the restenoses (22/44) extended beyond one or both ends of the original stenosis and 38% (6/16) of the reocclusions extended beyond the distal end of the original occlusion. Conclusions: The type of recurrent disease depends on the original lesion type and the restenotic lesion frequently extends beyond one or both ends of the original target lesion

  17. Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency?

    International Nuclear Information System (INIS)

    Sidhu, Arshdeep; Tan, Kong T.; Noel-Lamy, Maxime; Simons, Martin E.; Rajan, Dheeraj K.

    2016-01-01

    PurposeTo study if <30 % residual stenosis post angioplasty (PTA) correlates with primary access circuit patency, and if any variables predict technical success.Materials and MethodsA prospective observational study was performed between January 2009 and December 2012, wherein 76 patients underwent 154 PTA events in 56 prosthetic grafts (AVG) and 98 autogenous fistulas (AVF). Data collected included patient age, gender, lesion location and laterality, access type and location, number of prior interventions, and transonic flow rates pre- and postintervention. Impact of technical outcome on access patency was assessed. Univariate logistic regression was used to assess the impact of variables on technical success with significant factors assessed with a multiple variable model.ResultsTechnical success rates of PTA in AVFs and AVGs were 79.6 and 76.7 %, respectively. Technical failures of PTA were associated with an increased risk of patency loss among circuits with AVFs (p < 0.05), but not with AVGs (p = 0.7). In AVFs, primary access patency rates between technical successes and failures at three and 6 months were 74.4 versus 61.9 % (p = 0.3) and 53.8 versus 23.8 % (p < 0.05), respectively. In AVGs, primary access patency rates between technical successes and failures at three and six months were 72.1 versus 53.9 % (p = 0.5) and 33.6 versus 38.5 % (p = 0.8), respectively. Transonic flow rates did not significantly differ among technically successful or failed outcomes at one or three months.ConclusionTechnical failures of PTA had a significant impact on access patency among AVFs with a trend toward poorer access patency within AVGs.

  18. Diffusion-weighted magnetic resonance imaging in carotid angioplasty and stenting with balloon embolic protection devices

    International Nuclear Information System (INIS)

    Asakura, Fumio; Kawaguchi, Kenji; Sakaida, Hiroshi; Toma, Naoki; Matsushima, Satoshi; Kuraishi, Keita; Tanemura, Hiroshi; Miura, Yoichi; Taki, Waro; Maeda, Masayuki

    2006-01-01

    We compared the results of two procedures to protect against distal embolism caused by embolic debris from carotid angioplasty with stent deployment (CAS) using diffusion-weighted magnetic resonance imaging (MRI). The study group comprised 39 men and 3 women (42 and 3 CAS procedures, respectively) with severe carotid stenosis (average age 70.0±6.6 years). During 20 CAS procedures the internal carotid artery was protected with a single balloon. A PercuSurge GuardWire was used for temporary occlusion. During 25 CAS procedures the internal and external carotid arteries were simultaneously temporarily occluded with a PercuSurge GuardWire and a Sentry balloon catheter, respectively. Diffusion-weighted MRI was performed 1 to 3 days after CAS. Data from 26 patients undergoing conventional angiography for diagnosis of cerebral ischemic disease, cerebral aneurysm or brain tumors were included as controls. Diffusion-weighted MRI after conventional diagnostic angiography showed ischemic spots in 3 of the 26 controls (11.5%). Ischemic spots were observed during 11 of 20 CAS procedures with the internal carotid artery protected with a single balloon (55.0%), and were observed during 9 of 25 CAS procedures with both the internal and external carotid arteries protected (36.0%). This difference was significant (P=0.0068). Ischemic lesions appeared not only ipsilateral to the carotid stenosis but also in the contralateral carotid artery (31.9%) and vertebrobasilar territory (25.3%). Better protection was obtained with simultaneous double occlusion of both the internal and external carotid artery than with single protection of the internal carotid artery during CAS. (orig.)

  19. Reducing Radiation Dose in Coronary Angiography and Angioplasty Using Image Noise Reduction Technology.

    Science.gov (United States)

    Kastrati, Mirlind; Langenbrink, Lukas; Piatkowski, Michal; Michaelsen, Jochen; Reimann, Doris; Hoffmann, Rainer

    2016-08-01

    This study sought to quantitatively evaluate the reduction of radiation dose in coronary angiography and angioplasty with the use of image noise reduction technology in a routine clinical setting. Radiation dose data from consecutive 605 coronary procedures (397 consecutive coronary angiograms and 208 consecutive coronary interventions) performed from October 2014 to April 2015 on a coronary angiography system with noise reduction technology (Allura Clarity IQ) were collected. For comparison, radiation dose data from consecutive 695 coronary procedures (435 coronary angiograms and 260 coronary interventions) performed on a conventional coronary angiography system from October 2013 to April 2014 were evaluated. Patient radiation dosage was evaluated based on the cumulative dose area product. Operators and operator practice did not change between the 2 evaluated periods. Patient characteristics were collected to evaluate similarity of patient groups. Image quality was evaluated on a 5-grade scale in 30 patients of each group. There were no significant differences between the 2 evaluated groups in gender, age, weight, and fluoroscopy time (6.8 ± 6.1 vs 6.9 ± 6.3 minutes, not significant). The dose area product was reduced from 3195 ± 2359 to 983 ± 972 cGycm(2) (65%, p technology. Image quality was graded as similar between the evaluated systems (4.0 ± 0.7 vs 4.2 ± 0.6, not significant). In conclusion, a new x-ray technology with image noise reduction algorithm provides a substantial reduction in radiation exposure without the need to prolong the procedure or fluoroscopy time. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Quantitative exercise thallium-201 scintigraphy for predicting angina recurrence after percutaneous transluminal coronary angioplasty

    International Nuclear Information System (INIS)

    Stuckey, T.D.; Burwell, L.R.; Nygaard, T.W.; Gibson, R.S.; Watson, D.D.; Beller, G.A.

    1989-01-01

    The aim of this prospective study was to determine the value of quantitative exercise thallium-201 scintigraphy for predicting short-term outcome in patients after percutaneous transluminal coronary angioplasty (PTCA). Quantitative exercise thallium-201 scintigraphy was performed 2.2 +/- 1.2 weeks after successful PTCA in 68 asymptomatic patients, 64 (94%) of whom had class III or IV angina before the procedure. Clinical follow-up was obtained in all patients at a mean of 10 +/- 2 months and all were followed for at least 6 months; 45 patients (66%) remained asymptomatic during follow-up and 23 (34%) developed recurrent class III or IV angina at a mean of 2.6 +/- 1.2 months. Multivariate analysis of 22 clinical, angiographic and exercise test variables revealed that thallium-201 redistribution, any thallium scan abnormality, presence of a distal stenosis and treadmill time were the only significant predictors of recurrent angina after PTCA. Using a stepwise discriminant function model, thallium-201 redistribution was the only significant independent predictor. Despite its prognostic value relative to other variables as a predictor, thallium redistribution at 2 weeks after PTCA was only detected in 9 of the 23 patients (39%) who subsequently developed recurrent angina, although only 2 of the 45 patients (9%) who remained asymptomatic during follow-up demonstrated thallium-201 redistribution at the time of early testing. After repeat angiography was performed in 17 of the 23 patients with recurrent angina, 14 (82%) demonstrated restenosis and 3 (18%) had worse narrowing distal to or remote from the site of dilatation

  1. Carotid angioplasty and stenting for symptomatic carotid kinking combined with stenosis

    Directory of Open Access Journals (Sweden)

    JIANG Xue-li

    2013-03-01

    Full Text Available Background Carotid endarterectomy (CEA is currently the preferred treatment for severe carotid kinking and stenosis. Kinking is generally believed to be a relative contraindication for endovascular stent placement. This article aims to study the necessity, feasibility and security of carotid angioplasty and stenting (CAS for symptomatic carotid kinking combined with stenosis, and summarize clinical experience of this disease according to therapeutic results. Methods Twenty-two cases with symptomatic carotid kinking and high-grade stenosis demonstrated by digital subtraction angiography (DSA were performed CAS. Their clinical manifestations, imaging features, procedure safety and follow-up data were collected and retrospectively analyzed. All patients understood CEA and voluntarily received CAS. Results Twenty-two cases with carotid kinking and stenosis were all successfully performed CAS (the success rate was 100% without stent-related disability or mortality. Twenty-four self-expandable stents were implanted. The mean degree of stenosis was reduced from 85.63%before stenting to 11.25% after stenting and the angles of kinking were improved from 120° (Metz' category. During the period of hospitalization, no transient ischemic attack (TIA or cerebral infarction occurred, and the clinical symptoms and signs of ischemia, such as dizziness and headache, were improved or disappeared. Besides, no permenant complications or deaths happened. All cases were followed up from 6 to 72 months, among whom 1 patient experienced contralateral carotid TIA, and 2 patients experienced ipsilateral carotid TIA (one indicated aspirin resistance in platelet aggregation test and the other showed restenosis in DSA. Computed tomography angiography (CTA of 10 patients and Duplex scan of 7 patients during the follow-up demonstrated carotid in good morphology and fluent blood flow, without kinking or restenosis. Conclusion CAS is a feasible and safe therapeutic method and

  2. Endovascular recanalization of acute intracranial vertebrobasilar artery occlusion using local fibrinolysis and additional balloon angioplasty

    International Nuclear Information System (INIS)

    Kashiwagi, Junji; Okahara, Mika; Kiyosue, Hiro; Tanoue, Shuichi; Sagara, Yoshiko; Mori, Hiromu; Hori, Yuzo; Abe, Toshi

    2010-01-01

    Vertebrobasilar artery occlusion (VBO) produces high mortality and morbidity due to low recanalization rate utilization in endovascular therapy. The use of percutaneous transluminal angioplasty (PTA) to improve recanalization rate additional to local intra-arterial fibrinolysis (LIF) was investigated in this study. Results obtained following recanalization therapy in acute intracranial VBO are reported. Eighteen consecutive patients with acute VBO underwent LIF with or without PTA, from August 2000 to May 2006. Eight patients were treated using LIF alone, and ten required additional PTA. Rate of recanalization, neurological status before treatment, and clinical outcomes were evaluated. Of 18 patients, 17 achieved recanalization. One procedure-related complication of subarachnoid hemorrhage occurred. Overall survival rate was 94.4% at discharge. Seven patients achieved good outcomes [modified Rankin scale (mRS) 0-2], and the other 11 had poor outcomes (mRS 3-6). Five of six patients who scored 9-14 on the Glasgow Coma Scale (GCS) before treatment displayed good outcomes, whereas ten of 12 patients who scored 3-8 on the GCS showed poor outcomes. GCS prior to treatment showed a statistically significant correlation to outcomes (p < 0.05). Moreover, the National Institutes of Health Stroke Scale (NIHSS) before treatment correlated well with mRS (correlation coefficient 0.487). No statistical difference between the good and poor outcome groups was observed for the duration of symptoms, age, etiology, and occlusion site. Endovascular recanalization can reduce mortality and morbidity of acute VBO. Good GCS and NIHSS scores prior to treatment can predict the efficacy of endovascular recanalization. (orig.)

  3. Directional Atherectomy With Antirestenotic Therapy vs Drug-Coated Balloon Angioplasty Alone for Isolated Popliteal Artery Lesions.

