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

Energy Technology Data Exchange (ETDEWEB)

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

2014-12-15

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

Usefulness of CT angiography after metallic stent implantation of the internal carotid artery

International Nuclear Information System (INIS)

Yoon, Man Won; Kim, Hyeon Chul; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun

1999-01-01

To evaluate the usefulness of CT angiography in patients with implantation of metallic stent for stenosed internal carotid artery. Seven patients with atherosclerotic stenosis of the internal carotid artery underwent metallic stent implantation. All were male and their ages ranged from 36 to 69 years. A total of seven stents were placed in the internal carotid artery in five patients and in the carotid bifurcation in two. Spiral CT scans were obtained and CT angiographic images were reconstructed using MPR or curved MPR techniques at a workstation. The interval between CT and conventional angiography did not exceed six days except in one patient, in whom it was 61days. CT and conventional angiography were compared for stent position with respect to the carotid bifurcation, stent deformation, intraluminal filling defect, and luminal caliber and outflow. Luminal patency of the implanted stent was measured according to NASCET(North American Symptomatic Carotid Endarterectomy Trial) criteria, and statistically processed (p>.05). The presence or absence of intrastent thrombus and vascular wall calcification was determined using axial source images. In all patients, CT angiographic findings matched those obtained by conventional angiography. Complications such as migration or deformation of an implanted stent, intraluminal filling defect, change of luminal caliber or outflow of implanted stent were not observed in any patient. In two studies in which Wilcoxon signed rank test was used, degree of stent expansion correlated closely(p=0.237). Axial source images showed that in no patient was an intrastent thrombus present, though in five, vascular wall calcification of internal carotid arteries outside the stent was noted. CT angiography is useful for the assessment of positional change, occlusion, and luminal patency of a stent-implanted internal carotid artery

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 ...

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 ...

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)

Comparison of Durable-Polymer Zotarolimus-Eluting and Biodegradable-Polymer Biolimus-Eluting Coronary Stents in Patients With Coronary Artery Disease

DEFF Research Database (Denmark)

Raungaard, Bent; Christiansen, Evald H; Bøtker, Hans Erik

2017-01-01

artery disease or acute coronary syndromes and at least 1 coronary artery lesion requiring treatment with a drug-eluting stent. Endpoints included major adverse cardiac events (MACE), a composite of safety (cardiac death and myocardial infarction not clearly attributable to a non-target lesion......OBJECTIVES: The authors sought to compare the safety and efficacy of the biocompatible durable-polymer zotarolimus-eluting stent with the biodegradable-polymer biolimus-eluting stent in unselected coronary patients. BACKGROUND: Biodegradable-polymer biolimus-eluting stents are superior to first......-generation durable-polymer drug-eluting stents in long-term randomized all-comer trials. Long-term data comparing them to second-generation durable-polymer drug-eluting stents are lacking. METHODS: The study was a randomized, multicenter, all-comer, noninferiority trial in patients with chronic stable coronary...

Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries

International Nuclear Information System (INIS)

Saguner, Ardan M.; Traupe, Tobias; Räber, Lorenz; Hess, Nina; Banz, Yara; Saguner, Arhan R.; Diehm, Nicolas; Hess, Otto M.

2012-01-01

Purpose: Uncoated self-expanding nitinol stents (NS) are commonly oversized in peripheral arteries. In current practice, 1-mm oversizing is recommended. Yet, oversizing of NS may be associated with increased restenosis. To provide further evidence, NS were implanted in porcine iliofemoral arteries with a stent-to-artery-ratio between 1.0 and 2.3. Besides conventional uncoated NS, a novel self-expanding NS with an antiproliferative titanium-nitride-oxide (TiNOX) coating was tested for safety and efficacy. Methods: Ten uncoated NS and six TiNOX-coated NS (5–6 mm) were implanted randomly in the iliofemoral artery of six mini-pigs. After implantation, quantitative angiography (QA) was performed for calculation of artery and minimal luminal diameter. Follow-up was performed by QA and histomorphometry after 5 months. Results: Stent migration, stent fracture, or thrombus formation were not observed. All stents were patent at follow-up. Based on the location of the stent (iliac/femoral) and the stent-to-artery-ratio, stent segments were divided into “normal-sized” (stent-to-artery-ratio < 1.4, n = 12) and “oversized” (stent-to-artery-ratio ≥ 1.4, n = 9). All stent segments expanded to their near nominal diameter during follow-up. Normal-sized stent segments increased their diameter by 6% and oversized segments by 29%. A significant correlation between oversizing and restenosis by both angiography and histomorphometry was observed. Restenosis rates were similar for uncoated NS and TiNOX-coated NS. Conclusions: TiNOX-coated NS are as safe and effective as uncoated NS in the porcine iliofemoral artery. All stents further expand to near their nominal diameter during follow-up. Oversizing is linearly and positively correlated with neointimal proliferation and restenosis, which may not be reduced by TiNOX-coating.

In-stent restenosis of innominate artery with critical stenosis of right internal carotid artery

International Nuclear Information System (INIS)

Hussain, S.; Raza, A.; Ahmed, W.

2011-01-01

A lady with aortitis syndrome developed in-stent restenosis (ISR) of the innominate artery stent and critical stenosis of right internal carotid artery. The therapeutic challenge was gaining access to the carotid vessel, after treating the innominate artery ISR and all the while using distal protection to circumvent potential cerebral embolism. Percutaneous transluminal angioplasty (PTA) with or without stenting is a safe therapeutic option for re-vascularization of the supra aortic vessels. In the event of re-stenosis, re-treatment with PTA and stenting is safe. Ample evidence-base exists now for carotid artery stenting (CAS) in preference to carotid endarterectomy in patients with stenotic lesions of the carotid vessels. (author)

Stent sizing strategies in renal artery stenting: the comparison of conventional invasive renal angiography with renal computed tomographic angiography.

Science.gov (United States)

Kadziela, Jacek; Michalowska, Ilona; Pregowski, Jerzy; Janaszek-Sitkowska, Hanna; Lech, Katarzyna; Kabat, Marek; Staruch, Adam; Januszewicz, Andrzej; Witkowski, Adam

2016-01-01

Randomized trials comparing invasive treatment of renal artery stenosis with standard pharmacotherapy did not show substantial benefit from revascularization. One of the potential reasons for that may be suboptimal procedure technique. To compare renal stent sizing using two modalities: three-dimensional renal computed tomography angiography (CTA) versus conventional angiography. Forty patients (41 renal arteries), aged 65.1 ±8.5 years, who underwent renal artery stenting with preprocedural CTA performed within 6 months, were retrospectively analyzed. In CTA analysis, reference diameter (CTA-D) and lesion length (CTA_LL) were measured and proposed stent diameter and length were recorded. Similarly, angiographic reference diameter (ANGIO_D) and lesion length (ANGIO_LL) as well as proposed stent dimensions were obtained by visual estimation. The median CTA_D was 0.5 mm larger than the median ANGIO_D (p < 0.001). Also, the proposed stent diameter in CTA evaluation was 0.5 mm larger than that in angiography (p < 0.0001). The median CTA_LL was 1 mm longer than the ANGIO_LL (p = NS), with significant correlation of these variables (r = 0.66, p < 0.0001). The median proposed stent length with CTA was equal to that proposed with angiography. The median diameter of the implanted stent was 0.5 mm smaller than that proposed in CTA (p < 0.0005) and identical to that proposed in angiography. The median length of the actual stent was longer than that proposed in angiography (p = 0.0001). Renal CTA has potential advantages as a tool adjunctive to angiography in appropriate stent sizing. Careful evaluation of the available CTA scans may be beneficial and should be considered prior to the planned procedure.

Differentiated analysis of an everolimus-eluting stent and a paclitaxel-eluting stent among higher risk subgroups for restenosis: results from the SPIRIT II trial.

Science.gov (United States)

Khattab, Ahmed A; Richardt, Gert; Verin, Vitali; Kelbaek, Henning; Macaya, Carlos; Berland, Jacques; Miquel-Hebert, Karine; Dorange, Cécile; Serruys, Patrick W

2008-03-01

Restenosis is higher among certain subpopulations when subjected to percutaneous coronary interventions even when using drug-eluting stents. The randomised SPIRIT II trial demonstrated the superiority of the XIENCE V Everolimus Eluting Coronary Stent System over the TAXUS Paclitaxel-Eluting Stent System in terms of in-stent late loss at six months among 300 patients treated for de novo native coronary artery lesions. In this post-hoc analysis of SPIRIT II we focused on six-month angiographic outcomes of diabetic patients (n=69), left anterior descending arteries (n=149), long lesions >20 mm (n=43), small vessels B2 and C lesions (n=233). In-stent late loss was consistently less among all subgroups when treated by everolimus-eluting stents compared to paclitaxel-eluting stents: diabetics 0.15+/-0.26 mm versus 0.39+/-0.34 mm, p=0.006; LAD 0.12+/-0.23 mm versus 0.44+/-0.37 mm, pB2/C lesions 0.12+/-0.31 mm versus 0.36+/-0.36 mm, pSPIRIT II trial population.

Predictive Factors of In-Stent Restenosis in Renal Artery Stenting: A Retrospective Analysis

International Nuclear Information System (INIS)

Vignali, Claudio; Bargellini, Irene; Lazzereschi, Michele; Cioni, Roberto; Petruzzi, Pasquale; Caramella, Davide; Pinto, Stefania; Napoli, Vinicio; Zampa, Virna; Bartolozzi, Carlo

2005-01-01

Purpose. To retrospectively evaluate the role of clinical and procedural factors in predicting in-stent restenosis in patients with renovascular disease treated by renal artery stenting. Methods. From 1995 to 2002, 147 patients underwent renal artery stenting for the treatment of significant ostial atherosclerotic stenosis. Patients underwent strict clinical and color-coded duplex ultrasound follow-up. Ninety-nine patients (111 stents), with over 6 months of continuous follow-up (mean 22±12 months, range 6-60 months), were selected and classified according to the presence (group A, 30 patients, 32 lesions) or absence (group B, 69 patients, 79 lesions) of significant in-stent restenosis. A statistical analysis was performed to identify possible preprocedural and procedural predictors of restenosis considering the following data: sex, age, smoking habit, diabetes mellitus, hypertension, serum creatinine, cholesterol and triglyceride levels, renal artery stenosis grade, and stent type, length and diameter. Results. Comparing group A and B patients (χ 2 test), a statistically significant relation was demonstrated between stent diameter and length and restenosis: the risk of in-stent restenosis decreased when the stent was ≥6 mm in diameter and between 15 and 20 mm in length. This finding was confirmed by multiple logistic regression analysis. Stent diameter and length were proved to be significantly related to in-stent restenosis also when evaluating only patients treated by Palmaz stent (71 stents). Conclusion. Although it is based on a retrospective analysis, the present study confirms the importance of correct stent selection in increasing long-term patency, using stents of at least 6 mm in diameter and with a length of approximately 15-20 mm

Stent-induced flow disturbances in the ipsilateral external carotid artery following internal carotid artery stenting: a temporary cause of jaw claudication.

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Giurgea, Georgiana-Aura; Haumer, Markus; Mlekusch, Irene; Sabeti-Sandor, Schila; Dick, Petra; Schillinger, Martin; Minar, Erich; Mlekusch, Wolfgang

2017-07-01

We hypothesize that stenting of the internal carotid artery can immediately impede blood flow to the external carotid artery by either plaque shift or stent coverage of the ostium, and thereby cause ischemic symptoms like ipsilateral jaw claudication. Thirty-three patients with high-grade asymptomatic stenosis of the internal carotid artery who underwent endovascular treatment were examined by ultrasound of the external carotid artery and performed an exercise test by chewing chewing gum synchronously to an electronic metronome for 3 min. Tests were performed before, the day after, and 1 week after the stenting procedure. Claudication time was defined as the timespan until occurrence of pain of the masseter muscle and/or chewing dyssynchrony to the metronome for more than 15 s. Ten patients with an isolated, atherosclerotic stenosis of the external carotid artery served as controls. A significantly reduced claudication time (in seconds) was recorded in patients who underwent carotid artery stenting compared to baseline values; median 89 (interquartile range, IQR, 57 to 124) vs. median 180 (IQR 153 to 180; p external carotid artery into faster or slower as 200 cm/sec, the effect was even accentuated. Stenting values showed improvement 1 week after but did not return to baseline levels. No respective changes were found in controls. Stenting of the internal carotid artery lead to ipsilateral flow deterioration at the external carotid artery resulting in temporary jaw claudication. This impairment attenuated over the time and was significantly reduced after 1 week.

Stent Design Affects Femoropopliteal Artery Deformation.

Science.gov (United States)

MacTaggart, Jason; Poulson, William; Seas, Andreas; Deegan, Paul; Lomneth, Carol; Desyatova, Anastasia; Maleckis, Kaspars; Kamenskiy, Alexey

2018-03-23

Poor durability of femoropopliteal artery (FPA) stenting is multifactorial, and severe FPA deformations occurring with limb flexion are likely involved. Different stent designs result in dissimilar stent-artery interactions, but the degree of these effects in the FPA is insufficiently understood. To determine how different stent designs affect limb flexion-induced FPA deformations. Retrievable markers were deployed into n = 28 FPAs of lightly embalmed human cadavers. Bodies were perfused and CT images were acquired with limbs in the standing, walking, sitting, and gardening postures. Image analysis allowed measurement of baseline FPA foreshortening, bending, and twisting associated with each posture. Markers were retrieved and 7 different stents were deployed across the adductor hiatus in the same limbs. Markers were then redeployed in the stented FPAs, and limbs were reimaged. Baseline and stented FPA deformations were compared to determine the influence of each stent design. Proximal to the stent, Innova, Supera, and SmartFlex exacerbated foreshortening, SmartFlex exacerbated twisting, and SmartControl restricted bending of the FPA. Within the stent, all devices except Viabahn restricted foreshortening; Supera, SmartControl, and AbsolutePro restricted twisting; SmartFlex and Innova exacerbated twisting; and Supera and Viabahn restricted bending. Distal to the stents, all devices except AbsolutePro and Innova exacerbated foreshortening, and Viabahn, Supera, Zilver, and SmartControl exacerbated twisting. All stents except Supera were pinched in flexed limb postures. Peripheral self-expanding stents significantly affect limb flexion-induced FPA deformations, but in different ways. Although certain designs seem to accommodate some deformation modes, no device was able to match all FPA deformations.

MRT of carotid stents: influence of stent properties and sequence parameters on visualization of the carotid artery lumen

International Nuclear Information System (INIS)

Straube, T.; Wolf, S.; Alfke, K.; Jansen, O.; Flesser, A.; Deli, M.; Nabavi, A.

2005-01-01

Purpose: To evaluate MR artifacts of carotid artery stents and to optimize stent properties and sequence parameters. Material and Methods: Four carotid artery stents - Wallstent (mediloy), Precise (nitinol), ACCULINK (nitinol) and a stent prototype (nitinol) - were investigated in a flow model of the cervical vessels. The model was made of silicon tubing and a flow pump that produces realistic flow curves of the carotid artery. To investigate the effects of magnetic susceptibility and radiofrequency induced shielding artifacts, turbo spin echo and gradient echo sequences as well as CE-MRAs were measured. To improve the visualization of the stent lumen in a CE-MRA, flip angle as well as geometry and covering of the stent prototype were altered. Results: Susceptibility artifacts in stents of the carotid artery only influence the lumen visualization at the proximal and distal end of the braided mediloy stent. A change of stent coverings has no significant influence on radiofrequency artifacts, whereas a reduction in linking elements between stent segments and a change in diameter of stent struts improves visualization of the stent lumen. By increasing the flip angle in a CE-MRA, visualization of the stent lumen is possible in both mediloy and nitinol stents. Conclusion: The choice of stent material and changes in stent geometry as well as the optimization of the flip angle of the CE-MRA may reduce susceptibility and radiofrequency artifacts, rendering feasible the CE-MRA of a stented carotid artery. (orig.)

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

International Nuclear Information System (INIS)

Goltz, J.P.; Kickuth, R.; Bastuerk, P.; Hoppe, H.; Triller, J.

2011-01-01

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

An argument for the use of multiple segment stents in curved arteries.

Science.gov (United States)

Kasiri, Saeid; Kelly, Daniel J

2011-08-01

Stenting of curved arteries is generally perceived to be more challenging than straight vessels. Conceptually implanting multiple shorter stents rather than a single longer stent into such a curved artery represents a promising concept, but little is known about the impact of such an approach. The objective of this study is to evaluate the effectiveness of using a multiple segment stent rather than a single long stent to dilate a curved artery using the finite element method. A double segment stent (DSS) and a single segment stent (SSS) were modeled. The stents were compared when expanded into a model of a curved artery. The model predicts that the DSS provides higher flexibility, more conformity, and lower recoil in comparison to the SSS. The volume of arterial tissue experiencing high levels of stress due to stent implantation is also reduced for the DSS. It is suggested that a multiple segment stenting system is a potential solution to the problem of higher rates of in-stent restenosis in curved arteries and mechanically challenging environments.

Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance

International Nuclear Information System (INIS)

Köklü, Erkan; Arslan, Şakir; Yüksel, İsa Öner; Bayar, Nermin; Koç, Pınar

2015-01-01

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

Comparison of everolimus- and paclitaxel-eluting stents in patients with acute and stable coronary syndromes: pooled results from the SPIRIT (A Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System) and COMPARE (A Trial of Everolimus-Eluting Stents and Paclitaxel-Eluting Stents for Coronary Revascularization in Daily Practice) Trials.

Science.gov (United States)

Planer, David; Smits, Pieter C; Kereiakes, Dean J; Kedhi, Elvin; Fahy, Martin; Xu, Ke; Serruys, Patrick W; Stone, Gregg W

2011-10-01

This study sought to compare the clinical outcomes of everolimus-eluting stents (EES) versus paclitaxel-eluting stents (PES) in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD). Although randomized trials have shown superiority of EES to PES, the safety and efficacy of EES in ACS is unknown. We performed a patient-level pooled analysis from the prospective, randomized SPIRIT (Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System) II, III, IV, and COMPARE (A Trial of Everolimus-Eluting Stents and Paclitaxel-Eluting Stents for Coronary Revascularization in Daily Practice) trials in which 2,381 patients with ACS and 4,404 patients with stable CAD were randomized to EES or to PES. Kaplan-Meier estimates of death, myocardial infarction (MI), ischemia-driven target lesion revascularization, and stent thrombosis were assessed at 2 years and stratified by clinical presentation (ACS vs. stable CAD). At 2 years, patients with ACS compared with stable CAD had higher rates of death (3.2% vs. 2.4%, hazard ratio [HR]: 1.37 [95% confidence interval (CI): 1.02 to 1.85], p = 0.04) and MI (4.9% vs. 3.4%, HR: 1.45 [95% CI: 1.14 to 1.85], p = 0.02). In patients with ACS, EES versus PES reduced the rate of death or MI (6.6% vs. 9.3%, HR: 0.70 [95% CI: 0.52 to 0.94], p = 0.02), stent thrombosis (0.7% vs. 2.9%, HR: 0.25 [95% CI: 0.12 to 0.52], p = 0.0002), and ischemia-driven target lesion revascularization (4.7% vs. 6.2%, HR: 0.69 [95% CI: 0.48 to 0.99], p = 0.04). In patients with stable CAD, EES reduced the rate of death or MI (4.5% vs. 7.1%, HR: 0.62 [95% CI: 0.48 to 0.80], p = 0.0002), stent thrombosis (0.7% vs. 1.8%, HR: 0.34 [95% CI: 0.19 to 0.62], p = 0.0002), and ischemia-driven target lesion revascularization (3.9% vs. 6.9%, HR: 0.55 [95% CI: 0.42 to 0.73], p SPIRIT II]; NCT00180310; SPIRIT III: A Clinical Evaluation of the Investigational Device XIENCE V Everolimus Eluting Coronary Stent System [EECSS] in the

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.

Renal PTA stenting

International Nuclear Information System (INIS)

Tsetis, D.

2012-01-01

Full text: Renal artery stenosis (RAS) is a common condition that may lead to hypertension, progressive renal dysfunction and cardiovascular morbidity. Catheter-based therapy for symptomatic, haemodynamically significant, RAS has become the preferred method of revascularization. Balloon angioplasty has been the traditional treatment of choice for fibromuscular dysplasia, however stents are increasingly used for the treatment of atheromatous lesions; in many cases-such as in ostial lesions-, direct stenting is strongly indicated. Despite the increased use of endovascular therapy for renal artery stenosis, there is still controversy regarding the optimal management and the net benefit of this treatment. Several randomized trials of balloon angioplasty or stenting for renal artery stenosis compared with medical therapy alone have been conducted, however these could not show definite advantage of endovascular therapy. Problems encountered with those trials include enrollment of small number of patients, frequent crossover from medical to interventional therapy compromising the intention-to-treat results, or selection of patients that are not expected to show clear benefit. The Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) is the most important of these trials; however, it,s study design was faulty and therefore did not provide conclusive evidence to answer the question of whether angioplasty and stenting or medical therapy is the best treatment for haemodynamically significant RAS. All expectations are now focused on the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial which was designed to answer the same question, and its methodologies took into consideration the weaknesses of the ASTRAL trial. Regarding stent device itself, it seems that the optimal design is probably a stainless steel, laser cut, open-cells stent mounted on a rapid exchange delivery balloon catheter compatible with 0.014-in and 0.018-in guidewire. As a future

Angiographic CT: in vitro comparison of different carotid artery stents-does stent orientation matter?

Science.gov (United States)

Lettau, Michael; Bendszus, Martin; Hähnel, Stefan

2013-06-01

Our aim was to evaluate the in vitro visualization of different carotid artery stents on angiographic CT (ACT). Of particular interest was the influence of stent orientation to the angiography system by measurement of artificial lumen narrowing (ALN) caused by the stent material within the stented vessel segment to determine whether ACT can be used to detect restenosis within the stent. ACT appearances of 17 carotid artery stents of different designs and sizes (4.0 to 11.0 mm) were investigated in vitro. Stents were placed in different orientations to the angiography system. Standard algorithm image reconstruction and stent-optimized algorithm image reconstruction was performed. For each stent, ALN was calculated. With standard algorithm image reconstruction, ALN ranged from 19.0 to 43.6 %. With stent-optimized algorithm image reconstruction, ALN was significantly lower and ranged from 8.2 to 18.7 %. Stent struts could be visualized in all stents. Differences in ALN between the different stent orientations to the angiography system were not significant. ACT evaluation of vessel patency after stent placement is possible but is impaired by ALN. Stent orientation of the stents to the angiography system did not significantly influence ALN. Stent-optimized algorithm image reconstruction decreases ALN but further research is required to define the visibility of in-stent stenosis depending on image reconstruction.

Metallic stent for the treatment of iliac arterial stenosis

Energy Technology Data Exchange (ETDEWEB)

Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Suh, Chul Soo; Yoo, Jae Wook; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of); Song, Chi Sung [Seoul City Boramae Hospital, Seoul (Korea, Republic of)

1993-07-15

In order to study the clinical efficacy of the metallic stent of the treatment of iliac arterial stenosis, the clinical and arteriographic findings of the 8 patients were retrospectively reviewed. All 8 patients were males with an age of 51 to 79. The Fontaine class for the functional status of lower extremities was II in 4 patients, III in 3 patents and IV in 1 patient. Self expandable Gianturco stent was inserted of in 7 iliac arteries and balloon expandable Palmaz stent was inserted in 2 iliac arteries in the 8 patients. The indications for the metallic stent application were localized dissection with significant residual stenosis in 6 sites, recoiling due to calcification in one case and eccentricity of the stenosislesionin 2 sites. The deployment of the metallic stent was successful in all the cases to maintain the patency of iliac arteries with residual stenosis less than 30%. The Fontaine class was improved to 1 in 6 patients, IIa in 1 patient and IIb in another one. During the follow up period of 3 to 14 month, none except one developed recurrence of the symptom. On the basis of our experience, we believe that metallic stent is safe and effective for the treatment of iliac arterial stenosis. However, we think that it is a complementary measure to the percutaneous transluminal angioplasty. The comparative study between different types of metallic stent and the long term effect should be investigated further.

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 ...

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

Energy Technology Data Exchange (ETDEWEB)

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

2014-10-15

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

COVERED STENTS IN IATROGENIC CORONARY ARTERY FISTULA; A CASE REPORT

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Masoud Poormoghaddas

2010-11-01

Full Text Available Abstract    BACKGROUND: Coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber or major cardiac vessels, mostly congenital but some of them are acquired as a consequence of coronary artery perforation.    CASE PRESENTATION: We report a case of cavity spilling coronary artery perforation during percutaneous coronary intervention 7 years ago. Because of continuing symptoms and risk of developing heart failure and pulmonary hypertension we were ought to treat this iatrogenically formed coronary artery fistula. We used stent graft implantation to treat it with acceptable results.    CONCLUSION: Beside their application as a rescue for acute coronary artery perforations, stent grafts can be used with acceptable results in iatrogenically acquired coronary artery coronary artery fistula      Keywords: Coronary artery perforation, Coronary artery fistula, Stent graft.

Primary stent placement for recanalization of iliac artery occlusions: Using a self-expanding spiral stent

International Nuclear Information System (INIS)

Kim, Jae-Kyu; Kim, Yun-Hyeon; Chung, Sang-Yeung; Kang, Heoung-Keun

1999-01-01

Purpose: To report the clinical results for recanalizations of an occluded iliac artery by a self-expanding spiral stent.Methods: We attempted to recanalize 36 iliac artery occlusions in 34 patients [33 men, 1 woman, aged 51-75 years (average 61.6 years)]. The average lesion length was 6.92 cm (range 1-14 cm). The patients's chief complaints were intermittent claudication and resting pain. Fontaine classification was assigned before and after the procedure. Technical and clinical success were also analyzed.Results: Forty-five stents were successfully deployed in 34 patients. All 36 lesions (13 in the external iliac artery, 12 in the common iliac artery, and 11 in both) were patently recanalized on angiography. The follow-up period ranged from 6 months to 36 months (mean 11.9 months). Fourteen stents (39%) with incomplete expansion were dilated with a balloon catheter. Good technical (100%) and clinical (94%) results were obtained. The only complication was one hematoma at the puncture site. Reocclusions were noted in two lesions (5%) at 1 week and 15 months, respectively.Conclusion: A self-expanding spiral stent is a safe and effective device for recanalization of an iliac artery occlusion as the primary stent without any previous intervention.

Temporary stenting and retrieval of the self-expandable, intracranial stent in acute middle cerebral artery occlusion

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Suh, Sang Hyun; Chung, Tae-Sub [Yonsei University College of Medicine, Department of Radiology, Gangnam Severance Hospital, Seoul (Korea); Lee, Kyung-Yul [Yonsei University College of Medicine, Department of Neurology, Gangnam Severance Hospital, Seoul (Korea); Hong, Chang Ki; Kim, Chang-Hyun [Yonsei University College of Medicine, Department of Neurosurgery, Gangnam Severance Hospital, Seoul (Korea); Kim, Byung Moon; Kim, Dong Ik [Yonsei University College of Medicine, Department of Radiology, Seoul (Korea)

2009-08-15

We describe our experience in which a retrievable Enterprise stent was used as a temporary recanalization and embolectomy device in an acute middle cerebral artery (MCA) occlusion after urgent stenting for ipsilateral carotid artery stenosis. (orig.)

Experimental study of the preventive effect of 1'03Pd stent on in-stent restenosis in rabbit iliac artery

International Nuclear Information System (INIS)

Luo Quanyong; Chen Libo; Yuan Zhibin; Lu Hankui; Zhu Ruisen

2003-01-01

Objective: To investigate the ability of γ-emitting 103 Pd radioactive stent implantation for preventing in-stent restenosis in iliac artery of rabbits. Methods: Twenty New Zealand white rabbits were divided into six groups on the basis of radioactivity loading [2.22 (n=3), 5.55 (n=4), 9.25 (n=4), 14.8 (n=3), 22.2 (n=3), 33.3 MBq (n=3)]. 103 Pd stent was implanted in one of the two iliac arteries of each rabbit and nonradioactive stent in the contralateral artery. The rabbits were fed with high fat diet. Treatment efficiency was assessed by angiography and quantitative histomorphometry of the stented iliac segments 28 d after the implantation. Results: Quantitative histomorphometry analysis indicated that 103 Pd stents induced a significant reduction in neointimal area and the percentage of stenosis within radioactive stents was lower compared with that in the control stents. Nevertheless, the suppression of neointima formation by 103 Pd stent implantation was not in a dose-dependent manner. Conclusions: Low-dose intravascular brachytherapy via a γ-particle-emitting 103 Pd radioactive stent potently inhibits neointimal hyperplasia and prevents the in-stent restenosis in rabbit iliac artery. 103 Pd stent implantation probably can be employed as a novel means to prevent in-stent restenosis

Successful treatment of coronary artery pseudoaneurysm by graft stent, which developed after the implantation of bare metal stent

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Utku Şenol

2013-03-01

Full Text Available Although coronary artery pseudoaneurysm which couldoccur following percutaneous coronary interventions is arare complication, it can be mortal. As soon as the pseudoaneurysmis diagnosed, it should be treated by percutaneousintervention or surgery. Graft stent implantationis a preferred treatment for appropriate patients. In thiscase report, we presented a successful treatment of coronaryartery pseudoaneurysm by graft stent; which developedafter the implantation of bare metal stent into theleft anterior descending coronary artery. J Clin Exp Invest2013; 4 (1: 126-129Key words: Coronary artery, pseudoaneurysm, graft stent

The EPIC nitinol stent system in the treatment of iliac artery lesions: one-year results from the ORION clinical trial.

Science.gov (United States)

Clair, Daniel G; Adams, Julie; Reen, Bernard; Feldman, Robert; Starr, Jean; Diaz-Cartelle, Juan; Dawkins, Keith D

2014-04-01

To report the 1-year results of a pivotal study for a new-generation nitinol stent for the treatment of iliac atherosclerotic lesions. The ORION trial (ClinicalTrials.gov identifier NCT00896337) was a single-arm, non-randomized, prospective, multicenter clinical trial that enrolled 125 patients (81 men; mean age 61.1±9.3 years) implanted with the EPIC self-expanding nitinol stent system in 166 de novo or restenotic iliac artery lesions ≤13 cm long. The primary endpoint was the 9-month major adverse event rate [i.e., device- or procedure-related death within 30 days, myocardial infarction during the index hospitalization, target vessel revascularization (TVR), or index limb amputation]. Follow-up occurred at hospital discharge and at 1, 9, and 12 months. An independent core laboratory evaluated ultrasound results at 1, 9, and 12 months. The primary endpoint met the prespecified performance goal, with only 3.4% (4/117) of patients experiencing a major adverse event by 9 months (p<0.0001). By 12 months, 6 (5.4%) of 111 patients had TVR; none had an index limb amputation. The ankle-brachial index, Walking Impairment Questionnaire, and Rutherford classifications all showed sustained improvements through 12 months. Primary patency was 94.4% with comparable results for lesions classified as complex (TASC II C/D 95.5%) or non-complex (TASC II A/B 95.0%). The EPIC stent system demonstrated safety and effectiveness through 12 months, including improvements for complex lesions. The EPIC stent is a viable alternative to surgery for patients with either complex or non-complex lesions.

Impact of polymer formulations on neointimal proliferation after zotarolimus-eluting stent with different polymers: insights from the RESOLUTE trial.