    Science.gov (United States)

    Stavroulakis, Konstantinos; Schwindt, Arne; Torsello, Giovanni; Stachmann, Arne; Hericks, Christiane; Bosiers, Michel J; Beropoulis, Efthymios; Stahlhoff, Stefan; Bisdas, Theodosios

    2017-04-01

    To report a single-center study comparing drug-coated balloon (DCB) angioplasty vs directional atherectomy with antirestenotic therapy (DAART) for isolated lesions of the popliteal artery. Seventy-two patients were treated with either DCB angioplasty alone (n=31) or with DAART (n=41) for isolated popliteal artery stenotic disease between October 2009 and December 2015. The majority of patients presented with lifestyle-limiting claudication (74% vs 86%, respectively). Vessel calcification (29% vs 29%, respectively), mean lesion length (47 vs 42 mm, respectively), and number of runoff vessels were comparable between the groups. The primary outcome measure was primary patency; secondary outcomes were technical success (<30% residual stenosis or bailout stenting), secondary patency, and freedom from clinically driven target lesion revascularization (TLR). The technical success rate following DCB was 84% vs 93% (p=0.24) after DAART. The 12-month primary patency rate was significantly higher in the DAART group (65% vs 82%; hazard ratio 2.64, 95% confidence interval 1.09 to 6.37, p=0.021), while freedom from TLR did not differ between the 2 treatment strategies (82% vs 94%, p=0.072). Secondary patency at 12 months was identical for both groups (96% vs 96%). Although not statistically significant, bailout stenting was more common after DCB angioplasty (16% vs 5% for DAART, p=0.13) and aneurysmal degeneration of the popliteal artery was seen more often after DAART (7% vs 0% for DCB alone, p=0.25). Popliteal artery injury was observed in 2 patients treated using DAART (5% vs 0% for DCB alone, p=0.5), whereas distal embolization rates were comparable between the groups (3% for DCB alone vs 5% for DAART, p=0.99). In this study, the use of DAART was associated with a higher primary patency rate compared with DCB angioplasty for isolated popliteal lesions. Nonetheless, both treatment options were associated with excellent 12-month secondary patency. Aneurysmal degeneration of

  4. Restenosis after hot-tip laser-balloon angioplasty: histologic evaluation of the samples removed by Simpson atherectomy

    Science.gov (United States)

    Barbieri, Enrico; Tanganelli, Pietro; Taddei, Giuseppe; Perbellini, Antonio; Attino, Vito; Destro, Gianni; Zardini, Piero

    1991-05-01

    Laser balloon angioplasty has been used in recent years to treat peripheral artery disease. Despite a primary success the technique is plagued by a high restenosis rate. Directional atherectomy was performed in a small group of patients affected by primitive stenosis or restenosis after an invasive procedure. Light microscopy, immunohistochemistry, and transmission electron microscopy have identified the cellular component of intimal hyperplasia as smooth muscle cells in an active synthetic phenotype. The arterial healing process after invasive procedures seems to develop similarly independently of the device employed.

  5. Exercise electrocardiography and myocardial scintigraphy in the serial evaluation of the results of percutaneous transluminal coronary angioplasty

    International Nuclear Information System (INIS)

    Schall, J.M.; Chaitman, B.R.; David, P.R.; Dupras, G.; Brevers, G; Val, P.G.; Crepeau, J.; Lesperance, J.; Bourassa, M.G.

    1982-01-01

    The diagnostic value of exercise electrocardiography using 14 leads and thallium-201 scintigraphy were evaluated in 54 of 70 patients who underwent percutaneous transluminal coronary angioplasty (PTCA), both in the initial assessment and serial follow-up of patients after PTCA. Of the 45 patients who had successful PTCA, 36 had complete noninvasive studies performed before and 1 month after PTCA. The use of clinical symptoms in conjunction with the physiologic data, ECG and myocardial scintigram acquired during exercise provide important short-term data on the angiographic evolution of PTCA results. The noninvasive tests may be useful in determining guidelines for repeat angiography in patients who have had PTCA

  6. Brothers Grimm. [Lesson Plan].

    Science.gov (United States)

    Discovery Communications, Inc., Bethesda, MD.

    Based on Grimm's fairy tales, this lesson plan presents activities designed to help students understand that fairy tales connect them to earlier generations, help them think about present situations, that magic figures prominently in fairy tales, and that fairy tales can inspire readers to create original works of art. The main activity in the…

  7. DSCOVR Contamination Lessons Learned

    Science.gov (United States)

    Graziani, Larissa

    2015-01-01

    The Triana observatory was built at NASA GSFC in the late 1990's, then placed into storage. After approximately ten years it was removed from storage and repurposed as the Deep Space Climate Observatory (DSCOVR). This presentation outlines the contamination control program lessons learned during the integration, test and launch of DSCOVR.

  8. Phagocytosis: history's lessons.

    Science.gov (United States)

    Garg, Manish; Chandawarkar, Rajiv Y

    2013-01-01

    The assimilation of lessons from the past is an essential component of education for scientists of tomorrow. These lessons are not easy to find. History books on science are few and usually highly dramatized and biographies of scientists tend to exaggerate the pomp of scientific discovery. Both underplay the hard and laborious work that is integral to any scientific pursuit. Here we illustrate one such example. A century ago, the Nobel Prize in Medicine was awarded to two scientists: Ilya Metchnikoff, a Russian zoologist, for the discovery ofphagocytosis-a cell-mediated ingestion ofmicrobes; and Paul Ehrlich, a distinguished physician-scientist, for discovering a highly antigen-specific serum-derived antibody-based immune defense. These two diametrically opposing views of the host-pathogen interaction set the stage for a strife that led to seminal advancements in immunology. Mirrored in this journey are important lessons for scientists today--ubiquitously as applicable to modern scientific life as they were a century ago. This commentaryhighlights these lessons--a fitting centenary to a well-deserved recognition.

  9. Recycling Lesson Plan

    Science.gov (United States)

    Okaz, Abeer Ali

    2013-01-01

    This lesson plan designed for grade 2 students has the goal of teaching students about the environmental practice of recycling. Children will learn language words related to recycling such as: "we can recycle"/"we can't recycle" and how to avoid littering with such words as: "recycle paper" and/or "don't throw…

  10. Smart Consumer Lesson Plans.

    Science.gov (United States)

    New Jersey Consortium for Consumer Education, Newark.

    Lesson plans are provided for use with different populations of pre-K through senior high school students in four different areas of consumer education. Eight units in advertising are included: A First Look at Ads (pre-K-Grade 3), Don't Judge a Book by Its Cover (Grades 1-3), Fatal Distraction (Junior High), Package Labeling (Junior High), Product…

  11. Sharing Lessons Learned Between Industries in EU

    International Nuclear Information System (INIS)

    Muehleisen, A.; Strucic, M.

    2012-01-01

    Recent events in nuclear industry remind us on importance of continuous sharing of the knowledge and experience gained through evaluations of incidents and accidents. We frequently use experience from our daily life activities to improve our performance and avoid some mistakes or unwanted events. In the similar way we can use other industries experience. These experiences can be applied to improve nuclear safety. For example, Safety Culture, which has a great influence on the level of nuclear power plants safety, is similarly presented in other industries. Mechanisms which led to accidents from weak safety culture in one branch of other industry could be comparable to those in nuclear industry. Some other industries have many more cumulative years of experience than nuclear industry. Aviation and Oil industries are typical representatives. Part of their experience can be used in nuclear industry too. Number of reports from nuclear power plants showed us that not only specific equipment related causes lay behind accidents; there are also other causes and contributors which are more common for all industries. Hence lessons learned in other industry should be assessed and used in nuclear industry too. In the European Union, a regional initiative has been set up in 2008 in support of EU Member State nuclear safety authorities, but also EU technical support organizations, international organizations and the broader nuclear community, to enhance nuclear safety through improvement of the use of lessons learned from operational experience of nuclear power plants (NPPs). The initiative, called ''the EU Clearinghouse on Operational Experience Feedback for NPP'', is organized as a network operated by a centralized office located at the Joint Research Centre of the European Commission. The reduction of occurrence and significance of events in NPPs and their safe operation is its ultimate goal. Among others EU Clearinghouse provides services such as technical and scientific

  12. Four lessons on Randstad-Holland

    Directory of Open Access Journals (Sweden)

    Joan Moreno

    2014-10-01

    Full Text Available The Dutch delta, at the confluence of the courses of the Rhine, Meuse and Scheldt rivers, is the paradigmatic territory of networks from the earliest stages of the human settlement. In an unsteady landscape, made up of a mosaic of marshes, bogs and sand dunes; irrigated by a maze with rivers, streams and canals; transportation network is the element that strengthens and unites the urban structure for centuries. This article discusses the integration of the Dutch transport network and the urban network from four noted episodes in the history of mobility in the Netherlands: the Trekvaarten [towpaths], the Oude Lijn [Old railway line], the Halsketting [nodal corridor], and finally, the intermodal center Zuidas-Amsterdam. The aim of this article is to show how the development of the Dutch urban network is conditioned by structural changes in the transportation network, and how the evolution of the urban mobility system determines simultaneously both: regional and local spheres. Ultimately, four lessons in mobility and urbanity in the Randstad-Holland that take the case of study further and are a model in the development of an integrated metropolitan system.

  13. Reconstructive treatment of dural arteriovenous fistulas of the transverse and sigmoid sinus: transvenous angioplasty and stent deployment

    International Nuclear Information System (INIS)

    Liebig, T.; Henkes, H.; Brew, S.; Miloslavski, E.; Kuehne, D.; Kirsch, M.

    2005-01-01

    Various techniques for the endovascular treatment of dural arteriovenous fistulas (dAVFs) of the transverse and sigmoid sinus have recently evolved. Transvenous coil occlusion of the involved segment and transarterial embolization of the feeding arteries with liquid agents are the commonest treatments utilized. However, with respect to venous hypertension as the probable pathogenic cause of this disorder, a nonocclusive or remodeling technique might be preferable. We will present a series involving four patients, treated with transvenous angioplasty and stent deployment as a definitive treatment of dAVFs of the transverse and sigmoid sinus. This method was used as a primary treatment or as an adjunct to previous noncurative transarterial n-butyl cyanoacrylate and particle embolization. In three of the four cases, complete occlusion of the fistula was achieved with confirmation of occlusion seen on follow-up angiographical studies. In one case a negligible and nonsymptomatic remnant of the fistula fed by the tentorial artery was left untreated. From our experience, we conclude that transvenous stent deployment is an alternative to traditional concepts. Additionally, the pathological theory of dAVFs in this region located in venous pouches of the sinus wall is supported by the fact that they can be occluded by mechanical compression during angioplasty and subsequently maintained by a stent. (orig.)

  14. Suppressive activities and mechanisms of ugonin J on vascular smooth muscle cells and balloon angioplasty-induced neointimal hyperplasia.

    Science.gov (United States)

    Pan, Chun-Hsu; Li, Pei-Chuan; Chien, Yi-Chung; Yeh, Wan-Ting; Liaw, Chih-Chuang; Sheu, Ming-Jyh; Wu, Chieh-Hsi

    2018-02-01

    Neointimal hyperplasia (or restenosis) is primarily attributed to excessive proliferation and migration of vascular smooth muscle cells (VSMCs). In this study, we investigated the inhibitory effects and mechanisms of ugonin J on VSMC proliferation and migration as well as neointimal formation. Cell viability and the cell-cycle distribution were, respectively, analyzed using an MTT assay and flow cytometry. Cell migration was examined using a wound-healing analysis and a transwell assay. Protein expressions and gelatinase activities were, respectively, measured using Western blot and gelatin zymography. Balloon angioplasty-induced neointimal formation was induced in a rat carotid artery model and then examined using immunohistochemical staining. Ugonin J induced cell-cycle arrest at the G 0 /G 1 phase and apoptosis to inhibit VSMC growth. Ugonin J also exhibited marked suppressive activity on VSMC migration. Ugonin J significantly reduced activations of focal adhesion kinase, phosphoinositide 3-kinase, v-akt murine thymoma viral oncogene homolog 1, and extracellular signal-regulated kinase 1/2 proteins. Moreover, ugonin J obviously reduced expressions and activity levels of matrix metalloproteinase-2 and matrix metalloproteinase-9. In vivo data indicated that ugonin J prevented balloon angioplasty-induced neointimal hyperplasia. Our study suggested that ugonin J has the potential for application in the prevention of balloon injury-induced neointimal formation. Copyright © 2017 John Wiley & Sons, Ltd.

  15. Primary infragenicular angioplasty for diabetic neuroischemic foot ulcers following the angiosome distribution: a new paradigm for the vascular interventionist?

    Directory of Open Access Journals (Sweden)

    Alexandrescu V

    2011-08-01

    Full Text Available Vlad Alexandrescu1, Gerard Hubermont21Department of Vascular Surgery, Princess Paola Hospital, Marche- en-Famenne, Belgium; 2Department of Diabetology, Princess Paola Hospital, Marche-en-Famenne and Sainte-Thérèse Hospital, Bastogne, BelgiumAbstract: The angiosome principle was first described by Jan Taylor in 1987 in the plastic reconstructive surgery field, providing useful information on the vascular anatomy of the human body. Specifically concerning foot and ankle pathology, it may help the clinician to select better vascular access and specific strategies for revascularization. This knowledge may be particularly beneficial when treating diabetic neuroischemic foot wounds associated with particularly aggressive atherosclerotic disease and a poor collateral circulation. The implementation of angiosome-based strategies in diabetic infragenicular vascular reconstruction may afford encouraging wound healing and limb preservation rates using both bypass and endovascular techniques. The minimal invasiveness of these novel strategies enables us to perform more specific and more distal tibial and/or foot arterial reconstructions, in one or multiple targeted vessels. This paper reviews the available literature on this revascularization strategy and focuses on the potential benefit of angiosome-guided primary angioplasty for diabetic ischemic foot ulcers.Keywords: critical limb ischemia, diabetic foot, limb salvage, angiosomes, angioplasty

  16. Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: New Horizons in the Interventional Management of Pulmonary Embolism.