Science.gov (United States)

Waseda, Katsuhisa; Ako, Junya; Yamasaki, Masao; Koizumi, Tomomi; Sakurai, Ryota; Hongo, Yoichiro; Koo, Bon-Kwon; Ormiston, John; Worthley, Stephen G; Whitbourn, Robert J; Walters, Darren L; Meredith, Ian T; Fitzgerald, Peter J; Honda, Yasuhiro

2011-06-01

Polymer formulation may affect the efficacy of drug-eluting stents. Resolute, Endeavor, and ZoMaxx are zotarolimus-eluting stents with different stent platforms and different polymer coatings and have been tested in clinical trials. The aim of this analysis was to compare the efficacy of zotarolimus-eluting stents with different polymers. Data were obtained from the first-in man trial or first randomized trials of each stent, The Clinical RESpOnse EvaLUation of the MedTronic Endeavor CR ABT-578 Eluting Coronary Stent System in De Novo Native Coronary Artery Lesions (RESOLUTE), Randomized Controlled Trial to Evaluate the Safety and Efficacy of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo Native Coronary Artery Lesions (ENDEAVOR II), and ZoMaxx I trials. Follow-up intravascular ultrasound analyses (8 to 9 months of follow-up) were possible in 353 patients (Resolute: 88, Endeavor: 98, ZoMaxx: 82, Driver: 85). Volume index (volume/stent length) was obtained for vessel, stent, lumen, peristent plaque, and neointima. Cross-sectional narrowing was defined as neointimal area divided by stent area (%). Neointima-free frame ratio was calculated as the number of frames without intravascular ultrasound-detectable neointima divided by the total number of frames within the stent. At baseline, vessel, lumen, and peristent plaque volume index were not significantly different among the 4 stent groups. At follow-up, percent neointimal obstruction was significantly lower in Resolute compared with Endeavor, ZoMaxx, and Driver (Resolute: 3.7±4.0, Endeavor: 17.5±10.1, ZoMaxx: 14.6±8.1, Driver: 29.4±17.2%; Ppolymer used in Resolute independently correlated with neointimal suppression among 3 zotarolimus-eluting stents. The different polymer formulations significantly affect the relative amount of neointima for zotarolimus-eluting stents. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00248079.

Complication rate in unprotected carotid artery stenting with closed-cell stents

International Nuclear Information System (INIS)

Tietke, Marc W.K.; Kerby, Tina; Alfke, Karsten; Riedel, Christian; Rohr, Axel; Jensen, Ulf; Jansen, Olaf; Zimmermann, Phillip; Stingele, Robert

2010-01-01

The discussion on the use of protection devices (PDs) in carotid artery stenting (CAS) is gaining an increasing role in lowering the periprocedural complication rates. While many reviews and reports with retrospective data analysis do promote the use of PDs the most recent multi-centre trials are showing advantages for unprotected CAS combined with closed-cell stent designs. We retrospectively analysed 358 unprotected CAS procedures performed from January 2003 to June 2009 in our clinic. Male/female ratio was 2.68/1. The average age was 69.3 years. Seventy-three percent (261/358) showed initial neurological symptoms. All patients were treated on a standardised interventional protocol. A closed and small-sized cell designed stent was implanted in most cases (85.2%). One hundred seventy-one (47.8%) were controlled by Doppler ultrasonography usually at first in a 3-month and later in 6-month intervals. The peri-interventional and 30-day mortality/stroke rate was 4.19% (15/358). These events included three deaths, five hyperperfusion syndromes (comprising one death by a secondary fatal intracranial haemorrhage), one subarachnoid haemorrhage and seven ischaemic strokes. Only 20% (3/15) of all complications occurred directly peri-interventional. The overall peri-interventional complication rate was 0.8% (3/358). Most complications occurred in initial symptomatic patients (5.36%). The in-stent restenosis rate for more than 70% was 7% (12/171) detected at an average of 9.8 month. Our clinical outcome demonstrates that unprotected CAS with small cell designed stents results in a very low procedural complication rate, which makes the use of a protection device dispensable. (orig.)

Flow Velocities After Carotid Artery Stenting: Impact of Stent Design. A Fluid Dynamics Study in a Carotid Artery Model with Laser Doppler Anemometry

International Nuclear Information System (INIS)

Greil, Oliver; Kleinschmidt, Thomas; Weiss, Wolfgang; Wolf, Oliver; Heider, Peter; Schaffner, Silvio; Gianotti, Marc; Schmid, Thomas; Liepsch, Dieter; Berger, Hermann

2005-01-01

Purpose. To study the influence of a newly developed membrane stent design on flow patterns in a physiologic carotid artery model. Methods. Three different stents were positioned in silicone models of the carotid artery: a stainless steel stent (Wall-stent), a nitinol stent (SelfX), and a nitinol stent with a semipermeable membrane (MembraX). To increase the contact area of the membrane with the vessel wall, another MembranX model was modified at the outflow tract. The membrane consists of a biocompatible silicone-polyurethane copolymer (Elast-Eon) with a pore size of 100 μm. All stents were deployed across the bifurcation and the external carotid artery origin. Flow velocity measurements were performed with laser Doppler anemometry (LDA), using pulsatile flow conditions (Re = 220; flow 0.39 l/min; flow rate ratio ICA:ECA = 70:30) in hemodynamically relevant cross-sections. The hemodynamic changes were analyzed by comparing velocity fluctuations of corresponding flow profiles. Results. The flow rate ratio ICA:ECA shifted significantly from 70/30 to 73.9/26.1 in the MembraX and remained nearly unchanged in the SelfX and Wallstent. There were no changes in the flow patterns at the inflow proximal to the stents. In the stent no relevant changes were found in the SelfX. In the Wallstent the separation zone shifted from the orifice of the ICA to the distal end of the stent. Four millimeters distal to the SelfX and the Wallstent the flow profile returned to normal. In the MembraX an increase in the central slipstreams was found with creation of a flow separation distal to the stent. With a modification of the membrane this flow separation vanished. In the ECA flow disturbances were seen at the inner wall distal to the stent struts in the SelfX and the Wallstent. With the MembraX a calming of flow could be observed in the ECA with a slight loss of flow volume. Conclusions. Stent placement across the carotid artery bifurcation induces alterations of the physiologic flow

Transpedal approach for iliac artery stenting: A pilot study

Energy Technology Data Exchange (ETDEWEB)

Zachariah, Jips J., E-mail: jzachariah@chpnet.org [Mount Sinai Beth Israel Hospital, New York, NY (Israel); Ratcliffe, Justin A.; Ruisi, Michael; Puma, Joseph [Mount Sinai Beth Israel Hospital, New York, NY (Israel); Bertrand, Olivier [Quebec Heart and Lung Institute, Quebec (Canada); Kwan, Tak [Mount Sinai Beth Israel Hospital, New York, NY (Israel)

2016-12-15

Objective: To demonstrate the safety and feasibility of the transpedal approach as an alternate arterial access site for iliac artery intervention. Background: The common femoral artery is the traditional access site for the endovascular treatment of iliac artery stenoses. However, this approach is associated with complication rates as high as 2%, including retroperitoneal bleeding which carries high patient morbidity and mortality. Furthermore, the standard femoral approach is associated with longer recovery times and longer time to ambulation which are important considerations especially when performing procedures in an ambulatory setting. Methods: Twelve patients were prospectively followed after treatment for symptomatic iliac artery stenosis via transpedal access. Under ultrasound guidance, one of the pedal arteries was visualized and accessed, and stenting of the iliac arteries were performed as per protocol. The patient was monitored immediately post procedure and clinical follow up was performed at one week and one month later. Results: The average age of the patients was 71 years old. 58% were male. Most patients had Rutherford class III symptoms. Successful stent placement was achieved in all 12 patients via transpedal access. No conversion to femoral access was required. No complications immediately post procedure nor at any time period during follow up were noted. Lower extremity arterial duplex at one month showed patent stents and patent pedal access site vessels in all patients. Conclusion: Transpedal arterial access may be a safe and feasible approach for iliac artery stenting. Given the possible benefits of avoiding femoral artery access, larger studies should be conducted directly comparing the different approaches.

Treatment of Intra- and Extracranial Arterial Dissections Using Stents and Embolization

International Nuclear Information System (INIS)

Joo, Jin Yang; Ahn, Jung Yong; Chung, Young Sun; Han, In Bo; Chung, Sang Sup; Yoon, Pyeong Ho; Kim, Sang Heum; Choi, Eun Wan

2005-01-01

Purpose. To evaluate the safety and efficacy of stent placement for extracranial and intracranial arterial dissections. Methods. Eighteen patients underwent endovascular treatment of carotid and vertebral dissections using intraluminal stent placement. Five patients with arterial dissection were treated, 2 using one insertion of a single stent and 3 using placement of two stents. Patients with a dissecting aneurysm were treated as follows: 7 patients with insertion of one stent, 4 with placement of two stents, and 2 by stent-assisted Guglielmi detachable coil embolization. In the 18 patients in whom stenting was attempted, the overall success in reaching the target lesion was 94.4%. Of the 17 patients treated with stents, stent release and positioning were considered optimal in 16 (94%) and suboptimal in one (6%). In patients who underwent a successful procedure, all parent arteries were preserved. There were no instances of postprocedural ischemic attacks, new neurologic deficits, or new minor or major strokes prior to patient discharge. In follow up, all patients were assessed, using the modified Rankin scale, as functionally improved or of stable clinical status. The reduction in dissection-induced stenosis or pseudoaneurysm, the patency rate obtained at follow-up, and the lack of strokes (ischemic or hemorrhagic) suggest that stent placement offers a viable alternative to complex surgical bypass or reconstructive procedures. The long-term efficacy and durability of stent placement for arterial dissection remain to be determined in a larger series

Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis

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Lee, Cheng-Hung [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China); Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Jhong, Guan-Heng [Graduate Institute of Medical Mechatronics, Chang Gung University, Tao-Yuan, Taiwan (China); Hsu, Ming-Yi; Wang, Chao-Jan [Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan (China); Liu, Shih-Jung, E-mail: shihjung@mail.cgu.edu.tw [Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Hung, Kuo-Chun [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China)

2014-05-28

The deployment of metallic stents during percutaneous coronary intervention has become common in the treatment of coronary bifurcation lesions. However, restenosis occurs mostly at the bifurcation area even in present era of drug-eluting stents. To achieve adequate deployment, physicians may unintentionally apply force to the strut of the stents through balloon, guiding catheters, or other devices. This force may deform the struts and impose excessive mechanical stresses on the arterial vessels, resulting in detrimental outcomes. This study investigated the relationship between the distribution of stress in a stent and bifurcation angle using finite element analysis. The unintentionally applied force following stent implantation was measured using a force sensor that was made in the laboratory. Geometrical information on the coronary arteries of 11 subjects was extracted from contrast-enhanced computed tomography scan data. The numerical results reveal that the application of force by physicians generated significantly higher mechanical stresses in the arterial bifurcation than in the proximal and distal parts of the stent (post hoc P < 0.01). The maximal stress on the vessels was significantly higher at bifurcation angle <70° than at angle ≧70° (P < 0.05). The maximal stress on the vessels was negatively correlated with bifurcation angle (P < 0.01). Stresses at the bifurcation ostium may cause arterial wall injury and restenosis, especially at small bifurcation angles. These finding highlight the effect of force-induced mechanical stress at coronary artery bifurcation stenting, and potential mechanisms of in-stent restenosis, along with their relationship with bifurcation angle.

Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis

International Nuclear Information System (INIS)

Lee, Cheng-Hung; Jhong, Guan-Heng; Hsu, Ming-Yi; Wang, Chao-Jan; Liu, Shih-Jung; Hung, Kuo-Chun

2014-01-01

The deployment of metallic stents during percutaneous coronary intervention has become common in the treatment of coronary bifurcation lesions. However, restenosis occurs mostly at the bifurcation area even in present era of drug-eluting stents. To achieve adequate deployment, physicians may unintentionally apply force to the strut of the stents through balloon, guiding catheters, or other devices. This force may deform the struts and impose excessive mechanical stresses on the arterial vessels, resulting in detrimental outcomes. This study investigated the relationship between the distribution of stress in a stent and bifurcation angle using finite element analysis. The unintentionally applied force following stent implantation was measured using a force sensor that was made in the laboratory. Geometrical information on the coronary arteries of 11 subjects was extracted from contrast-enhanced computed tomography scan data. The numerical results reveal that the application of force by physicians generated significantly higher mechanical stresses in the arterial bifurcation than in the proximal and distal parts of the stent (post hoc P < 0.01). The maximal stress on the vessels was significantly higher at bifurcation angle <70° than at angle ≧70° (P < 0.05). The maximal stress on the vessels was negatively correlated with bifurcation angle (P < 0.01). Stresses at the bifurcation ostium may cause arterial wall injury and restenosis, especially at small bifurcation angles. These finding highlight the effect of force-induced mechanical stress at coronary artery bifurcation stenting, and potential mechanisms of in-stent restenosis, along with their relationship with bifurcation angle.

Long-term outcome in patients treated with sirolimus-eluting stents in complex coronary artery lesions: 3-year results of the SCANDSTENT (Stenting Coronary Arteries in Non-Stress/Benestent Disease) trial

DEFF Research Database (Denmark)

Kelbaek, H.; Klovgaard, L.; Helqvist, S.

2008-01-01

data of the long-term outcome of patients with complex coronary artery lesions. METHODS: We randomly assigned 322 patients with total coronary occlusions or lesions located in bifurcations, ostial, or angulated segments of the coronary arteries to have SES or BMS implanted. RESULTS: At 3 years, major...... performed between 1 and 3 years after the index treatment (p = NS). According to revised definitions, stent thrombosis occurred in 5 patients (3.1%) in the SES group and in 7 patients (4.4%) in the BMS group (p = NS); very late stent thrombosis was observed in 4 versus 1 patient. CONCLUSIONS: A continued...

The 'Harmonizing Optimal Strategy for Treatment of coronary artery stenosis - sAfety & effectiveneSS of drug-elUting stents & antiplatelet REgimen' (HOST-ASSURE trial: study protocol for a randomized controlled trial

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Park Kyung

2012-03-01

Full Text Available Abstract Background Second-generation drug-eluting stents (DES have raised the bar of clinical performance. These stents are mostly made from cobalt chromium alloy. A newer generation DES has been developed from platinum chromium alloy, but clinical data regarding the efficacy and safety of the platinum chromium-based everolimus-eluting stent (PtCr-EES is limited, with no comparison data against the cobalt chromium-based zotarolimus-eluting stent (CoCr-ZES. In addition, an antiplatelet regimen is an integral component of medical therapy after percutaneous coronary intervention (PCI. A 1-week duration of doubling the dose of clopidogrel (double-dose antiplatelet therapy (DDAT was shown to improve outcome at 1 month compared with conventional dose in acute coronary syndrome (ACS patients undergoing PCI. However in Asia, including Korea, the addition of cilostazol (triplet antiplatelet therapy (TAT is used more commonly than doubling the dose of clopidogrel in high-risk patients. Methods In the 'Harmonizing Optimal Strategy for Treatment of coronary artery stenosis - sAfety & effectiveneSS of drug-elUting stents & antiplatelet REgimen' (HOST-ASSURE trial, approximately 3,750 patients are being prospectively and randomly assigned in a 2 × 2 factorial design according to the type of stent (PtCr-EES vs CoCr-ZES and antiplatelet regimen (TAT vs DDAT. The first primary endpoint is target lesion failure at 1 year for the stent comparison, and the second primary endpoint is net clinical outcome at 1 month for comparison of antiplatelet therapy regimen. Discussion The HOST-ASSURE trial is the largest study yet performed to directly compare the efficacy and safety of the PtCr-EES versus CoCr-ZES in an 'all-comers' population. In addition, this study will also compare the clinical outcome of TAT versus DDAT for 1-month post PCI. Trial registration ClincalTrials.gov number NCT01267734.

Renal artery stent fracture with refractory hypertension: a case report and review of the literature.

Science.gov (United States)

Chua, Su-Kiat; Hung, Huei-Fong

2009-07-01

A 73-year-old man with resistant hypertension and impaired renal function underwent stenting for right renal artery (RRA) stenosis. Two years later, he presented with uncontrolled hypertension and worse renal function. Renal arteriogram revealed RRA stent fracture with in-stent restenosis. Another stent was deployed. Four months later, however, renal arteriogram revealed in-stent restenosis again. This time, balloon angioplasty alone was performed. He had been symptom-free with stable condition at 2-year follow-up. A literature review disclosed six renal artery stent fracture cases, including the present one, who developed in-stent stenosis resulted from stent fracture. Two major anatomy features of renal artery stenosis were suggestive for development of stent fracture: (1) renal artery entrapment by diaphragmatic crus, and (2) mobile kidney with acute angulation at proximal segment of the renal artery. It is important to detect this etiology of renal artery stenosis because stenting in these vessels may contribute to in-stent restenosis or stent fracture. Management of renal artery stent fracture, including endovascular treatment or aortorenal bypass, should be considered on a case-by-case basis in relation to clinical settings. Copyright 2009 Wiley-Liss, Inc.

Mechanical thrombectomy using Rotarex system and stent-in-stent placement for treatment of distal femoral artery occlusion secondary to stent fracture – a case report and literature review

International Nuclear Information System (INIS)

Dys, Krzysztof; Drelichowska-Durawa, Justyna; Dołega-Kozierowski, Bartosz; Lis, Michał; Sokratous, Kyriakos; Iwanowski, Wojciech; Drelichowski, Stanisław; Witkiewicz, Wojciech

2013-01-01

Treatment of peripheral arterial diseases may be distinguished into conservative and interventional management; the latter is divided into surgical and endovascular procedures. Management of peripheral artery stenosis and occlusion with vascular stents is associated with the risk of late complications such as restenosis, stent fracture or dislocation. A 62-year-old woman with generalized atherosclerosis, particularly extensive in lower limb arteries, was admitted to the Department of Angiology 11 months after having an endovascular procedure performed due to critical ischemia of left lower limb. Because of stent occlusion, a decision to perform angiographic examination of lower limb arteries was made. Examination revealed occlusion of the superficial femoral artery along its entire length, including previously implanted stents. Distal stent was fractured with slight dislocation of the proximal segment. A decision was made to perform mechanical thrombectomy using a Rotarex system followed by a stent-in-stent placement procedure. Follow-up angiography and ultrasound scan performed 24 hours after the procedure revealed a patent vessel with satisfactory blood flow. Nowadays, imaging diagnostics of peripheral artery stenosis involves non-invasive examinations such as ultrasound, minimally invasive examinations such as angio-MRI and MDCT, or invasive examinations such as DSA and IVUS. DSA examinations are used to confirm significant stenosis or occlusion of a vessel, particularly when qualifying a patient for endovascular treatment. Due to their anatomic location, the superficial femoral artery and the popliteal artery are subject to various forces e.g. those exerted by the working muscles. Mechanical thrombectomy and atherectomy are efficient methods of arterial recanalization used in the treatment of acute, subacute or even chronic occlusions or stenosis of peripheral vessels. Frequency of angioplasty and vascular stent implantation procedures is increased in patients

Stent grafting of acute hepatic artery bleeding following pancreatic head resection

International Nuclear Information System (INIS)

Stoupis, Christoforos; Ludwig, Karin; Triller, Juergen; Inderbitzin, Daniel; Do, Dai-Do

2007-01-01

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

53. Bilateral ductal stenting for nonconfluent pulmonary arteries in a newborn

Directory of Open Access Journals (Sweden)

K. Al Dhahri

2016-07-01

Full Text Available Bilateral PDA dependent pulmonary circulation with right and left pulmonary artery discontinuity is very rare. Limited data available for bilateral PDA stenting. Bilateral PDA stenting in nonconfluent pulmonary arteries is challenging procedure but can be considered as an option in the management of complex conditions like this. 12 days old Preterm (36 weeks gestation male baby with birth weight of 2.6 kg developed respiratory distress with severe cyanosis and desaturation upto 50%. Baby was intubated and started on Prostaglandin 0.05 mic/kg/mt. His saturation improved to 80%. Echocardiogram showed complex cyanotic heart disease, Situs ambiguous, dextrocardia, complete unbalanced AV septal defect, pulmonary atresia , nonconfluent small branch pulmonary arteries supplied by the bilateral patent ductus arteriosus (PDA from right aortic arch and all four pulmonary veins form a confluence and drain into superior vena cava(SVC through vertical vein with no obstruction. Baby was taken up for PDA stenting. descending aortogram showed right aortic arch with vertical tortuous duct to right pulmonary artery (RPA and another short duct with acute angle from left subclavian artery to left pulmonary artery (LPA . Both ducti stented with coronary stents. Vertical vein angiogram showed both lungs drain to a confluence and then to SVC via ascending vertical vein with no obstruction. After stenting lung perfusion improved and the baby was stable and maintained 80% saturation on room air. Bilateral PDA dependent pulmonary circulation with right and left pulmonary artery discontinuity is very rare. Our case is unique with Heterotaxy, TAPVC, Dextrocardia and double ducti. Eventhough bilateral ductal stenting is technically challenging it is successful through femoral artery approach.

Hemodynamics in stented vertebral artery ostial stenosis based on computational fluid dynamics simulations.

Science.gov (United States)

Qiao, Aike; Dai, Xuan; Niu, Jing; Jiao, Liqun

2016-01-01

Hemodynamic factors may affect the potential occurrence of in-stent restenosis (ISR) after intervention procedure of vertebral artery ostial stenosis (VAOS). The purpose of the present study is to investigate the influence of stent protrusion length in implantation strategy on the local hemodynamics of the VAOS. CTA images of a 58-year-old female patient with posterior circulation transient ischemic attack were used to perform a 3D reconstruction of the vertebral artery. Five models of the vertebral artery before and after the stent implantation were established. Model 1 was without stent implantation, Model 2-5 was with stent protruding into the subclavian artery for 0, 1, 2, 3 mm, respectively. Computational fluid dynamics simulations based on finite element analysis were employed to mimic the blood flow in arteries and to assess hemodynamic conditions, particularly the blood flow velocity and wall shear stress (WSS). The WSS and the blood flow velocity at the vertebral artery ostium were reduced by 85.33 and 35.36% respectively after stents implantation. The phenomenon of helical flow disappeared. Hemodynamics comparison showed that stent struts that protruded 1 mm into the subclavian artery induced the least decrease in blood speed and WSS. The results suggest that stent implantation can improve the hemodynamics of VAOS, while stent struts that had protruded 1 mm into the subclavian artery would result in less thrombogenesis and neointimal hyperplasia and most likely decrease the risk of ISR.

Subintimal stent placement in patients with long segment occlusion of the iliac artery

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Yu, Ho Jung; Kim, Young Hwan; Kim, Si Hyung; Ko, Sung Min; Choi, Jin Soo; Lee, Hyun Jin; Kim, Hyung Tae; Jo, Won Hyun [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of)

2008-01-15

We evaluated the technical feasibility and clinical efficacy of subintimal stent placement for long segment occlusion of the iliac artery. From March 2003 to February 2007, subintimal stent placement for long segment occlusion of the iliac artery of 24 limbs in 22 patients was analyzed retrospectively. Endovascular access was performed via the ipsilateral femoral artery in 7 cases, via the contralateral femoral artery in 6 cases, via both femoral arteries in 10 cases and via the brachial artery in one case. The SAFARI (subintimal arterial flossing with antegrade-retrograde intervention) technique using a microcatheter was performed to recannalize iliac artery occlusion in three cases. Medical records were reviewed for the collection of follow-up data. The stent patency rate was analyzed by use of the Kaplan-Meier method. Subintimal stent placement was technically successful in 23 of 24 procedures (95.8%). The mean ankle-brachial index (ABI) increased form 0.26 to 0.82. The Fontaine classification was improved after stent placement in all patients. Major complications occurred in four procedures: three distal embolizations and one arterial rupture. All of the complications were successfully treated by endovascular intervention. The primary stent patency rates at 6-months, 1-, 2-and 3-years were 95%, 88%, 88% and 88%, respectively. Subintimal stent placement is a safe and effective treatment for long segment occlusion of the iliac artery.

Incidence of New Ischaemic Brain Lesions After Carotid Artery Stenting with the Micromesh Roadsaver Carotid Artery Stent: A Prospective Single-Centre Study

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Ruffino, Maria Antonella, E-mail: mruffino@cittadellasalute.to.it [Azienda Ospedaliera Universitaria- Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, Vascular Radiology Unit, Department of Diagnostic Imaging and Radiotherapy (Italy); Faletti, Riccardo [University of Torino, Azienda Ospedaliera Universitaria- Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, Radiology Unit, Department of Surgical Sciences (Italy); Bergamasco, Laura [University of Torino, Azienda Ospedaliera Universitaria- Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, Department of Surgical Sciences (Italy); Fonio, Paolo [University of Torino, Azienda Ospedaliera Universitaria- Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, Radiology Unit, Department of Surgical Sciences (Italy); Righi, Dorico [Azienda Ospedaliera Universitaria- Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, Vascular Radiology Unit, Department of Diagnostic Imaging and Radiotherapy (Italy)

2016-11-15

AimsSeveral randomized trials of patients with carotid stenosis show increased adverse neurological events with stenting versus endarterectomy in the 30-day post-procedure. This study examines the incidence of new ischaemic lesions in patients treated in our centre using the new Roadsaver stent.Methods and resultsBetween September 2015 and January 2016, 23 consecutive patients (age 74.3 ± 7.3 years, 17.4 % female) underwent carotid artery stenting with the Roadsaver stent, a nitinol double-layer micromesh device. A distal protection device was used in all cases. Diffusion-weighted magnetic resonance imaging was performed 24 h before, and 24 h and 30 days after the procedure. The 24-h post-procedure imaging showed 15 new ipsilateral ischaemic lesions in 7 (30.4 %) patients: median volume 0.076 cm{sup 3} (interquartile range 0.065–0.146 cm{sup 3}). All lesions were asymptomatic. The 30-day imaging showed complete resolution of all lesions and no new ischaemic lesions. Follow-up clinical and ultrasound examinations at 30 days and 6 months recorded no adverse cardiac or cerebrovascular events.ConclusionsProtected stenting with micromesh Roadsaver stent showed good safety and efficacy in the treatment of carotid stenosis, with a low incidence of delayed embolic events and new ipsilateral ischaemic brain lesions. These preliminary results are encouraging, but need to be confirmed with larger populations.

Incidence of New Ischaemic Brain Lesions After Carotid Artery Stenting with the Micromesh Roadsaver Carotid Artery Stent: A Prospective Single-Centre Study

International Nuclear Information System (INIS)

Ruffino, Maria Antonella; Faletti, Riccardo; Bergamasco, Laura; Fonio, Paolo; Righi, Dorico

2016-01-01

AimsSeveral randomized trials of patients with carotid stenosis show increased adverse neurological events with stenting versus endarterectomy in the 30-day post-procedure. This study examines the incidence of new ischaemic lesions in patients treated in our centre using the new Roadsaver stent.Methods and resultsBetween September 2015 and January 2016, 23 consecutive patients (age 74.3 ± 7.3 years, 17.4 % female) underwent carotid artery stenting with the Roadsaver stent, a nitinol double-layer micromesh device. A distal protection device was used in all cases. Diffusion-weighted magnetic resonance imaging was performed 24 h before, and 24 h and 30 days after the procedure. The 24-h post-procedure imaging showed 15 new ipsilateral ischaemic lesions in 7 (30.4 %) patients: median volume 0.076 cm"3 (interquartile range 0.065–0.146 cm"3). All lesions were asymptomatic. The 30-day imaging showed complete resolution of all lesions and no new ischaemic lesions. Follow-up clinical and ultrasound examinations at 30 days and 6 months recorded no adverse cardiac or cerebrovascular events.ConclusionsProtected stenting with micromesh Roadsaver stent showed good safety and efficacy in the treatment of carotid stenosis, with a low incidence of delayed embolic events and new ipsilateral ischaemic brain lesions. These preliminary results are encouraging, but need to be confirmed with larger populations.

Changes in the mechanical environment of stenotic arteries during interaction with stents: computational assessment of parametric stent designs.

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Holzapfel, Gerhard A; Stadler, Michael; Gasser, Thomas C

2005-02-01

Clinical studies have identified factors such as the stent design and the deployment technique that are one cause for the success or failure of angioplasty treatments. In addition, the success rate may also depend on the stenosis type. Hence, for a particular stenotic artery, the optimal intervention can only be identified by studying the influence of factors such as stent type, strut thickness, geometry of the stent cell, and stent-artery radial mismatch with the wall. We propose a methodology that allows a set of stent parameters to be varied, with the aim of evaluating the difference in the mechanical environment within the wall before and after angioplasty with stenting. Novel scalar quantities attempt to characterize the wall changes inform of the contact pressure caused by the stent struts, and the stresses within the individual components of the wall caused by the stent. These quantities are derived numerically and serve as indicators, which allow the determination of the correct size and type of the stent for each individual stenosis. In addition, the luminal change due to angioplasty may be computed as well. The methodology is demonstrated by using a full three-dimensional geometrical model of a postmortem specimen of a human iliac artery with a stenosis using imaging data. To describe the material behavior of the artery, we considered mechanical data of eight different vascular tissues, which formed the stenosis. The constitutive models for the tissue components capture the typical anisotropic, nonlinear and dissipative characteristics under supra-physiological loading conditions. Three-dimensional stent models were parametrized in such a way as to enable new designs to be generated simply with regard to variations in their geometric structure. For the three-dimensional stent-artery interaction we use a contact algorithm based on smooth contact surfaces of at least C-continuity, which prevents numerical problems known from standard facet-based contact

Coronary artery aneurysm after stent implantation: acute and long-term results after percutaneous treatment with a stent graft.

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Rubartelli, Paolo; Terzi, Giacomo; Borgo, Lorenzo; Giachero, Corinna

2002-03-01

A patient with unstable angina was treated with elective Palmaz-Schatz stent implantation on a focal stenosis of the left circumflex artery. One year later, a large (13 mm in diameter) coronary artery aneurysm was diagnosed at angiography in the stented site. Intravascular ultrasound examination confirmed the presence of a true aneurysm located at the proximal end of the stent. The aneurysm was successfully treated with a Jostent Graft (Jomed Implantate) consisting of two slotted tube stainless steel stents supporting a polytetrafluoroethylene tube. The stent graft was implanted under intravascular ultrasound guidance. The 18-month angiographic follow-up showed good patency of the stent graft and complete exclusion of the aneurysm.

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

Flow Characteristics Near to Stent Strut Configurations on Femoropopliteal Artery

Science.gov (United States)

Paisal, Muhammad Sufyan Amir; Fadhil Syed Adnan, Syed; Taib, Ishkrizat; Ismail, Al Emran; Kamil Abdullah, Mohammad; Nordin, Normayati; Seri, Suzairin Md; Darlis, Nofrizalidris

2017-08-01

Femoropopiteal artery stenting is a common procedure suggested by medical expert especially for patient who is diagnosed with severe stenosis. Many researchers reported that the growth of stenosis is significantly related to the geometry of stent strut configuration. The different shapes of stent geometry are presenting the different flow pattern and re-circulation in stented femoropopliteal artery. The blood flow characteristics near to the stent geometry are predicted for the possibility of thrombosis and atherosclerosis to be formed as well as increase the growth of stenosis. Thus, this study aims to determine the flow characteristic near to stent strut configuration based on different hemodynamic parameters. Three dimensional models of stent and simplified femoropopliteal artery are modelled using computer aided design (CAD) software. Three different models of stent shapes; hexagon, circle and rectangle are simulated using computational fluid dynamic (CFD) method. Then, parametric study is implemented to predict the performance of stent due to hemodynamic differences. The hemodynamic parameters considered are pressure, velocity, low wall shear stress (WSSlow) and wall shear stress (WSS). From the observation, flow re-circulation has been formed for all simulated stent models which the proximal region shown the severe vortices. However, rectangular shape of stent strut (Type P3) shows the lowest WSSlow and the highest WSS between the range of 4 dyne/cm2 and 70 dyne/cm2. Stent Type P3 also shows the best hemodynamic stent performance as compare to others. In conclusion, Type P3 has a favourable result in hemodynamic stent performance that predicted less probability of thrombosis and atherosclerosis to be formed as well as reduces the growth of restenosis.