    Science.gov (United States)

    Rivers-Bowerman, Michael D; Zener, Rebecca; Jaberi, Arash; de Perrot, Marc; Granton, John; Moriarty, John M; Tan, Kong T

    2017-09-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed potential complication of acute or recurrent pulmonary thromboembolic disease. Multiple studies suggest that up to 5% of patients with acute pulmonary thromboembolic disease go on to develop CTEPH. The prognosis of untreated CTEPH is poor, but advances in medical and surgical treatments over the past few decades have improved patient outcomes. The gold standard and curative treatment for CTEPH is pulmonary endarterectomy; however, some patients are inoperable and others who have undergone pulmonary endarterectomy experience persistent or recurrent pulmonary hypertension despite medical therapy. In recent years, balloon pulmonary angioplasty has emerged as a primary and adjunctive treatment for these CTEPH patients at expert or specialized centers. This review outlines an approach to balloon pulmonary angioplasty for CTEPH, including clinical presentation and evaluation; patient selection and indications; treatment planning; equipment and technique; overcoming technical challenges; recognition and management of complications; postprocedural care and clinical follow-up; and expected outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. High-dose-rate (HDR) brachytherapy after percutaneous coronary angioplasty (PTCA). Clinical pilot trial; feasibility study

    International Nuclear Information System (INIS)

    Popowski, Youri; Verin, Vitali; Urban, Philippe; Nouet, Philippe; Rouzaud, Michel; Schwager, Michaeel; Rutishauser, Wilhelm; Kurtz, John

    1996-01-01

    Introduction. With the aim of reducing the incidence of restenosis, we developed a technique of intracoronary beta irradiation using an enylenediamine centered pure metallic 90-yttrium source fixed to a thrust wire. The outer diameter of both the active and thrust wires is 0.34 mm. A centering balloon with a monorail design and a blind lumen for source advancement has been developed. The source can be advanced manually in 10-13'' from the protection container to the target site. Its flexibility allows easy insertion despite tortuous anatomy. Dosimetric tests have been performed with 2.5, 3, 3.5 and 4 mm centering balloons. The standard deviation values varied between 8 and 12 % of the mean surface doses, which confirms the efficacy of the source centering. The purpose of this study was to evaluate its technical feasibility and short-term safety in the clinical setting. Methods and results. Between June 21 and November 15, 1995 fifteen patients (6 women and 9 men, aged 72 ± 5 years) underwent intracoronary beta irradiation immediately after a conventional percutaneous transluminal coronary angioplasty (P TCA) procedure. Both the PTCA and the irradiation procedure were done in an ordinary catheterization laboratory. They were technically feasible in all cases, and the delivery of the 18 Gy dose was accomplished within a local exposure time 391 ± 206 sec (range 153 - 768 sec) without any complication. In four patients, the intervention was completed by intraarterial stent implantation because of dissection induced by the initial PTCA. No in-hospital complications occurred, and serial creatine kinase measurements remained within the normal range in all cases. During a follow-up period of 54±46 days (range 20 days - 5 months) all patients remained well and free of cardiac events. Conclusions. Our early experience thus suggests that this approach is both feasible and safe on a short-term basis. Whether beta-irradiation will favorably influence post PTCA restenosis in

  18. The role of percutaneous transluminal coronary angioplasty in heart transplant recipients.

    Science.gov (United States)

    Schnetzler, B; Drobinski, G; Dorent, R; Camproux, A C; Ghossoub, J; Thomas, D; Gandjbakhch, I

    2000-06-01

    Review the acute and late results of percutaneous transluminal coronary angioplasty (PTCA) in heart transplant recipients and examine the factors predictive of restenosis. Coronary graft disease (CGD) is the main factor responsible for late graft loss. Medical treatment, surgical revascularization, or retransplantation gives only suboptimal results in this regard. Therefore, PTCA has been attempted in this situation. More than 332 heart transplantations in our institution have been performed since 1992, the date of the first PTCA in our patients. We are currently in charge of 450 patients. All the characteristics, procedure-related information, and clinical outcome of patients needing PTCA were assessed by review of each patient's clinical records. All coronary angiograms were reviewed by an independent cardiologist. Since 1992, 53 coronary sites have been dilated in the course of 39 procedures in 29 patients. Indication for PTCA was asymptomatic angiographic coronary graft disease in 35 sites (64.8%), angina in 9 (16.6%), silent ischemia in 2 (3.7%), acute myocardial infarction in 1 (1.8%), and CHF in 7 (12.9%). Primary success ( 50%) was 32.5% (14/43). Mean follow-up was 1.27 year +/- 1.2 (SD). Five deaths (17. 2%) occurred in follow-up and were all in relation to coronary graft disease. Mean time separating PTCA from death was 0.9 year +/- 1.3 (SD). We also sought to look at factors predictive of restenosis. By multivariate analysis, a positive recipient's serology for cytomegalovirus (CMV) before the graft was the only factor found protective against restenosis (odds ratio 22.4; confidence interval 1.1 to 443.4). PTCA in heart transplant recipients allows a high level of primary success with a low periprocedural-complication rate. Restenosis rate seems equivalent to restenosis rate in native coronary arteries. Mortality during follow-up is increased in this population and is the consequence of a high level of coronary events. Recipient positivity for CMV before

  19. Lessons from Goiania

    International Nuclear Information System (INIS)

    Nazari Alves, R.

    2000-01-01

    The lessons learned from the radiological accident of Goiania in 1987 derived from the observations from the Regulatory Agency which was in charge of the decontamination tasks may be consolidated into four classes: Preventive Actions, characterised as those that aim to minimise the probability of occurrence of a radiological accident; Minimisation of time between the moment of the accident occurrence and the beginning of intervention, in case a radiological accident does occur, despite all preventive measures; Intervention, which is correlated to the type of installation, its geographical location, the social classes involved and their contamination vectors; and Follow up, for which well established rules to allow continuing monitoring of the victims and rebuilding of homes are necessary. The greatest lesson of all was the need for integration of the professionals involved, from all organizations. (author)

  20. Five-year Irish trial of CLI patients with TASC II type C/D lesions undergoing subintimal angioplasty or bypass surgery based on plaque echolucency.

    LENUS (Irish Health Repository)

    Sultan, Sherif

    2009-06-01

    To report a 5-year observational parallel group study comparing the effectiveness of subintimal angioplasty (SIA) to bypass grafting (BG) for treatment of TASC II type C\\/D lesions in the lower limb arteries of patients with critical limb ischemia (CLI).

  1. Long-Term Follow-up of the PADI Trial : Percutaneous Transluminal Angioplasty Versus Drug-Eluting Stents for Infrapopliteal Lesions in Critical Limb Ischemia

    NARCIS (Netherlands)

    Spreen, Marlon I; Martens, Jasper M; Knippenberg, Bob; van Dijk, Lukas C; De Vries, Jean-Paul P. M.; Vos, Jan Albert; de Borst, Gert Jan; Vonken, Evert-Jan P A; Bijlstra, Okker D; Wever, Jan J; Statius van Eps, Randolph G; Mali, Willem P Th M; van Overhagen, Hendrik

    2017-01-01

    BACKGROUND: Clinical outcomes reported after treatment of infrapopliteal lesions with drug-eluting stents (DESs) have been more favorable compared with percutaneous transluminal angioplasty with a bailout bare metal stent (PTA-BMS) through midterm follow-up in patients with critical limb ischemia.

  2. Changing Health Behaviors to Improve Health Outcomes after Angioplasty: A Randomized Trial of Net Present Value versus Future Value Risk Communication

    Science.gov (United States)

    Charlson, M. E.; Peterson, J. C.; Boutin-Foster, C.; Briggs, W. M.; Ogedegbe, G. G.; McCulloch, C. E.; Hollenberg, J.; Wong, C.; Allegrante, J. P.

    2008-01-01

    Patients who have undergone angioplasty experience difficulty modifying at-risk behaviors for subsequent cardiac events. The purpose of this study was to test whether an innovative approach to framing of risk, based on "net present value" economic theory, would be more effective in behavioral intervention than the standard "future value approach"…

  3. Comparison of the effect of stem cell therapy and percutaneous transluminal angioplasty on diabetic foot disease in patients with critical limb ischemia

    Czech Academy of Sciences Publication Activity Database

    Dubský, M.; Jirkovská, A.; Bém, R.; Fejfarová, V.; Pagacová, L.; Němcová, A.; Sixta, B.; Chlupáč, J.; Peregrin, J. H.; Syková, Eva; Jude, E. B.

    2014-01-01

    Roč. 16, č. 12 (2014), s. 1733-1738 ISSN 1465-3249 Grant - others:GA MZd(CZ) 00023001IKEM Institutional support: RVO:68378041 Keywords : critical limb ischemia * stem cell therapy * percutaneous transluminal angioplasty Subject RIV: FH - Neurology Impact factor: 3.293, year: 2014

  4. Gender-related differences in outcome after BMS or DES implantation in patients with ST-segment elevation myocardial infarction treated by primary angioplasty

    DEFF Research Database (Denmark)

    De Luca, Giuseppe; Verdoia, Monica; Dirksen, Maurits T

    2013-01-01

    Several studies have found that among patients with ST-segment elevation myocardial infarction (STEMI) treated by thrombolysis, female sex is associated with a worse outcome. However, still controversial is the prognostic impact of gender in primary angioplasty, especially in the era of drug-elut...

  5. Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

    NARCIS (Netherlands)

    Drenth, Derk Jan

    2005-01-01

    This thesis describes and discusses the results of a prospective randomized controlled clinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and off-pump coronary artery bypass grafting with a left internal mammary artery (surgery) in patients with a high-grade stenosis

  6. Clinical impact and risk stratification of balloon angioplasty for femoropopliteal disease in nitinol stenting era: Retrospective multicenter study using propensity score matching analysis

    Directory of Open Access Journals (Sweden)

    Taketsugu Tsuchiya

    2016-07-01

    Full Text Available Objective: Nitinol stenting could bring the better outcome in endovascular therapy for femoropopliteal disease. However, it might be expected that recent marked advances in both device technology and operator technique had led to improved efficacy of balloon angioplasty even in this segment. The aims of this study were to evaluate the clinical impact of balloon angioplasty for femoropopliteal disease and make risk stratification clear by propensity score matching analysis. Methods: Based on the multicenter retrospective data, 2758 patients (balloon angioplasty: 729 patients and nitinol stenting: 2029 patients, those who underwent endovascular therapy for femoropopliteal disease, were analyzed. Results: The propensity score matching procedure extracted a total of 572 cases per group, and the primary patency rate of balloon angioplasty and nitinol stenting groups after matching was significantly the same (77.2% vs 82.7% at 1 year; 62.2% vs 64.3% at 3 years; 47.8% vs 54.3% at 5 years. In multivariate Cox hazard regression analysis, significant predictors for primary patency were diabetes mellitus, regular dialysis, cilostazol use, chronic total occlusion, and intra-vascular ultra-sonography use. The strategy of balloon angioplasty was not evaluated as a significant predictor for the primary patency. After risk stratification using five items (diabetes mellitus, regular dialysis, no use of intra-vascular ultra-sonography, chronic total occlusion, and no use of cilostazol: the DDICC score, the estimated primary patency rates of each group (low, DDICC score 0–2; moderate, DDICC score 3; high risk, DDICC score 4–5 were 88.6%, 78.3%, and 63.5% at 1 year; 75.2%, 60.7%, and 39.8% at 3 years; and 66.0%, 47.1%, and 26.3% at 5 years (p < 0.0001. The primary patency rate of balloon angioplasty and nitinol stenting groups was significantly the same in each risk stratification. Conclusion: This study suggests that balloon angioplasty does

  7. Magnetic Particle / Magnetic Resonance Imaging: In-Vitro MPI-Guided Real Time Catheter Tracking and 4D Angioplasty Using a Road Map and Blood Pool Tracer Approach.