Stenting for peripheral artery disease of the lower extremities: an evidence-based analysis.

Science.gov (United States)

2010-01-01

-popliteal, crural and iliac artery stenosis or occlusion), does primary stenting provide immediate success compared to PTA?In individuals with PAD of the lower extremities (superficial femoral artery, infra-popliteal, crural and iliac artery stenosis or occlusion), is primary stenting associated with less complications compared to PTA?In individuals with PAD of the lower extremities (superficial femoral artery, infra-popliteal, crural and iliac artery stenosis or occlusion), does primary stenting compared to PTA reduce the rate of re-intervention?In individuals with PAD of the lower extremities (superficial femoral artery, infra-popliteal, crural and iliac artery stenosis or occlusion) is primary stenting more effective than PTA in improving clinical and hemodynamic success?Are drug eluting stents more effective than bare stents in improving patency, reducing rates of re-interventions or complications? A literature search was performed on February 2, 2010 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA). Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. The quality of evidence was assessed as high, moderate, low or very low according to GRADE methodology. English language full-reports from 1950 to January Week 3, 2010Comparative randomized controlled trials (RCTs), systematic reviews and meta-analyses of RCTsProven diagnosis of PAD of the lower extremities in all patients.Adult patients at least 18 years of age.Stent as at least one treatment arm.Patency, re-stenosis, re-intervention, technical success, hemodynamic (ABI) and clinical improvement and complications as at least an outcome. Non-randomized studiesObservational studies (cohort or retrospective studies) and

Short-term safety and efficacy of the biodegradable iron stent in mini-swine coronary arteries

Institute of Scientific and Technical Information of China (English)

WU Chao; QIU Hong; HU Xiao-ying; RUAN Ying-mao; TIAN Yi; CHU Yan; XU Xin-lin

2013-01-01

Background To overcome the drawbacks of permanent stents,biodegradable stents have been studied in recent years.The bioabsorbable polymer vascular scaffold (BVS) was the first bioabsorbable stent to undergo clinical trials,demonstrating safety and feasibility in the ABSORB studies.Iron can potentially serve as the biomaterial for biodegradable stents.This study aimed to assess the short-term safety and efficacy of a biodegradable iron stent in mini-swine coronary arteries.Methods Eight iron stents and eight cobalt chromium alloy (VISION) control stents were randomly implanted into the LAD and RCA of eight healthy mini-swine,respectively.Two stents of the same metal base were implanted into one animal.At 28 days the animals were sacrificed after coronary angiography,and histopathological examinations were performed.Results Histomorphometric measurements showed that mean neointimal thickness ((0.46±0.17) mm vs.(0.45±0.18)mm,P=0.878),neointimal area ((2.55±0.91) mm2 vs.(3.04±1.15) mm2,P=0.360) and percentage of area stenosis ((44.50±11.40)％ vs.(46.00±17.95)％,P=0.845) were not significantly different between the iron stents and VISION stents.There was no inflammation,thrombosis or necrosis in either group.The scanning electron microscopy (SEM) intimal injury scores (0.75±1.04 vs.0.88±0.99,P=0.809) and number of proliferating cell nuclear antigen (PCNA) positive staining cells were not significantly different between the two groups.The percentage of neointimal coverage by SEM examination was numerically higher in iron stents than in VISION stents ((84.38±14.50)％ vs.(65.00±22.04)％,P=0.057),but the difference was not statistically significant.Iron staining in the tissue surrounding the iron stents at 28 days was positive and the vascular wall adjacent to the iron stent had a brownish tinge,consistent with iron degradation.No abnormal histopathological changes were detected in coronary arteries or major organs.Conclusions The biodegradable iron stent has

Imaging of coronary artery stents using multislice computed tomography: in vitro evaluation

International Nuclear Information System (INIS)

Maintz, David; Juergens, Kai-Uwe; Heindel, Walter; Fischbach, Roman; Wichter, Thomas; Grude, Matthias

2003-01-01

The aim of this study was to evaluate imaging features of different coronary artery stents during multislice CT Angiography (MSCTA). Nineteen stents made of varying material (steel, nitinol, tantalum) and of varying stent design were implanted in plastic tubes with an inner diameter of 3 mm to simulate a coronary artery. The tubes were filled with iodinated contrast material diluted to 200 Hounsfield units (HU), closed at both ends and positioned in a plastic container filled with oil (-70 HU). The MSCT scans were obtained perpendicular to the stent axes (detector collimation 4 x 1 mm, table feed 2 mm/rotation, 300 mAs, 120 kV). Axial images and multiplanar reformations were evaluated regarding artifact size, lumen visibility, and intraluminal attenuation values. Artifacts characterized by artifactual thickening of the stent struts leading to apparent reduction in the lumen diameter and increased intraluminal attenuation values were observed in all cases. The stent lumen was totally obscured in the Wiktor stent, the Wallgraft stent, and the Nir Royal stent. Partial residual of the stent lumen could be visualized in all other utilized stent products (artificial lumen reductions ranged from 62% in the V-Flex stent to 94% in the Bx Velocity stent). Parts of the stent lumen can be visualized in most coronary artery stents; however, detectability of in-stent stenoses remains to be evaluated for each stent type. (orig.)

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)

Primary stenting as emergency therapy in acute basilar artery occlusion

International Nuclear Information System (INIS)

Spreer, Joachim; Arnold, Sebastian; Klisch, Joachim; Schumacher, Martin; Els, Thomas; Hetzel, Andreas; Huppertz, Hans-Juergen; Oehm, Eckhardt

2002-01-01

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

Feasibility of Angioplasty and Stenting for Abdominal Aortic Lesions Adjacent to Previously Stented Visceral Artery Lesions in Patients with Takayasu Arteritis

International Nuclear Information System (INIS)

Joseph, George; George, Paul V.; Pati, Purendra Kumar; Chandy, Sunil Thomas

2007-01-01

Two young female patients with Takayasu arteritis presented with symptomatic long-segment abdominal aortic stenosis in the vicinity of previously deployed celiac and renal artery stents that projected markedly into the narrowed aortic lumen. Crushing or distortion of the visceral artery stents during aortic angioplasty was avoided by performing simultaneous or alternating balloon dilatations in the aorta and in the visceral artery stents. Consequently, the visceral artery stents remained patent and shortened longitudinally, allowing unhindered deployment of Wallstents in the adjacent aorta and abolition of a pressure gradient across the aortic lesions. Access to side branches covered by the Wallstent was obtained without difficulty, enabling the performance of balloon dilatation in multiple side branches and ostial stent deployment in a renal artery. These techniques could increase the scope of endovascular therapy in the treatment of patients with Takayasu arteritis

Treatment of carotid artery aneurysms with covered stents; Aneurysmabehandlung der Arteria carotis interna mit gecoverten Stents

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Rohr, A.; Alfke, K.; Doerner, L.; Jansen, O. [UKSH Kiel (Germany). Neurochirurgie Neuroradiologie; Bartsch, T.; Stingele, R. [UKSH Kiel (Germany). Neurologie

2007-10-15

Purpose: Evaluation of the use of covered stents in treating pseudoaneurysms of the cervical and intracranial/extradural carotid artery and determination of the periprocedural and short- to mid-term complication rate. Materials and Methods: 8 patients with 9 spontaneous dissecting aneurysms of the cervical carotid artery - 5 of which were symptomatic - plus one patient with ofthalmoplegia due to an aneurysm of the cavernous carotid artery were studied. While the latter was treated with a PTFE-covered balloon-mounted stainless steel stent (Jostent/Graftmaster), a self-expanding PTFE-covered Nitonol Stent (Symbiot) was used in all other cases. Intervention was performed with local anesthesia. Aspirin and Clopidogrel were both used as antiplatelet drugs. Clinical signs and symptoms and vascular imaging with DS, MR, CT angiography and ultrasound were recorded during patient follow-up, with a mean follow-up period of 14.6 months (4 - 30). Results: We were able to treat 8 out of 10 aneurysms (80 %) using covered stents. The aneurysms were immediately occluded and the associated stenoses of the parent vessel were eliminated. No clinically relevant complications occurred during the procedure or in the follow-up interval. In two cases, elongation of the carotid artery prevented the stent from being positioned over the aneurysm neck. These cases were shown to be stable with the use of antiplatelet drugs. Conclusion: Covered stents can be used in the treatment of pseudoaneurysms of the carotid artery as an alternative to long-term antithrombotic medication or surgery. In our study treatment was effective (80 %) and free of complications in the short- and mid-term follow-up. Possible indications, technique and the use of imaging modalities for patient follow-up are discussed. (orig.)

[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.

The use of coronary stent in hepatic artery stenosis after orthotopic liver transplantation

International Nuclear Information System (INIS)

Huang Mingsheng; Shan Hong; Jiang Zaibo; Li Zhengran; Zhu Kangshun; Guan Shouhai; Qian Jiesheng; Chen Guihua; Lu Minqiang; Yang Yang

2006-01-01

Purpose: This retrospective study was undertaken to evaluate the effectiveness of coronary stent placement in hepatic artery stenosis after orthotopic liver transplantation (OLT). Materials and methods: Of 430 consecutive adult orthotopic liver transplant recipients between November 2003 and September 2005, 17 had hepatic artery stenosis (HAS). Fourteen of them underwent coronary stent placement in the HAS. The technical results, complications, hepatic artery patency and clinical outcome were reviewed. Results: Technical and immediate success was 100%. After a mean follow-up of 159.4 days (range, 9-375 days), all patients obtained patent hepatic arteries except 2 patients occurred hepatic artery restenoses at 26 and 45 days after stent placement, respectively. Kaplan-Meier curve of patency showed cumulated stent patency at 3, 6, and 12 months of 78%, 58% and 45%, respectively. During the follow-up, 8 patients survived, 5 died of septic multiple-organ failure, 1 received retransplantation because of refractory biliary infection. Hepatic artery dissection induced by a guiding catheter occurred in one patient and was successfully treated with a coronary stent. Conclusion: Hepatic artery stenosis after OLT can be successfully treated with coronary stent placement with low complication rate and an acceptable 1-year hepatic artery patency rate

Nitinol Stents in the Femoropopliteal Artery: A Mechanical Perspective on Material, Design, and Performance

Science.gov (United States)

Maleckis, Kaspars; Anttila, Eric; Aylward, Paul; Poulson, William; Desyatova, Anastasia; MacTaggart, Jason; Kamenskiy, Alexey

2018-01-01

Endovascular stenting has matured into a commonly used treatment for peripheral arterial disease (PAD) due to its minimally invasive nature and associated reductions in short-termmorbidity and mortality. The mechanical properties of the superelastic Nitinol alloy have played a major role in the explosion of peripheral artery stenting, with modern stents demonstrating reasonable resilience and durability. Yet in the superficial femoral and popliteal arteries, even the newest generation Nitinol stents continue to demonstrate clinical outcomes that leave significant room for improvement. Restenosis and progression of native arterial disease often lead to recurrence of symptoms and reinterventions that increase morbidity and health care expenditures. One of the main factors thought to be associated with stent failure in the femoropopliteal artery (FPA) is the unique and highly dynamic mechanical environment of the lower limb. Clinical and experimental data demonstrate that the FPA undergoes significant deformations with limb flexion. It is hypothesized that the inability of many existing stent designs to conform to these deformations likely plays a role in reconstruction failure, as repetitive movements of the leg and thigh combine with mechanical mismatch between the artery and the stent and result in mechanical damage to both the artery and the stent. In this review we will identify challenges and provide a mechanical perspective of FPA stenting, and then discuss current research directions with promise to provide a better understanding of Nitinol, specific features of stent design, and improved characterization of the biomechanical environment of the FPA to facilitate development of better stents for patients with PAD. PMID:29470746

Nitinol Stents in the Femoropopliteal Artery: A Mechanical Perspective on Material, Design, and Performance.

Science.gov (United States)

Maleckis, Kaspars; Anttila, Eric; Aylward, Paul; Poulson, William; Desyatova, Anastasia; MacTaggart, Jason; Kamenskiy, Alexey

2018-05-01

Endovascular stenting has matured into a commonly used treatment for peripheral arterial disease (PAD) due to its minimally invasive nature and associated reductions in short-term morbidity and mortality. The mechanical properties of the superelastic Nitinol alloy have played a major role in the explosion of peripheral artery stenting, with modern stents demonstrating reasonable resilience and durability. Yet in the superficial femoral and popliteal arteries, even the newest generation Nitinol stents continue to demonstrate clinical outcomes that leave significant room for improvement. Restenosis and progression of native arterial disease often lead to recurrence of symptoms and reinterventions that increase morbidity and health care expenditures. One of the main factors thought to be associated with stent failure in the femoropopliteal artery (FPA) is the unique and highly dynamic mechanical environment of the lower limb. Clinical and experimental data demonstrate that the FPA undergoes significant deformations with limb flexion. It is hypothesized that the inability of many existing stent designs to conform to these deformations likely plays a role in reconstruction failure, as repetitive movements of the leg and thigh combine with mechanical mismatch between the artery and the stent and result in mechanical damage to both the artery and the stent. In this review we will identify challenges and provide a mechanical perspective of FPA stenting, and then discuss current research directions with promise to provide a better understanding of Nitinol, specific features of stent design, and improved characterization of the biomechanical environment of the FPA to facilitate development of better stents for patients with PAD.

Treatment of splenic artery aneurysm with double overlapping bare stents: case report

International Nuclear Information System (INIS)

Kwak, Hyo Sung; Han, Young Min; Jin, Gong Yong

2004-01-01

The traditional treatment of splenic artery aneurysm (SAA) is generally surgery and/or transcatheter arterial embolization, but recently, the treatment of SAA using a stent graft has been reported. However, the acute angle of the celiac axis, as well as the tortuous path of the splenic artery makes the use of stent graft difficult for treatment of aneurysma. We report here a case of SAA treated with the technique of double overlapping metallic stents

Endovascular stent-assisted thrombolysis in acute occlusive carotid artery dissection

Energy Technology Data Exchange (ETDEWEB)

Mourand, Isabelle [Hopital Gui de Chauliac, Department of Neurology, CHU Montpellier, Montpellier, Cedex 5 (France); Hopital Gui de Chauliac, Department of Neurology, Service de Neurologie, Montpellier, Cedex 5 (France); Brunel, Herve; Vendrell, Jean-Francois; Bonafe, Alain [Hopital Gui de Chauliac, Department of Neuroradiology, CHU Montpellier, Montpellier, Cedex 5 (France); Thouvenot, Eric [Hopital Gui de Chauliac, Department of Neurology, CHU Montpellier, Montpellier, Cedex 5 (France)

2010-02-15

Internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion may be responsible for large cerebral infarction that carries a general poor prognosis. Recanalization of internal carotid artery (ICA) dissection by stent-assisted thrombolysis has been recently proposed. We report two cases of acute symptomatic ICA dissection with tandem occlusion successfully treated with emergent endovascular stent-assisted thrombolysis using new self-expandable intracranial stents. A 37-year-old woman and a 59-year-old man were admitted in our hospital after acute severe symptoms of right-hemispheric stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 15 and 18, respectively. In both cases, magnetic resonance angiography showed tandem occlusion and angiography confirmed tandem occlusion with ICA dissection. An extensive mismatch region was diagnosed by Perfusion-diffusion MRI of the brain within 3 h after symptoms onset. Treatment was initiated 4 h after symptom onset by implantation of self-expandable intracranial stents into the dissected ICA and administration of intra-arterial recombinant tissue plasminogen activator. Recanalization of the ICA and middle cerebral artery (MCA) was accomplished within 6 h after symptoms onset. In both cases, no periprocedural complication was observed and follow-up CT scan showed only a mild brain infarct in the MCA territory. After, respectively, 12 and 10 months follow-up, patients had a favorable outcome with NIHSS 0 and mRS {<=}1. Endovascular stent-assisted thrombolysis appears to be a promising treatment in tandem occlusion due to ICA dissection. Our work underline the potential use of self-expandable intracranial stents in symptomatic acute ICA dissection. (orig.)

Time-dependent 3D simulations of the hemodynamics in a stented coronary artery

International Nuclear Information System (INIS)

Faik, Isam; Mongrain, Rosaire; Leask, Richard L; Rodes-Cabau, Josep; Larose, Eric; Bertrand, Olivier

2007-01-01

Stenting is becoming the major interventional cardiology procedure worldwide. However restenosis remains a major limitation to the effectiveness of stents. Alterations to the local hemodynamics in the stented segment of the artery could be a potential factor in the development of in-stent restenosis. The characterization of wall shear stress and of blood flow patterns in a stented artery is therefore necessary for a good understanding of the role of hemodynamics in the development of in-stent restenosis. We have used a time-dependent 3D numerical model of a stented coronary artery to study the characteristics of the blood flow and the shear stress distribution. Our results show that the presence of the stent produces significant secondary flow that is limited to an annulus in the near wall region. Low shear stress zones were localized in the vicinity of the struts while the tips of the struts exhibited high values of shear stress. These results support the hypothesis that local hemodynamics may affect the development of in-stent restenosis and could influence the choice of stent geometries for future stent designs

Randomized Comparison of Ridaforolimus- and Zotarolimus-Eluting Coronary Stents in Patients With Coronary Artery Disease: Primary Results From the BIONICS Trial (BioNIR Ridaforolimus-Eluting Coronary Stent System in Coronary Stenosis).

Science.gov (United States)

Kandzari, David E; Smits, Pieter C; Love, Michael P; Ben-Yehuda, Ori; Banai, Shmuel; Robinson, Simon D; Jonas, Michael; Kornowski, Ran; Bagur, Rodrigo; Iniguez, Andres; Danenberg, Haim; Feldman, Robert; Jauhar, Rajiv; Chandna, Harish; Parikh, Manish; Perlman, Gidon Y; Balcells, Mercedes; Markham, Peter; Ozan, Melek Ozgu; Genereux, Philippe; Edelman, Elazer R; Leon, Martin B; Stone, Gregg W

2017-10-03

The safety and efficacy of a novel cobalt alloy-based coronary stent with a durable elastomeric polymer eluting the antiproliferative agent ridaforolimus for treatment of patients with coronary artery disease is undetermined. A prospective, international 1:1 randomized trial was conducted to evaluate in a noninferiority design the relative safety and efficacy of ridaforolimus-eluting stents (RESs) and slow-release zotarolimus-eluting stents among 1919 patients undergoing percutaneous coronary intervention at 76 centers. Inclusion criteria allowed enrollment of patients with recent myocardial infarction, total occlusions, bifurcations lesions, and other complex conditions. Baseline clinical and angiographic characteristics were similar between the groups. Overall, mean age was 63.4 years, 32.5% had diabetes mellitus, and 39.7% presented with acute coronary syndromes. At 12 months, the primary end point of target lesion failure (composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization) was 5.4% for both devices (upper bound of 1-sided 95% confidence interval 1.8%, P noninferiority =0.001). Definite/probable stent thrombosis rates were low in both groups (0.4% RES versus 0.6% zotarolimus-eluting stent, P =0.75); 13-month angiographic in-stent late lumen loss was 0.22±0.41 mm and 0.23±0.39 mm ( P noninferiority =0.004) for the RES and zotarolimus-eluting stent groups, respectively, and intravascular ultrasound percent neointimal hyperplasia was 8.10±5.81 and 8.85±7.77, respectively ( P noninferiority =0.01). In the present trial, which allowed broad inclusion criteria, the novel RESs met the prespecified criteria for noninferiority compared with zotarolimus-eluting stents for the primary end point of target lesion failure at 12 months and had similar measures of late lumen loss. These findings support the safety and efficacy of RESs in patients who are representative of clinical practice. URL: http

Experimental research of covered stent implanted in canine hepatic artery

International Nuclear Information System (INIS)

Zhou Bing; Liu Linxiang; Li Minghua; Wang Yongli; Cheng Yongde

2007-01-01

Objective: To evaluate the feasibility of success rate of implantation, post-procedure stenosis rate, apposition ability and endothelialization level, etc. for implantation with balloon-expandable covered stent in canine hepatic artery. Methods: 8 adult canines were implanted with balloon-expendable stents covered by expandable poly Teflon ester membrane (e-PTFEM). Follow-up DSA was performed immediately, 2, 4 and 12 wk after the procedure. The canines were sacrificed for histopathologic examination and statistical analysis with correlation of implantation manenvor and angiographic manifestations. Results: 8 cases were all implanted with the covered stents in proper hepatic artery/right hepatic artery successfully; showing good apposition ability and non-opacification of the separated branches. 2 cases showed intraluminal obvious stenosis( > 50%)of the stent at 2 weeks follow-up, so did 3 cases at 12 weeks follow-up, and the total stenosis rate was 37.5% and 5 cases manifested full endothelialization (3 different locations of the sample all manifested full endothelialization), 3 cased manifested partial endothelialization (at least 1 location of the sample didn't show full endothelialization), and the two terminal parts were easier to get endothelialization than the central part. Before and after the stent implantation, hepatic function of all cases didn't demonstrate any obvious changes. Conclusions: Balloon-expandable covered stent can be implanted in canine hepatic artery. successfully, with good apposition ability, full endothelialization, and no influence on hepatic function. (authors)

Endovascular stent-assisted thrombolysis in acute occlusive carotid artery dissection

International Nuclear Information System (INIS)

Mourand, Isabelle; Brunel, Herve; Vendrell, Jean-Francois; Bonafe, Alain; Thouvenot, Eric

2010-01-01

Internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion may be responsible for large cerebral infarction that carries a general poor prognosis. Recanalization of internal carotid artery (ICA) dissection by stent-assisted thrombolysis has been recently proposed. We report two cases of acute symptomatic ICA dissection with tandem occlusion successfully treated with emergent endovascular stent-assisted thrombolysis using new self-expandable intracranial stents. A 37-year-old woman and a 59-year-old man were admitted in our hospital after acute severe symptoms of right-hemispheric stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 15 and 18, respectively. In both cases, magnetic resonance angiography showed tandem occlusion and angiography confirmed tandem occlusion with ICA dissection. An extensive mismatch region was diagnosed by Perfusion-diffusion MRI of the brain within 3 h after symptoms onset. Treatment was initiated 4 h after symptom onset by implantation of self-expandable intracranial stents into the dissected ICA and administration of intra-arterial recombinant tissue plasminogen activator. Recanalization of the ICA and middle cerebral artery (MCA) was accomplished within 6 h after symptoms onset. In both cases, no periprocedural complication was observed and follow-up CT scan showed only a mild brain infarct in the MCA territory. After, respectively, 12 and 10 months follow-up, patients had a favorable outcome with NIHSS 0 and mRS ≤1. Endovascular stent-assisted thrombolysis appears to be a promising treatment in tandem occlusion due to ICA dissection. Our work underline the potential use of self-expandable intracranial stents in symptomatic acute ICA dissection. (orig.)

Fenestrated Stent Graft Repair of Abdominal Aortic Aneurysm: Hemodynamic Analysis of the Effect of Fenestrated Stents on the Renal Arteries

Energy Technology Data Exchange (ETDEWEB)

Sun, Zhonghua; Chaichana, Thanapong [Curtin University of Technology, Perth (Australia)

2010-02-15

We wanted to investigate the hemodynamic effect of fenestrated stents on the renal arteries with using a fluid structure interaction method. Two representative patients who each had abdominal aortic aneurysm that was treated with fenestrated stent grafts were selected for the study. 3D realistic aorta models for the main artery branches and aneurysm were generated based on the multislice CT scans from two patients with different aortic geometries. The simulated fenestrated stents were designed and modelled based on the 3D intraluminal appearance, and these were placed inside the renal artery with an intra-aortic protrusion of 5.0-7.0 mm to reflect the actual patients' treatment. The stent wire thickness was simulated with a diameter of 0.4 mm and hemodynamic analysis was performed at different cardiac cycles. Our results showed that the effect of the fenestrated stent wires on the renal blood flow was minimal because the flow velocity was not significantly affected when compared to that calculated at pre-stent graft implantation, and this was despite the presence of recirculation patterns at the proximal part of the renal arteries. The wall pressure was found to be significantly decreased after fenestration, yet no significant change of the wall shear stress was noticed at post-fenestration, although the wall shear stress was shown to decrease slightly at the proximal aneurysm necks. Our analysis demonstrates that the hemodynamic effect of fenestrated renal stents on the renal arteries is insignificant. Further studies are needed to investigate the effect of different lengths of stent protrusion with variable stent thicknesses on the renal blood flow, and this is valuable for understanding the long-term outcomes of fenestrated repair.

Fenestrated Stent Graft Repair of Abdominal Aortic Aneurysm: Hemodynamic Analysis of the Effect of Fenestrated Stents on the Renal Arteries

International Nuclear Information System (INIS)

Sun, Zhonghua; Chaichana, Thanapong

2010-01-01

We wanted to investigate the hemodynamic effect of fenestrated stents on the renal arteries with using a fluid structure interaction method. Two representative patients who each had abdominal aortic aneurysm that was treated with fenestrated stent grafts were selected for the study. 3D realistic aorta models for the main artery branches and aneurysm were generated based on the multislice CT scans from two patients with different aortic geometries. The simulated fenestrated stents were designed and modelled based on the 3D intraluminal appearance, and these were placed inside the renal artery with an intra-aortic protrusion of 5.0-7.0 mm to reflect the actual patients' treatment. The stent wire thickness was simulated with a diameter of 0.4 mm and hemodynamic analysis was performed at different cardiac cycles. Our results showed that the effect of the fenestrated stent wires on the renal blood flow was minimal because the flow velocity was not significantly affected when compared to that calculated at pre-stent graft implantation, and this was despite the presence of recirculation patterns at the proximal part of the renal arteries. The wall pressure was found to be significantly decreased after fenestration, yet no significant change of the wall shear stress was noticed at post-fenestration, although the wall shear stress was shown to decrease slightly at the proximal aneurysm necks. Our analysis demonstrates that the hemodynamic effect of fenestrated renal stents on the renal arteries is insignificant. Further studies are needed to investigate the effect of different lengths of stent protrusion with variable stent thicknesses on the renal blood flow, and this is valuable for understanding the long-term outcomes of fenestrated repair

Carotid artery stenting: Rationale, technique, and current concepts

International Nuclear Information System (INIS)

Yilmaz, Hasan; Pereira, Vitor Mendes; Narata, Ana-Paula; Sztajzel, Roman; Lovblad, Karl-Olof

2010-01-01

Carotid stenosis is a major risk factor for stroke. With the aging of the general population and the availability of non-invasive vascular imaging studies, the diagnosis of a carotid plaque is commonly made in medical practice. Asymptomatic and symptomatic carotid stenoses need to be considered separately because their natural history is different. Two large randomized controlled trials (RCTs) showed the effectiveness of carotid endarterectomy (CEA) in preventing ipsilateral ischemic events in patients with symptomatic severe stenosis. The benefit of surgery is much less for moderate stenosis and harmful in patients with stenosis less than 50%. Surgery has a marginal benefit in patients with asymptomatic stenosis. Improvements in medical treatment must be taken into consideration when interpreting the results of these previous trials which compared surgery against medical treatment available at the time the trials were conducted. Carotid artery stenting (CAS) might avoid the risks associated with surgery, including cranial nerve palsy, myocardial infarction, or pulmonary embolism. Therefore and additionally to well-established indications of CAS, this endovascular approach might be a valid alternative particularly in patients at high surgical risk. However, trials of endovascular treatment of carotid stenosis have failed to provide enough evidence to justify routine CAS as an alternative to CEA in patients suitable for surgery. More data from ongoing randomized trials of CEA versus CAS will be soon available. These results will help determining the role of CAS in the management of patients with carotid artery stenosis.

Factors that affect mass transport from drug eluting stents into the artery wall

Directory of Open Access Journals (Sweden)

Walsh Michael T

2010-03-01

Full Text Available Abstract Coronary artery disease can be treated by implanting a stent into the blocked region of an artery, thus enabling blood perfusion to distal vessels. Minimally invasive procedures of this nature often result in damage to the arterial tissue culminating in the re-blocking of the vessel. In an effort to alleviate this phenomenon, known as restenosis, drug eluting stents were developed. They are similar in composition to a bare metal stent but encompass a coating with therapeutic agents designed to reduce the overly aggressive healing response that contributes to restenosis. There are many variables that can influence the effectiveness of these therapeutic drugs being transported from the stent coating to and within the artery wall, many of which have been analysed and documented by researchers. However, the physical deformation of the artery substructure due to stent expansion, and its influence on a drugs ability to diffuse evenly within the artery wall have been lacking in published work to date. The paper highlights previous approaches adopted by researchers and proposes the addition of porous artery wall deformation to increase model accuracy.

Mechanical Recanalization of Cerebral Artery Embolic Occlusion Using a Self-Expanding Stent: Experimental Analysis in Canine Model

International Nuclear Information System (INIS)

Choi, Jin Woo; Kim, Snag Joon; Lee, Deok Hee; Suh, Dae Chul

2011-01-01

To evaluate the feasibility of a self-expanding stent for acute embolic occlusion, and recanalization mechanism by histologic examination. Five mongrel dogs were used as study subjects. Each vertebral artery was occluded, and a self-expanding stent was used for recanalization. We evaluated the technical success rate for the placement of the stent to the targeted vessel, the recanalization rate, and residual stenosis. We obtained two specimens of the stented vertebral arteries for histologic evaluation. One dog died of an unknown cause during the induction of anesthesia. In two dogs, only one side of the vertebral artery was used, whereas both vertebral arteries were used in the remaining dogs. A total of six vertebral arteries were successfully occluded. The technical success rate for stenting without complication was 66.7%. The immediate recanalization rate after stenting was 100%. The residual stenosis was 35.6 ± 18.6%. On microscopic examination, the stent concentrically displaced the clot and the clot was captured between the stent mesh and arterial wall. Self-expanding stents were effective in revascularizing the cerebrovascular embolic occlusion. The self-expanding stent seemed to achieve recanalization by pushing the clot to the arterial wall and capturing the clot between the stent mesh and arterial wall.

Mechanical Recanalization of Cerebral Artery Embolic Occlusion Using a Self-Expanding Stent: Experimental Analysis in Canine Model

Energy Technology Data Exchange (ETDEWEB)

Choi, Jin Woo; Kim, Snag Joon; Lee, Deok Hee; Suh, Dae Chul [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

2011-07-15

To evaluate the feasibility of a self-expanding stent for acute embolic occlusion, and recanalization mechanism by histologic examination. Five mongrel dogs were used as study subjects. Each vertebral artery was occluded, and a self-expanding stent was used for recanalization. We evaluated the technical success rate for the placement of the stent to the targeted vessel, the recanalization rate, and residual stenosis. We obtained two specimens of the stented vertebral arteries for histologic evaluation. One dog died of an unknown cause during the induction of anesthesia. In two dogs, only one side of the vertebral artery was used, whereas both vertebral arteries were used in the remaining dogs. A total of six vertebral arteries were successfully occluded. The technical success rate for stenting without complication was 66.7%. The immediate recanalization rate after stenting was 100%. The residual stenosis was 35.6 {+-} 18.6%. On microscopic examination, the stent concentrically displaced the clot and the clot was captured between the stent mesh and arterial wall. Self-expanding stents were effective in revascularizing the cerebrovascular embolic occlusion. The self-expanding stent seemed to achieve recanalization by pushing the clot to the arterial wall and capturing the clot between the stent mesh and arterial wall.