    Directory of Open Access Journals (Sweden)

    Johannes Salamon

    Full Text Available In-vitro evaluation of the feasibility of 4D real time tracking of endovascular devices and stenosis treatment with a magnetic particle imaging (MPI / magnetic resonance imaging (MRI road map approach and an MPI-guided approach using a blood pool tracer.A guide wire and angioplasty-catheter were labeled with a thin layer of magnetic lacquer. For real time MPI a custom made software framework was developed. A stenotic vessel phantom filled with saline or superparamagnetic iron oxide nanoparticles (MM4 was equipped with bimodal fiducial markers for co-registration in preclinical 7T MRI and MPI. In-vitro angioplasty was performed inflating the balloon with saline or MM4. MPI data were acquired using a field of view of 37.3×37.3×18.6 mm3 and a frame rate of 46 volumes/sec. Analysis of the magnetic lacquer-marks on the devices were performed with electron microscopy, atomic absorption spectrometry and micro-computed tomography.Magnetic marks allowed for MPI/MRI guidance of interventional devices. Bimodal fiducial markers enable MPI/MRI image fusion for MRI based roadmapping. MRI roadmapping and the blood pool tracer approach facilitate MPI real time monitoring of in-vitro angioplasty. Successful angioplasty was verified with MPI and MRI. Magnetic marks consist of micrometer sized ferromagnetic plates mainly composed of iron and iron oxide.4D real time MP imaging, tracking and guiding of endovascular instruments and in-vitro angioplasty is feasible. In addition to an approach that requires a blood pool tracer, MRI based roadmapping might emerge as a promising tool for radiation free 4D MPI-guided interventions.

  8. Why does primary angioplasty not work in registries? Quantifying the susceptibility of real-world comparative effectiveness data to allocation bias.

    Science.gov (United States)

    Sen, Sayan; Davies, Justin E; Malik, Iqbal S; Foale, Rodney A; Mikhail, Ghada W; Hadjiloizou, Nearchos; Hughes, Alun; Mayet, Jamil; Francis, Darrel P

    2012-11-01

    Meta-analysis of registries (comparative effectiveness research) shows that primary angioplasty and fibrinolysis have equivalent real-world survival. Yet, randomized, controlled trials consistently find primary angioplasty superior. Can unequal allocation of higher-risk patients in registries have masked primary angioplasty benefit? First, we constructed a model to demonstrate the potential effect of allocation bias. We then analyzed published registries (55022 patients) for allocation of higher-risk patients (Killip class ≥1) to determine whether the choice of reperfusion therapy was affected by the risk level of the patient. Meta-regression was used to examine the relationship between differences in allocation of high-risk patient to primary angioplasty or fibrinolysis and mortality. Initial modeling suggested that registry outcomes are sensitive to allocation bias of high-risk patients. Across the registries, the therapy receiving excess high-risk patients had worse mortality. Unequal distribution of high-risk status accounted for most of the between-registry variance (adjusted R(2)(meta)=83.1%). Accounting for differential allocation of higher-risk patients, primary angioplasty gave 22% lower mortality (odds ratio, 0.78; 95% confidence interval, 0.64-0.97; P=0.029). We derive a formula, called the number needed to abolish, highlighting situations in which comparative effectiveness studies are particularly vulnerable to this bias. In ST-segment elevation myocardial infarction, clinicians' preference for management of a few high-risk patients can shift mortality substantially. Comparative effectiveness research in any disease is vulnerable to this, especially diseases with an immediately identifiable high-risk subgroup that clinicians prefer to allocate to 1 therapy. For this reason, preliminary indications from registry-based comparative effectiveness research should be definitively tested by randomized, controlled trials.

  9. Magnetic Particle / Magnetic Resonance Imaging: In-Vitro MPI-Guided Real Time Catheter Tracking and 4D Angioplasty Using a Road Map and Blood Pool Tracer Approach.

    Science.gov (United States)

    Salamon, Johannes; Hofmann, Martin; Jung, Caroline; Kaul, Michael Gerhard; Werner, Franziska; Them, Kolja; Reimer, Rudolph; Nielsen, Peter; Vom Scheidt, Annika; Adam, Gerhard; Knopp, Tobias; Ittrich, Harald

    2016-01-01

    In-vitro evaluation of the feasibility of 4D real time tracking of endovascular devices and stenosis treatment with a magnetic particle imaging (MPI) / magnetic resonance imaging (MRI) road map approach and an MPI-guided approach using a blood pool tracer. A guide wire and angioplasty-catheter were labeled with a thin layer of magnetic lacquer. For real time MPI a custom made software framework was developed. A stenotic vessel phantom filled with saline or superparamagnetic iron oxide nanoparticles (MM4) was equipped with bimodal fiducial markers for co-registration in preclinical 7T MRI and MPI. In-vitro angioplasty was performed inflating the balloon with saline or MM4. MPI data were acquired using a field of view of 37.3×37.3×18.6 mm3 and a frame rate of 46 volumes/sec. Analysis of the magnetic lacquer-marks on the devices were performed with electron microscopy, atomic absorption spectrometry and micro-computed tomography. Magnetic marks allowed for MPI/MRI guidance of interventional devices. Bimodal fiducial markers enable MPI/MRI image fusion for MRI based roadmapping. MRI roadmapping and the blood pool tracer approach facilitate MPI real time monitoring of in-vitro angioplasty. Successful angioplasty was verified with MPI and MRI. Magnetic marks consist of micrometer sized ferromagnetic plates mainly composed of iron and iron oxide. 4D real time MP imaging, tracking and guiding of endovascular instruments and in-vitro angioplasty is feasible. In addition to an approach that requires a blood pool tracer, MRI based roadmapping might emerge as a promising tool for radiation free 4D MPI-guided interventions.

  10. Predicting late restenosis after coronary angioplasty by very early (12 to 24 h) thallium-201 scintigraphy: Implications with regard to mechanisms of late coronary restenosis

    International Nuclear Information System (INIS)

    Hardoff, R.; Shefer, A.; Gips, S.; Merdler, A.; Flugelman, M.Y.; Halon, D.A.; Lewis, B.S.

    1990-01-01

    To examine whether late coronary restenosis may be predicted by abnormalities of myocardial perfusion in the early hours after successful percutaneous transluminal coronary angioplasty and to study in greater detail the mechanisms involved in the development of late coronary restenosis after angioplasty, a prospective study was undertaken in 90 consecutive patients. Thallium-201 scintigrams were recorded at rest and during the stress of atrial pacing, 12 to 24 h after angioplasty, and the results were related to the findings at angiography in 70 patients undergoing late cardiac catheterization. A reversible thallium-201 perfusion defect was found in 39 (38%) of 104 myocardial regions supplied by the dilated coronary vessel and identified a subset of patients at high risk of late (6 to 12 months) angiographic restenosis (sensitivity 77%, specificity 67%). In contrast, late coronary restenosis developed in only 7 (11%) of 65 vessels and in 5 (14%) of 37 patients with a nonischemic thallium-201 scintigram on day 1 (p less than 0.005). Multivariate logistic regression analysis of 14 possible preangioplasty and periangioplasty clinical and angiographic variables selected reversible perfusion defect on the thallium-201 scintigram on day 1 (p = 0.016) and immediate postangioplasty residual coronary narrowing (p = 0.004) as significant independent predictors of late restenosis, with younger patient age as an additional less powerful predictor (p less than 0.05). The findings have important implications regarding the pathogenesis of late coronary restenosis in patients undergoing successful angioplasty and they imply that in the majority of these patients pathophysiologic events in the early minutes and hours after angioplasty may determine the development of late restenosis

  11. 65. Impact of focused echocardiography in clinical decision of patients presented with STMI, underwent primary percutenouse angioplasty

    Directory of Open Access Journals (Sweden)

    M. Qasem

    2016-07-01

    Full Text Available Echocardiography in coronary artery diseases is an essential, routine echocardiography prior to primary percutaneous angioplasty is not clear. In our clinical practice in primary angioplasty we faced lots of complications either before or during or after the procedure. Moreover, lots of incidental findings that discovered after the procedure which if known will affect the plan of management. One-hundred-nineteen consecutive underwent primary angioplasty. All patients underwent FE prior to the procedure in catheterization lab while the patient was preparing for the procedure. FE with 2DE of LV at base, mid and apex, and apical stander views. Diastology grading, E/E′ and color doppler of mitral and aortic valve were performed. (N = 119 case of STMI were enrolled, mean age 51 ± 12 year. Eleven cases (9.2% had normal coronary and normal LV function. Twenty cases (17% of MI complication detected before the procedures: RV infarction 8.4% (5.1% asymptomatic and 3.3% symptomatic, ischemic MR (8.4%, LV apical aneurysm (0.8%, significant pericardial effusion (0.80%. Acute pulmonary edema in 17 cases (14.3%: six cases (5.1% developed acute pulmonary edema on the cath lab with grade 3 diastolic dysfunction and E/E ′  >20, 9 cases (7.6% develop acute pulmonary edema in CCU with grade 2–3 diastolic dysfunction and E/E′ 15–20. 2 cases (2.7% develop acute pulmonary in CCU with grade 1–2 diastolic dysfunction and E/E′ 9–14. One case (0.8% presented cardiac tamponade 2 h post PCI. Incidental finding not related to STMI were as follow: 2 cases (1.7% with severe fibro degenerative MR, 2 cases (1.7% with mild to moderate AR and 2 cases (1.7% with mild to moderate AS. Isoled CABG 5/4.2% and CABG and MVR 2/1.7%. FE play an important role in guiding the management, early detection the incidental findings and complication post PCI.

  12. Mid-term outcomes of orbital atherectomy combined with drug-coated balloon angioplasty for treatment of femoropopliteal disease.

    Science.gov (United States)

    Foley, T Raymond; Cotter, Ryan P; Kokkinidis, Damianos G; Nguyen, Daniel D; Waldo, Stephen W; Armstrong, Ehrin J

    2017-05-01

    To assess the intraprocedural and mid-term outcomes of orbital atherectomy (OA) combined with drug-coated balloon (DCB) angioplasty for the treatment of calcified femoropopliteal disease. In this single-center cohort, 89 patients (139 lesions) were treated with DCB angioplasty for claudication or critical limb ischemia (CLI). Angiographic characteristics and procedural outcomes were reviewed for patients treated with or without adjunctive OA. Lesion calcification was graded using two previously published scoring systems, the angiographic calcium score (ACS) and the peripheral artery calcification scoring system (PACSS). Among 139 lesions, 40 (29%) were treated with OA + DCB. Mean lesion length was 135 ± 100 mm for lesions treated with OA + DCB and 139 ± 100 mm for DCB alone (P = 0.9). Moderate to severe calcification was present in 83% of patients treated with OA, compared to 42% of patients treated with DCB alone (P < 0.001). Lesions treated with OA + DCB were less likely to require bailout stenting (18% vs. 39%, P =0.01). Rates of embolization (0% in OA + DCB vs. 2% in DCB only, P = 0.4), dissection (13% vs. 14%, P = 0.8), and perforation (0%) did not differ significantly between groups. The freedom from TLR at 1 year was 82% in both groups (P = 0.6) while primary patency was 81% in-patients treated with DCB alone and 77% in-patients treated with DCB with concomitant OA (P = 0.8). In this single-center analysis of patients undergoing DCB angioplasty for claudication or CLI, OA was most often used for the treatment of severely calcified lesions. These lesions were more likely to be treated with scoring balloons and less likely to require bailout stenting. At 1 year, target lesion revascularization and primary patency was similar in patients treated with and without adjunctive OA, despite the higher lesion complexity among those receiving the combination procedure. © 2017 Wiley Periodicals, Inc. © 2017 Wiley

  13. Evaluation of batroxobin in preventing vascular restenosis in diabetic patients after infrapopliteal arterial angioplasty: a randomized comparative study

    International Nuclear Information System (INIS)

    Xue Bo; Zhang Peilei; Wang Jue; Li Minghua; Zhao Jungong; Zhu Yueqi; Tan Huaqiao; Wang Jianbo

    2011-01-01

    Objective: To evaluate batroxobin in preventing vascular restenosis in diabetic patients after infrapopliteal arterial angioplasty through comparing the clinical results of the combination use of batroxobin and aspirin with that of simple use of aspirin. Methods: After a successful angioplasty, fifty-two diabetic patients with symptomatic infrapopliteal obstructions were randomly divided into the study group (n=26) and the control group (n=26). Patients in both groups received 100 aspirin everyday, but the patients in study group additionally received 5 IU batroxobin intravenous drip every day for six times. At the end of the follow-up period lasting for 12 months, magnetic resonance angiography (MRA) or Doppler ultrasonic angiography was performed to check the vessels to see if there was any restenosis or reocclusion. The relief degree of clinical symptoms were observed, and both preoperative and postoperative ankle-brachial index (ABI) were regularly determined and compared. Kaplan-Meier curves were constructed to evaluate restenosis/reocclusion-free rate, limb salvage rate and amputation-free rate. Results: During the follow-up period the occurrence of restenosis/reocclusion in study group and control group was 22.0% and 34.5% respectively (P=0.0307). Statistically significant difference in ABI existed between two groups both after the procedure (P<0.05) and at 12 months after the treatment (P=0.0094). Clinical improvement and tissue healing in study group and control group were observed in 23 and 19 patients respectively (P=0.0544). Twelve months after angioplasty, Kaplan-Meier analysis showed that the restenosis/reocclusion-free rate, the limb salvage rate and the amputation-free rate for study group were 74.0%, 96.2% and 84.6% respectively, while they was 54.8%, 92.3% and 84.6% respectively for control group. Conclusion: The results of this study indicate that the use of the clinical therapeutic efficacy and markedly relieve the symptoms, although this

  14. Masterwork Art Lesson: Kandinsky Watercolors.

    Science.gov (United States)

    LiPira, Michael

    2003-01-01

    Presents an art lesson used with sixth-grade students which also can be used with other grade levels. Explains that the artwork of Wassily Kandinsky served as inspiration for this lesson. Explains that the students learned about abstract art and used watercolors to create their own paintings in the style of Kandinsky. (CMK)

  15. Bead Game Simulation. Lesson Plan.

    Science.gov (United States)

    Ripp, Ken

    This lesson plan offers students the opportunity to participate in the three basic economic systems (market, command, and tradition). By working in each of the systems, students will internalize the fundamental values present in each system and will gain insights into the basic advantages and disadvantages of each system. The lesson plan provides…

  16. Simple and Practical Efficiency Lessons

    Science.gov (United States)

    Kolpin, Van

    2018-01-01

    The derivation of conditions necessary for Pareto efficient production and exchange is a lesson frequently showcased in microeconomic theory textbooks. Traditional delivery of this lesson is, however, limited in its scope of application and can be unnecessarily convoluted. The author shows that the universe of application is greatly expanded and a…

  17. Keiko, Killer Whale. [Lesson Plan].

    Science.gov (United States)

    Discovery Communications, Inc., Bethesda, MD.