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.

Risk factors for in-stent restenosis of vertebral artery origin after stent implantation: a Meta-analysis

Directory of Open Access Journals (Sweden)

Fang-fang HAO

2018-01-01

Full Text Available Objective To systematically review the risk factors for in-stent restenosis (ISR of vertebral artery origin after sent implantation to provide theoretical foundation for clinical prevention and treatment. Methods Taking vertebral artery, vertebrobasilar insufficiency, stents, drug-eluting stents, self expandable metallic stents in English and Chinese as key words, retrospective clinical studies about risk factors for ISR of vertebral artery origin were searched by using PubMed, EMBASE/SCOPUS, Cochrane Library, China Biology Medicine (CBM, China National Knowledge Infrastructure (CNKI, Wanfang Data and VIP database from January 1, 1966 to March 30, 2017. Quality assessment and Meta-analysis were made by using Newcastle-Ottawa Scale (NOS and Stata 12.0 software. Results The research enrolled 3468 articles in all, from which 11 studies were chosen after excluding duplicates and those not meeting the inclusion criteria. A total number of 1352 patients were divided into ISR group (N = 440 and non-ISR group (N = 912. The ISR incidence rate of smokers was significantly higher than non-smokers (OR = 2.179, 95%CI: 1.373-3.458; P = 0.001. The differences of bare metal stents (BMS utilization rate (OR = 2.072, 95% CI: 1.560-2.753; P = 0.000 and drug-eluting stents (DES utilization rate (OR = 0.483, 95% CI: 0.363-0.641; P = 0.000 between ISR group and non-ISR group were statistically significant. Conclusions Smoking and using BMS are risk factors for ISR of vertebral artery origin, and using DES is protective factor. Due to limited study quality, more high-quality studies are needed to verify this conclusion. DOI: 10.3969/j.issn.1672-6731.2017.12.004

Self-Expandable Stent Placement in Infrapopliteal Arteries After Unsuccessful Angioplasty Failure: One-Year Follow-up

International Nuclear Information System (INIS)

Peregrin, J. H.; Smirova, S.; Koznar, B.; Novotny, J.; Kovac, J.; Lastovickova, J.; Skibova, J.

2008-01-01

The purpose of this prospective study was to evaluate whether stent placement in infrapopliteal arteries is helpful in failed percutaneous transluminal angioplasty (PTA). Infrapopliteal PTA was performed in 70 arteries of 66 patients with chronic critical lower limb ischemia. The group comprised 55 males and 11 females, with an average age of 63.4 (range, 42-82) years. Diabetes mellitus was present in 92.4% of patients. Only the palpable anterior tibial and posterior tibial arteries were evaluated. Stents (Xpert stent; Abbot Vascular, Redwood City, CA, USA) were placed in 16 arteries where PTA was not successful (the failure was defined as residual stenosis >30% after PTA). In 54 arteries simple PTA was performed and was technically successful. Twenty-four nondilated arteries with no significant stenosis served as a comparison group. The 12-month patency rate was evaluated according to a combination of palpation and Doppler ultrasound. In all cases stent placement restored the flow in the artery immediately after unsuccessful PTA. Twelve-month follow-up showed a patency rate of 82% in the PTA group, 78% in the stent group, and 69% in the comparison group. We conclude that stent placement in the case of unsuccessful infrapopliteal PTA changed technical failure to success and restored flow in the dilated artery. At 12-month follow-up the patency rate of infrapopliteal arteries stented for PTA failure did not differ significantly either from nonstented arteries with an optimal PTA result or from a comparison group of nonintervened arteries.

A Comparison of Stent Implant versus Medical Treatment for Severe Symptomatic Intracranial Stenosis: A Controlled Clinical Trial

Directory of Open Access Journals (Sweden)

Rezao Mohammadian

2012-11-01

Full Text Available Background: Atherosclerotic stenosis of the major intracranial arteries is the most common cause of ischemic stroke. There are limited treatments for severe intracranial stenosis, and stent placement versus medical treatment remains controversial. The aim of this study was to compare functional outcomes of these two modalities in patients with severe symptomatic intracranial stenosis. Methods: At a single center, between 2008 and 2011, patients with angiographically demonstrated severe (70–90% symptomatic intracranial atherosclerosis were divided into two groups: group A, which received only medical treatment, and group B, which underwent endovascular stent implant treatment. The severity and location of the stenosis was determined by digital subtraction angiography and the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID trial criteria in all patients. The exclusion criteria were: specific causes other than atherosclerosis, such as artery dissection, fibromuscular dysplasia, vasculitis, radiation and intracranial hemorrhage, focal neurological deficit that did not correlate to internal carotid artery or middle cerebral artery stenosis. All procedures were done under light anesthesia. Technical success was defined as the reduction of stenosis to Results: Overall, 63 patients (29 in group A and 34 in group B were evaluated and followed for a mean period of 15.22 months (range 6–25. The technical success rate was 97% in a total of 34 stents in 34 patients. There was no difference between the early (within 30 days adverse event rates of the two groups. The median follow-up duration for the stent implant patients was 15 months (range 6–25, and for the medically treated cohort it was 14 months (range 8–25. The re-stenosis rate was 5.8% and the total number of late (>30 days adverse events, including stroke, myocardial infarction and death, was 1 (2.9% and 6 (20.7% in the stent implant and medical groups, respectively (p = 0.042. The

Study on the effect of location of intracranial arterial stenosis on the safety of stenting

Directory of Open Access Journals (Sweden)

Yu-jie SUN

2017-11-01

Full Text Available Objective To investigate the effect of location of intracranial arterial stenosis on the safety of intracranial stenting. Methods A total of 73 patients with symptomatic intracranial atherosclerotic stenosis (ICAS were divided into intracranial internal carotid artery (IICA, N = 18, middle cerebral artery (MCA-M1 segment (MCA-M1, N = 11, intracranial vertebral artery (IVA, N = 27 and basilar artery (BA, N = 17. All of them underwent intracranial stenting. The improvement of intracranial arterial stenosis, cerebrovascular complications including perforating events, artery dissection, in-stent thrombosis, distal stent arterial embolism and cerebral hyperperfusion, and neurological complications including transient ischemic attack (TIA, ischemic stroke and intracranial hemorrhage were recorded. Modified Rankin Scale (mRS was used to evaluate the prognosis 30 d after operation. Results A total of 73 stents were implanted in 73 patients (35 Apollo balloon-expandable stents and 38 Wingspan self-expandable stents. Among them, 10 cases (10/18 were treated with Apollo stents and 8 cases (8/18 with Wingspan stents in IICA group, 5 cases (5/11 were treated with Apollo stents and 6 cases (6/11 with Wingspan stents in MCA-M1 group, 16 cases (59.26%, 16/27 were treated with Apollo stents and 11 cases (40.74%, 11/27 with Wingspan stents in IVA group, and 4 cases (4/17 were treated with Apollo stents and 13 cases (13/17 with Wingspan stents in BA group. No significant difference was seen in stent type among 4 groups (χ2 = 7.422, P = 0.201. The stenosis rate of IICA group after treatment [(10.94 ± 1.99%] was significantly improved than before treatment [(90.89 ± 7.71%; t = 69.545, P = 0.000]. The stenosis rate of MCA-M1 group after treatment [(10.37 ± 2.14%] was significantly improved than before treatment [(87.64 ± 9.46%; t = 26.000, P = 0.000]. The stenosis rate of IVA group after treatment [(11.02 ± 1.99% ] was significantly improved than before

Current global status of carotid artery stent placement.

Science.gov (United States)

Wholey, M H; Wholey, M; Bergeron, P; Diethrich, E B; Henry, M; Laborde, J C; Mathias, K; Myla, S; Roubin, G S; Shawl, F; Theron, J G; Yadav, J S; Dorros, G; Guimaraens, J; Higashida, R; Kumar, V; Leon, M; Lim, M; Londero, H; Mesa, J; Ramee, S; Rodriguez, A; Rosenfield, K; Teitelbaum, G; Vozzi, C

1998-05-01

Our purpose was to review the current status of carotid artery stent placement throughout the world. Surveys were sent to major interventional centers in Europe, North and South America, and Asia. Information from peer-reviewed journals was also included and supplemented the survey. The survey asked various questions regarding the patients enrolled, procedure techniques, and results of carotid stenting, including complications and restenosis. Of the centers which were sent surveys, 24 responded. The total number of endovascular carotid stent procedures that have been performed worldwide to date included 2,048 cases, with a technical success of 98.6%. Complications that occurred during carotid stent placement or within a 30-day period following placement were recorded. Overall, there were 63 minor strokes, with a rate of occurrence of 3.08%. The total number of major strokes was 27, for a rate of 1.32%. There were 28 deaths within a 30-day postprocedure period, resulting in a mortality rate of 1.37%. Restenosis rates of carotid stenting have been 4.80% at 6 mo. Endovascular stent treatment of carotid artery atherosclerotic disease is growing as an alternative to vascular surgery, especially for patients that are at high risk for standard carotid endarterectomy. The periprocedural risks for major and minor strokes and death are generally acceptable at this early stage of development.

Randomized Comparison of Paclitaxel-Eluting Balloon and Stenting Versus Plain Balloon Plus Stenting Versus Directional Atherectomy for Femoral Artery Disease (ISAR-STATH).

Science.gov (United States)

Ott, Ilka; Cassese, Salvatore; Groha, Philipp; Steppich, Birgit; Hadamitzky, Martin; Ibrahim, Tareq; Kufner, Sebastian; Dewitz, Karl; Hiendlmayer, Regina; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan; Fusaro, Massimiliano

2017-06-06

Atherosclerosis in the superficial femoral artery is common in patients suffering from peripheral artery disease. Paclitaxel-eluting balloon (PEB) angioplasty, stenting, and directional atherectomy (DA) have provided new options for the treatment of superficial femoral artery disease; however, the comparative efficacy of these interventional strategies remains uncertain. One hundred and fifty-five patients with symptomatic peripheral artery disease due to de novo superficial femoral artery stenotic or occlusive lesions were randomized to treatment with plain balloon angioplasty (BA) followed by PEB angioplasty and stenting (n=48), BA and stenting (n=52), or DA with distal protection and bailout stenting (n=55). The primary end point of the study was percentage diameter stenosis after 6 months measured by angiography. Other end points included target lesion revascularization, thrombosis, ipsilateral amputation, binary restenosis, and all-cause mortality at 6 and 24 months. Baseline and lesion characteristics were comparable in all groups with a mean lesion length of 65.9±46.8 mm and 56% total occlusions. At 6 months angiography, the percent diameter stenosis was significantly lower in patients treated by PEB angioplasty and stenting (34±31%) as compared with BA angioplasty and stenting (56±29%, P =0.009) or DA (55±29%, P =0.007). Similarly, binary restenosis was significantly lower after treatment with PEB and stenting as compared with BA and stenting or DA. Clinical follow-up at 24 months revealed a lower risk for target lesion revascularization after PEB angioplasty and stenting as compared with BA and stenting or DA. We found no difference in terms of target lesion thrombosis and mortality among groups, and no patient underwent amputation. Treatment of de novo superficial femoral artery lesions with PEB angioplasty and stenting is superior to BA angioplasty and stenting or DA in terms of angiographic diameter stenosis at 6 months and target lesion

Functional effects of renal artery stent placement on treated and contralateral kidneys.

NARCIS (Netherlands)

Leertouwer, T.C.; Derkx, F.H.M.; Pattynama, P.M.; Deinum, J.; Dijk, L.C. van; Schalekamp, M.A.D.H.

2002-01-01

BACKGROUND: This study examined the effects of stent placement for renal artery stenosis on the function of treated and contralateral kidneys. METHODS: Eighteen patients who underwent stent placement for unilateral renal artery stenosis presenting with hypertension and/or renal failure were studied

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

Combined Arterial Infusion and Stent Implantation Compared with Metal Stent Alone in Treatment of Malignant Gastroduodenal Obstruction

International Nuclear Information System (INIS)

Wang Zhongmin; Chen Kemin; Gong Ju; Zheng Yunfeng; Wang Tianxiang

2009-01-01

Many patients with malignant gastroduodenal obstruction have an unresectable primary lesion and distant metastases, which may prompt palliative management to allow the patient to eat and to improve the quality of life. Intraluminal metallic stent implantation (MSI) under fluoroscopic guidance has been reported to be an effective option for symptomatic relief in these patients, with a good safety record. An alternative, dual interventional therapy (DIT), has been used during the last decade, in which prosthesis insertion is followed by intra-arterial chemotherapy via the tumor-feeding arteries. The aim of this study was to compare success rates, complication rates, and survival time between MSI and DIT in patients who presented with gastroduodenal obstruction from advanced upper gastrointestinal tract cancer. All consecutive patients with malignant gastroduodenal obstruction seen at our center between October 2002 and August 2007 were retrospectively studied. Patients were treated palliatively by either MSI or DIT by the patient's or the next of kin's decision. Outcomes included technical and clinical success, complication rates, and survival. Of the 164 patients with malignant gastric and duodenal outlet obstructions, 80 (49%) underwent stent insertion as the primary therapy, while the remaining 84 (51%) received DIT. Clinical characteristics were similar between the two groups. In the MSI cohort initial stent implantation was successful in 73 patients (91%), two stents were used in 5 patients, and delayed additional stent insertion for stent obstruction related to tumor overgrowth was required in 3 patients during follow-up. In the DIT cohort the technical success rate was 94%, 3 patients required two stents, and stent obstruction occurred in 2 patients after initial stent placement. Early postprocedural clinical success, indicated by average dysphagia score, improved significantly in both groups: MSI group, from 4.56 to 1.51 (P < 0.01); and DIT group, from 4

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.)

Enterprise stent for waffle-cone stent-assisted coil embolization of large wide-necked arterial bifurcation aneurysms.

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Padalino, David J; Singla, Amit; Jacobsen, Walter; Deshaies, Eric M

2013-01-01

Large wide-necked arterial bifurcation aneurysms present a unique challenge for endovascular coil embolization treatment. One technique described in the literature deploys a Neuroform stent into the neck of the aneurysm in the shape of a waffle-cone, thereby acting as a scaffold for the coil mass. This case series presents four patients with large wide-necked bifurcation aneurysms treated with the closed-cell Enterprise stent using the waffle-cone technique. Four patients (59 ± 18 years of age) with large wide-necked arterial bifurcation aneurysms (three basilar apex and one MCA bifurcation) were treated with the waffle-cone technique using the Enterprise stent as a supporting device for stent-assisted coil embolization. Three of the patients presented with aneurysmal subarachnoid hemorrhage (Hunt-Hess 2-3; Fisher Grade 3-4). There was no procedural morbidity or mortality associated with treatment itself. One aneurysm was completely obliterated, and three had small residual necks. One patient developed an area of PCA infarct and visual field cut one month after the procedure and required recoiling of the residual neck. The flared ends of the Enterprise stent remodeled the aneurysm neck by conforming to the shape of the neck without any technical difficulty, resulting in a stable scaffold holding the coils into the aneurysm. The closed cell construction, flexibility, and flared ends of the Enterprise stent allow it to conform to the waffle-cone configuration and provide a stable scaffold for coil embolization of large wide-necked arterial bifurcation aneurysms. We have had excellent initial results using the Enterprise stent with the waffle-cone technique. However, this technique is higher risk than standard treatment methods and therefore should be reserved for large wide-necked bifurcation aneurysms where Y stenting is needed, but not possible, and surgical clip ligation is not an option.

Relationship between the Direction of Ophthalmic Artery Blood Flow and Ocular Microcirculation before and after Carotid Artery Stenting.

Science.gov (United States)

Ishii, Masashi; Hayashi, Morito; Yagi, Fumihiko; Sato, Kenichiro; Tomita, Goji; Iwabuchi, Satoshi

2016-01-01

When internal carotid artery stenosis is accompanied by ocular ischemic syndrome, intervention is recommended to prevent irreversible visual loss. In this study, we used laser speckle flowgraphy to measure the ocular microcirculation in the optic nerve head before and after carotid artery stenting (CAS) of 40 advanced internal carotid stenosis lesions from 37 patients. The aim was to investigate the relationship between ocular microcirculation and the direction of ophthalmic artery blood flow obtained by angiography. We found that there was a significant increase in blood flow after CAS ( P = 0.003). Peak systolic velocity as an indicator of the rate of stenosis was also significantly higher in the group with retrograde/undetected flow of the ophthalmic artery than in the group with antegrade flow ( P = 0.002). In all cases where retrograde flow of the ophthalmic artery was observed before stenting, the flow changed to antegrade after stenting. Through the use of laser speckle flowgraphy, this study found that CAS can improve ocular microcirculation. Furthermore, while patients displaying retrograde flow of the ophthalmic artery before stenting have a poor prognosis, CAS corrected the flow to antegrade, suggesting that visual loss can be prevented by improving the ocular microcirculation.

Assessment of coronary artery stent patency by electron-beam CT

International Nuclear Information System (INIS)

Knollmann, Friedrich D.; Felix, Roland; Moeller, Joerg; Gebert, Axel; Bethge, Christian

2004-01-01

Following coronary angioplasty and stent implantation, restenosis remains common and its outcome difficult to predict. We set out to determine the diagnostic accuracy of electron-beam computed tomography (EBCT) for the non-invasive detection of stent obstruction. In a prospective, blinded investigation, we included 152 coronary artery segments in 117 patients treated with a stent implant. All segments were evaluated by a dynamic EBCT study that depicted contrast bolus passage distal to the stent and a CT angiographic study of the entire coronary arteries. It was found that delayed contrast enhancement in the distal segment correlated with angiographic stent obstruction (Spearman's rank correlation, P=0.008), while all other indicators of stent occlusion did not correlate with angiographic diagnosis. However, direct comparison of patients with obstruction of less vs. more than 75% of luminal diameter did not yield any statistically significant differences of distal enhancement delay, and for the detection of >90% occlusion, the sensitivity was 72% at a specificity of 60%. Although delayed contrast enhancement distal to the stent upon EBCT did correlate with angiographical obstruction, the correlation did not suffice to appear clinically satisfactory. (orig.)

Assessment of coronary artery stent patency by electron-beam CT

Energy Technology Data Exchange (ETDEWEB)

Knollmann, Friedrich D.; Felix, Roland [Department of Radiology, Charite, Campus Virchow-Klinikum, Humboldt-University, Augustenburger Platz 1, 13353, Berlin (Germany); Moeller, Joerg; Gebert, Axel; Bethge, Christian [Department of Cardiology, Juedisches Krankenhaus, Berlin (Germany)

2004-08-01

Following coronary angioplasty and stent implantation, restenosis remains common and its outcome difficult to predict. We set out to determine the diagnostic accuracy of electron-beam computed tomography (EBCT) for the non-invasive detection of stent obstruction. In a prospective, blinded investigation, we included 152 coronary artery segments in 117 patients treated with a stent implant. All segments were evaluated by a dynamic EBCT study that depicted contrast bolus passage distal to the stent and a CT angiographic study of the entire coronary arteries. It was found that delayed contrast enhancement in the distal segment correlated with angiographic stent obstruction (Spearman's rank correlation, P=0.008), while all other indicators of stent occlusion did not correlate with angiographic diagnosis. However, direct comparison of patients with obstruction of less vs. more than 75% of luminal diameter did not yield any statistically significant differences of distal enhancement delay, and for the detection of >90% occlusion, the sensitivity was 72% at a specificity of 60%. Although delayed contrast enhancement distal to the stent upon EBCT did correlate with angiographical obstruction, the correlation did not suffice to appear clinically satisfactory. (orig.)

Low-profile stent placement with the monorail technique for treatment of renal artery stenosis: midterm results of a prospective trial.

Science.gov (United States)

Müller-Hülsbeck, Stefan; Frahm, Christian; Behm, Charlotte; Schäfer, Phillip Jobst; Bolte, Hendrik; Heller, Martin; Jahnke, Thomas

2005-07-01

To determine feasibility, safety, and midterm patency of a monorail balloon stent device for the treatment of renal artery stenosis (RAS). During a period of 30 months, 47 patients (with severe hypertension, n=45; renal insufficiency, n=20) with 50 cases of RAS and indications for stent implantation (calcified ostial lesion, n=41; insufficient percutaneous transluminal angioplasty, n=6; dissection, n=3) were enrolled into the prospective evaluation. After predilation, 59 stents (Rx-Herculink 4 mm, n=2; 5 mm, n=19; 6 mm, n=35; 7 mm, n=3) were implanted under manometer control with use of the long-sheath technique (5 F; 6 F for 7-mm stents) via a femoral (n=44) or transbrachial approach (n=6). Parameters of hypertension and renal insufficiency were determined before and after the procedure and for a maximum of 18 months. Restenosis rate was determined with color duplex ultrasonography. Renal artery stent placement (mean diameter, 5.7 mm; mean length, 16 mm) was technically successful in all cases (100%). Mean blood pressure and serum creatinine level decreased from 177/93 mm Hg to 145/78 mm Hg and from 1.8 mg/dL to 1.5 mg/dL, respectively. Within 48 hours after the implantation, acute occlusions occurred in two patients, supposedly triggered by cholesterol embolization. Primary and primary assisted patency rates were 87% and 92% at 6 months and 75% and 84% at 18 months. Renal artery stent placement with the rapid-exchange monorail system is a safe procedure with promising patency rates. In combination with the long-sheath technique, adequate control of stent deployment is guaranteed during the entire intervention. The low profile of the device facilitates the use of small sheaths (5 F) to minimize access-site complications.

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

DEFF Research Database (Denmark)

Rasmussen, Klaus; Maeng, Michael; Kaltoft, Anne

2010-01-01

BACKGROUND: In low-risk patients, the zotarolimus-eluting stent has been shown to reduce rates of restenosis without increasing the risk of stent thrombosis. We compared the efficacy and safety of the zotarolimus-eluting stent versus the sirolimus-eluting stent in patients with coronary artery...... disease who were receiving routine clinical care with no direct follow-up. METHODS: We did a single-blind, all-comer superiority trial in adult patients with chronic stable coronary artery disease or acute coronary syndromes, and at least one target lesion. Patients were treated at one of five...... Danish administrative and health-care registries. The primary endpoint was a composite of major adverse cardiac events within 9 months: cardiac death, myocardial infarction, and target vessel revascularisation. Intention-to-treat analyses were done at 9-month and 18-month follow-up. This trial...

The stenting strategy of drug-eluting stents for coronary artery disease in patients on dialysis

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Hiroshi Fujita

2014-12-01

Full Text Available Background: Reports regarding the relationship between the length and diameter of implanted drug-eluting stents and clinical and angiographic outcomes in dialysis patients are limited. Aim: We investigated the efficiency of drug-eluting stents for coronary artery disease in patients on dialysis from the viewpoint of stent sizing. Methods: Sirolimus-eluting stents were implanted in 88 lesions and bare metal stents were implanted in 43 lesions. We compared stenting strategy, major adverse cardiac events, and angiographic results between sirolimus-eluting stent and bare metal stent groups. Results: Stent diameter was smaller and stent length was longer in the sirolimus-eluting stent group than in the bare metal stent group in our routine practices. There was no significant between-group difference in late diameter loss. Rates of angiographic restenosis and target lesion revascularization were significantly higher in the sirolimus-eluting stent group than in the bare metal stent group. Although stent length was significantly longer and stent diameter was smaller in the sirolimus-eluting stent group, sirolimus-eluting stents did not improve the subsequent clinical and angiographic results compared with bare metal stents in dialysis patients. Conclusion: In dialysis patients, a longer length and/or smaller diameter sirolimus-eluting stent implantation was associated with high rates of restenosis and target lesion revascularization compared with bare metal stents.

Impact on outcome of different types of carotid stent: results from the European Registry of Carotid Artery Stenting.

Science.gov (United States)

Stabile, Eugenio; Giugliano, Giuseppe; Cremonesi, Alberto; Bosiers, Marc; Reimers, Bernhard; Setacci, Carlo; Cao, Piergiorgio; Schmidt, Andrej; Sievert, Horst; Peeters, Patrick; Nikas, Dimitrios; Sannino, Anna; de Donato, Gianmarco; Parlani, Giambattista; Castriota, Fausto; Hornung, Marius; Rubino, Paolo; Esposito, Giovanni; Tesorio, Tullio

2016-06-12

Conflicting data exist on the impact on outcome of the use of different stent types during carotid artery stenting (CAS). The aim of this study was to evaluate clinical outcomes according to different carotid stent design among the population of the European Registry of Carotid Artery Stenting (ERCAS). The present study was conducted in 1,604 patients who underwent neuroprotected CAS in ERCAS. All types of commercially available carotid stent were used. Open-cell design stents were classified according to free cell area into 7.5 mm2. A total of 713 closed-cell, 456 hybrid-cell, 238 7.5 mm2 open-cell stents were implanted. Overall, the 30-day stroke and death rate was 1.37%. At 30 days, 19 strokes occurred (1.18%): eight in the group of patients treated with a closed-cell (1.12%), two in those with a hybrid-cell (0.44%), three in those with a 7.5 mm2 open-cell stent (3.05%) (p=0.045). Data of the present study suggest that, in the setting of neuroprotected CAS performed in high-volume centres by properly trained operators, the use of an open-cell design stent with a free cell area >7.5 mm2 may be associated with an increased 30-day stroke risk.

Neuropsychological outcome after percutaneous coronary intervention or coronary artery bypass grafting: results from the Stent or Surgery (SoS) Trial.

Science.gov (United States)

Währborg, Peter; Booth, Jean E; Clayton, Tim; Nugara, Fiona; Pepper, John; Weintraub, William S; Sigwart, Ulrich; Stables, Rod H

2004-11-30

Coronary artery bypass surgery (CABG) has been associated with a range of neurological and neuropsychological complications from stroke to cognitive problems such as memory and problem solving disturbance. However, little is known about the impact of percutaneous coronary intervention (PCI) on neuropsychological outcome. In the Stent or Surgery Trial (SoS), 988 patients were randomized in equal proportions between PCI supported by stent implantation and CABG. As a substudy of this trial, we undertook an evaluation of neurological and neuropsychological outcomes after intervention. A clinical examination and neuropsychological assessment consisting of 5 tests (Digit Span Forwards and Backwards, Visual Reproduction, Bourdon, and Block Design) were performed at baseline and 6 and 12 months after the procedure. A total of 145 patients were included in the substudy analysis: 77 in the PCI group and 68 in the CABG group. One patient in the PCI arm had a stroke. There was no significant difference between treatment groups at 6 and 12 months for any of the 5 tests. The mean change from baseline was also similar in both groups. We were not able to demonstrate an important and significant difference in neuropsychological outcome in patients treated with different revascularization strategies. This important finding needs to be examined in further research.

Feasibility and Safety of Transradial Arterial Approach for Simultaneous Right and Left Vertebral Artery Angiographic Studies and Stenting

International Nuclear Information System (INIS)

Yip, H.-K.; Youssef, Ali A.; Chang, W.-N.; Lu, C.-H.; Yang, C.-H.; Chen, S.-M.; Wu, C.-J.

2007-01-01

Objectives. This study investigated whether the transradial artery (TRA) approach using a 6-French (F) Kimny guiding catheter for right vertebral artery (VA) angiographic study and stenting is safe and effective for patients with significant VA stenosis. Background. The TRA approach is commonly performed worldwide for both diagnostic cardiac catheterization and catheter-based coronary intervention. However, to our knowledge, the safety and feasibility of left and right VA angiographic study and stenting, in the same procedure, using the TRA approach for patients with brain ischemia have not been reported. Methods. The study included 24 consecutive patients (22 male, 2 female; age, 63-78 years). Indications for VA angiographic study and stenting were (1) prior stroke or symptoms related to vertebrobasilar ischemia and (2) an asymptomatic but vertebral angiographic finding of severe stenosis (>70%). A combination of the ipsilateral and retrograde-engagement technique, which involved a looping 6-F Kimny guiding catheter, was utilized for VA angiographic study. For VA stenting, an ipsilateral TRA approach with either a Kimny guiding catheter or a left internal mammary artery guiding catheter was utilized in 22 patients and retrograde-engagement technique in 2 patients. Results. A technically successful procedure was achieved in all patients, including left VA stenting in 15 patients and right VA stenting in 9 patients. The mean time for stenting (from engagement to stent deployment) was 12.7 min. There were no vascular complications or mortality. However, one patient suffered from a transient ischemic attack that resolved within 3 h. Conclusion. We conclude that TRA access for both VA angiographic study and VA stenting is safe and effective, and provides a simple and useful clinical tool for patients unsuited for femoral arterial access

Comparison of closed-cell and hybrid-cell stent designs in carotid artery stenting: clinical and procedural outcomes

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Ersan TatlI

2017-05-01

Full Text Available Introduction: Carotid artery stenting (CAS is a promising alternative to surgery in high-risk patients. However, the impact of stent cell design on outcomes in CAS is a matter of continued debate. Aim : To compare the periprocedural and clinical outcomes of different stent designs for CAS with distal protection devices. Material and methods : All CAS procedures with both closed- and hybrid-cell stents performed at our institution between February 2010 and December 2015 were analyzed retrospectively. Adverse events were defined as death, major stroke, minor stroke, transient ischemic attack and myocardial infarction. Periprocedural and 30-day adverse events and internal carotid artery (ICA vasospasm rates were compared between the closed-cell and hybrid-cell stent groups. Results : The study included 234 patients comprising 146 patients with a closed-cell stent (Xact stent, Abbott Vascular (mean age: 68.5 ±8.6; 67.1% male and 88 patients with a hybrid-cell stent (Cristallo Ideale, Medtronic (mean age: 67.2 ±12.8; 68.2% male. There was no significant difference between the groups with respect to periprocedural or 30-day adverse event rates. While there was no difference in terms of tortuosity index between the groups, there was a higher procedural ICA vasospasm rate in the closed-cell stent group (35 patients, 23% compared with the hybrid-cell stent group (10 patients, 11% (p = 0.017. Conclusions : The results of this study showed no significant difference in the clinical adverse event rates after CAS between the closed-cell stent group and the hybrid-cell stent group. However, procedural ICA vasospasm was more common in the closed-cell stent group.

Luminal flow amplifies stent-based drug deposition in arterial bifurcations.

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Vijaya B Kolachalama

2009-12-01

Full Text Available Treatment of arterial bifurcation lesions using drug-eluting stents (DES is now common clinical practice and yet the mechanisms governing drug distribution in these complex morphologies are incompletely understood. It is still not evident how to efficiently determine the efficacy of local drug delivery and quantify zones of excessive drug that are harbingers of vascular toxicity and thrombosis, and areas of depletion that are associated with tissue overgrowth and luminal re-narrowing.We constructed two-phase computational models of stent-deployed arterial bifurcations simulating blood flow and drug transport to investigate the factors modulating drug distribution when the main-branch (MB was treated using a DES. Simulations predicted extensive flow-mediated drug delivery in bifurcated vascular beds where the drug distribution patterns are heterogeneous and sensitive to relative stent position and luminal flow. A single DES in the MB coupled with large retrograde luminal flow on the lateral wall of the side-branch (SB can provide drug deposition on the SB lumen-wall interface, except when the MB stent is downstream of the SB flow divider. In an even more dramatic fashion, the presence of the SB affects drug distribution in the stented MB. Here fluid mechanic effects play an even greater role than in the SB especially when the DES is across and downstream to the flow divider and in a manner dependent upon the Reynolds number.The flow effects on drug deposition and subsequent uptake from endovascular DES are amplified in bifurcation lesions. When only one branch is stented, a complex interplay occurs - drug deposition in the stented MB is altered by the flow divider imposed by the SB and in the SB by the presence of a DES in the MB. The use of DES in arterial bifurcations requires a complex calculus that balances vascular and stent geometry as well as luminal flow.

Iliac Artery Stent Placement Relieves Claudication in Patients with Iliac and Superficial Femoral Artery Lesions

International Nuclear Information System (INIS)

Ichihashi, Shigeo; Higashiura, Wataru; Itoh, Hirofumi; Sakaguchi, Shoji; Kichikawa, Kimihiko

2013-01-01

Purpose. To evaluate the efficacy of iliac artery stent placement for relief of claudication in patients with both iliac and superficial femoral artery (SFA) lesions. Methods. Stent placement for only iliac artery occlusive disease was performed in 94 limbs (74 patients) with both iliac and SFA occlusive disease on the same limb. All procedures were performed because intermittent claudication did not improve after continuation of antiplatelet medication therapy and home-based exercise for 3 months. Rutherford classification was 2 in 20 limbs and 3 in 74 limbs. Patients with critical limb ischemia were excluded. Median duration of follow-up was 40 months. Primary patency rates of the iliac stent, clinical improvement rates, and risk factors for requiring additional SFA procedures were evaluated. Results. Primary patency rates of the iliac stent at 1, 3, 5, and 7 years were 97, 93, 79, and 79 %, respectively. The initial clinical improvement rate was 87 %. Continued clinical improvement rates at 1, 3, 5, and 7 years were 87, 81, 69, and 66 %, respectively. SFA Trans-Atlantic Inter-Society Consensus (TASC) II C/D lesion was a significant risk factor for requiring additional SFA procedures. Conclusion. Intermittent claudication was relieved by iliac stent placement in most patients with both iliac and SFA lesions. Thus, the indications for treatment of the SFA intended for claudicants should be evaluated after treatment of the iliac lesion.

Stent Fracture and Reocclusion After Placement of a Single Self-Expanding Stent in the Common Iliac Artery and Endovascular Treatment

International Nuclear Information System (INIS)

Higashiura, Wataru; Sakaguchi, Shoji; Morimoto, Kengo; Kichikawa, Kimihiko

2008-01-01

We present a case of fracture of a single self-expanding stent placed in the common iliac artery (CIA). An 80-year-old woman underwent placement of a self-expanding stent for CIA occlusion. Stent fracture and reocclusion were detected after 18 months. Successful revascularization was achieved using a stent-in-stent maneuver. The possibility of stent fracture with reocclusion should be considered following treatment with a single self-expanding stent for CIA occlusion.

Bioabsorbable coronary stents--are these the next big thing in coronary angioplasty?

Science.gov (United States)

Balla, Sudarshan; Aggarwal, Kul; Nistala, Ravi

2010-06-01

The role of percutaneous coronary intervention (PCI) in the treatment of coronary artery disease has grown at an astronomical pace. Drug eluting stents (DES) offer advantages over bare metal stents (BMS) such as reduction in early in-stent restenosis rates. However, they have disadvantages like from increased late stent thrombosis when compared with BMS. Furthermore, recent data suggest endothelial dysfunction in the DES stented segments of the arteries. Currently, bioabsorbable stents are under development to avert the complications of DES such as stent thrombosis via degradation of the stent over time. The hypothetical advantage of leaving behind a natural vessel and restoring vasoreactivity may be the almost normal physiology which can be achieved after an intervention with a stent. The ABSORB and the PROGRESS AMS are two of the recent clinical trials that have looked at the outcomes of using bioabsorbable stents. So far, data from these and other studies has yielded mixed results in terms of angiographic and clinical outcomes. Newer stents such as REVA and WHISPER are presently being tested in preclinical and clinical trials. The landscape for bioabsorbable stents is constantly evolving through continued improvisation on existing technology and emergence of new technology. Large scale randomized trials are still needed with adequate long term follow-up for safety and benefits to have mainstream application in coronary artery disease, bioabsorbable stents are a promising innovation in the field of PCI. We review some of the patents and the data that is emerging on bioabsorbable stents in addition to currently ongoing clinical trials.

Drug diffusion and biological responses of arteries using a drug-eluting stent with nonuniform coating

Directory of Open Access Journals (Sweden)

Saito N

2016-03-01

Full Text Available Noboru Saito, Yuhei Mori, Sayaka Uchiyama Terumo Corporation R&D Center, Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, Japan Abstract: The purpose of this study was to determine the effect of a nonuniform coating, abluminal-gradient coating (AGC, which leaves the abluminal surface of the curves and links parts of the stent free from the drug coating, on the diffusion direction of the drug and the biological responses of the artery to drug-eluting stent (DES by comparing the AGC-sirolimus stent and the conventional full-surface coating (CFC sirolimus stent. The study aimed to verify whether the AGC approach was appropriate for the development of a safer DES, minimizing the risks of stent thrombosis due to delayed endothelialization by the drug and distal embolization due to cracking of the coating layer on the hinge parts of the DES on stent expansion. In the in vitro local drug diffusion study, we used rhodamine B as a model drug, and rhodamine B released from the AGC stent diffused predominantly into the abluminal side of the alginate artery model. Conversely, rhodamine B released from the CFC stent quickly spread to the luminal side of the artery model, where endothelial cell regeneration is required. In the biological responses study, the luminal surface of the iliac artery implanted with the AGC-sirolimus stent in a rabbit iliac artery for 2 weeks was completely covered with endothelial-like cells. On the other hand, the luminal surface of the iliac artery implanted with the CFC-sirolimus stent for 2 weeks only showed partial coverage with endothelial-like cells. While thrombosis was observed in two of the three CFC-sirolimus stents, it was observed in only one of the three AGC-sirolimus stents. Taken together, these findings indicate that the designed nonuniform coating (AGC is an appropriate approach to ensure a safer DES. However, the number of studies is limited and a larger study should be conducted to reach a statistically

Iliac artery stenting in patients with poor distal runoff: Influence of concomitant infrainguinal arterial reconstruction.

Science.gov (United States)

Timaran, Carlos H; Ohki, Takao; Gargiulo, Nicholas J; Veith, Frank J; Stevens, Scott L; Freeman, Michael B; Goldman, Mitchell H

2003-09-01

Inadequate infrainguinal runoff is considered an important risk factor for iliac stent failure. However, the influence of concomitant infrainguinal arterial reconstruction (CIAR) on iliac stent patency is unknown. This study evaluated the influence of CIAR on outcome of iliac angioplasty and stenting (IAS) in patients with poor distal runoff. Over 5 years (1996 to 2001), 68 IAS procedures (78 stents) were performed in 62 patients with poor distal runoff (angiographic runoff score >or=5). The SVS/AAVS reporting standards were followed to define outcome variables and risk factors. Data were analyzed with both univariate analysis (Kaplan-Meier method [K-M]) and regression analysis (Cox proportional hazards model). Indications for iliac artery stenting were disabling claudication (59%) and limb salvage (41%). Of the 68 procedures, IAS with CIAR was performed in 31 patients (46%), and IAS alone was performed in 37 patients (54%). Patients undergoing IAS with CIAR were older (P =.03) and had more extensive and multifocal iliac artery occlusive disease, with more TASC (TransAtlantic Inter-Society Consensus) type C lesions (P =.03), compared with patients undergoing IAS alone. No other significant differences in risk factors were noted. Runoff scores between patients undergoing IAS with CIAR and those undergoing IAS alone were not significantly different (median runoff scores, 6 [range, 5-8] and 7 [range, 5-9], respectively; P =.77). Primary stent patency rate at 1, 3, and 5 years was 87%, 54%, and 42%, respectively, for patients undergoing IAS with CIAR, and was 76%, 66%, and 55%, respectively, for patients undergoing IAS. Univariate analysis revealed that primary stent patency rate was not significantly different between the 2 groups (K-M, log-rank test, P =.81). Primary graft patency rate for CIAR was 81%, 52%, and 46% at 1, 3, and 5 years, respectively. Performing CIAR did not affect primary iliac stent patency (relative risk, 1.1; 95% confidence interval, 0.49-2.47; P

ILIAC-ARTERY URETERAL-FISTULA ASSOCIATED WITH AN INDWELLING URETERAL STENT

NARCIS (Netherlands)

ZWEERS, HMM; VANDRIEL, MF; MENSINK, HJA

1991-01-01

We report on a patient with an ureteroiliac artery fistula, which developed after double J stenting. The stent was introduced because of unilateral hydronephrosis 2 months after a Wertheim-Meigs operation preceded by cesium application. The presenting symptom of gross hematuria was initially

Preliminary application of 320-detector spiral CT with ECG editing for assessing coronary artery in-stent restenosis

International Nuclear Information System (INIS)

Li Zhiming; Tan Lilian; Li Shuxin; Fu Xi; He Weihong; Liu Ke; Huang Yong; Yu Lin

2011-01-01

Objective: To determine the value of 320-detector spiral CT with retrospective ECG gating and editing software for detecting coronary artery in-stent restenosis. Methods: CT scans of 14 patients with coronary artery stnets were retrospectively analyzed. The examinations were performed using a 320-detector spiral CT scanner and retrospective ECG gating combined with ECG editing software. The image quality of reconstructed coronary artery in-stents was compared before and after the editing of synchronously recorded ECG. The paired-sample t test was used for statistical analysis. Results: Before ECG editing, arrhythmia and in-stent artifact resulted in image blurring, missing arterial segments, significant stepladder artifacts or non-visualization of the interior of stents. Of 14 cases before ECG editing, in-stent restenosis was detected in 10 and patency in 3. The coronary artery stent and distal bifurcation were delineated in one patient. After ECG editing, the image quality of coronary artery stents was improved with detection of in-stent restenosis (4 cases) including the one case that not evaluable before ECG editing. The average image quality score before ECG editing (2.14±0.86) was significantly (P<0.001) lower than that after ECG editing (3.07±0.73). Conclusion: Retrospective ECG gating combined with ECG editing of 320-detector spiral CT can reduce the artifacts produced by arrhythmia or in-stent swings and improve the imaging quality of coronary artery stents. (authors)

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

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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

Stent-Assisted Coil Embolization of a Mycotic Renal Artery Aneurysm by Use of a Self-Expanding Neurointerventional Stent

International Nuclear Information System (INIS)

Rabellino, Martin; García-Nielsen, Luis; Zander, Tobias; Baldi, Sebastián; Llorens, Rafael; Maynar, Manuel

2011-01-01

Mycotic aneurysms are uncommon, especially those located in visceral arteries. We present a case of a patient with two visceral mycotic aneurysms due to bacterial endocarditis, one located in right upper pole renal artery and the second in the splenic artery. Both aneurysms were treated as endovascular embolization using microcoils. In the aneurysm located at the renal artery, the technique of stent-assisted coils embolization was preferred to avoid coils migration due to its wide neck. The stent used was the Solitaire AB, which was designed for the treatment of intracranial aneurysms and was used recently in acute stroke as a mechanical thrombectomy device. Complete embolization of the aneurysm was achieved, preserving all the arterial branches without nephrogram defects in the final angiogram.

The Incidence and Risk Factors of In-Stent Restenosis for Vertebrobasilar Artery Stenting.

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Zheng, Dai; Mingyue, Zhu; Wei, Shi; Min, Li; Wanhong, Chen; Qiliang, Dai; Yongjun, Jiang; Xinfeng, Liu

2018-02-01

In-stent restenosis (ISR) remains a challenge for vertebrobasilar artery stenting (VBAS). We aimed to investigate the incidence and risk factors of ISR. This was a retrospective study. From July 28, 2005, to July 30, 2015, patients who received VBAS with an angiographic follow-up time of 6 to 12 months after surgery were enrolled. The clinical and angiographic issues were recorded and analyzed. In total, 283 patients with 335 stents were incorporated into the study. Vertebral ostial lesions accounted for 73.4% (246/335) of the lesions. During the follow-up period, 58 patients with 60 stents experienced ISR (>50%). Stepwise logistic regression analysis showed that the degree of residual stenosis, stent diameter, and alcohol consumption were independent predictors of ISR. Our study demonstrated the incidence and risk factors of ISR after VBAS. This retrospective study with the largest cohort to date provided insight into the occurrence of ISR after VBAS. Copyright © 2017 Elsevier Inc. All rights reserved.

Potential mechanisms of in-stent occlusion in the femoropopliteal artery: an angioscopic assessment.

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Ishihara, Takayuki; Iida, Osamu; Okamoto, Shin; Fujita, Masashi; Masuda, Masaharu; Nanto, Kiyonori; Shiraki, Tatsuya; Kanda, Takashi; Tsujimura, Takuya; Okuno, Shota; Yanaka, Koji; Uematsu, Masaaki

2017-10-01

Although stent implantation has become widespread for the treatment of patients with peripheral artery disease with femoropopliteal (FP) lesions, in-stent restenosis, especially in-stent occlusion (ISO), remains as a major concern for refractory recurrence. Furthermore, the mechanisms of ISO in FP lesions have not been well elucidated. We performed angioscopy for 6 lesions (bare-metal stent: 3, drug-eluting stent: 3) from 5 patients (mean age 74 ± 10 years, male 40 %) with ISO in the FP artery immediately after wire-passing or thrombus aspiration. The presence of thrombus as well as the presence and location of organic stenosis were evaluated. Median duration from stent implantation to angioscopic evaluation was 1099.5 (514.5-2272.5) days, while the duration from recurrence of symptoms to angioscopic evaluation was 45 (5.75-60) days. Mixed thrombi were observed in all stents. Organic stenosis was detected at the proximal edge of the stents in 5 lesions. Organic stenosis was observed at the overlapping segment of the stent in one lesion. The distal edge of the stents could be evaluated in 3 lesions, and all of them showed organic stenosis at the site. Mixed thrombi and organic stenosis were observed in all stents. Partial development of organic stenosis in a stent followed by thrombus formation may be the potential mechanism of the development of ISO in the FP artery though the sample size of this study was small and it had no serial angioscopic data so that we should consider it as preliminary one at best.

Comparison of diamond-like carbon-coated nitinol stents with or without polyethylene glycol grafting and uncoated nitinol stents in a canine iliac artery model

Science.gov (United States)

Kim, J H; Shin, J H; Shin, D H; Moon, M-W; Park, K; Kim, T-H; Shin, K M; Won, Y H; Han, D K; Lee, K-R

2011-01-01

Objective Neointimal hyperplasia is a major complication of endovascular stent placement with consequent in-stent restenosis or occlusion. Improvements in the biocompatibility of stent designs could reduce stent-associated thrombosis and in-stent restenosis. We hypothesised that the use of a diamond-like carbon (DLC)-coated nitinol stent or a polyethylene glycol (PEG)-DLC-coated nitinol stent could reduce the formation of neointimal hyperplasia, thereby improving stent patency with improved biocompatibility. Methods A total of 24 stents were implanted, under general anaesthesia, into the iliac arteries of six dogs (four stents in each dog) using the carotid artery approach. The experimental study dogs were divided into three groups: the uncoated nitinol stent group (n = 8), the DLC-nitinol stent group (n = 8) and the PEG-DLC-nitinol stent group (n = 8). Results The mean percentage of neointimal hyperplasia was significantly less in the DLC-nitinol stent group (26.7±7.6%) than in the nitinol stent group (40.0±20.3%) (p = 0.021). However, the mean percentage of neointimal hyperplasia was significantly greater in the PEG-DLC-nitinol stent group (58.7±24.7%) than in the nitinol stent group (40.0±20.3%) (p = 0.01). Conclusion Our findings indicate that DLC-coated nitinol stents might induce less neointimal hyperplasia than conventional nitinol stents following implantation in a canine iliac artery model; however, the DLC-coated nitinol stent surface when reformed with PEG induces more neointimal hyperplasia than either a conventional or DLC-coated nitinol stent. PMID:21325363

Drug-eluting versus bare-metal stents in large coronary arteries

DEFF Research Database (Denmark)

Kaiser, Christoph; Galatius, Soeren; Erne, Paul

2010-01-01

Recent data have suggested that patients with coronary disease in large arteries are at increased risk for late cardiac events after percutaneous intervention with first-generation drug-eluting stents, as compared with bare-metal stents. We sought to confirm this observation and to assess whether...

Design of the Revascularization With Open Bypass vs Angioplasty and Stenting of the Lower Extremity Trial (ROBUST): a randomized clinical trial.

Science.gov (United States)

Malas, Mahmoud B; Qazi, Umair; Glebova, Natalia; Arhuidese, Isibor; Reifsnyder, Thomas; Black, James; Perler, Bruce A; Freischlag, Julie A

2014-12-01

To our knowledge, there is no level 1 evidence comparing open bypass with angioplasty and stenting in TransAtlantic Inter-Society Consensus (TASC II) B and C superficial femoral artery lesions. The Revascularization With Open Bypass vs Angioplasty and Stenting of the Lower Extremity Trial (ROBUST) is the first prospective randomized clinical trial comparing both treatments. To report the design of the ROBUST trial. The primary aim of the trial is to compare (1) the patency rate (primary, primary assisted, and secondary patency at 6 and 12 months), (2) improvement of quality of life, (3) clinical improvement (at least 1 Rutherford category), and (4) wound healing and limb salvage in patients presenting with critical limb ischemia; secondary aims include (1) cost-effectiveness by factoring procedure and hospital admission costs including rehabilitation, readmission, and reintervention costs, (2) amputation-free survival, (3) reintervention rate, and (4) 30-day operative mortality, morbidity, and wound and access complications. ROBUST is a prospective randomized clinical trial with the aim to enroll 320 patients with intermittent claudication that does not respond to medical management and patients with critical limb ischemia. The maximum level of medical therapy will be administered using antiplatelet agents and statins, as well as measures to control hypertension and diabetes mellitus. Patients with TASC II B or C lesions are prospectively randomized to receive either femoropopliteal bypass or percutaneous transluminal angioplasty and stenting; patients with TASC II A and D lesions are not randomized and receive percutaneous transluminal angioplasty and stenting or femoropopliteal bypass, respectively. All patients will be evaluated at 1, 6, and 12 months postoperatively with physical examination, ankle brachial index, duplex, and a quality-of-life questionnaire. The trial is actively enrolling participants. At the time of writing, 29 patients have been enrolled

Dual-therapy stent technology for patients with coronary artery disease : A great catch?

NARCIS (Netherlands)

Kalkman, D.N.

2018-01-01

This thesis investigates the possible advantages of a new stent technology that aims to improve care for patients with coronary artery disease. The COMBO stent (OrbusNeich Medical BV, The Netherlands) contains a dual-therapy stent technology. The stent combines two techniques: a sirolimus-elution

Multislice CT Angiography in Renal Artery Stent Evaluation: Prospective Comparison with Intra-Arterial Digital Subtraction Angiography

International Nuclear Information System (INIS)

Raza, Syed A.; Chughtai, Aamer R.; Wahba, Mona; Cowling, Mark G.; Taube, David; Wright, Andrew R.

2004-01-01

Purpose: To assess the role of multislice computed tomography angiography (MCTA) in the evaluation of renal artery stents, using intra-arterial digital subtraction angiography (DSA) as the gold standard. Methods: Twenty consecutive patients (15 men, 5 women) with 23 renal artery stents prospectively underwent both MCTA and DSA. Axial images, multiplanar reconstructions and maximum intensity projection images were used for diagnosis. The MCTA and DSA images were each interpreted without reference to the result of the other investigation. Results:The three cases of restenosis on DSA were detected correctly by MCTA; in 19 cases where MCTA showed a fully patent stent, the DSA was also negative. Sensitivity and negative predictive value (NPV) of MCTA were therefore 100%. In four cases, MCTA showed apparently minimal disease which was not shown on DSA. These cases are taken as false positive giving a specificity of 80% and a positive predictive value of 43%. Conclusion: The high sensitivity and NPV suggest MCTA may be useful as a noninvasive screen for renal artery stentrestenosis. MCTA detected mild disease in a few patients which was not confirmed on angiography

Effect of longitudinal anatomical mismatch of stenting on the mechanical environment in human carotid artery with atherosclerotic plaques.

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Fan, Zhenmin; Liu, Xiao; Sun, Anqiang; Zhang, Nan; Fan, Zhanming; Fan, Yubo; Deng, Xiaoyan

2017-10-01

Longitudinal anatomic mismatch (LAM) of stenting (i.e., a stenotic artery segment is not fully covered by a deployed stent) worsens the mechanical environment in the treated artery, which most likely is the cause for the associated high risks of restenosis, myocardial infarction and stent thrombosis. To probe the possibility, we constructed a patient-specific carotid model with two components of plaques (lipid and calcified plaque) based on MRI images; we numerically compared three different stenting scenarios in terms of von Mises stress (VMS) distribution in the treated arteries, namely, the short stenting (LAM), the medium stenting and the long stenting. The results showed that the short stenting led to more areas with abnormally high VMS along the inner surface of the treated artery with a much higher surface-averaged VMS at the distal end of the stent than both the medium and long stenting. While the VMS distribution in the calcified plaques was similar for the three stenting models, it was quite different in the lipid plaques among the three stenting models. The lipid plaque of the short-stent model showed more volume of the lipid plaque subjected to high VMS than those of the other two models. Based on the obtained results, we may infer that the short stenting (i.e., LAM) may aggravate vascular injury due to high VMS on the artery-stent interaction surface and within the lipid plaque. Therefore, to obtain a better outcome, a longer stent, rather than a short one, might be needed for arterial stenting. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

Early experience with the multilayer aneurysm repair stent in the endovascular treatment of trans/infragenicular popliteal artery aneurysms: a mixed bag.

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Thakar, Tejal; Chaudhuri, Arindam

2013-06-01

To present a preliminary experience using a multilayer flow-modulating stent for trans/infragenicular popliteal endovascular aneurysm repair. Five men (mean age 76 years, range 62-86) with 6 popliteal artery aneurysms (PAAs) measuring 22 to 39 mm in diameter (mean 30) underwent endovascular repair using the Cardiatis Multilayer Aneurysm Repair System (MARS) between June and August 2011. Radiological assessments post procedure using duplex ultrasonography and biplanar knee radiographs (additional contrast studies as necessary) sought evidence of aneurysm exclusion, graft patency, and preservation of branches and runoff vessels. Technical success was achieved in each case. There was one symptomatic stent occlusion requiring thrombectomy at 4 days, with reocclusion, and one leak via the stent struts into the sac with no branch outflow identified. Two further symptomatic stent occlusions were identified within a 6-week follow-up period, totaling 3 occlusions among the 6 devices deployed. No firm conclusion can be reached on the efficacy of the MARS in PAAs due to the inherent limitations of this small series, although a 50% thrombosis rate is a poor outcome. The risk of early thrombosis in flow-modulating stents deployed in the popliteal artery exists, as it does with earlier generation stent-grafts. Larger prospective trials and the influence of more aggressive antithrombotic/anticoagulant therapy should be considered to enable accurate evaluation of this device in popliteal artery aneurysms.

Late effects of low-energy gamma-emitting stents in a rabbit iliac artery model

International Nuclear Information System (INIS)

Strauss, Bradley H.; Li, Chris; Whittingham, Heather A.; Tio, Fermin O.; Kutryk, Michael J.B.; Janicki, Christian; Sparkes, John D.; Turnlund, Todd; Sweet, William L.

2002-01-01

Purpose: To determine the long-term dose response of novel low-dose γ-emitting stents in a rabbit iliac artery model. Methods and Materials: Control stents (n=24) and 103 Pd stents 1.0 to 4.0 mCi (n=36) were implanted in the iliac arteries of 30 New Zealand rabbits. Stents were evaluated by intravascular ultrasound (immediately post procedure and before killing) and by histomorphometry. Results: At 26 weeks, 28 rabbits were killed, with no evidence of stent thrombosis. In the body of the stent there was a dose-response relationship with 50% inhibition of intimal hyperplasia at the highest activity compared to control stents (p=0.07) and a significant increase in intimal hyperplasia at the lowest activity (p 103 Pd stents is feasible with reduction of in-stent hyperplasia in a dose-related manner. However, significant narrowing at the stent edges, increased in-stent hyperplasia at lower activities, and incomplete vascular healing with persistence of immature neointima at higher activities are significant limitations

An everolimus-eluting stent versus a paclitaxel-eluting stent in small vessel coronary artery disease: a pooled analysis from the SPIRIT II and SPIRIT III trials.

Science.gov (United States)

Bartorelli, Antonio L; Serruys, Patrick W; Miquel-Hébert, Karine; Yu, Shui; Pierson, Wes; Stone, Gregg W

2010-07-01

To evaluate the safety and efficacy of the XIENCE V everolimus-eluting stent compared to the TAXUS paclitaxel-eluting stent in small vessels. The XIENCE V everolimus-eluting stent (EES) has been shown to improve angiographic and clinical outcomes after percutaneous myocardial revascularization, but its performance in small coronary arteries has not been investigated. In this pooled analysis, we studied a cohort of 541 patients with small coronary vessels (reference diameter SPIRIT II and SPIRIT III studies. TAXUS Express (73% of lesions) and TAXUS Liberté (27% of lesions) paclitaxel-eluting stents (PES) were used as controls in SPIRIT II. In SPIRIT III, Taxus Express(2) PES was the control. Mean angiographic in-stent and in-segment late loss was significantly less in the EES group compared with the PES group, (0.15 +/- 0.37 mm vs. 0.30 +/- 0.44 mm; P = 0.011 for in-stent; 0.10 +/- 0.38 mm vs. 0.21 +/- 0.34 mm; P = 0.034 for in-segment). EES also resulted in a significant reduction in composite major adverse cardiac events at 1 year (19/366 [5.2%] vs. 17/159 [10.7%]; P = 0.037), due to fewer non-Q-wave myocardial infarctions and target lesion revascularizations. At 1 year, the rate of non-Q-wave myocardial infarction was significantly lower in the EES group compared with that of the PES group (6/366 [1.6%] vs. 8/159 [5.0%]; P = 0.037). In patients with small vessel coronary arteries, the XIENCE V EES was superior to the TAXUS PES. (c) 2010 Wiley-Liss, Inc.

MR Angiography of Peripheral Arterial Stents: In Vitro Evaluation of 22 Different Stent Types

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Matthias C. Burg

2011-01-01

Full Text Available Purpose. To evaluate stent lumen visibility of a large sample of different peripheral arterial (iliac, renal, carotid stents using magnetic resonance angiography in vitro. Materials and Methods. 21 different stents and one stentgraft (10 nitinol, 7 316L, 2 tantalum, 1 cobalt superalloy, 1 PET + cobalt superalloy, and 1 platinum alloy were examined in a vessel phantom (vessel diameters ranging from 5 to 13 mm filled with a solution of Gd-DTPA. Stents were imaged at 1.5 Tesla using a T1-weighted 3D spoiled gradient-echo sequence. Image analysis was performed measuring three categories: Signal intensity in the stent lumen, lumen visibility of the stented lumen, and homogeneity of the stented lumen. The results were classified using a 3-point scale (good, intermediate, and poor results. Results. 7 stents showed good MR lumen visibility (4x nitinol, 2x tantalum, and 1x cobalt superalloy. 9 stents showed intermediate results (5x nitinol, 2x 316L, 1x PET + cobalt superalloy, and 1x platinum alloy and 6 stents showed poor results (1x nitinol, and 5x 316L. Conclusion. Stent lumen visibility varies depending on the stent material and type. Some products show good lumen visibility which may allow the detection of stenoses inside the lumen, while other products cause artifacts which prevent reliable evaluation of the stent lumen with this technique.

Renal artery stenting in solitary functioning kidneys: Technical and clinical results

International Nuclear Information System (INIS)

Sahin, Sinan; Cimsit, Cagatay; Andac, Nurten; Baltacioglu, Feyyaz; Tuglular, Serhan; Akoglu, Emel

2006-01-01

Objective: To evaluate the clinical and technical results of renal artery stenting for the treatment of renovascular hypertension and renal failure in patients with solitary functioning kidney. Materials and methods: Fifteen patients with solitary functioning kidney underwent renal artery stenting and were followed up for 12-60 months. Before the procedures, systolic and diastolic blood pressures and serum creatinine levels were measured and the number of antihypertensive drugs was recorded and followed up after stenting. In case of restenosis, either in-stent percutaneous transluminal renal angioplasty or stent-in-stent placement was performed. Results: Primary technical success rate was 100%. One lesion was nonostial while 14 were ostial. Primary patency rates were 100% for 6 months, 92.3% for 12 months, and 69.2% for 24 months. The secondary patency rate at 24 months was 100%. The differences between the baseline and postprocedural values of systolic blood pressures, diastolic blood pressures and the number of antihypertensive drug were statistically significant (P < 0.05), except the values of serum creatinine. Hypertension was cured in 1 (6.7%) patient, improved in 4 (26.6%) and stabilized in 10 (66.7%) patients. Renal function improved in 9 (60%), stabilized in 4 (26.6%), and deteriorated in 2 (13.4%) patients. Minor complication rate was 13.4% and major complication rate was 13.4%. Conclusion: Revascularization of renal artery stenosis using stent in solitary functioning kidneys is a safe and efficient procedure with high primary technical results, low restenosis rates and acceptable complication rates. It has an improving and controlling effect on blood pressure and renal functions

Renal artery stenting in solitary functioning kidneys: Technical and clinical results

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Sahin, Sinan [Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Department of Radiology, Istanbul (Turkey)]. E-mail: sinan.sahin@e-kolay.net; Cimsit, Cagatay [Marmara University, School of Medicine, Department of Radiology, Istanbul (Turkey); Andac, Nurten [Marmara University, School of Medicine, Department of Radiology, Istanbul (Turkey); Baltacioglu, Feyyaz [Marmara University, School of Medicine, Department of Radiology, Istanbul (Turkey); Tuglular, Serhan [Marmara University, School of Medicine, Department of Nephrology, Istanbul (Turkey); Akoglu, Emel [Marmara University, School of Medicine, Department of Nephrology, Istanbul (Turkey)

2006-01-15

Objective: To evaluate the clinical and technical results of renal artery stenting for the treatment of renovascular hypertension and renal failure in patients with solitary functioning kidney. Materials and methods: Fifteen patients with solitary functioning kidney underwent renal artery stenting and were followed up for 12-60 months. Before the procedures, systolic and diastolic blood pressures and serum creatinine levels were measured and the number of antihypertensive drugs was recorded and followed up after stenting. In case of restenosis, either in-stent percutaneous transluminal renal angioplasty or stent-in-stent placement was performed. Results: Primary technical success rate was 100%. One lesion was nonostial while 14 were ostial. Primary patency rates were 100% for 6 months, 92.3% for 12 months, and 69.2% for 24 months. The secondary patency rate at 24 months was 100%. The differences between the baseline and postprocedural values of systolic blood pressures, diastolic blood pressures and the number of antihypertensive drug were statistically significant (P < 0.05), except the values of serum creatinine. Hypertension was cured in 1 (6.7%) patient, improved in 4 (26.6%) and stabilized in 10 (66.7%) patients. Renal function improved in 9 (60%), stabilized in 4 (26.6%), and deteriorated in 2 (13.4%) patients. Minor complication rate was 13.4% and major complication rate was 13.4%. Conclusion: Revascularization of renal artery stenosis using stent in solitary functioning kidneys is a safe and efficient procedure with high primary technical results, low restenosis rates and acceptable complication rates. It has an improving and controlling effect on blood pressure and renal functions.