    This lesson plan presents activities designed to help students understand that Keiko, the killer whale, lived for a long time in an aquarium and had to be taught to live independently; and that computer users can get updates on how Keiko is doing. The main activity of the lesson involves middle school students working in small groups to produce a…

  18. Lesson Study and History Education

    Science.gov (United States)

    Halvorsen, Anne-Lise; Kesler Lund, Alisa

    2013-01-01

    This article examines the experiences of a group of fifth-grade teachers who used lesson study, a teacher-driven form of professional development, to teach history in a project supported by a Teaching American History Grant. The project addressed the following questions: What does a lesson study cycle for history education look like? What…

  19. A User Driven Dynamic Circuit Network Implementation

    Energy Technology Data Exchange (ETDEWEB)

    Guok, Chin; Robertson, David; Chaniotakis, Evangelos; Thompson, Mary; Johnston, William; Tierney, Brian

    2008-10-01

    The requirements for network predictability are becoming increasingly critical to the DoE science community where resources are widely distributed and collaborations are world-wide. To accommodate these emerging requirements, the Energy Sciences Network has established a Science Data Network to provide user driven guaranteed bandwidth allocations. In this paper we outline the design, implementation, and secure coordinated use of such a network, as well as some lessons learned.

  20. Classroom Management and Lesson Planning(4)

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Lesson PlanningTask 1As teachers,we all need to plan our lessons before we teach.Make a list of things that you think need tobe included in a lesson plan.Then compare and discuss your list with another teacher.Also think about reasonswhy we need to plan our lessons.

  1. Classroom Management and Lesson Planning(4)

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Lesson Planning Task 1 As teachers,we all need to plan our lessons before we teach.Make a list of things that you think need to be included in a lesson plan.Then compare and discuss your list with another teacher.Also think about reasons why we need to plan our lessons.

  2. Shuttle Lesson Learned - Toxicology

    Science.gov (United States)

    James, John T.

    2010-01-01

    This is a script for a video about toxicology and the space shuttle. The first segment is deals with dust in the space vehicle. The next segment will be about archival samples. Then we'll look at real time on-board analyzers that give us a lot of capability in terms of monitoring for combustion products and the ability to monitor volatile organics on the station. Finally we will look at other issues that are about setting limits and dealing with ground based lessons that pertain to toxicology.

  3. Letter regarding article "Primary coronary angioplasty for ST-°©‐Elevation Myocardial Infarction in Qatar: First nationwide program"

    Directory of Open Access Journals (Sweden)

    Mohamed Badreldin Elshazly

    2012-03-01

    Full Text Available Dear Editor: In their article “Primary Coronary Angioplasty for ST-Elevation Myocardial Infarction (STEMI in Qatar: First Nationwide Program”, Gehani et al. developed an impressive plan to implement primary percutaneous coronary intervention (PCI for the first time in Qatar [1]. As a graduate of Weill Cornell Medical College in Qatar, I have witnessed immense improvement in the Qatari healthcare system over the past few years. From building the new state of the art Heart Hospital to developing the first unified nationwide primary PCI program in the world, there is no doubt that Qatar has made an immense leap towards implementing world-class cardiovascular healthcare in the Middle East.

  4. The Future of Electricity Distribution Regulation. Lessons from International Experience

    Energy Technology Data Exchange (ETDEWEB)

    Nillesen, P.H.L.

    2008-12-03

    This thesis contains five essays on the regulation of electricity distribution networks, each presenting a different point of view. Two essays use US data to demonstrate that incentive-based regulation has valuable application within a management setting and can lead to gaming behaviour within a regulatory setting. One essay discusses the lessons that can be drawn from the failed first electricity distribution price control review in the Netherlands. One essay presents the views of 75 international regulation managers and gives recommendations on ways to improve the regulatory quality and process. The final essay analyses the economic consequences of the forced ownership unbundling of the electricity distribution networks in 1998 in New Zealand, and draws lessons for future structural remedies that may be sought in other countries.

  5. The Future of Electricity Distribution Regulation. Lessons from International Experience

    International Nuclear Information System (INIS)

    Nillesen, P.H.L.

    2008-01-01

    This thesis contains five essays on the regulation of electricity distribution networks, each presenting a different point of view. Two essays use US data to demonstrate that incentive-based regulation has valuable application within a management setting and can lead to gaming behaviour within a regulatory setting. One essay discusses the lessons that can be drawn from the failed first electricity distribution price control review in the Netherlands. One essay presents the views of 75 international regulation managers and gives recommendations on ways to improve the regulatory quality and process. The final essay analyses the economic consequences of the forced ownership unbundling of the electricity distribution networks in 1998 in New Zealand, and draws lessons for future structural remedies that may be sought in other countries

  6. The effect of local sustained delivery of sirolimus on the vascular PAI-1 and t-PA expression after angioplasty

    International Nuclear Information System (INIS)

    E Yajun; He Nengshu; Fan Hailun

    2011-01-01

    Objective: To investigate the effect of local sustained delivery of sirolimus on the vascular inhibitor of plasminogen activator-1 (PAI-1) and tissue type plasminogen activator (t-PA) expression after angioplasty. Methods: Experimental common carotid artery injury model was established in the rats. A total of 30 male Wistar rats were divided into experimental group (n=20) and control group (n=10). Adventitial administration of drug was applied. Pluronic F-127 gel containing sirolimus was administered to the exposed adventitial surface of injured carotid artery. The experimental group was divided into high concentration (600 μg/100 μl) sub-group and low concentration (300 μg/100μl) sub-group according to the concentration of sirolimus delivered. The effect of local sustained delivery sirolimus on vascular PAI-1 and t-PA expression after percutaneous angioplasty was evaluated by immunohistochemistry. Results: Compared to control group, 15 and 30 days after injury local sustained delivery of sirolimus in both high concentration and low concentration sub-groups the expression of the PAI-1 in neointima was significantly enhanced (P 0.05). At 15 and 30 days after injury, the expression of t-PA in neointima was decreased in both high and low concentration sub-groups (P<0.05), and the expression of t-PA in media was significantly decreased in high concentration sub-group (P<0.05) while on significant difference could be detected in low concentration sub-group. Conclusion: Local sustained delivery of sirolimus can induce the high expression of PAI-1 and low expression of t-PA in neointima although it inhibits the proliferation of neointima in the same time, and the imbalanced expression of t-PA and PAI-1 may probably play an important role in the late formation of thrombosis after the placement of drug-eluting stent. (authors)

  7. Effects of ilexonin a on IL-6 and M-CSF following ballon angioplasty in rabbit common carotid artery

    International Nuclear Information System (INIS)

    Zhao Lihua; Li Zhangwei; Yang Chuang; Jiang Yaqiu

    2008-01-01

    Objective: To observe the effects of ilexonin A(IA) on IL-6 and M-CSF following ballon angioplasty in rabbit common carotide artery to provide experimental basis for percutaneous coronary interventions. Mehtods: 30 Japanese rabbits were fed with high cholesterol food for 4 weeks. Then they were divided into three groups randomly. Each group had ten rabbits. 1) Control group: the incision was sew directly after right carotide artery of the rabbit was seeked. 2) Balloon dilation group: the proximal of the carotide artery was cuted, the ballon was delivered and distended, after it was drawn repeatly, the incision was closed. 3) IA therapy group: operation was the same to the balloon dilation group, then IA was administered in vein. All of them were fed with high cholesterol diet for 4 weeks and the blood samples were collected 1 d before the operation and 1 d, 1,2,4 weeks after the operation. The serum IL-6 and M-CSF levels were determined with radioimmunoassay. The pathological changes of injuried artery were observed. Results: 1) The IL-6 level in balloon dilation group was higher than that in IA therapy group after the operation (P<0.05), and came back later to preoperation level. 2) Though the M-CSF level in IA therapy group was increased, but it was lower than that in dilation group (P<0.05). 3) The pathological results demonstrated that the artery endothelial in control group was smooth and no foam cell in sight. In bolloon dilation group, the endangium was thickened, the vascular smooth muscle cells proliferated, there were many foam cells and the lumen was constrictive. In IA therapy group, the number of foam cells reduced, the constrictive degree of lumen was alleviated. Conclusion: IA can redece the levels of serum IL-6 and M-CSF and inhibit the proliferation of vascular smooth muscle cells following ballon angioplasty. (authors)

  8. Efficacy of percutaneous transluminal renal angioplasty with stent in elderly male patients with atherosclerotic renal artery stenosis

    Directory of Open Access Journals (Sweden)

    Zhao J

    2012-10-01

    Full Text Available Jiahui Zhao, Qingli Cheng, Xiaoying Zhang, Meihua Li, Sheng Liu, Xiaodan WangDepartment of Geriatric Nephrology, Chinese PLA General Hospital, Beijing, ChinaObjectives: Percutaneous transluminal renal angioplasty with stent implantation (PTRAS has become the treatment of choice for atherosclerotic renal artery stenosis (ARAS. This study evaluates the long-term effects of PTRAS on hypertension and renal function in elderly patients with ARAS.Methods: We conducted a retrospective cohort study of all patients who underwent PTRAS in the geriatric division of a tertiary medical center during the period 2003–2010. The clinical data were extracted from the medical records of each patient. Changes in blood pressure, antihypertensive treatment, and estimated glomerular filtration rate were analyzed before and after PTRAS.Results: Eighty-six stents in 81 elderly patients were placed successfully. The average age of the patients was 76.2 years (65–89 years. Mean follow-up was 31.3 months (range 12 –49 months. There was a significant decrease in both systolic and diastolic blood pressure at the third day after the PTRAS procedure and the reduction in blood pressure was constant throughout the follow-up period until 36 months after PTRAS. However, there was no marked benefit to renal function outcome during the follow-up period. The incidence of contrast-induced nephropathy was 9.9% in this study group. The rate of renal artery restenosis was 14.8%. The survival rate was 96.3% for 4 years after the procedure.Conclusion: It is beneficial to control blood pressure in elderly patients with ARAS up to 36 months after a PTRAS procedure. However, their renal function improvement is limited.Keywords: angioplasty, hypertension, renal function, elderly, renal artery stenosis

  9. Predictors of Long-Term Results After Treatment of Iliac Artery Obliteration by Transluminal Angioplasty and Stent Deployment

    International Nuclear Information System (INIS)

    Funovics, M.A.; Lackner, B.; Cejna, M.; Peloschek, P.; Sailer, J.; Philipp, M.O.; Maca, T.; Ahmadi, A.; Minar, E.; Lammer, J.