Safety of non-ionic contrast media during renal artery stenting

International Nuclear Information System (INIS)

Ni Jun; Shen Weifeng; Zhang Ruiyan; Zhang Qi; Zhang Xian; Zheng Aifang

2004-01-01

Objective: To evaluate the safety of non-ionic contras media during interventional treatment of renal artery stenosis (RAS). Methods: Fifty four coronary artery disease patients associated with RAS (luminal narrowing > 50%) underwent renal artery stent implantation and percutaneous coronary intervention, only 10 of them with merely renoarterial stenosis undergone renal artery stent implantation. The successful rates of the procedure and complication together with the volumes of contrast media were recorded respectively. And the serum creatine before and 12 hours after the successful procedure were also measured. Results: Both rates of procedural success and complication were similar among the three groups. The serum creatine levels, 12 hours after the procedure, showed no difference in comparing with the baseline. Conclusion: Non-ionic contrast media (Iopamiro 370) could be safely used in patients with RAS. (authors)

Protein losing enteropathy secondary to a pulmonary artery stent

Directory of Open Access Journals (Sweden)

Narayanswami Sreeram

2012-01-01

Full Text Available A 2-year-old patient with hypoplastic left heart syndrome presented 6 months following Fontan completion with protein-losing enteropathy (PLE. He had undergone stent implantation in the left pulmonary artery after the Norwood procedure, followed by redilation of the stent prior to Fontan completion. Combined bronchoscopic and catheterization studies during spontaneous breathing confirmed left bronchial stenosis behind the stent, and diastolic systemic ventricular pressure during expiration of 25 mm Hg. We postulate that the stent acts as a valve, against which the patient generates high expiratory pressures, which are reflected in the ventricular diastolic pressure. This may be the cause of PLE.

Pulmonary Arterial Stent Implantation in an Adult with Williams Syndrome

International Nuclear Information System (INIS)

Reesink, Herre J.; Henneman, Onno D. F.; Delden, Otto M. van; Biervliet, Jules D.; Kloek, Jaap J.; Reekers, Jim A.; Bresser, Paul

2007-01-01

We report a 38-year-old patient who presented with pulmonary hypertension and right ventricular dysfunction due to pulmonary artery stenoses as a manifestation of Williams syndrome, mimicking chronic thromboembolic pulmonary hypertension. The patient was treated with balloon angioplasty and stent implantation. Short-term follow-up showed a good clinical result with excellent patency of the stents but early restenosis of the segments in which only balloon angioplasty was performed. These stenoses were subsequently also treated successfully by stent implantation. Stent patency was observed 3 years after the first procedure

Heparin-bonded covered stents versus bare-metal stents for complex femoropopliteal artery lesions: the randomized VIASTAR trial (Viabahn endoprosthesis with PROPATEN bioactive surface [VIA] versus bare nitinol stent in the treatment of long lesions in superficial femoral artery occlusive disease).

Science.gov (United States)

Lammer, Johannes; Zeller, Thomas; Hausegger, Klaus A; Schaefer, Philipp J; Gschwendtner, Manfred; Mueller-Huelsbeck, Stefan; Rand, Thomas; Funovics, Martin; Wolf, Florian; Rastan, Aljoscha; Gschwandtner, Michael; Puchner, Stefan; Ristl, Robin; Schoder, Maria

2013-10-08

The hypothesis that endovascular treatment with covered stents has equal risks but higher efficacy than bare-metal stents (BMS) in long femoropopliteal artery disease was tested. Although endovascular treatment of short superficial femoral artery lesions revealed excellent results, efficacy in long lesions remains unsatisfactory. In a prospective, randomized, single-blind, multicenter study, 141 patients with symptomatic peripheral arterial disease were assigned to treatment with heparin-bonded, covered stents (Viabahn 72 patients) or BMS (69 patients). Clinical outcomes and patency rates were assessed at 1, 6, and 12 months. Mean ± SD lesion length was 19.0 ± 6.3 cm in the Viabahn group and 17.3 ± 6.6 cm in the BMS group. Major complications within 30 days were observed in 1.4%. The 12-month primary patency rates in the Viabahn and BMS groups were: intention-to-treat (ITT) 70.9% (95% confidence interval [CI]: 0.58 to 0.80) and 55.1% (95% CI: 0.41 to 0.67) (log-rank test p = 0.11); treatment per-protocol (TPP) 78.1% (95% CI: 0.65 to 0.86) and 53.5% (95% CI: 0.39 to 0.65) (hazard ratio: 2.23 [95% CI: 1.14 to 4.34) (log-rank test p = 0.009). In lesions ≥20 cm, (TransAtlantic Inter-Society Consensus class D), the 12-month patency rate was significantly longer in VIA patients in the ITT analysis (VIA 71.3% vs. BMS 36.8%; p = 0.01) and the TPP analysis (VIA 73.3% vs. BMS 33.3%; p = 0.004). Freedom from target lesion revascularization was 84.6% for Viabahn (95% CI: 0.72 to 0.91) versus 77.0% for BMS (95% CI: 0.63 to 0.85; p = 0.37). The ankle-brachial index in the Viabahn group significantly increased to 0.94 ± 0.23 compared with the BMS group (0.85 ± 0.23; p stents compared with BMS in lesions ≥20 cm and for all lesions in the TPP analysis. In the ITT analysis for all lesions, which was flawed by major protocol deviations in 8.5% of the patients, the difference was not significant. (GORE VIABAHN® endoprosthesis with bioactive propaten surface versus bare

Restenosis after stenting in symptomatic vertebral arterial orifice disease and considerations for better outcome

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Chang, Jun Young; Park, Hyun; Kwon, Oki

2017-01-01

We have performed stenting in 11 patients with symptomatic vertebral arterial orifice stenosis refractory to medical treatment or impairment in anterior circulation. Three of the 11 patients experienced asymptomatic severe in-stent restenosis or occlusion. Bare metal stents were used in those three patients, two of whom received revascularization therapy. Development of sufficient cervical collateral channels reconstituting the distal vertebral artery was the common feature in patients with asymptomatic in-stent restenosis. In selecting appropriate stents, consideration of mechanical strength and drug-eluting properties of a stent according to characteristics of the target vessel is important to reduce the risk of in-stent restenosis. Any decision to perform revascularization should be based on the presence of abundant cervical collaterals as well as clinical symptoms of vertebrobasilar ischemia. PMID:28304206

Primary Stenting of Subclavian and Innominate Artery Occlusive Disease: A Single Center's Experience

International Nuclear Information System (INIS)

Brountzos, E. N.; Petersen, B.; Binkert, C.; Panagiotou, I.; Kaufman, J. A.

2004-01-01

Purpose: To review immediate and midterm results of primary stenting for innominate and subclavian artery occlusive lesions. Methods: Retrospective data were collected from 48 consecutive symptomatic patients (27 men and 21 women, median age 64 years) having 49 subclavian and innominate artery lesions treated with stenting. Of the patients 52% had concomitant ischemic heart disease, and 30% had carotid and/or vertebral artery disease. Indication for treatment was vertebrobasilar insufficiency (VBI) in 16.6% of the patients; upper limb ischemia (ULI) in 31.3%; VBI and ULI in 12.5%; transient ischemic attack in 16.7%; angina in 12.5% before or after left internal mammary artery-to-coronary artery bypass grafting; and leg claudication in 10.4% before or after axillofemoral bypass grafting. Balloon-expandable stents were used in 44 lesions and self-expandable stents in 5 lesions. In total, 53 stents were placed in 48 patients. Results: Technical success was 96%, and clinical success 94%. We encountered four complications (two puncture site hematomas, one distal hand embolization and one transient cerebral ischemia). Two patients died within 30 days from other causes, and seven patients were lost to follow-up. Mean follow-up time was 16.7 months (range 0.3 to 68.2). Five patients had recurrent lesions treated by surgical (n = 2) or endovascular (n = 3) means. Cumulative primary patency rate was 91.7% and 77% at 12 and 24 months, respectively. Cumulative secondary patency rate was 96.5% and 91.7% at 12 and 24 months, respectively. Conclusion: Stenting of subclavian and innominate artery lesions resulted in immediate resolution of patients' symptoms with durable midterm effect and few complications in a larger patient group with serious comorbid conditions

Percutaneous Coronary Intervention of Left Main Disease: Pre- and Post-EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization Study) Era.

Science.gov (United States)

Park, Duk-Woo; Park, Seung-Jung

2017-06-01

For nearly half a century, coronary artery bypass grafting has been the standard treatment for patients with obstructive left main coronary artery (LMCA) disease. However, there has been considerable evolution in the field of percutaneous coronary intervention, and especially, percutaneous coronary intervention for LMCA disease has been rapidly expanded with adoption of drug-eluting stents. Some, but not all randomized trials, have shown that percutaneous coronary intervention with drug-eluting stents might be a suitable alternative for selected patients with LMCA disease instead of bypass surgery. However, none of previous trials involving early-generation drug-eluting stents was sufficiently powered and comparative trials using contemporary drug-eluting stents were limited. Recently, primary results of 2 new trials of EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization Study) were reported. However, these trials showed conflicting results, which might pose uncertainty on the optimal revascularization strategy for LMCA disease. In this article, with the incorporation of a key review on evolution of LMCA treatment, we summarize the similarity or disparity of the EXCEL and NOBLE trials, focus on how they relate to previous trials in the field, and finally speculate on how the treatment strategy may be changed or recommended for LMCA treatment. © 2017 American Heart Association, Inc.

Covered Stent and Coils Embolization of a Pulmonary Artery Pseudoaneurysm After Gunshot Wound

International Nuclear Information System (INIS)

Huet, Nicolas; Rodiere, Mathieu; Badet, Michel; Michoud, Marie; Brichon, Pierre-Yves; Ferretti, Gilbert; Thony, Frédéric

2016-01-01

We report the first case of endovascular covered stent implantation for the treatment of a large pulmonary artery pseudoaneurysm (PAPA) following a right thoracic gunshot wound. After resuscitation and hemodynamic stabilization, a CT angiography was performed to analyze the neck size of the PAPA and its position relative to the branches of the parent artery. Covered stent implantation with additional coil embolization was successfully performed. At the 4-year follow-up, the stents remained patent and there was neither pseudoaneurysm recurrence nor treatment-related complication.

Covered Stent and Coils Embolization of a Pulmonary Artery Pseudoaneurysm After Gunshot Wound

Energy Technology Data Exchange (ETDEWEB)

Huet, Nicolas, E-mail: nhuet@chu-grenoble.fr; Rodiere, Mathieu, E-mail: mrodiere@chu-grenoble.fr [Hôpital Universitaire de Grenoble and Université Grenoble Alpes, Department of Radiology and Medical Imaging (France); Badet, Michel, E-mail: michel.badet@ch-chambery.fr [Centre Hospitalier Métropôle Savoie, site de Chambéry, Intensive Care Unit (France); Michoud, Marie, E-mail: marie.michoud@ch-chambery.fr [Centre Hospitalier Métropôle Savoie, Site de Chambéry, Department of Radiology (France); Brichon, Pierre-Yves, E-mail: pybrichon@chu-grenoble.fr [Hôpital Universitaire de Grenoble and Université Grenoble Alpes, Department of Thoracic and Vascular Surgery (France); Ferretti, Gilbert, E-mail: gferretti@chu-grenoble.fr; Thony, Frédéric, E-mail: fthony@chu-grenoble.fr [Hôpital Universitaire de Grenoble and Université Grenoble Alpes, Department of Radiology and Medical Imaging (France)

2016-05-15

We report the first case of endovascular covered stent implantation for the treatment of a large pulmonary artery pseudoaneurysm (PAPA) following a right thoracic gunshot wound. After resuscitation and hemodynamic stabilization, a CT angiography was performed to analyze the neck size of the PAPA and its position relative to the branches of the parent artery. Covered stent implantation with additional coil embolization was successfully performed. At the 4-year follow-up, the stents remained patent and there was neither pseudoaneurysm recurrence nor treatment-related complication.

Angle change of the parent arteries after stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms

International Nuclear Information System (INIS)

Cho, W.-S.; Kang, H.-S.; Kim, J.E.; Kwon, O.-K.; Oh, C.W.; Cho, Y.D.; Han, M.H.

2014-01-01

Aim: To investigate the angle changes of the parent arteries after stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms. Materials and methods: The adjacent parent arterial angles before and after stent-assisted coil embolization were measured in 38 patients with aneurysms of the anterior communicating artery (ACoAA) and 41 patients with bifurcation aneurysms of the middle cerebral artery (MCABA). Variables were analysed in relation to the angle changes. Results: Vascular angles of the parent arteries significantly increased by 27.8° (±18.5°) immediately after stent-assisted coil embolization in 79 cases (p < 0.001), with 25.7° (±14.8°) in ACoAA and 29.7° (±21.4°) in MCABA, respectively. In 51 (64.6%) cases with follow-up angiography (mean interval 13.5 ± 4.1 months), vascular angles increased by 27.2° (±17.1°) immediately after treatment and further increased by 20.7° (±14.3°) at the last follow-up (all p < 0.001). More acute pre-stent angles of the parent arteries correlated with greater post-stent angle changes (p = 0.006). Younger age tended to be inversely related to post-stent angle changes (p = 0.091). Conclusion: Stent placement during coil embolization induced significant changes in the aneurysm–parent artery relationship. Further study is needed to elicit the association between angle change of the parent arteries and aneurysmal stability after coil embolization

Placement of hemoparin-coated stents in the iliac arteries: Early experience and midterm results in 28 patients

Energy Technology Data Exchange (ETDEWEB)

Kalmar, Peter I., E-mail: peter.kalmar@medunigraz.at; Portugaller, Rupert H., E-mail: rupert.portugaller@medunigraz.at; Schedlbauer, Peter, E-mail: peter.schedlbauer@klinikum-graz.at; Bohlsen, Dennis, E-mail: dennis.bohlsen@medunigraz.at; Deutschmann, Hannes A., E-mail: hannes.deutschmann@medunigraz.at

2014-07-15

Purpose: Aim was to determine immediate results and mid-term outcome of the hemoparin-coated (HC) stainless-steel stent (camouflage coating) in the treatment of occlusive lesions of the iliac arteries. Materials and methods: Twenty-eight patients were prospectively treated with the use of a HC stent between January 2007 and March 2010. Clinical examination and color-doppler ultrasound were performed at 1, 3, 6 and 12 months, CT angiography (CTA) or MR angiography (MRA) at 12 months. Indication for treatment was a high-grade stenosis of the common iliac and/or external iliac artery. Results: Successful placement was achieved in all patients. Significant decrease in translesional pressure gradient (>10 mmHg) was measured in 27 patients (96%). In one patient, proximal dissection occurred without flow limitation. A minor complication (small access site hematoma) occurred in one patient (4%). Two patients (7%) were lost to follow-up. After 12 months, stent patency in CTA, MRA and ultrasound was 100%. 20 patients (77%) experienced an initial improvement of at least one clinical stage. In one patient (4%), mild intimal hyperplasia without significant stenosis was observed. In three patients (12%), proximal or distal stenosis occurred. A non-significant increase of mean ankle-brachial index (ABI) after treatment was measured (0.85 ± 0.27 vs. 0.75 ± 0.22, respectively; p = 0.328). Conclusions: The use of HC stents in patients with iliac artery occlusive disease may lead to a lower rate of intimal hyperplasia and thus to increased patency rates even in heavily calcified vessels. However, large-scale prospective trials have to be performed to evaluate the long-term patency rates of the HC coated stents.

Placement of hemoparin-coated stents in the iliac arteries: Early experience and midterm results in 28 patients

International Nuclear Information System (INIS)

Kalmar, Peter I.; Portugaller, Rupert H.; Schedlbauer, Peter; Bohlsen, Dennis; Deutschmann, Hannes A.

2014-01-01

Purpose: Aim was to determine immediate results and mid-term outcome of the hemoparin-coated (HC) stainless-steel stent (camouflage coating) in the treatment of occlusive lesions of the iliac arteries. Materials and methods: Twenty-eight patients were prospectively treated with the use of a HC stent between January 2007 and March 2010. Clinical examination and color-doppler ultrasound were performed at 1, 3, 6 and 12 months, CT angiography (CTA) or MR angiography (MRA) at 12 months. Indication for treatment was a high-grade stenosis of the common iliac and/or external iliac artery. Results: Successful placement was achieved in all patients. Significant decrease in translesional pressure gradient (>10 mmHg) was measured in 27 patients (96%). In one patient, proximal dissection occurred without flow limitation. A minor complication (small access site hematoma) occurred in one patient (4%). Two patients (7%) were lost to follow-up. After 12 months, stent patency in CTA, MRA and ultrasound was 100%. 20 patients (77%) experienced an initial improvement of at least one clinical stage. In one patient (4%), mild intimal hyperplasia without significant stenosis was observed. In three patients (12%), proximal or distal stenosis occurred. A non-significant increase of mean ankle-brachial index (ABI) after treatment was measured (0.85 ± 0.27 vs. 0.75 ± 0.22, respectively; p = 0.328). Conclusions: The use of HC stents in patients with iliac artery occlusive disease may lead to a lower rate of intimal hyperplasia and thus to increased patency rates even in heavily calcified vessels. However, large-scale prospective trials have to be performed to evaluate the long-term patency rates of the HC coated stents

Improved safety and reduction in stent thrombosis associated with biodegradable polymer-based biolimus-eluting stents versus durable polymer-based sirolimus-eluting stents in patients with coronary artery disease: final 5-year report of the LEADERS (Limus Eluted From A Durable Versus ERodable Stent Coating) randomized, noninferiority trial.

Science.gov (United States)

Serruys, Patrick W; Farooq, Vasim; Kalesan, Bindu; de Vries, Ton; Buszman, Pawel; Linke, Axel; Ischinger, Thomas; Klauss, Volker; Eberli, Franz; Wijns, William; Morice, Marie Claude; Di Mario, Carlo; Corti, Roberto; Antoni, Diethmar; Sohn, Hae Y; Eerdmans, Pedro; Rademaker-Havinga, Tessa; van Es, Gerrit-Anne; Meier, Bernhard; Jüni, Peter; Windecker, Stephan

2013-08-01

This study sought to report the final 5 years follow-up of the landmark LEADERS (Limus Eluted From A Durable Versus ERodable Stent Coating) trial. The LEADERS trial is the first randomized study to evaluate biodegradable polymer-based drug-eluting stents (DES) against durable polymer DES. The LEADERS trial was a 10-center, assessor-blind, noninferiority, "all-comers" trial (N = 1,707). All patients were centrally randomized to treatment with either biodegradable polymer biolimus-eluting stents (BES) (n = 857) or durable polymer sirolimus-eluting stents (SES) (n = 850). The primary endpoint was a composite of cardiac death, myocardial infarction (MI), or clinically indicated target vessel revascularization within 9 months. Secondary endpoints included extending the primary endpoint to 5 years and stent thrombosis (ST) (Academic Research Consortium definition). Analysis was by intention to treat. At 5 years, the BES was noninferior to SES for the primary endpoint (186 [22.3%] vs. 216 [26.1%], rate ratio [RR]: 0.83 [95% confidence interval (CI): 0.68 to 1.02], p for noninferiority 1 year) and associated composite clinical outcomes. (Limus Eluted From A Durable Versus ERodable Stent Coating [LEADERS] trial; NCT00389220). Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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.

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

Investigation of adverse events associated with an off-label use of arterial stents and CE-marked iliac vein stents in the iliac vein: insights into developing a better iliac vein stent.

Science.gov (United States)

Shida, Takuya; Umezu, Mitsuo; Iwasaki, Kiyotaka

2018-06-01

We analyzed the adverse events associated with an off-label use of arterial stents and CE-marked iliac vein stents for the treatment of iliac venous thromboembolism and investigated their relationships with the anatomical features of the iliac vein, to gain insights into the development of a better iliac vein stent. Reports of adverse events following the use of stents in the iliac vein were retrieved from the Manufacturer and User Facility Device Experience (MAUDE) database that contain suspected device-associated complications reported to the Food and Drug Administration. Data from 2006 to 2016 were investigated. The literature analysis was also conducted using PubMed, Cochrane Library, EMBASE, and Web of Science focusing on English articles published up to 4 October 2016. The analysis of 88 adverse events from the MAUDE database and 182 articles from the literature revealed that a higher number of adverse events had been reported following the use of arterial stents in the iliac vein compared to CE-marked iliac vein stents. While stent migration and shortening were reported only for the arterial stents, stent fracture and compression occurred regardless of the stent type, even though a vein does not pulsate. A study of the anatomical features of the iliac vein implies that bending, compression, and kink loads are applied to the iliac vein stents in vivo. For designing, developing, and pre-clinical testing of stents intended for use in the iliac vein, the above mechanical load environments induced by the anatomical features should be considered.

Pancreatitis-Associated Splenic Artery Pseudoaneurysm: Endovascular Treatment with Self-Expandable Stent-Grafts

International Nuclear Information System (INIS)

Brountzos, Elias N.; Vagenas, Kostantinos; Apostolopoulou, Sotiria C.; Panagiotou, Irene; Lymberopoulou, Dimitra; Kelekis, Dimitrios A.

2003-01-01

We present a patient with a splenic arterypseudoaneurysm (SAPA) treated with placement of self-expandable stent-grafts. The procedure was complicated by stent-graft migration,but successful management resulted in lasting exclusion of the SAPA,while the patency of the splenic artery was preserved. This is the first report of self-expandable stent-graft treatment of SAPA

Conformally integrated stent cell resonators for wireless monitoring of peripheral artery disease

KAUST Repository

Viswanath, Anupam; Green, Scott Ryan; Kosel, Jü rgen; Gianchandani, Yogesh B.

2013-01-01

This paper presents the design and in vitro evaluation of magnetoelastic sensors intended for wireless monitoring of tissue accumulation in peripheral artery stents. The sensors, shaped like stent cells, are fabricated from 28-μm thick foils

Percutaneous stenting of the superior mesenteric artery for the treatment of chronic mesenteric ischemia

International Nuclear Information System (INIS)

Gweon, Hye Mi; Suh, Sang Hyun; Won, Jong Yun; Lee, Do Yun; Kim, Sam Soo

2008-01-01

We wanted to evaluate the effectiveness of stent placement on the superior mesenteric artery as a treatment for chronic mesenteric ischemia. Seven patients (mean age: 55 years, age range: 43-66 years) with chronic mesenteric ischemia were enrolled between March 2000 and September 2003. All the patients underwent pre-procedure contrast enhanced computerized tomography to evaluate for occlusion or stenosis of the mesenteric arteries and they then underwent an angiographic procedure. A balloon-expandable metal stent was placed in the superior mesenteric artery, and this was combined with balloon angioplasty and thrombolysis. We evaluated the angiographic and procedural success after the procedures. Angiographic and procedural success was obtained in 100% of the patients and the clinical symptoms improved in 100% of the patients. The patency at 6-months and 1-year was 85% and 71%, respectively. The mean follow-up period was 12 months (range: 1-25 months). During the follow-up period, ischemic symptoms recurred in 2 patients, and restenosis in a stent was confirmed with angiography; one patient was successfully treated by stent placement in the celiac artery and the other patient died due to extensive mesenteric thrombosis. For the treatment of chronic mesenteric ischemia, percutaneous stent placement on the superior mesenteric artery showed a favorable result and it was an effective alternative to surgery for the high-risk patients

Safety and effectiveness of the INVATEC MO.MA proximal cerebral protection device during carotid artery stenting: results from the ARMOUR pivotal trial.

Science.gov (United States)

Ansel, Gary M; Hopkins, L Nelson; Jaff, Michael R; Rubino, Paolo; Bacharach, J Michael; Scheinert, Dierk; Myla, Subbarao; Das, Tony; Cremonesi, Alberto

2010-07-01

The multicenter ARMOUR (ProximAl PRotection with the MO.MA Device DUring CaRotid Stenting) trial evaluated the 30-day safety and effectiveness of the MO.MA Proximal Cerebral Protection Device (Invatec, Roncadelle, Italy) utilized to treat high surgical risk patients undergoing carotid artery stenting (CAS). Distal embolic protection devices (EPD) have been traditionally utilized during CAS. The MO.MA device acts as a balloon occlusion "endovascular clamping" system to achieve cerebral protection prior to crossing the carotid stenosis. This prospective registry enrolled 262 subjects, 37 roll-in and 225 pivotal subjects evaluated with intention to treat (ITT) from September 2007 to February 2009. Subjects underwent CAS using the MO.MA device. The primary endpoint, myocardial infarction, stroke, or death through 30 days (30-day major adverse cardiac and cerebrovascular events [MACCE]) was compared to a performance goal of 13% derived from trials utilizing distal EPD. For the ITT population, the mean age was 74.7 years with 66.7% of the cohort being male. Symptomatic patients comprised 15.1% and 28.9% were octogenarians. Device success was 98.2% and procedural success was 93.2%. The 30-day MACCE rate was 2.7% [95% CI (1.0-5.8%)] with a 30-day major stroke rate of 0.9%. No symptomatic patient suffered a stroke during this trial. The ARMOUR trial demonstrated that the MO.MA(R) Proximal Cerebral Protection Device is safe and effective for high surgical risk patients undergoing CAS. The absence of stroke in symptomatic patients is the lowest rate reported in any independently adjudicated prospective multicenter registry trial to date. (c) 2010 Wiley-Liss, Inc.

3-Year Clinical Follow-Up of the RIBS IV Clinical Trial: A Prospective Randomized Study of Drug-Eluting Balloons Versus Everolimus-Eluting Stents in Patients With In-Stent Restenosis in Coronary Arteries Previously Treated With Drug-Eluting Stents.

Science.gov (United States)

Alfonso, Fernando; Pérez-Vizcayno, María José; Cuesta, Javier; García Del Blanco, Bruno; García-Touchard, Arturo; López-Mínguez, José Ramón; Masotti, Mónica; Zueco, Javier; Cequier, Angel; Velázquez, Maite; Moreno, Raúl; Mainar, Vicente; Domínguez, Antonio; Moris, Cesar; Molina, Eduardo; Rivero, Fernando; Jiménez-Quevedo, Pilar; Gonzalo, Nieves; Fernández-Pérez, Cristina

2018-05-28

This study sought to compare the long-term safety and efficacy of drug-eluting balloons (DEB) and everolimus-eluting stents (EES) in patients with in-stent restenosis (ISR) of drug-eluting stents (DES). Treatment of patients with DES-ISR remains a challenge. The RIBS IV (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloons vs Everolimus-Eluting Stents) trial is a prospective multicenter randomized clinical trial comparing DEB and EES in patients with DES-ISR. The pre-specified comparison of the 3-year clinical outcomes obtained with these interventions is the main objective of the present study. A total of 309 patients with DES-ISR were randomized to DEB (n = 154) or EES (n = 155). At angiographic follow-up, the in-segment minimal lumen diameter was larger in the EES arm (2.03 ± 0.7 mm vs. 1.80 ± 0.6 mm; p 1 year) target lesion revascularization (2.6% vs. 4%) and target vessel revascularization (4% vs. 6.6%) was similar in the 2 arms. Rates of cardiac death (3.9% vs. 3.2%), myocardial infarction (2.6% vs. 4.5%), and stent thrombosis (1.3% vs. 2.6%) at 3 years were also similar in both arms. The 3-year clinical follow-up of this randomized clinical trial demonstrates that in patients with DES-ISR, EES reduce the need for repeat interventions compared with DEB. (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloons vs Everolimus-Eluting Stents [RIBS IV]; NCT01239940). Published by Elsevier Inc.

Clinical experience of cerebral protection with balloon occlusion during carotid artery stenting

International Nuclear Information System (INIS)

Jaeger, H.J.; Mathias, K.D.; Drescher, R.; Bockisch, G.; Hauth, E.; Demirel, E.; Gissler, H.M.; Witten/Herdecke Univ.

2001-01-01

Purpose: To asses the technical feasibility and the results of cerebral protection with the GuardWire Plus Temporary Occlusion and Aspiration System during carotid artery stenting for high-grade stenosis. Patients and Methods: In 20 patients 20 carotid artery stenoses were treated with stent placement under cerebral protection. A contralateral carotid occlusion was an exclusion criteria for the use of the protection device. In all cases only aspiration, but no flushing was used before deflation of the occlusion balloon. In 17 of 20 patients diffusion-weighted (DW-)MRT imaging of the brain was performed before and 24 hours after the procedure. Results: The stent implantation was successfully performed in all patients. In 3 patients neurologic symptoms occurred during the occlusion time. In these 3 patients the symptoms immediately disappeared after deflation of the balloon. In one case there was dilatation of the internal carotid artery at the site of the balloon inflation. In 3 of the 17 DW-MR images new ipsilateral cerebral lesions, in one case a new contralateral lesion occurred after the procedure. Conclusions: The cerebral protection procedure is technically feasible. The occlusion of the internal carotid artery was not tolerated by all patients. The DW-MR imaging demonstrated cerebral lesions indicating the occurrence of cerebral microemboli during the procedure. Further investigations are necessary to determine if the use of the cerebral protection device will improve the results of the carotid artery stenting for high-grade stenoses. (orig.) [de

Influence of stent design and use of protection devices on outcome of carotid artery stenting: a pooled analysis of individual patient data.

Science.gov (United States)

Wodarg, Fritz; Turner, Elisabeth L; Dobson, Joanna; Ringleb, Peter A; Mali, Willem P; Fraedrich, Gustav; Chatellier, Gilles; Bequemin, Jean-Pierre; Brown, Martin M; Algra, Ale; Mas, Jean-Louis; Jansen, Olav; Bonati, Leo H

2018-04-19

Carotid artery stenting is an alternative to endarterectomy for the treatment of symptomatic carotid stenosis but was associated with a higher risk of procedural stroke or death in randomized controlled trials (RCTs). Technical aspects of treatment may partly explain these results. The purpose of this analysis was to investigate the influence of technical aspects such as stent design or the use of protection devices, as well as clinical variables, on procedural risk. We pooled data of 1557 individual patients receiving stent treatment in three large RCTs comparing stenting versus endarterectomy for symptomatic carotid stenosis. The primary outcome event was any procedural stroke or death occurring within 30 days after stenting. Procedural stroke or death occurred significantly more often with the use of open-cell stents (61/595 patients, 10.3%) than with closed-cell stents (58/962 patients, 6.0%; RR 1.76; 95% CI 1.23 to 2.52; P=0.002). Procedural stroke or death occurred in 76/950 patients (8.0%) treated with protection devices (predominantly distal filters) and in 43/607 (7.1%) treated without protection devices (RR 1.10; 95% CI 0.71 to 1.70; P=0.67). Clinical variables predicting the primary outcome event were age, severity of the qualifying event, history of prior stroke, and level of disability at baseline. The effect of stent design remained similar after adjustment for these variables. In symptomatic carotid stenosis, the use of stents with a closed-cell design is independently associated with a lower risk of procedural stroke or death compared with open-cell stents. Filter-type protection devices do not appear to reduce procedural risk. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effects of 32P radioactive stents on in-stent restenosis in a double stent injury model of the porcine coronary arteries

International Nuclear Information System (INIS)

Kim, Han-Soo; Chan, Rosanna C.; Kollum, Marc; Au, Arthur; Tio, Fermin O.; Yazdi, Hamid A.; Ajani, Andrew E.; Waksman, Ron

2001-01-01

Background: The major limitation of coronary stenting remains in-stent restenosis, due to the development of neointimal proliferation. Radioactive stents have demonstrated the ability to reduce this proliferation in the healthy nonatherosclerotic porcine animal model. However, inhibition of tissue proliferation in the in-stent restenotic lesion in a porcine model is not well characterized. The objective of this study was to examine the efficacy and safety of the 32 P radioactive stent for the treatment of in-stent restenosis in a double stent injury model of the porcine coronaries. Methods and Materials: Eighteen coronary arteries in 9 pigs underwent nonradioactive stent (8 mm in length) implantation. Thirty days after the initial stent implantation, a 32 P radioactive stent (18 mm in length) with an activity of 0 and 18 μCi was implanted to cover the initial stent. The swine were killed 30 days after the second stent implantation. Histomorphometric analysis was performed for vessel area (VA), stent strut area (SSA), intimal area (IA), and lumen area (LA). Results: Injury scores, VA, SSA, and LA were similar among the control and radiated groups. Neointimal formation was significantly reduced after placement of radioactive stents as compared to control in both the overlapped (0.93±0.12 vs. 1.31±0.51 mm 2 , p 2 , p 32 P radioactive stents may be safe and effective in reducing neointimal formation leading to in-stent restenosis. Longer follow-up will be required to examine whether these positive findings can be maintained

Kissing stenting of aorto-ostial lesions in juxtaposed renal arteries

OpenAIRE

Hasija, Pradeep; Chadha, Davinder; Kalra, Ravi

2014-01-01

Percutaneous angioplasty with or without stenting has become an established procedure for treatment of renal artery stenosis for control of hypertension or progressive renal dysfunction. Anatomic variation of renal arteries is common with dual blood supply of unilateral kidney noted in almost 25% of the general population. Renal angioplasty of these anatomic variants of renal arteries is challenging. We present an unusual case of juxtaposed renal arteries with aorto-ostial lesion where direct...

Complications in percutaneous transluminal stenting for carotid artery stenosis

International Nuclear Information System (INIS)

Li Shenmao; Miao Zhongrong; Zhu Fengshui; Ji Xunming; Jiao Liqun; Qi Jianshu; Ling Feng

2007-01-01

Objective: To discuss the complications of endovascular stenting for carotid artery stenosis. Methods: Cerebral vascular angiography and cervical Doppler sonography were performed in 648 patients with carotid artery stenosis. Emboli-protected device was used in 365 patients and none in 283 patients. Results: All 648 patients were technically successful (100%). Symptoms disappeared or improved in 78.7% patients. Slow heart rate during operation existed in 26.4% patients. Embolism caused by dislodgment of emboli occurred in 5 patients, 3 of them recovered after treatment and 2 had unilateral dyskinesias. Intracranial hemorrhage occurred in 3 patients. Stroke or death within 30 days after operation occurred in 6 patients(1.24%). 322 patients (77.8%)were followed up. Restenosis occurred in 17 patients(3.3%). Conclusion: Percutaneous transluminal stenting is a safe option for carotid artery stenosis. Correct evaluation of clinical and angiographic data before operation, together with normative manipulation and nursing during and after operation are the key points to avoid complications. (authors)

Reliability of mechanical and phased-array designs for serial intravascular ultrasound examinations--animal and clinical studies in stented and non-stented coronary arteries.

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Tardif, J C; Bertrand, O F; Mongrain, R; Lespérance, J; Grégoire, J; Paiement, P; Bonan, R

2000-10-01

Both mechanical and multi-element intravascular ultrasound designs have potential advantages and limitations that may impact on their value for clinical and research purposes. Determination of the reproducibility of measurements is critical before a given system can be used in studies such as regression of atherosclerosis trials. We performed serial intravascular ultrasound imaging with catheters using mechanical and phased-array designs in stented and non-stented coronary arteries in dogs and in patients. Both systems correlated well for areas (r > or = 0.90, p or = 0.84. p mechanical designs for measurements of area (mean difference in dogs and in patients: -0.24 and 0.96 mm2, p mechanical system (r > or = 0.96 for all measurements). The differences in absolute and relative variability between the mechanical and phased-array designs, both for reanalysis of same frames and serial pullbacks, were very small. Although multi-element and mechanical intravascular ultrasound designs are not strictly interchangeable, their similar reproducibility and the small differences in measurements demonstrate that both designs are acceptable alternatives for trials of regression of atherosclerosis. Determination of the variability for serial pullbacks of both designs was also important to assess the statistical power of such trials.

Percutaneous subclavian artery stent-graft placement following failed ultrasound guided subclavian venous access

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Szkup Peter

2006-05-01

Full Text Available Abstract Background Ultrasound guidance for central and peripheral venous access has been proven to improve success rates and reduce complications of venous cannulation. Appropriately trained and experienced operators add significantly to diminished patient morbidity related to venous access procedures. We discuss a patient who required an arterial stent-graft to prevent arterial hemorrhage following inadvertent cannulation of the proximal, ventral, right subclavian artery related to unsuccessful ultrasound guided access of the subclavian vein. Case presentation During pre-operative preparation for aortic valve replacement and aorto-coronary bypass surgery an anesthetist attempted ultrasound guided venous access. The ultrasound guided attempt to access the right jugular vein failed and the ultrasound guided attempt at accessing the subclavian vein resulted in inappropriate placement of an 8.5 F sheath in the arterial system. Following angiographic imaging and specialist consultations, an arterial stent-graft was deployed in the right subclavian artery rather than perform an extensive anterior chest wall resection and dissection to extract the arterial sheath. The patient tolerated the procedure, without complication, despite occlusion of the right internal mammary artery and the right vertebral artery. There were no neurologic sequelae. There was no evidence of hemorrhage after subclavian artery sheath extraction and stent-graft implantation. Conclusion The attempted ultrasound guided puncture of the subclavian vein resulted in placement of an 8.5 F subclavian artery catheter. Entry of the catheter into the proximal subclavian artery beneath the medial clavicle, the medial first rib and the manubrium suggests that the operator, most likely, did not directly visualize the puncture needle enter the vessel with the ultrasound. The bones of the anterior chest impede the ultrasound beam and the vessels in this area would not be visible to ultrasound

Orbital atherectomy as an adjunct to debulk difficult calcified lesions prior to mesenteric artery stenting.

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Manunga, Jesse M; Oderich, Gustavo S

2012-08-01

To describe a technique in which percutaneous orbital atherectomy is used to debulk heavily calcified superior mesenteric artery (SMA) occlusions as an adjunct in patients undergoing angioplasty and stenting. The technique is demonstrated in a 62-year-old woman with a replaced right hepatic artery originating from an SMA occluded by densely calcified lesions. Via a left transbrachial approach, a 7-F MPA guide catheter was used to engage the ostium of the SMA, which was crossed using a catheter and guidewire. The calcified lesion was debulked using the 2-mm Diamondback 360° orbital atherectomy system. The wire was exchanged for a 0.014-inch filter wire and 0.018-inch guidewire. Using a 2-guidewire technique, the SMA was stented with a self-expanding stent for the distal lesion that crossed side branches and a balloon-expandable stent at the ostium. A 0.014-inch guidewire was placed into the replaced hepatic artery through a cell of the self-expanding stent, followed by deployment of a small balloon-expandable stent to address the residual lesion. The use of orbital atherectomy to debulk occluded and heavily calcified SMA lesions may optimize the technical results with angioplasty and stenting.

Long term outcomes of new generation drug eluting stents versus coronary artery bypass grafting for multivessel and/or left main coronary artery disease. A Bayesian network meta-analysis of randomized controlled trials.

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Mina, George S; Watti, Hussam; Soliman, Demiana; Shewale, Anand; Atkins, Jessica; Reddy, Pratap; Dominic, Paari

2018-01-05

Most data guiding revascularization of multivessel disease (MVD) and/or left main disease (LMD) favor coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI). However, those data are based on trials comparing CABG to bare metal stents (BMS) or old generation drug eluting stents (OG-DES). Hence, it is essential to outcomes of CABG to those of new generation drug eluting stents (NG-DES). We searched PUBMED and Cochrane database for trials evaluating revascularization of MVD and/or LMD with CABG and/or PCI. A Bayesian network meta-analysis was performed to calculate odds ratios (OR) and 95% credible intervals (CrI). Primary outcome was major adverse cardiovascular events (MACE) at 3-5 years. Secondary outcomes were mortality, cerebrovascular accidents (CVA), myocardial infarction (MI) and repeat revascularization. We included 10 trials with a total of 9287 patients. CABG was associated with lower MACE when compared to BMS or OG-DES. However, MACE was not significantly different between CABG and NG-DES (OR 0.79, CrI 0.45-1.40). Moreover, there were no significant differences between CABG and NG-DES in mortality (OR 0.78, CrI 0.45-1.37), CVA (OR 0.93 CrI 0.35-2.2) or MI (OR 0.6, CrI 0.17-2.0). On the other hand, CABG was associated with lower repeat revascularization (OR 0.55, CrI 0.36-0.84). Our study suggests that NG-DES is an acceptable alternative to CABG in patients with MVD and/or LMD. However, repeat revascularization remains to be lower with CABG than with PCI. Copyright © 2018. Published by Elsevier Inc.

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)

High-dose external beam irradiation inhibits neointima formation in stented pig coronary arteries

International Nuclear Information System (INIS)

Verheye, Stefan; Coussement, Patrick K.; Salame, Mahomed Y.; Fallahi, Payam; Cui Jianhua; Chronos, Nicolas A.F.; King, Spencer B.; Crocker, Ian R.; Robinson, Keith A.

2001-01-01

Purpose: To evaluate high-dose external beam irradiation (EBRT) in a pig coronary stent preparation because low and intermediate-dose EBRT failed to show inhibition of neointima formation in stented animal models. Methods and Materials: Thirty-five stents were implanted in the coronary arteries of 17 pigs. Seven pigs were exposed to a single dose of 21 Gy EBRT immediately after stenting. Ten stented, nonirradiated pigs served as controls. After 4 weeks, the study arteries and myocardium were examined by light and scanning electron microscopy. Results: Compared with controls, 21 Gy EBRT resulted in a larger lumen area (7.57±1.67 mm 2 vs. 4.00±1.63 mm 2 , p 2 vs. 3.36±2.26 mm 2 , p<0.001) and a smaller maximal intimal thickness (0.16±0.09 mm vs. 0.68±0.31 mm, p<0.001). Unresorbed intramural hemorrhages and adherent mural thrombi were present in the irradiated vessels, which also showed incomplete re-endothelialization. The irradiated hearts demonstrated diffuse interstitial and perivascular inflammation and fibrosis. Conclusions: EBRT at 21 Gy to the entire heart significantly inhibited neointima formation in stented pig coronary arteries but also resulted in incomplete re-endothelialization, myocardial inflammation, and fibrosis. Improvements in localization and delivery techniques are required to allow clinical implementation of this technique

Wingspan stent for symptomatic M1 stenosis of middle cerebral artery

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Guo Xinbin; Ma Nan; Hu Xiaobo; Guan Sheng; Fan Yimu

2011-01-01

Objective: Stent placement for intracranial atherosclerotic stenosis has become an alternative treatment technique; however, stent placement for middle cerebral artery (MCA) stenosis remains a technical and clinical challenge. Our purpose was to assess the safety and feasibility of Wingspan stent for patients with symptomatic M1 stenosis, and its initial effect on prevention of ischemic events. Methods: Fifty-three cases with recurrent symptomatic MCA stenosis resistant to medical therapy treated by self-expanding stent were reviewed retrospectively (average 58 ± 18.5 years old, 19 women). All patients underwent angioplasty and stenting with the Gateway balloon–Wingspan stent system, and advised follow-up with DSA or TCD at 6th month. Results: Patients had an average stenosis ratio of 76.5 ± 15.4% prior to the treatment. Of the 53 patients, the technical success rate was 98.1% as a whole (52/53). The mean degree of stenosis reduced from (76.5 ± 15.4)% to (18.2 ± 11.3)%. Complications associated with the procedure include subarachnoid hemorrhage (1.89%) and occlusion (3.78%) occurred. During a follow-up of 6 months, there was no recurrence of transient ischemic attack or stroke in 52 cases with successful stenting. Cerebral hemodynamics of MCA using transcranial Doppler monitoring were at normal level (<120 cm/s) in 41 follow-up patients. The follow up angiography at 6 month post-procedure was conducted in 32 patients and showed good patency in stented vessels. Conclusions: Wingspan stent for symptomatic stenosis of middle cerebral artery is a safe and feasible procedure. It improves clinical outcome in the intermediate follow up, but its long-term effect remains to be further evaluated.

Coronary artery stent mimicking intracardiac thrombus on cardiac magnetic resonance imaging due to signal loss

DEFF Research Database (Denmark)

Qayyum, Abbas Ali; Vejlstrup, Niels Grove; Ahtarovski, Kiril Aleksov

2012-01-01

Since the introduction of percutaneous coronary intervention for coronary artery disease, thousands of patients have been treated with the implantation of coronary stents. Moreover, several of the patients with coronary stent undergo cardiac magnetic resonance (CMR) imaging every year. This case...... report is of a 77-year-old man who was previously treated with the implantation of a coronary stent in the left circumflex artery. He underwent CMR imaging, which revealed a process 14×21 mm in the left atrium. Cardiac contrast computed tomography did not demonstrate any cardiac pathology. While...... the signal loss on MRI associated with implanted metallic devices is known, we report a case where an implanted coronary stent in the left circumflex artery led to an intracardiac signal loss mimicking intracardiac thrombus/tumor....

The risk of endoleak following stent covering of the internal iliac artery during endovascular aneurysm repair

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Rajesparan, K.; Partridge, W.; Refson, J.; Abidia, A.; Aldin, Z.

2014-01-01

Aim: To investigate the risk of endoleak during endovascular aneurysm repair (EVAR) involving the distal common iliac artery (CIA) when the internal iliac artery (IIA) is covered without prior coil embolization. Materials and methods: Retrospective analysis of 145 (125 men, 20 women) consecutive EVAR cases. Clinical notes and radiological images were reviewed, and data collected on patient demographics, aneurysm morphology, covering of the IIA with or without embolization, presence of endoleaks, and patient symptoms relating to IIA ischaemia. Results: A total of 29 IIAs (10%) were covered in a total of 25 patients. Seven IIAs (24%) were embolized before stent covering (Embolization group), and 22 IIAs (76%) were covered only without embolization (Cover group). There was no statistically significant difference in the mean size of the abdominal aortic aneurysm diameter or CIA diameter between each group. No endoleaks from IIA retrograde filling were found in either group. Conclusion: The results of the present study do not support the traditional view that coverage of the IIA without prior embolization carries a high risk of endoleak, with no endoleaks seen in all 22 cases. Large-scale trials are required. However, the advent of branched-stenting techniques and the emergence of their success in long-term follow-up may preclude the former. - Highlights: • No EVAR endoleaks due to retrograde filling of the internal iliac artery (IIA). • No increased risk of endoleak with stent coverage of the IIA without embolisation. • Current evidence does not support traditional views

Intravascular stenting in the superior mesenteric artery for chronic abdominal angina.

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Busquet, J

1997-11-01

Abdominal angina is an early clinical expression of occlusive mesenteric arterial insufficiency, a condition that requires aggressive treatment to prevent intestinal infarction. We report a case of chronic mesenteric ischemia in a young polyvascular man who had symptoms of abdominal angina. An aortic angiogram revealed a significant ostial stenosis of the superior mesenteric artery (SMA) associated with an occlusion of the inferior mesenteric artery. After predilation of the ostial portion of the SMA, significant residual stenosis remained. A balloon-expandable Palmaz P154 stent was deployed, restoring adequate luminal dimensions and blood flow. The patient was discharged after 2 days and remains asymptomatic at 5 months. Intraluminal stenting for treatment of mesenteric ischemia represents a viable alternative to surgical revascularization in selected cases.

Second generation drug-eluting stents versus bare-metal stents for percutaneous coronary intervention of the proximal left anterior descending artery

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Mangione, Fernanda Marinho; Biering-Sørensen, Tor; Nochioka, Kotaro

2017-01-01

OBJECTIVES: To compare mid-term outcomes between patients undergoing proximal left anterior descending artery (LAD) percutaneous coronary intervention (PCI) with second generation drug-eluting stent (DES) or bare-metal stent (BMS). BACKGROUND: PCI with BMS and first-generation DES have shown to b...

Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting

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George S. Georgiadis

2015-01-01

Full Text Available Endovascular therapy for iliac artery chronic total occlusions is nowadays associated with low rates of procedure-related complications and improved clinical outcomes, and it is predominantly used as first-line therapy prior to aortobifemoral bypass grafting. Herein, we describe the case of a patient presenting with an ischemic left foot digit ulcer and suffering complex aortoiliac lesions, who received common iliac arteries kissing stents, illustrating at final antegrade and retrograde angiograms the early recognition of a blood flow obstructing valve-like calcified intimal flap protruding through the stent struts, which was obstructing antegrade but not retrograde unilateral iliac arterial axis blood flow. The problem was resolved by reconstructing the aortic bifurcation at a more proximal level. Completion angiogram verified normal patency of aorta and iliac vessels. Additionally, a severe left femoral bifurcation stenosis was also corrected by endarterectomy-arterioplasty with a bovine patch. Postintervention ankle brachial pressure indices were significantly improved. At the 6-month and 2-year follow-up, normal peripheral pulses were still reported without intermittent claudication suggesting the durability of the procedure. Through stent-protruding calcified intimal flap, is a very rare, but existing source of antegrade blood flow obstruction after common iliac arteries kissing stents.

Drug-eluting stent implantation for the percutaneous treatment of vertebro-basilar arterial stenosis

International Nuclear Information System (INIS)

Ma Rujun; Liu Jianmin; Huang Haiqing; Hong Bo; Xu Yi; Zhao Wenyuan; Zhao Rui; Chen Jun

2006-01-01

Objective: To evaluate the early results and mid-term outcomes following angioplasty of vertebro-basilar arterial stenosis with drug-eluting stents. Methods: All of the patients presented with recurrent TIA or ceretral infarction with >50% stenoses in vertebro-basilar arteries, and having failure in maximal medical therapy. All of the lesions were treated with primary stenting under local or general anesthesia and followed by continual anticoagulant therapy of clopidogrel and aspirin together with clinical follow-up and vascular imagings. Results: Of 28 stenoses (27 patients), 27 lesions were successfully treated with implantation of 24 Cypher stents, 2 Taxus stents and one Firebird stent. The mean stenotic severity reduced from (74 ± 6.7)% to (8.7 ± 4.4)%. Two patients had inchemic events relating to penetration vascular obstruction. During 2-14 months follow-up, the patients were clinically asymptomatic with no recurrent TIA/stoke. Angiographic follow-up was obtained in 14 patients at a mean of 7.2 months. Proximal restenosis (<50%) occurred in one patient (3.3%), and corrected with restenting, while others were free of intra-stent restenoses. Conclusion: Using DES in cerebrovascular stenosis is safe and effective with lowing the risk of intra-stent restenosis in comparison with bare stent. Further study for long term efficiency is still in need. (authors)

Carotid Artery Stenting Successfully Prevents Progressive Stroke Due to Mobile Plaque

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Masahiro Oomura

2015-05-01

Full Text Available We report a case of progressive ischemic stroke due to a mobile plaque, in which carotid artery stenting successfully prevented further infarctions. A 78-year-old man developed acute multiple infarcts in the right hemisphere, and a duplex ultrasound showed a mobile plaque involving the bifurcation of the left common carotid artery. Maximal medical therapy failed to prevent further infarcts, and the number of infarcts increased with his neurological deterioration. Our present case suggests that the deployment of a closed-cell stent is effective to prevent the progression of the ischemic stroke due to the mobile plaque.

High-resolution ex vivo imaging of coronary artery stents using 64-slice computed tomography - initial experience

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Rist, Carsten; Nikolaou, Konstantin; Wintersperger, Bernd J.; Reiser, Maximilian F.; Becker, Christoph R.; Flohr, Thomas

2006-01-01

The aim of the study was to evaluate the potential of new-generation multi-slice computed tomography (CT) scanner technology for the delineation of coronary artery stents in an ex vivo setting. Nine stents of various diameters (seven stents 3 mm, two stents 2.5 mm) were implanted into the coronary arteries of ex vivo porcine hearts and filled with a mixture of an iodine-containing contrast agent. Specimens were scanned with a 16-slice CT (16SCT) machine; (Somatom Sensation 16, Siemens Medical Solutions), slice thickness 0.75 mm, and a 64-slice CT (64SCT, Somatom Sensation 64), slice-thickness 0.6 mm. Stent diameters as well as contrast densities were measured, on both the 16SCT and 64SCT images. No significant differences of CT densities were observed between the 16SCT and 64SCT images outside the stent lumen: 265±25HU and 254±16HU (P=0.33), respectively. CT densities derived from the 64SCT images and 16SCT images within the stent lumen were 367±36HU versus 402±28HU, P<0.05, respectively. Inner and outer stent diameters as measured from 16SCT and 64SCT images were 2.68±0.08 mm versus 2.81±0.07 mm and 3.29±0.06 mm versus 3.18±0.07 mm (P<0.05), respectively. The new 64SCT scanner proved to be superior in the ex vivo assessment of coronary artery stents to the conventional 16SCT machine. Increased spatial resolution allows for improved assessment of the coronary artery stent lumen. (orig.)

Evolution of patency rates of self-expandable bare metal stents for endovascular treatment of femoro-popliteal arterial occlusive disease: Does stent design matter?

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Treitl, Karla Maria; Woerner, Benedikt; Schinner, Regina; Czihal, Michael; Notohamiprodjo, Susan; Hoffmann, Ulrich; Treitl, Marcus

2017-09-01

To analyse the patency rates of femoro-popliteal stenting with different self-expandable Nitinol stent-designs. Two hundred and twenty-two patients (142 (64%) male; age 72.4 ± 11.6 years) with symptomatic femoro-popliteal peripheral arterial occlusive disease (PAOD) underwent percutaneous transluminal angioplasty (PTA) and stenting with three different Nitinol stents (interwoven IW: n = 70; closed-cell CC: n = 85; open-cell OC: n = 67). One-year post-procedural target lesion revascularization (TLR_12M) rates were investigated with regard to co-morbidities: diabetes (DBM), hyperlipidaemia (HLP), hypertension (RR), coronary artery disease (CAD) and degree of calcification. Twelve-month follow-up data were available for 60, 69 and 50 patients in the IW, OC and CC groups (179 patients in total). The cumulative patency (IW: 52 (86.7%); OC: 50 (72.5%); CC: 23 (46.0%); P stent and the highest TLR_12M for the CC stent. The interwoven stent-design was superior to the standard open- and closed-cell stent-designs in endovascular treatment of femoro-popliteal PAOD in a follow-up period of 12 months. • Results of femoro-popliteal stenting are still unsatisfactory. • Comparative studies for currently available different Nitinol stent-designs are lacking. • This is a first comparative study on long-term patency of different Nitinol stent-designs. • Interwoven stent-design leads to improved long-term patency. • Interwoven stent-design leads to lower TLR than other stent-designs.

Percutaneous coronary intervention with second-generation paclitaxel-eluting stents versus everolimus-eluting stents in United States contemporary practice (REWARDS TLX Trial).

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Waksman, Ron; Ghali, Magdi; Goodroe, Randy; Ryan, Thomas; Turco, Mark; Ring, Michael; McGarry, Thomas; Dobies, David; Shammas, Nicolas; Steinberg, Daniel H; Swymelar, Stacy; Kaneshige, Kimberly; Torguson, Rebecca

2012-10-15

Registry Experience at the Washington Hospital Center, DES - Taxus Liberte Versus Xience V (REWARDS TLX) is a physician-initiated, retrospective, real-world, multicenter, observational study for all patients >18 years of age subjected to percutaneous coronary intervention with everolimus-eluting stents (EESs) or paclitaxel-eluting stents (PESs). Outcomes of patients receiving a TAXUS Liberté or XIENCE V drug-eluting stent were compared. Baseline clinical, procedural, and follow-up data at 12 months were collected from 10 clinical centers by an electronic data capture system. The study's primary end point was major adverse cardiac events: a composite of all-cause death, Q-wave myocardial infarction, target vessel revascularization, and stent thrombosis. The trial is registered with http://www.clinicaltrials.gov (NCT01134159). Data were entered for 1,195 patients (PES, n = 595; EES, n = 600). Baseline clinical characteristics were similar except for higher dyslipidemia, systemic hypertension, and family history of coronary artery disease in the EES group. In-hospital outcome was similar between groups, with an overall in-hospital stent thrombosis rate of 0.2%. The primary end point at 12 months was similar (EES 7.8% vs 10.8%, p = 0.082). Overall stent thrombosis rate was lower in the EES group (0.3% vs 1.2%, respectively, p = 0.107); however, target lesion revascularization was similar (PES, hazard ratio 1.46, 95% confidence interval 0.98 to 2.19, p = 0.064). There was no difference in overall mortality between groups. In conclusion, second-generation EESs and PESs demonstrated similar efficacy and safety profiles for broadened patient and lesion subsets compared to a selected population from the pivotal trials. However, for composite efficacy and safety end points, EESs outperformed second-generation PESs. Copyright © 2012 Elsevier Inc. All rights reserved.

Stenting of the cervical internal carotid artery in acute stroke management: The Karolinska experience.

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Mpotsaris, Anastasios; Kabbasch, Christoph; Borggrefe, Jan; Gontu, Vamsi; Soderman, Michael

2017-04-01

Background Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre. Methods This was a retrospective analysis of all consecutive patients with acute extracranial carotid artery occlusion including acute dissection or high-grade stenosis and concomitant intracranial large-vessel occlusion treated with emergency carotid stenting and intracranial mechanical thrombectomy between November 2007 and May 2015. Results A total of 63 patients with a median age of 67 years (range 33-84 years) were treated. Of these, 33 (52%) patients had concomitant intravenous thrombolysis with recombinant tissue-type plasminogen activator initially. Median admission National Institutes of Health Stroke Scale was 14 (range 1-29). Median time from stroke onset to recanalization was 408 minutes (range 165-1846 minutes). Procedure time was significantly shorter after intravenous thrombolysis (110 minutes [range 15-202 minutes] vs. 130 minutes [range 60-280 minutes]; p = 0.02). Three (5%) patients experienced post-procedural symptomatic intracerebral haemorrhage. In 55/63 (87%) patients, a score of ≥2b on the Thrombolysis in Cerebral Infarction scale could be achieved. Eight (13%) patients died, five (8%) during the acute phase. A total of 29/63 (46%) patients showed a favourable outcome (modified Rankin Scale score of 0-2) after three months. Conclusions Our single-centre retrospective analysis of emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy demonstrated high

Interventional Management of Delayed and Massive Hemobilia due to Arterial Erosion by Metallic Biliary Stent

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Jeong, Hee Seok [Dept. of Radiology, Gyeongsang National University Hospital, Jinju (Korea, Republic of); Shin, Tae Beom [Dept. of Diagnostic Radiology, Kimhae Jung Ang Hospital, Kimhae (Korea, Republic of); Hwang, Jae Cheol [Dept. of Radiology, Ulsan Hospital, Ulsan (Korea, Republic of); Bae, Jae Ik [Dept. of Radiology, Ajou University Hospital, Suwon (Korea, Republic of); Kim, Chang Won [Dept. of Radiology, Busan National University Hospital, Busan (Korea, Republic of)

2012-01-15

To evaluate the effectiveness of interventional management for delayed and massive hemobilia secondary to arterial erosion self expandable metallic stent (SES) in with biliary duct malignancy. Over 8-year period, eight patients who suffered from delayed massive hemobilia after SES placement for malignant biliary obstruction as palliative procedure, were included. The mean period between SES placement and presence of massive gastrointestinal hemorrhage was 66.5 days (15-152 days), pancreatic cancer (n = 2), Klatskin tumor (n = 2), common bile duct cancer (n = 2), intrahepatic cholangiocarcinoma (n = 1), and gastric cancer with ductal invasion (n = 1). Angiographic findings were pseudoaneurysm (n = 6), contrast extravasation (n = 1) and arterial spasm at segment (n = 1). Six patients underwent embolization of injured vessels using microcoils and N-butyl cyanoacrylate. Two patients underwent stent graft placement at right hepatic artery to prevent ischemic hepatic damage because of the presence of portal vein occlusion. Massive hemobilia was successfully controlled by the embolization of arteries (n = 6) and stent graft placement (n = 2) without related complications. The delayed massive hemobilia to arterial erosion metallic biliary stent is rare this complication be successfully treated by interventional management.

Efficacy of different types of self-expandable stents in carotid artery stenting for carotid bifurcation stenosis.

Science.gov (United States)

Liu, Ya-min; Qin, Hao; Zhang, Bo; Wang, Yu-jing; Feng, Jun; Wu, Xiang

2016-02-01

Both open and closed loop self-expandable stents were used in carotid artery stenting (CAS) for carotid bifurcation stenosis. We sought to compare the efficacy of two types of stents in CAS. The data of 212 patients treated with CAS (42 and 170 cases implanted with closed and open loop stents, respectively) for carotid bifurcation stenosis and distal filtration protection devices were retrospectively analyzed. Between closed and open loop stents, there were no significant differences in hospitalization duration, NIHSS score before and after the treatment, stenosis at 12th month, and cumulative incidence of primary endpoint events within 30 days or from the 31st day to the 12th month; while there were significant differences in hemodynamic changes and rate of difficulty in recycling distal filtration protection devices. Use of open vs. closed loop stents for carotid bifurcation stenosis seems to be associated with similar incidence of complications, except for greater rate of hemodynamic changes and lower rate of difficulty in recycling the distal filtration protection devices.

Assessment Of Coronary Arterial Stents By Multislice-CT Angiography

International Nuclear Information System (INIS)

Maintz, D.; Fallenberg, E. M.; Heindel, W.; Fischbach, R.; Grude, M.

2003-01-01

Purpose: To assess patency and lumen visibility of coronary artery stents by multislice-CT angiography (MSCTA) in comparison with conventional coronary angiography as the standard of reference. Material and Methods: 47 stents of 13 different types were evaluated in 29 patients. MSCTA was performed on a 4-slice scanner with a standard coronary protocol (detector collimation 4 x 1 mm; table feed 1.5 mm/rotation, 400 mAs, 120 kV). Image evaluation was performed by two readers who were blinded to the reports from the catheter angiography. MIP reconstructions were evaluated for image quality on a 4-point scale (1 = poor, 4 = excellent) and stent patency (contrast distal to the stent as an indirect patency sign). Axial images and multiplanar reformations through the stents were used for assessment of stent lumen visibility (measurement of the visible stent lumen diameter) and detection of relevant in-stent stenosis (50%). Results: Image quality was fair to good on average (score 2.64 ± 1.0) and depended on the heart rate (heart rate 45-60: average score 3.2, heart rate 61-70: average score 2.8, heart rate >71: average score 1.4). Thirty-seven stents were correctly classified as patent, 1 was correctly classified as occluded and 9 stents were not assessable due to insufficient image quality because of triggering artifacts. Parts of the stent lumen could be visualized in 30 cases. On average, 20-40% of the stent lumen diameter was visible. Twenty-five stents were correctly classified as having no stenosis, 1 was falsely classified as stenosed, 1 was correctly classified as occluded. In 20 stents lumen visibility was not sufficient for stenosis evaluation. Conclusion: Although the stent lumen may be partly visualized in most stents, a reliable evaluation of in-stent stenoses does not seem practical by 4-slice MSCT. Nevertheless, for stent patency evaluation, MS-CTA might provide valuable clinical information. With submillimeter MSCT (e.g. 16-slice scanners) and more

Results of a randomized clinical trial of external beam radiation to prevent restenosis after superficial femoral artery stenting.