    2002-01-01

    Purpose: To investigate initial and long-term success rate after percutaneous treatment of iliac artery occlusion with angioplasty and stent deployment. To investigate the influence of vascular comorbidity, lesion length, stent placement and lesion coverage as possible predictors of outcome. Methods: Between January 1994 and December 1999, 80 iliac recanalizations were performed on 78 patients, median age 61.1 ±11.5 (SD) years. All patients were followed up by clinical examinations, duplex ultrasound and intravenous digital subtraction angiography. Mean follow-up time was 2.0 ± 1.53 (SD) years.Multivariate Cox regression analysis was used to determine the influence of cofactors on patency. Results: One, 2 and 4 years after recanalization, primary patency was 78.1%, 74.5% and 64.0%; secondary patency was 88.8%, 88.8% and 77.9%, respectively.Patients with shorter occlusions, complete lesion coverage and patent ipsilateral femoral arteries had significantly longer patency rates.Complications included inguinal hematoma (n=1), technical failure (n=3) aortic dissection (n=1), embolic occlusions (n=7), gluteal claudication (n=1) and genital necrosis after subsequent urethral surgery in one patient with contralateral occlusion and ipsilateral overstenting of the internal iliac artery with subsequent stenosis. Complications were of permanent clinical significance in seven of 78 (9%) of the patients. In 17 (22%) cases, percutaneous reintervention was performed with angioplasty in the stent (n=16) or deployment of a new stent (n=1). Conclusion: Endoluminal stent placement has its place in an interdisciplinary therapeutic approach as a viable therapeutic alternative to major transabdominal bypass surgery and can be performed with comparable complication rates. Patients with short occlusions, patent femoral arteries, and stents covering the entire occlusion have significant longer patency

  10. Radiation dose to patients from the coronary angiography and percutaneous transluminal coronary angioplasty in interventional radiology procedures

    International Nuclear Information System (INIS)

    Zheng, Jun-Zheng; Bai, Mei; Liu, Bin

    2008-01-01

    Full text: Objective: To survey and assess radiation dose to patients from coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) in Beijing Xuanwu Hospital of Capital University of Medical Sciences. Methods: The dose-area product (DAP) values to the patient and cumulative dose (CD) were recorded from 84 coronary angiographies and 51 percutaneous transluminal coronary angioplasty. A Monte-Carlo based program PCXMC was used to calculate the effective dose from DAP values for each patient. Organ doses were also measured by thermoluminescent dosimeters (TLD) using a human-shaped phantom to compare the calculated organ dose from DAP. Results: The difference between the organ doses measured by TLDs and those from PCXMC software (P>0.05) were tolerable. The DAP value ranged from 7611∼60538 mGy·cm 2 for CA and 16423∼161973 mGy·cm 2 for PTCA. The effective dose for all procedures was determined to be in the range of 1.1∼6.9 mSv for CA and 2.3∼20.1 mSv for PTCA. CD ranged from 120.0 to 1016.0 mGy for CA and 287 to 2883 mGy for PTCA. Conversion factors between effective dose and DAP were 0.114∼0.139 mSv·Gy - 1·cm -2 for CA and 0.124∼0.142 mSv·Gy -1 ·cm -2 for PTCA; Conversion factors between organ dose and CD were derived for CA and PTCA, respectively. Conclusions: DAP and CD can be used as the dose indicator to calculate the organ dose and effective dose of patient based on Monte Carlo simulation. Using this method can provide important information of patient absorbed dose and enhance the radiation protection of patient in interventional radiology procedures. (author)

  11. Insertion of Self-Expandable Nitinol Stents Without Previous Balloon Angioplasty Reduces Restenosis Compared with PTA Prior to Stenting

    International Nuclear Information System (INIS)

    Harnek, Jan; Zoucas, Evita; Stenram, Unne; Cwikiel, Wojciech

    2002-01-01

    Purpose: To compare the development of intimal hyperplasia after deployment of a self-expanding nitinol stent with and without previous percutaneous transluminal balloon angioplasty (PTA), with the results after PTA alone. Methods: In nine healthy pigs, the iliac arteries were divided into three groups: group 1 (n = 6 arteries) was treated with PTA; group 2 n 6)with insertion of self-expanding stents after PTA; and group 3 (n = 6) with stent insertion without previous PTA. After 8 weeks the vessels were examined with intravascular ultrasonography,histologic examination and morphometric analysis. Results: Although the injury index in group 1 (0.17± 0.57) was lower (p <0.05) than in group 2 (0.26 ± 0.06) and group 3 (0.26 ± 0.08), PTA-treated arteries showed significantly (p <0.05) reduced mean luminal gain (0.53 ± 2.84) compared with arteries treated with PTA prior to stenting (2.58 ± 1.38) and compared with stenting alone (4.65 ±5.34). Stenting after PTA resulted in a higher (p<0.05) restenosis index (2.63 ± 1.06) compared with stenting without PTA (1.35 ± 0.59). Group 2 also had a significantly thicker intimap <0.05) and 83% and 74% higher intima/mediaratio (p <0.05) compared with groups 1 and 3, respectively. Conclusion: Insertion of a self-expandable nitinol stent without previous PTA results in less intimalhyperplasia than if PTA is performed prior to stenting, suggesting that direct stenting can be used in angioplasty sessions with a favorable outcome

  12. Post-marketing surveillance in the published medical and grey literature for percutaneous transluminal coronary angioplasty catheters: a systematic review.

    Science.gov (United States)

    Polisena, Julie; Forster, Alan J; Cimon, Karen; Rabb, Danielle

    2013-10-10

    Post-marketing surveillance (PMS) may identify rare serious incidents or adverse events due to the long-term use of a medical device, which was not captured in the pre-market process. Percutaneous transluminal coronary angioplasty (PTCA) is a non-surgical procedure that uses a balloon-tipped catheter to enlarge a narrowed artery. In 2011, 1,942 adverse event reports related to the use of PTCA catheters were submitted to the FDA by the manufacturers, an increase from the 883 reported in 2008. The primary research objective is to conduct a systematic review of the published and grey literature published between 2007 and 2012 for the frequency of incidents, adverse events and malfunctions associated with the use of PTCA catheters in patients with coronary artery disease (CAD). Grey literature has not been commercially published. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and PubMed for medical literature on PMS for PTCA catheters in patients with CAD published between January 2007 and July 2012. We also searched the grey literature. This review included 11 studies. The in-hospital adverse events reported were individual cases of myocardial infarction and hematoma. In studies of patients with coronary perforation, more patients with balloon angioplasty were identified compared with patients who required stenting. Our systematic review illustrates that the volume and quality of PMS studies associated with the use of PTCA catheters in patients with CAD are low in the published and grey literature, and may not be useful sources of information for decisions on safety. In most studies, the objectives were not to monitor the long-term safety of the use of PTCA catheters in clinical practice. Future studies can explore the strengths and limitations of PMS databases administered by regulatory authorities.

  13. Long-term outcome of endovascular treatment versus medical care for carotid artery stenosis in patients not suitable for surgery and randomised in the Carotid and Vertebral Artery Transluminal Angioplasty study (CAVATAS).

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2009-01-01

    Optimal treatment of carotid stenosis in patients not suitable for surgery is unclear. The Carotid and Vertebral Artery Transluminal Angioplasty study contained a trial comparing medical and endovascular treatment in patients not suitable for surgery.

  14. Building Trust-Based Sustainable Networks

    Science.gov (United States)

    2013-06-05

    entities to build sustainable networks with limited resources or misbehaving entities by learning from the lessons in the social sciences. We discuss...their individuality); and ■ Misbehaving nodes in terms of environmental, economic, and social perspectives. The sustainable network concerns...equitable access to particular services which are otherwise abused by misbehaving or malicious users. Such approaches provide a fair and

  15. St. Louis FUSRAP Lessons Learned

    International Nuclear Information System (INIS)

    Eberlin, J.; Williams, D.; Mueller, D.

    2003-01-01

    The purpose of this paper is to present lessons learned from fours years' experience conducting Remedial Investigation and Remedial Action activities at the St. Louis Downtown Site (SLDS) under the Formerly Utilized Sites Remedial Action Program (FUSRAP). Many FUSRAP sites are experiencing challenges conducting Remedial Actions within forecasted volume and budget estimates. The St. Louis FUSRAP lessons learned provide insight to options for cost effective remediation at FUSRAP sites. The lessons learned are focused on project planning (budget and schedule), investigation, design, and construction

  16. HYPNOTEACHING IN HISTORY LESSON

    Directory of Open Access Journals (Sweden)

    Agus Budianto

    2017-07-01

    Full Text Available Abstract: Hypnoteaching in History Lesson. Historical learning is a science that can’t be separated in educating the younger generation. Through this lesson, teachers in secondary schools can provide the foundation of nationality through important events in the study of the social sciences. Many of the problems that occur in learning history, such as the boring and make sleepy. Everyone must have heard the term hypnosis, hypnotism, or hypnotherapy. Each person must also have a different view or understanding when hearing these terms. Hypnoteaching is one of the learning methods by using the art of communicating to influence learners. Hypnoteaching is a combination of five teaching-learning methods such as quantum learning, accelerate learning, power teaching, neuro-linguistic programming (NLP and hypnosis. Hypnoteaching can be done using informal hypnosis as well as formal hypnosis. Informal hypnosis is also called indirect hypnosis ie teachers can naturally make the Critical Area learners become no longer critical, through a very persuasive communication pattern. Here's what the teacher can do in Informal hypnosis: (1 get attention; (2 establishing Themes; (3 presenting the structure and regulations; (4 building relationships. If the learners are already comfortable and interested, the next step is to do a formal hypnosis before the lesson begins. Here are the steps that must be done: (1 Induction; (2 Deepening; (3 Deep level test; (4 Suggestion, and; (5 Termination.   Keywords: Historical learning, hypnoteaching, hypnosis, hypnotism, hypnotherapy, history Abstrak: Hipnoteaching dalam Pembelajaran Sejarah. Pelajaran sejarah tidak bisa dihilangkan dalam mendidik para generasi muda. Melalui pembelajaran ini, guru pada sekolah menengah pertama dapat memberikan pondasi rasa nasionalisme melalui peristiwa peristiwa penting dalam pelajaran ilmu pengetahuan social. Masalah yang sering muncul pada pembelajaran ini adalah kebosanan siswa dan

  17. Drug-Coated Balloon Angioplasty: A Novel Treatment for Pulmonary Artery In-Stent Stenosis in a Patient with Williams Syndrome.

    Science.gov (United States)

    Cohen, Jennifer L; Glickstein, Julie S; Crystal, Matthew A

    2017-12-01

    A 20-month-old boy with Williams syndrome had undergone multiple surgical and catheter-based interventions for resistant peripheral pulmonary arterial stenoses with eventual bilateral stent placement and conventional balloon angioplasty. He persistently developed suprasystemic right ventricular (RV) pressure. Angioplasty with a drug-coated balloon (DCB) was performed for in-stent restenosis and to remodel his distal pulmonary vessels bilaterally. This resulted in immediate improvement in the in-stent stenosis and resultant decrease in RV pressure. Follow-up catheterization two months later continued to show long-lasting improvement in the in-stent stenosis. We hypothesize that the anti-proliferative effects of DCBs may be of benefit in the arteriopathy associated with Williams syndrome. We report this as a novel use of a DCB in the pulmonary arterial circulation in a patient with Williams syndrome.

  18. Higher Education ERP: Lessons Learned.

    Science.gov (United States)

    Swartz, Dave; Orgill, Ken

    2001-01-01

    Shares experiences and lessons learned by chief information officers of large universities about enterprise resource planning (ERP). Specifically, provides a framework for approaching an ERP that could save universities millions of dollars. (EV)

  19. lessons from tuberous sclerosis complex

    African Journals Online (AJOL)

    intellectual disability, autism, specific learning disorders) and mental health disorders (e.g. depression, psychosis and anxiety disorders). The first lesson, therefore, is ... of an adolescent with TSC, facial angiofibromas and a presumed fat-poor ...

  20. Lessons of nuclear power

    International Nuclear Information System (INIS)

    Collingridge, D.

    1984-01-01

    In an earlier article the author has argued that the turbulent history of nuclear power in Britain and the USA stems from the technology itself, and has little to do with the very different institutional arrangements made for the new technology in the two countries. Nuclear plant has various features which make its planning extraordinarily difficult. Its long lead time, large unit size, capital intensity and dependence on complex infrastructure combine to ensure that mistakes are likely to be made in planning the technology and that what mistakes do occur are expensive. This article aims to expand on the earlier one in two ways; by looking at the apparent success of the French nuclear programme which seems to run counter to the thesis of the earlier article, and by trying to draw lessons from the earlier analysis for the breeder reactor. (author)

  1. Lesson "Balance in Nature

    Science.gov (United States)

    Chapanova, V.

    2012-04-01

    Lesson "Balance in Nature" This simulation game-lesson (Balance in Nature) gives an opportunity for the students to show creativity, work independently, and to create models and ideas. It creates future-oriented thought connected to their experience, allowing them to propose solutions for global problems and personal responsibility for their activities. The class is divided in two teams. Each team chooses questions. 1. Question: Pollution in the environment. 2. Question: Care for nature and climate. The teams work on the chosen tasks. They make drafts, notes and formulate their solutions on small pieces of paper, explaining the impact on nature and society. They express their points of view using many different opinions. This generates alternative thoughts and results in creative solutions. With the new knowledge and positive behaviour defined, everybody realizes that they can do something positive towards nature and climate problems and the importance of individuals for solving global problems is evident. Our main goal is to recover the ecological balance, and everybody explains his or her own well-grounded opinions. In this work process the students obtain knowledge, skills and more responsible behaviour. This process, based on his or her own experience, dialogue and teamwork, helps the participant's self-development. Making the model "human↔ nature" expresses how human activities impact the natural Earth and how these impacts in turn affect society. Taking personal responsibility, we can reduce global warming and help the Earth. By helping nature we help ourselves. Teacher: Veselina Boycheva-Chapanova " Saint Patriarch Evtimii" Scholl Str. "Ivan Vazov"-19 Plovdiv Bulgaria

  2. Lessons learned in radiology

    International Nuclear Information System (INIS)

    Goodenough, D.J.

    2001-01-01

    The paper reviews aspects of the history of radiology with the goal of identifying lessons learned, particularly in the area of radiological protection of the patient in diagnostic and interventional radiology, nuclear medicine and radiotherapy. It is pointed out that since the days of Roentgen there has been a need not only to control and quantify the amount of radiation reaching the patient but also to optimize the imaging process to offer the greatest diagnostic benefit within allowable levels of patient dose. To this end, in diagnostic radiology, one finds the development of better films, X rays tubes, grids, screens and processing techniques, while in fluoroscopy, one sees the increased luminance of calcium tungstate. In interventional radiology, one finds an improvement in catheterization techniques and contrast agents. In nuclear medicine, the development of tracer techniques into modern cameras and isotopes such as technetium can be followed. In radiotherapy, one sees the early superficial X rays and radium sources gradually replaced with radon seeds, supervoltage, 60 Co and today's linear accelerators. Along with the incredible advances in imaging and therapeutic technologies comes the growing realization of the potential danger of radiation and the need to protect the patient (as well as physicians, ancillary personnel and the general population) from unnecessary radiation. The important lesson learned is that we must walk a tightrope, balancing the benefits and risks of any technology utilizing radiation to produce the greatest benefits at the lowest acceptable risk. The alternative techniques using non-ionizing radiation will have to be considered as part of the general armamentarium for medical imaging whenever radiation consequences are unacceptable. (author)

  3. Lessons Learned from FUSRAP

    Energy Technology Data Exchange (ETDEWEB)

    Castillo, Darina [U.S. Department of Energy, Office of Legacy Management; Carpenter, Cliff [U.S. Department of Energy, Office of Legacy Management; Miller, Michele [Navarro Research and Engineering

    2016-03-06

    The US DOE Office of Legacy Management (LM) is the long-term steward for 90 sites remediated under numerous regulatory regimes including the Formerly Utilized Sites Remedial Action Program (FUSRAP) sites. In addition, LM holds considerable historical information, gathered in the 1970s, to determine site eligibility for remediation under FUSRAP. To date, 29 FUSRAP sites are in LM’s inventory of sites for long-term surveillance and maintenance (LTS&M), and 25 are with the US Army Corps of Engineers (USACE) for remediation or in the process of being transitioned to LM. It is forecasted that 13 FUSRAP sites will transfer from the USACE to LM over the next 10 years; however, the timing of the transfers is strongly dependent upon federal funding of the ongoing remedial actions. Historically, FUSRAP sites were generally cleaned up for “unrestricted” industrial use or remediated to the “cleanup standards” at that time, and their use remained unchanged. Today, these sites as well as the adjacent properties are now changing or envisioned to have changes in land use, typically from industrial to commercial or residential uses. The implication of land-use change affects DOE’s LTS&M responsibility for the sites under LM stewardship as well as the planning for the additional sites scheduled to transition in time. Coinciding with land-use changes at or near FUSRAP sites is an increased community awareness of these sites. As property development increases near FUSRAP sites, the general public and interested stakeholders regularly inquire about the sufficiency of cleanups that impact their neighborhoods and communities. LM has used this experience to address a series of lessons learned to improve our program management in light of the changing conditions of our sites. We describe these lessons learned as (1) improved stakeholder relations, (2) enhanced LTS&M requirements for the sites, and (3) greater involvement in the transition process.

  4. Lessons learned from accidents investigations

    Energy Technology Data Exchange (ETDEWEB)

    Zuniga-Bello, P. [Consejo Nacional de Ciencia y Tecnologia (CONACYT), Mexico City (Mexico); Croft, J. [National Radiological Protection Board (United Kingdom); Glenn, J

    1997-12-31

    Accidents from three main practices: medical applications, industrial radiography and industrial irradiators are used to illustrate some common causes of accidents and the main lessons to be learned. A brief description of some of these accidents is given. Lessons learned from the described accidents are approached by subjects covering: safety culture, quality assurance, human factors, good engineering practice, defence in depth, security of sources, safety assessment and monitoring and verification compliance. (author)

  5. Lessons learned from accident investigations

    International Nuclear Information System (INIS)

    Zuniga-Bello, P.; Croft, J.R.; Glenn, J.

    1998-01-01

    Accidents in three main practices - medical applications, industrial radiography and industrial irradiators - are used to illustrate some common causes of accidents and the main lessons to be learned from them. A brief description of some of these accidents is given. Lessons learned from the accidents described are approached bearing in mind: safety culture, quality assurance, human factors, good engineering practice, defence in depth, security of sources, safety assessment and monitoring and verification compliance. (author)

  6. [Efficacy of angioplasty of native coarctations of the aorta of the big infant and of the adult with systematic endoprosthesis implantation].

    Science.gov (United States)

    Fraisse, A; Amabile, N; Errera, J; Aubert, F; Chetaille, P; Kreitmann, B; Metras, D; Durieux, O; Bonnet, J L; Djiane, P

    2004-05-01

    The angioplasty of native coarcatations of the aorta remains a controversial treatment due to recurrences and the potential risk of aneurysm or of descending aorta dissection during catheterization. The interest of a systematic implantation of an endoprothesis is poorly documented. We report our experience in a small series of 3 patients aged from 7, 28 to 52 years at the moment of the angioplasty of their native aortic coarctation. In all the three cases it corresponded to a "membranous" type, localized a the level of the isthmus without hypoplasia of the aortic arch. All presented a refractory hypertension. One patient presented an intermittent claudication related to a low perfusion of lower limbs. The angioplasty was performed with BIB balloon, associated at the same time with the implantation of a Palmaz P308 stent in two cases and Genesis PG2910P in the last patient. The efficacy was immediate in all the 3 cases with stopping antihypertensive drugs at the very day of the procedure. The immediate results were complicated by a bilateral hematoma of the scarpa in a context of excessive anticoagulation in one patient requiring blood tranfusion. After a follow-up of one, 12 and 21 months, all the 3 patients are asymptomatic without any significant residual hypertension. The control scan of the infant confirmed the absence of re-coarctation. In conclusion, the angioplasty followed by systematic implantation of an endoprosthesis is a safe and effective technique for treating simple forms of native coarctations of the aortic isthmus. It can be proposed as a first line treatment for big infants and adults affected by localized types.

  7. Budd-Chiari and inferior caval vein syndromes due to membranous obstruction of the liver veins. Successful treatment with angioplasty and transcaval TIPS

    DEFF Research Database (Denmark)

    Holland-Fischer, Peter

    2004-01-01

    The case is presented of a 25-year-old Caucasian patient with Budd-Chiari syndrome due to membranous obstruction of the liver veins and inferior caval vein syndrome as a result of secondary hyperplasia of the caudate lobe of the liver, obstructing the caval vein. Diagnosis was established...... that angioplasty and TIPS are safe and efficient procedures to reduce liver engorgement and complications of portal hypertension in selected patients with Budd-Chiari syndrome....

  8. Observation and nursing of complications due to high re-perfusion injury occurring after balloon angioplasty for diabetic vascular diseases of lower extremity

    International Nuclear Information System (INIS)

    Zhang Lingling; Zhu Yueqi; Mou Ling

    2011-01-01

    Objective: To evaluate the symptomatic nursing in treating the complications caused by high re-perfusion which develops after balloon angioplasty for the treatment of diabetic vascular diseases of lower extremity. Methods: Eighteen patients with lower limb ischemia caused by diabetes mellitus developed high re-perfusion injury complications after receiving balloon angioplasty. The patients were randomly and equally divided into study group and control group. The special nursing measures designed by the author's department, including raising the diseased lower limb, enforcing the flexion and extension movement of the leg, cold compress, wound exposure, etc. were carried out for patients of study group, while no special nursing measures were adopted for patients of control group. The clinical results, such as limb pain, swelling and subcutaneous petechia after re-perfusion injury, were evaluated and compared between two groups. Results: After the treatment, the limb pain, swelling and subcutaneous petechia due to high re-perfusion injury in study group were relieved more markedly than that in control group, the difference in evaluation score between two groups was statistically significant (P<0.01). Conclusion: The special symptomatic nursing measures are very effective in relieving the high re-perfusion injury after balloon angioplasty for the treatment of diabetic lower limb ischemia. (authors)

  9. Endovascular gamma-irradiation for prevention of restenosis after angioplasty of femoropopliteal de-novo-stenoses. Long-term results of a feasibility study

    International Nuclear Information System (INIS)

    Krueger, K.; Zaehringer, M.; Schulte, O.; Lackner, K.; Bendel, M.; Bongartz, R.; Nolte, M.

    2002-01-01

    Objectives: To evaluate the performance and efficacy of endovascular irradiation after percutaneous transluminal angioplasty (PTA) of de-novo femoropopliteal stenoses in a pilot study. Methods: 6 patients received non-centered endovascular irradiation (12 Gray at surface of the vessel wall) immediately after angioplasty of de-novo femoropopliteal stenosis, 1 patient was given centered endovascular irradiation using 192-iridium (12 Gray at surface of the vessel wall) Centered irradiation was considered for two other patients. Duplex sonographies and interviews were performed the day before and after PTA and after 1, 3, 6, 9, 12, 18, 24 months up to 4 years. Intraarterial angiography was performed in symptomatic patients. Results: Non-centered endovascular irradiation was possible in all patiens without problems or complications. Centered irradiation was not possible in two patients with the cross-over approach. One thromboembolic complication occurred during centered irradiation. Both restenosis and new stenosis at the edge of irradiated distance occurred in 1/7 patiens. No other side effects were observed during follow-up. Conclusions: In our pilot study endovascular irradiation after angioplasty of de-novo femoropopliteal stenosis was possible with low rates of complications and restenosis and taking vessel anatomy into account. (orig.) [de

  10. Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions

    International Nuclear Information System (INIS)

    Nogueira, Raul G.; Schwamm, Lee H.; Buonanno, Ferdinando S.; Koroshetz, Walter J.; Yoo, Albert J.; Rabinov, James D.; Pryor, Johnny C.; Hirsch, Joshua A.

    2008-01-01

    The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke. We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score ≤2), dependent (mRS score 3-5), or dead (mRS score 6). Included in the study were 12 patients (mean age 66±17 years, range 31-88 years; mean baseline National Institutes of Health stroke scale score 17±3, range 12-23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9±3.9 h (anterior circulation) and 11.0±7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care). Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and glycoprotein IIb

  11. Subintimal angioplasty for below-the-ankle arterial occlusion in diabetic patients with chronic critical limb ischemia

    International Nuclear Information System (INIS)

    Xu Ying; Zhu Yueqi; Zhao Jungong; Wang Jianbo; Tan Huaqiao; Cheng Yingsheng; Li Minghua; Wang Jue; Cheng Yongde

    2011-01-01

    Objective: To assess the feasibility and efficacy of subintimal angioplasty (SA) for the treatment of below-the-arterial occlusion in diabetic patients with chronic critical limb ischemia (CLI). Methods: SA was adopted for 57 diseased lower limbs in 37 diabetic patients with chronic CLI and occlusive disease of the dorsalis pedis artery (DPA) and/or planter artery (PA), who were not suitable candidates for intraluminal angioplasty or bypass surgery. Of the total 57 diseased lower limbs, tissue loss was seen in 31 (54.4%) and pain was reported in 51 (89.5%). SA was carried out to create continuous arterial flow to the foot for limb salvage. Both before and after the procedure the clinical symptoms, DPA or PA pulse volume scores and ankle-brachial indexes (ABI) were determined in all patients, the results were compared and statistically analysed. During the follow-up period, the healing of the wound, the salvage of the diseased limb and the re-stenosis occurrence of the target vessels were evaluated. Kaplan-Meier curves were constructed to evaluate limb salvage, survival rate and freedom from amputation. Results: A total of 66 below-the-ankle arterial lesions were detected in 57 affected limbs. Of the 66 lesions, SA was successfully performed in 55 (83.3%). Before SA the median pulse volume scores and ABIs were 0.33±0.54 and 0.31±0.19 respectively, which became 2.04±1.05 and 0.80±0.14 respectively after SA, the differences in both median pulse volume scores and ABI were statistically significant (P<0.01 for both). One patient (2.7%) died within 30 days after the procedure. Mild complications, such as bleeding, thrombosis or angiospasm etc. occurred in five patents (13.5%). Twelve months after SA. Kaplan-Meier analysis showed that the limb salvage rate was 94.6%, the freedom from amputation was 89.2% and the survival rate was 97.3%. Conclusion: SA of the dorsalis pedis artery and/or planter artery is an effective technique for lower limb salvage in diabetic

  12. Retrograde transdorsal-to-plantar or transplantar-to-dorsal intraluminal re-entry treatment following unsuccessful subintimal angioplasty for below-the-ankle arterial occlusion

    International Nuclear Information System (INIS)

    Zhu Yueqi; Zhao Jungong; Li Minghua; Tan Huaqiao; Wang Jianbo; Liu Fang; Cheng Yingsheng; Wang Jue; Cheng Yongde

    2011-01-01

    Objective: To assess the technical feasibility and efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) intraluminal re-entry procedure following unsuccessful subintimal angioplasty for the treatment of arterial occlusion below the ankle. Methods: TDP or TPD retrograde intraluminal re-entry angioplasty was carried out in 8 diseased limbs of 8 diabetic patients (5 males and 3 females, aged 62∼81 years with a mean age of 75±8 years), who were accompanied with chronic below-the-ankle arterial occlusive disease, after the standard transtibial subintimal angioplasty had failed. Both before and after the procedure the clinical symptoms, dorsal or plantar arterial pulse volume scores and ankle-brachial indexes (ABI) were determined in all patients, the results were compared and statistically analysed. During the follow-up period, the degree of pain relief, the healing of the wound, the salvage of the diseased limb and the restenosis occurrence of the target vessels were evaluated. Results: Of the total 8 patients, TDP or TPD retrograde intraluminal re-entry angioplasty was successfully performed in 5(62.5%). After the treatment the foot pain was markedly relieved, the median pulse volume scores and ankle-brachial indexes were increased from 0.60±0.55 and 0.32±0.20 before the procedure to 2.40±0.55 and 0.75±0.12 after the procedure, respectively (P<0.01 for both). At the end of the follow-up lasting for twelve months, the visual analogue scale was apparently improved, the scores decreased from preoperative 7.40±1.14 to 2.20±1.48 (P=0.002). Of two cases with intractable skin ulcer, the skin lesion was completely healed in one and was significantly decreased in size in another. No amputation surgery was needed in all successfully treated patients. Magnetic resonance angiography revealed that one target vessel developed re-stenosis. Conclusion: TDP and TDP retrograde intraluminal re-entry techniques are clinically feasible and effective for the

  13. Early outcome of high energy Laser (Excimer) facilitated coronary angioplasty ON hARD and complex calcified and balloOn-resistant coronary lesions: LEONARDO Study

    International Nuclear Information System (INIS)

    Ambrosini, Vittorio; Sorropago, Giovanni; Laurenzano, Eugenio; Golino, Luca; Casafina, Alfredo; Schiano, Vittorio; Gabrielli, Gabriele; Ettori, Federica; Chizzola, Giuliano; Bernardi, Guglielmo; Spedicato, Leonardo; Armigliato, Pietro; Spampanato, Carmine; Furegato, Martina

    2015-01-01

    Aim: An innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) has been recently used for the treatment of complex coronary lesions, as calcified stenosis, chronic total occlusions and non-compliant plaques. Such complex lesions are difficult to adequately treat with balloon angioplasty and/or intracoronary stenting. The aim of this study was to examine the acute outcome of this approach on a cohort of patients with coronary lesions. Methods and Results: Eighty patients with 100 lesions were enrolled through four centers, and excimer laser coronary angioplasty was performed on 96 lesions (96%). Safety and effectiveness data were compared between patients treated with standard laser therapy and those treated with increased laser therapy. Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success in was obtained in 87 lesions (90.6%). There was no perforation, major side branch occlusion, spasm, no-reflow phenomenon, dissection nor acute vessel closure. Increased laser parameters were used successfully for 49 resistant lesions without complications. Conclusions: This study suggests that laser-facilitated coronary angioplasty is a simple, safe and effective device for the management of complex coronary lesions. Furthermore, higher laser energy levels delivered by this catheter improved the device performance without increasing complications. - Highlights: • We planned this multicenter study to examine the acute outcome of an innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) for treatment of complex coronary lesions. • We enrolled 80 patients with 100 lesions and performed excimer laser coronary angioplasty in 96 lesions (96%). • Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success was obtained in 87 lesions (90.6%). • Increased laser parameters were used successfully for 49 resistant

  14. Early outcome of high energy Laser (Excimer) facilitated coronary angioplasty ON hARD and complex calcified and balloOn-resistant coronary lesions: LEONARDO Study

    Energy Technology Data Exchange (ETDEWEB)

    Ambrosini, Vittorio; Sorropago, Giovanni; Laurenzano, Eugenio [Montevergine Clinic, Mercogliano (Italy); Golino, Luca, E-mail: lucagolino.jazz@alice.it [Montevergine Clinic, Mercogliano (Italy); Moriggia-Pelascini Hospital, Gravedona, Como (Italy); Casafina, Alfredo; Schiano, Vittorio [Montevergine Clinic, Mercogliano (Italy); Gabrielli, Gabriele [University Hospital Ospedali Riuniti, Ancona (Italy); Ettori, Federica; Chizzola, Giuliano [Spedali Civili University Hospital, Brescia (Italy); Bernardi, Guglielmo; Spedicato, Leonardo [University Hospital S. Maria Misericordia, Udine (Italy); Armigliato, Pietro [Istituto Italiano Ricerche Mediche, Verona (Italy); Spampanato, Carmine [Telethon Institute of Genetics and Medicine (TIGEM), Naples (Italy); Furegato, Martina [Istituto Italiano Ricerche Mediche, Verona (Italy)

    2015-04-15

    Aim: An innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) has been recently used for the treatment of complex coronary lesions, as calcified stenosis, chronic total occlusions and non-compliant plaques. Such complex lesions are difficult to adequately treat with balloon angioplasty and/or intracoronary stenting. The aim of this study was to examine the acute outcome of this approach on a cohort of patients with coronary lesions. Methods and Results: Eighty patients with 100 lesions were enrolled through four centers, and excimer laser coronary angioplasty was performed on 96 lesions (96%). Safety and effectiveness data were compared between patients treated with standard laser therapy and those treated with increased laser therapy. Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success in was obtained in 87 lesions (90.6%). There was no perforation, major side branch occlusion, spasm, no-reflow phenomenon, dissection nor acute vessel closure. Increased laser parameters were used successfully for 49 resistant lesions without complications. Conclusions: This study suggests that laser-facilitated coronary angioplasty is a simple, safe and effective device for the management of complex coronary lesions. Furthermore, higher laser energy levels delivered by this catheter improved the device performance without increasing complications. - Highlights: • We planned this multicenter study to examine the acute outcome of an innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) for treatment of complex coronary lesions. • We enrolled 80 patients with 100 lesions and performed excimer laser coronary angioplasty in 96 lesions (96%). • Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success was obtained in 87 lesions (90.6%). • Increased laser parameters were used successfully for 49 resistant

  15. Preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty for the treatment of chronic occlusive arterial disorders of lower extremities

    International Nuclear Information System (INIS)

    Zhang Fuxian; Zhang Changming; Hu Lu; Feng Yaping; Liang Gangzhu; Zhang Huan

    2010-01-01

    Objective: To evaluate the safety and efficacy of preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty in treating chronic occlusive arterial disorders of lower extremities. Methods: From January 2008 to December 2009, preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty was performed in 12 patients with chronic occlusive arterial disorders of lower extremities, including 8 males and 4 females with an average age of 56.3 years (within a range of 38-71 years). All 12 patients had a history of chronic ischemia of lower limb,the mean ill duration was 19.3 months (3-48 months). All patients complained of intermittent claudication with a mean distance of 125 m (50-200 m). Rest pain occurred in 5 patients (42%), toe necrosis was seen in 3 patients (25%) and critically ischemic limb in 4 patients (33%). Ankle-brachial index (ABI) was 0.00 0.65 with a mean of 0.33. In all 12 patients catheter-directed thrombolysis with rt-PA or urokinase was initially carried out, which was followed by endovascular angioplasty (balloon dilatation or stent placement) in two days. The clinical data and the therapeutic results were analyzed. Results: Technical success was achieved in all 12 patients. The mean time of thrombolysis was 48 hours. Of 12 patients, rt-PA was employed in 4 and urokinase in 8. The occluded length of the diseased arteries before the treatment was 60-150 mm, with a mean of 80 mm. After catheter-directed thrombolysis,the occluded length decreased to 10-50 mm (mean of 30 mm). Endovascular angioplasty was successfully completed in all patients after thrombolysis therapy. Postoperative ABI was 0.64-1.0 (mean of 0.86), which was increased by 0.53 when compared to the preoperative figure. During the perioperative period neither complications needed to be surgically treated nor death occurred. All patients were followed up, and the arteries remained open after one year in all cases. Conclusion

  16. Supporting teachers' technology integration in lesson plans

    NARCIS (Netherlands)

    Janssen, Noortje

    2017-01-01

    Lesson planning offers rich opportunities for teachers to consider and implement technology in the classroom. This dissertation investigated the design and effectiveness of supplementary information to assist pre-service teachers during the lesson planning process. Based on the Technological,

  17. Value pricing pilot program : lessons learned

    Science.gov (United States)

    2008-08-01

    This "Lessons Learned Report" provides a summary of projects sponsored by the Federal Highway Administration's (FHWA's) Congestion and Value Pricing Pilot Programs from 1991 through 2006 and draws lessons from a sample of projects with the richest an...

  18. Lessons from independence

    International Nuclear Information System (INIS)

    Hauptfuhrer, R.R.

    1990-01-01

    The recent history of Oryx provides invaluable lessons for those who plan future energy strategies, relates the author of this paper. When Oryx became an independent oil and gas company, its reserves were declining, its stock was selling below asset values, and the price of oil seemed stuck below $15 per barrel. The message from Oryx management to Oryx employees was: We are in charge of our own destiny. We are about to create our own future. Oryx had developed a new, positive corporate culture and the corporate credit required for growth. This paper points to two basic principles that have guided the metamorphosis in Oryx's performance. The first objective was to improve operational efficiency and to identify the right performance indicators to measure this improvement. It states that the most critical performance indicator for an exploration and production company must be replacement and expansion of reserves at a competitive replacement cost. Oryx has cut its finding costs from $12 to $5 per barrel, while the BP acquisition provided proven reserves at a cost of only $4 per barrel. Another performance indicator measures Oryx's standing in the financial markets

  19. Patient safety: lessons learned

    International Nuclear Information System (INIS)

    Bagian, James P.

    2006-01-01

    The traditional approach to patient safety in health care has ranged from reticence to outward denial of serious flaws. This undermines the otherwise remarkable advances in technology and information that have characterized the specialty of medical practice. In addition, lessons learned in industries outside health care, such as in aviation, provide opportunities for improvements that successfully reduce mishaps and errors while maintaining a standard of excellence. This is precisely the call in medicine prompted by the 1999 Institute of Medicine report ''To Err Is Human: Building a Safer Health System.'' However, to effect these changes, key components of a successful safety system must include: (1) communication, (2) a shift from a posture of reliance on human infallibility (hence ''shame and blame'') to checklists that recognize the contribution of the system and account for human limitations, and (3) a cultivation of non-punitive open and/or de-identified/anonymous reporting of safety concerns, including close calls, in addition to adverse events. (orig.)

  20. Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block for Analgesia During Percutaneous Transluminal Angioplasty for Dialysis Access

    International Nuclear Information System (INIS)

    Chiba, Emiko; Hamamoto, Kohei; Nagashima, Michio; Matsuura, Katsuhiko; Okochi, Tomohisa; Tanno, Keisuke; Tanaka, Osamu

    2016-01-01

    PurposeTo evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access.Subjects and MethodsTwenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. The patient’s motor/sensory paralysis after PTA was also examined.ResultsThe mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min.ConclusionUS-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites.Level of EvidenceLevel 4 (case series).