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Therasse, Eric; Donath, David; Elkouri, Stéphane; Lespérance, Jacques; Giroux, Marie-France; Oliva, Vincent L; Guertin, Marie-Claude; Bouchard, Louis; Perreault, Pierre; Gilbert, Patrick; Soulez, Gilles

2016-06-01

The objective of this study was to evaluate the safety and efficacy of external beam radiation (EBR) in preventing restenosis after superficial femoral artery (SFA) stenting in comparison with a control group treated with SFA stenting only. In this Institutional Review Board-approved study, patients who provided written informed consent were randomly assigned to 0 Gy or 14 Gy of EBR to the stent site 24 hours after SFA stenting. The primary end point was the angiographic binary restenosis rate 2 years after stenting. Categorical and continuous end points were respectively analyzed using logistic regression models and Wilcoxon tests. End points expressed as time to event were analyzed using a log-rank test. The study included 155 patients, 46 women and 109 men (mean age, 66 years; range, 45-85 years). In the 0 and 14 Gy groups, binary restenosis was present, respectively, in 44% (34/77) and 68% (52/76; P = .003) 2 years after stenting. Stent thrombosis occurred in 13% (10/78) of the 0 Gy group and in 33% (25/77) of the 14 Gy group (P = .003). Target lesion revascularization at 2 years was 26% (25/78) in the 0 Gy group and 30% (23/77) in the 14 Gy group (P = .56). There were no significant differences in total walking distances change from baseline to 2 years (46 ± 100 and 26 ± 79 m, respectively, in the 0 Gy and 14 Gy group; P = .25). There were no procedure-related deaths and no major amputations. A single 14 Gy dose of EBR to the SFA stenting site did not prevent in-stent restenosis. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Enterprise stent in recanalizing non-acute atherosclerotic intracranial internal carotid artery occlusion.

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Wang, Xiaofei; Wang, Zhigang; Ji, Yong; Ding, Xuan; Zang, Yizheng; Wang, Chengwei

2017-11-01

To investigate the safety and effectiveness of recanalization in non-acute occlusion of intracranial internal carotid arteries using the flexible Enterprise self-expanding stent. From June 2014 to June 2016, 12 consecutive patients with non-acute occlusion of intracranial internal carotid arteries received endovascular recanalization with Enterprise stenting. All patients received medication for anti-platelet aggregation therapy before and after the operation. The perioperative complications and recanalization efficacy were evaluated with the modified Rankin scoring system and digital subtraction angiography (DSA) follow-up, respectively. Endovascular recanalization was successfully performed in 10 out of 12 patients with Enterprise stenting. Stent implantation following balloon dilatation failed in one patient because the lumen diameter was too small. Another recanalization failed because the guide wire could not pass through the occlusion. No perioperative mortality was observed. One case of acute thrombosis and one case of intraoperative carotid spasm occurred, but these were resolved with thrombolytic therapy by microcatheter exposure treatment and antispasmodic medications, respectively. DSA follow-up in seven patients revealed no re-occlusion. One stroke event occurred in the 10 patients who completed the follow-up. A meaningful improvement in the modified Rankin score during follow-up was suggested by Wilcoxon signed-rank test results. The Enterprise stent was shown to be safe and efficient in recanalizing non-acute atherosclerotic intracranial internal carotid artery occlusion. However, the long-term outcomes need to be further investigated. Copyright © 2017 Elsevier B.V. All rights reserved.

Efficacy and safety of catheter-based radiofrequency renal denervation in stented renal arteries.

Science.gov (United States)

Mahfoud, Felix; Tunev, Stefan; Ruwart, Jennifer; Schulz-Jander, Daniel; Cremers, Bodo; Linz, Dominik; Zeller, Thomas; Bhatt, Deepak L; Rocha-Singh, Krishna; Böhm, Michael; Melder, Robert J

2014-12-01

In selected patients with hypertension, renal artery (RA) stenting is used to treat significant atherosclerotic stenoses. However, blood pressure often remains uncontrolled after the procedure. Although catheter-based renal denervation (RDN) can reduce blood pressure in certain patients with resistant hypertension, there are no data on the feasibility and safety of RDN in stented RA. We report marked blood pressure reduction after RDN in a patient with resistant hypertension who underwent previous stenting. Subsequently, radiofrequency ablation was investigated within the stented segment of porcine RA, distal to the stented segment, and in nonstented RA and compared with stent only and untreated controls. There were neither observations of thrombus nor gross or histological changes in the kidneys. After radiofrequency ablation of the nonstented RA, sympathetic nerves innervating the kidney were significantly reduced, as indicated by significant decreases in sympathetic terminal axons and reduction of norepinephrine in renal tissue. Similar denervation efficacy was found when RDN was performed distal to a renal stent. In contrast, when radiofrequency ablation was performed within the stented segment of the RA, significant sympathetic nerve ablation was not seen. Histological observation showed favorable healing in all arteries. Radiofrequency ablation of previously stented RA demonstrated that RDN provides equally safe experimental procedural outcomes in a porcine model whether the radiofrequency treatment is delivered within, adjacent, or without the stent struts being present in the RA. However, efficacious RDN is only achieved when radiofrequency ablation is delivered to the nonstented RA segment distal to the stent. © 2014 American Heart Association, Inc.

Use of a Stent Graft for Bleeding Hepatic Artery Pseudoaneurysm Following Pancreaticoduodenectomy

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Leoncio L. Kaw, Jr

2006-10-01

Full Text Available Although uncommon, bleeding following pancreaticoduodenectomy is associated with high mortality. Management generally includes surgical reexploration or, alternatively, transarterial embolization. We report the case of a 62-year-old man who presented with massive upper gastrointestinal bleeding 3 weeks after pancreaticoduodenectomy. Selective coeliac angiography revealed a large pseudoaneurysm involving the proper hepatic artery. This was treated successfully with a stent graft. There was no recurrence of bleeding at the 6-month follow-up. To our knowledge, this is the first report of stent graft repair of bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy.

Efficacy of Carotid Artery Stenting by the Universal Protection Method.

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Goto, Shunsaku; Ohshima, Tomotaka; Kato, Kyozo; Izumi, Takashi; Wakabayashi, Toshihiko

2018-04-18

To avoid distal plaques embolization during carotid artery stenting, we developed Universal Protection Method that combined the use of a proximal common carotid artery balloon, an external carotid artery balloon, and a distal internal carotid artery filter, with continuous flow reversal to the femoral vein. Herein, we assessed the efficacy of the Universal Protection Method by comparing stenting outcomes before and after its introduction. We assessed outcomes for 115 cases before and 41 cases after the Universal Protection Method was adopted (non-Universal Protection Method and Universal Protection Method groups, respectively). We then compared procedure details, magnetic resonance imaging (within 48 hours after the procedure), intraprocedural complications, and postoperative stroke rates. Ischemic stroke was not observed in the Universal Protection Method group, but 1 major stroke and 2 minor strokes were observed in the non-Universal Protection Method group. High-intensity areas were seen in 6 (15.0%) and 49 (42.6%) cases in the Universal Protection Method and non-Universal Protection Method groups, respectively (P = .001). Contrastingly, intraprocedural complications were observed in 9 (22.5%) and 21 (18.3%) cases in the Universal Protection Method and non-Universal Protection Method groups, respectively. Among these intraprocedural complication cases, high-intensity areas were observed in 1 case (11.1%) in the Universal Protection Method group and in 15 cases (71.4%) in the non-Universal Protection Method group. Universal Protection Method is a safe technique that is applicable to all patients undergoing carotid artery stenting, irrespective of individual risk factors. Notably, the incidence rates of both distal embolization and unexpected intraprocedural complications are low. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Prognostic value of renal fractional flow reserve in blood pressure response after renal artery stenting (PREFER study).

Science.gov (United States)

Kądziela, Jacek; Januszewicz, Andrzej; Prejbisz, Aleksander; Michałowska, Ilona; Januszewicz, Magdalena; Florczak, Elżbieta; Kalińczuk, Łukasz; Norwa-Otto, Bożena; Warchoł, Ewa; Witkowski, Adam

2013-01-01

The aim of our study was to determine a potential relationship between resting translesional pressures ratio (Pd/Pa ratio), renal fractional flow reserve (rFFR) and blood pressure response after renal artery stenting. Thirty five hypertensive patients (49% males, mean age 64 years) with at least 60% stenosis in angiography, underwent renal artery stenting. Translesional systolic pressure gradient (TSPG), Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures) and hyperemic rFFR - after intrarenal administration of papaverine - were measured before stent implantation. Ambulatory blood pressure measurements (ABPM) were recorded before the procedure and after 6 months. The ABPM results were presented as blood pressure changes in subgroups of patients with normal (≥ 0.9) vs. abnormal (renal artery stenting. Median changes of 24-h systolic/diastolic blood pressure were comparable in patients with abnormal vs. normal Pd/Pa ratio (-4/-3 vs. 0/2 mm Hg; p = NS) and with abnormal vs. normal rFFR (-2/-1 vs. -2/-0.5 mm Hg, respectively). Physiological assessment of renal artery stenosis using Pd/Pa ratio and papaverine- induced renal fractional fl ow reserve did not predict hypertension response after renal artery stenting.

Stent-protected angioplasty versus carotid endarterectomy in patients with carotid artery stenosis: meta-analysis of randomized trial data

International Nuclear Information System (INIS)

Wiesmann, Martin; Schoepf, Veronika; Brueckmann, Hartmut; Jansen, Olav

2008-01-01

Stent-protected angioplasty of carotid artery stenosis may be an alternative to surgical endarterectomy. Results published so far are indecisive, with evidence both in favour of and against this procedure. After the recent publication of two large European multicentre trials (SPACE and EVA-3S) almost 3,000 patients have been included in randomized studies. For this report, we therefore conducted a systematic review of randomized studies that compared endovascular treatment with surgery for carotid stenosis. We evaluated seven trials including 2,973 patients. In our meta-analysis endovascular treatment seemed to carry a slightly higher risk for stroke or death within 30 days after the procedure as compared with surgery (8.2% vs. 6.2%; p = 0.04; OR 1.35), whereas the rates of disabling stroke or death within 30 days did not differ significantly (p = 0.47; n.s.). On the other hand, surgery carried a significantly higher risk for cranial nerve palsy (4.7% vs. 0.2%; p < 0.0001; OR 0.17) and myocardial infarction (2.3% vs. 0.9%; p = 0.03; OR 0.37). Long-term effects of both methods still need to be evaluated. Two other large multicentre trials (ICSS and CREST) are ongoing. Results of these studies will increase the database to about 7,000 randomized patients. Future meta-analyses should then allow definitive treatment recommendations. (orig.)

One Year Clinical Outcomes of Renal Artery Stenting: The Results of ODORI Registry

International Nuclear Information System (INIS)

Sapoval, M.; Tamari, I.; Goffette, P.; Downes, M.; Senechal, Q.; Fanelli, F.; Reimer, P.; Negaiwi, Z.; Cassin, P. De; Heye, S.; Korobov, V.; Tsetis, D.; Abada, H.

2010-01-01

The safety, efficacy and long term clinical benefits of renal artery revascularization by stenting are still a matter of debate. The aim of our study was to define the safety and efficacy of renal artery stenting with the Tsunami peripheral stent (Terumo Corporation, Tokyo, Japan). The ODORI was a prospective, multicentre registry which enrolled 251 consecutive patients, (276 renal arteries) in 36 centres across Europe. The primary endpoint was acute procedural success defined as <30% residual stenosis after stent placement. Secondary endpoints included major adverse events, blood pressure control, serum creatinine level, and target lesion revascularization (TLR) at 6 and 12 months. Patients were 70 ± 10 years old, 59% were male, 33% had diabetes, and 96% hypertension. The main indications for renal stent implantation were hypertension in 83% and renal salvage in 39%. Direct stent implantation was performed in 76% of the cases. Acute success rate was 100% with residual stenosis of 2.5 ± 5.4%. Systolic/diastolic blood pressure decreased from a mean of 171/89 at baseline to 142/78 mmHg at 6 months (p < 0.0001 vs. baseline), and 141/80 mmHg at 12 months (p < 0.0001 vs. baseline). Mean serum creatinine concentration did not change significantly in the total population. However, there was significant improvement in the highest tercile (from 283 μmol/l at baseline to 205 and 209 μmol/l at 6 and 12 months respectively). At 12-months, rates of restenosis and TLR were 6.6 and 0.8% respectively. The 12 month cumulative rate of all major clinical adverse events was 6.4% while the rate of device or procedure related events was 2.4%. In hypertensive patients with atherosclerotic renal artery stenosis Tsunami peripheral balloon-expandable stent provides a safe revascularization strategy, with a potential beneficial impact on hypertension control and renal function in the highest risk patients.

Evaluation of peripheral artery stent with 64-slice multi-detector row CT angiography: Prospective comparison with digital subtraction angiography

International Nuclear Information System (INIS)

Li Xiaoming; Li Yuhua; Tian Jianming; Xiao Yi; Lu Jianping; Jing Zaiping; Sheng Jing; Edwin, Angela; Wu Fanghong

2010-01-01

Purpose: To assess the accuracy of 64-slice multi-detector row computed tomography (MDCT) angiography in the evaluation of peripheral artery in-stent or peristent restenosis, with conventional digital subtraction angiography (DSA) as the reference standard. Materials and methods: Forty-one patients (30 men, 11 women; mean age, 69.8 ± 9.2 years) with symptomatic peripheral arterial occlusive disease after peripheral artery stenting (81 stented lesions) underwent both conventional DSA and 64-slice MDCT angiography. Each stent was classified as evaluable or unevaluable, and every stent was divided into three segments (proximal stent, stent body, and distal stent), resulting in 243 segments. For evaluation, stenosis was graded as follows: 1, none or slight stenosis (<25%); 2, mild stenosis (25-49%); 3, moderate stenosis (50-74%); 4, severe stenosis or total occlusion (≥75%). Two readers evaluated all CT angiograms with regard to narrowing of in-stent or peristent restenosis by consensus. Results were compared with findings of the DSA. Results: Of 81 stents, 62 (76.5%) were determined to be assessable. The metal artifact of the gold marker and motion artifact increased uninterpretability of the images of stents. Overall, 24 of 28 in-stent restenosis and 38 of 53 persistent restenosis were correctly detected by MDCT (85.7% and 71.7% sensitivity). In evaluable stents, 21 of 22 in-stent restenoses and 27 of 28 persistent restenosis were correctly detected (95.4% and 96.4% sensitivity). Additionally, as the grade of stenosis increases, the mean level of CT values in the stent lumina decreases linearly accordingly. Conclusion: 64-Slice MDCT has a high accuracy for the detection of significant in-stent or peristent restenosis of assessable stents in patients with peripheral artery stent implantation and therefore can be considered as a valuable noninvasive technique for stent surveillance.

A bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions (ABSORB II): an interim 1-year analysis of clinical and procedural secondary outcomes from a randomised controlled trial

NARCIS (Netherlands)

Serruys, Patrick W.; Chevalier, Bernard; Dudek, Dariusz; Cequier, Angel; Carrié, Didier; Iniguez, Andres; Dominici, Marcello; van der Schaaf, René J.; Haude, Michael; Wasungu, Luc; Veldhof, Susan; Peng, Lei; Staehr, Peter; Grundeken, Maik J.; Ishibashi, Yuki; Garcia-Garcia, Hector M.; Onuma, Yoshinobu

2015-01-01

Despite rapid dissemination of an everolimus-eluting bioresorbable scaffold for treatment for coronary artery disease, no data from comparisons with its metallic stent counterpart are available. In a randomised controlled trial we aimed to compare an everolimus-eluting bioresorbable scaffold with an

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

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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.

Dual-artery stenting of a type III single coronary artery from right aortic sinus

Directory of Open Access Journals (Sweden)

Shivanad Patil

2015-12-01

Full Text Available A single coronary artery presenting with stenosis in two of the three vessels arising from a common ostium is a rare anomaly Lipton et al. proposed a classification, which was modified by Yamanaka and Hobbs. In our case, a single coronary artery was giving rise to the LAD, left circumflex (LCx, and the right coronary artery (RCA. There was 80% stenosis in the ostium of the LCx. The RCA in the mid and distal segment had stenosis of 80% and 70%, respectively. We were able to successfully stent the three stenotic segments.

Stent implantation for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation

International Nuclear Information System (INIS)

Xing Ming; Yang Pengfei; Huang Qinghai; Zhao Wenyuan; Hong Bo; Xu Yi; Liu Jianmin

2012-01-01

Objective: To preliminarily evaluate the feasibility, safety and efficacy of stent placement for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation. Methods: Eleven patients with wide-necked aneurysms located at internal carotid artery bifurcation, who were encountered during the period from Jan. 2004 to Dec. 2010 in hospital, were collected. A total of 16 intracranial aneurysms were detected, of which 11 were wide-necked and were located at internal carotid artery bifurcation. The diameters of the aneurysms ranged from 2.5 mm to 18 mm. Individual stent type and stenting technique was employed for each patient. Follow-up at 1, 3, 6 and 12 months after the procedure was conducted. Results: A total of 11 different stents were successfully deployed in the eleven patients. The stents included balloon expandable stent (n=1) and self-expanding stent (n=10). According to Raymond grading for the immediate occlusion of the aneurysm, grade Ⅰ (complete obliteration) was obtained in 4, grade Ⅱ (residual neck) in 2 and grade Ⅲ (residual aneurysm) in 5 cases. No procedure-related complications occurred. At the time of discharge, the modified Rankin score was 0-1 in the eleven patients. During the follow-up period lasting for 1-108 months, all the patients were in stable condition and no newly-developed neurological dysfunction or bleeding observed. Follow-up examination with angiography (1-48 months) showed that the aneurysms were cured (no visualization) in 4 cases, improved in 2 cases and in stable condition in one case. Conclusion: For the treatment of wide-necked aneurysms located at internal carotid artery bifurcation, stent implantation is clinically feasible, safe and effective. Further studies are required to evaluate its long-term efficacy. (authors)

Fibrosing Mediastinitis: Successful Stenting of the Pulmonary Artery

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Rennae Thiessen

2008-01-01

Full Text Available Fibrosing mediastinitis is a rare benign condition, which can cause compression of the pulmonary or systemic vessels, tracheobronchial tree, coronary arteries or esophagus, leading to disabling clinical symptoms and even death. The case of a 26-year-old woman who presented with dyspnea is described. She was found to have 80% stenosis of the right pulmonary artery secondary to fibrosing mediastinitis. The stenosis was managed successfully with an endovascular Palmaz-Schatz stent, and the patient remains symptom-free 10 years later.

Stent-Graft Repair of a Large Cervical Internal Carotid Artery Pseudoaneurysm Causing Dysphagia

International Nuclear Information System (INIS)

Gupta, Vivek; Niranjan, Khandelwal; Rawat, Lokesh; Gupta, A. K.

2009-01-01

Pseudoaneurysms of the cervical internal carotid artery (ICA) are rare and most frequently result from trauma, infection, or sometimes spontaneously. They have the potential to cause life-threatening hemorrhage; thus, their immediate management is necessary. Endovascular treatment by stent graft placement in the affected artery appears to be a safe and effective treatment option. We present a case of a child who presented with neck swelling and dysphagia caused by a ruptured cervical ICA pseudoaneurysm which was managed by stent graft placement.

Fracture and Collapse of Balloon-Expandable Stents in the Bilateral Common Iliac Arteries Due to Shiatsu Massage

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Ichihashi, Shigeo, E-mail: shigeoichihashi@yahoo.co.jp; Higashiura, Wataru; Itoh, Hirofumi; Sakaguchi, Shoji; Kichikawa, Kimihiko [Nara Medical University, Department of Radiology (Japan)

2012-12-15

We report a case of stent fracture and collapse of balloon-expandable stents caused by shiatsu massage. A 76-year-old man presented with complaints of intermittent claudication of the right lower extremity. Stenoses of the bilateral common iliac arteries (CIAs) were detected. Balloon-expandable stents were deployed in both CIAs, resulting in resolution of symptoms. Five months later, pelvis x-ray showed collapse of both stents. Despite the stent collapse, the patient was asymptomatic, and his ankle brachial index values were within the normal range. Further history showed that the patient underwent daily shiatsu therapy in the umbilical region, which may have triggered collapse of the stent. Physicians should advise patients to avoid compression of the abdominal wall after implantation of a stent in the iliac artery.

Fracture and Collapse of Balloon-Expandable Stents in the Bilateral Common Iliac Arteries Due to Shiatsu Massage

International Nuclear Information System (INIS)

Ichihashi, Shigeo; Higashiura, Wataru; Itoh, Hirofumi; Sakaguchi, Shoji; Kichikawa, Kimihiko

2012-01-01

We report a case of stent fracture and collapse of balloon-expandable stents caused by shiatsu massage. A 76-year-old man presented with complaints of intermittent claudication of the right lower extremity. Stenoses of the bilateral common iliac arteries (CIAs) were detected. Balloon-expandable stents were deployed in both CIAs, resulting in resolution of symptoms. Five months later, pelvis x-ray showed collapse of both stents. Despite the stent collapse, the patient was asymptomatic, and his ankle brachial index values were within the normal range. Further history showed that the patient underwent daily shiatsu therapy in the umbilical region, which may have triggered collapse of the stent. Physicians should advise patients to avoid compression of the abdominal wall after implantation of a stent in the iliac artery.

Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

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Mehta, Vimal, E-mail: drvimalmehta@yahoo.co.in; Pandit, Bhagya Narayan; Mehra, Pratishtha; Nigam, Arima; Vyas, Aniruddha; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay [G.B. Pant Institute of Postgraduate Medical Education and Research (India)

2016-01-15

We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory.

Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

International Nuclear Information System (INIS)

Mehta, Vimal; Pandit, Bhagya Narayan; Mehra, Pratishtha; Nigam, Arima; Vyas, Aniruddha; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay

2016-01-01

We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory

Incremental benefit of three-dimensional transesophageal echocardiography in the assessment of left main coronary artery stent protrusion.

Science.gov (United States)

Arisha, Mohammed J; Hsiung, Ming C; Ahmad, Amier; Nanda, Navin C; Elkaryoni, Ahmed; Mohamed, Ahmed H; Yin, Wei-Hsian

2017-06-01

Ostial lesions represent a challenging clinical scenario and percutaneous intervention (PCI) of left main coronary artery ostial lesions has been associated with postintervention complications, including protrusion of deployed stents into a sinus of Valsalva or aortic root. We report a case of stent protrusion into the aortic root following aorto-ostial left main coronary artery PCI, in which three-dimensional transesophageal echocardiography (3DTEE) provided incremental benefit over standard two-dimensional images. Specifically, 3DTEE confirmed the presence of stent protrusion by allowing clear visualization of the stent scaffold, in addition to characterizing the relationship between the stent and surrounding structures. © 2017, Wiley Periodicals, Inc.

Surgical treatment of massive bleeding of a right aberrant subclavian artery after oesophageal stent removal

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Michael Raum

2018-06-01

Full Text Available We report a case of a 9-year-old female who required surgical treatment and resuscitation after severe transoesophageal bleeding of a right aberrant subclavian artery (RASA. Bleeding of this RASA was caused by a mechanical irritation due to an oesophageal stent. The stent was placed weeks before to dilate the oesophagus after accidental ingestion of a caustic agent. Although conservative management of benign oesophageal stenosis in children is highly recommended, there are still some major complications to be considered. To avoid erosion of aberrant subclavian artery vascular rings and slings, as described in several case reports, these vessels should be excluded by computed tomography (CT or magnetic resonance imaging (MRI scans before placement of oesophageal stents. This case suggests that management of caustic ingestion in children is still a major challenge in paediatric surgical departments. Keywords: Paediatric surgery, Chemical Burn, Oesophageal stenosis, Oesophageal stenting, Vascular abnormalities, Right aberrant subclavian artery

Sustained Benefit at 2 Years for Covered Stents Versus Bare-Metal Stents in Long SFA Lesions: The VIASTAR Trial

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Lammer, Johannes, E-mail: jlammer@gmx.at, E-mail: johannes.lammer@meduniwien.ac.at [Medical University Vienna, The Department of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy (Austria); Zeller, Thomas, E-mail: thomas.zeller@universitaets-herzzentrum.de [Universitaets-Herzzentrum Freiburg-Bad Krozingen, Department of Angiology (Germany); Hausegger, Klaus A., E-mail: klaus.hausegger@lkh-klu.at [Klinikum Klagenfurt, The Department of Diagnostic and Interventional Radiology (Austria); Schaefer, Philipp J., E-mail: jp.schaefer@rad.uni-kiel.de [University Clinics Schleswig-Holstein, The Department of Radiology (Germany); Gschwendtner, Manfred, E-mail: manfred.gschwendtner@elisabethinen.or.at [Elisabethinen Hospital, The Department of Diagnostic and Interventional Radiology (Austria); Mueller-Huelsbeck, Stefan, E-mail: muehue@diako.de [Diakonissen Hospital, The Department of Diagnostic and Interventional Radiology (Germany); Rand, Thomas, E-mail: thomas.rand@wienkav.at [Hietzing Hospital, The Department of Radiology (Austria); Funovics, Martin, E-mail: martin.funovics@meduniwien.ac.at; Wolf, Florian, E-mail: florian.wolf@meduniwien.ac.at [Medical University Vienna, The Department of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy (Austria); Rastan, Aljoscha, E-mail: aljoscha.rastan@universitaets-herzzentrum.de [Universitaets-Herzzentrum Freiburg-Bad Krozingen, Department of Angiology (Germany); Gschwandtner, Michael, E-mail: michael.gschwandtner@meduniwien.ac.at [Medical University Vienna, The Department of Angiology (Austria); Puchner, Stefan, E-mail: stefan.puchner@meduniwien.ac.at [Medical University Vienna, The Department of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy (Austria); and others

2015-02-15

PurposeThe hypothesis that covered stents are superior to bare-metal stents (BMS) in long femoropopliteal artery disease was tested. The one-year results of the VIASTAR trial revealed a patency benefit of covered stents in the treatment-per-protocol (TPP) analysis only.MethodsA prospective, randomized, single-blind, multicenter study evaluated 141 patients with symptomatic peripheral arterial disease (PAD) after treatment with heparin-bonded covered stents (VIABAHN{sup ®} Endoprosthesis) or BMS. Clinical outcomes and patency rates were assessed at 1, 6, 12, and 24 months. Mean lesion length was 19.0 ± 6.3 cm in the VIABAHN{sup ®} versus 17.3 ± 6.6 cm in the BMS group.ResultsThe 24-month primary patency rates in the VIABAHN{sup ®} and BMS group were: intention-to-treat 63.1 (95 % CI 0.52–0.76) versus 41.2 % (95 % CI 0.29–0.57; log rank p = 0.04) and TPP 69.4 (95 % CI 0.58–0.83) versus 40.0 % (95 % CI 0.28–0.56; log rank p = 0.004). Freedom from target-lesion-revascularization (TLR) was 79.4 (95 % CI 0.70–0.90) versus 73.0 % (95 % CI 0.63–0.85) for VIABAHN{sup ®} versus BMS (log rank p = 0.37). For the TPP group in lesions ≥20 cm, the 24-month patency rates were 65.2 (95 % CI 0.50–0.85) versus 26.7 % (95 % CI 0.12–0.59; log rank p = 0.004) for VIABAHN{sup ®} versus BMS, and freedom from TLR was 80.0 (95 % CI 0.68–0.94) versus 61.9 % (95 % CI 0.44–0.87; log rank p = 0.13). The ankle brachial index was 0.89 ± 0.18 versus 0.91 ± 0.17 (p = 0.76) at 24-month in the VIABAHN{sup ®} versus the BMS group, respectively.ConclusionAt 24-month, this trial in PAD patients with long femoropopliteal lesions demonstrated a significantly improved primary patency rate for heparin-bonded covered stents compared to BMS, however, without a significant impact on clinical outcomes and TLR rate (Reg. Nr. ISRCTN48164244)

Vertebral artery origin stent placement with distal protection: technical and clinical results.

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Qureshi, A I; Kirmani, J F; Harris-Lane, P; Divani, A A; Ahmed, S; Ebrihimi, A; Al Kawi, A; Janjua, N

2006-05-01

To report the feasibility, safety, and 1-month results of performing stent placement for vertebral origin stenosis with the use of a distal protection device. Distal protection devices have been shown to reduce the number of cerebral emboli and subsequent ischemic events when used as adjuncts to percutaneous carotid intervention; however, one case of the use of a distal protection device for vertebral artery has been reported in the literature. We retrospectively determined rates of technical success and 1-month stroke or death associated with stent placement by using distal protection (Filter EX; Boston Scientific, Natick, Mass) in patients with symptomatic vertebral artery origin stenosis. Technical success was defined as successful deployment of distal protection device and stent at target lesion followed by successful retrieval of the device and a final residual stenosis of less than 30%. Other outcomes ascertained included any stroke, death, and semiquantitative assessment of particulate material retained by the filter device. The mean age of the 12 treated patients was 68 years (range, 52-88 years) and the group included 9 men and 3 women. The mean percentage of vertebral artery origin stenosis was 71 +/- 6%. Femoral and radial approaches were used in 9 and 3 cases, respectively. Technical success was achieved in 11 of the 12 patients in whom distal protection device placement was attempted. Postprocedure residual stenosis was 5 +/- 4%. Eight devices held macroscopically visible embolic debris (large and small amounts in 3 and 5 devices, respectively). No stroke or death was observed in the 1-month follow-up. The present study demonstrates the feasibility of performing stent placement for vertebral artery origin stenosis by using a distal protection device. Further studies are required to determine the effectiveness of this approach for vertebral artery origin atherosclerosis.

Stent placement with the monorail technique for treatment of mesenteric artery stenosis.

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Schaefer, Philipp J; Schaefer, Fritz K W; Hinrichsen, Holger; Jahnke, Thomas; Charalambous, Nikolas; Heller, Martin; Mueller-Huelsbeck, Stefan

2006-04-01

To analyze the immediate and midterm success of stenting of mesenteric arteries by a monorail technique in patients with chronic mesenteric ischemia. In this prospective case series, 19 patients (11 male, 8 female; mean age, 62.9 +/- 10.4 y; range, 36-82 y) with 23 symptomatic stenoses of mesenteric arteries were treated with stent placement by a monorail technique in a radiologic intervention center over a period of 4.5 years. Clinical examinations and duplex sonography were used to evaluate the stents' patency and clinical success. Kaplan-Meier graphs were calculated to analyze the patency and freedom-from-symptom rate. Initial technical success rate was 22/23 (96%). Mean follow-up was 17 months (range, 1-58 mo). Primary patency and primary clinical success rates were 82% and 78%, respectively. According to Kaplan-Meier tables, the patency rates were 96%, 87%, 76%, and 61% at 0, 1, 15, and 24 months, respectively, and the freedom-from-symptom rates were 95%, 90%, 72%, and 54% at 0, 1, 24, and 30 months, respectively. No peri-interventional complications occurred. Two patients died of cardiac failure in the hospital within 30 days after intervention; deaths were not related to the intervention. Stent placement by a monorail technique in mesenteric arteries is an effective and safe treatment for symptomatic stenoses in patients with chronic mesenteric ischemia after a mean follow-up of 17 months.

Treatment of internal carotid artery dissections with endovascular stent placement: report of two cases

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Lee, Deok Hee; Hur, Seung Ho; Kim, Hyeon Gak; Jung, Seung Mun; Ryu, Dae Sik; Park, Man Soo [Kangnung Hospital, Kangnung (Korea, Republic of)

2000-03-01

Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of trauma-related extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpetrosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.

Outcomes of emergent carotid artery stenting within 6 hours of symptom onset in patients with acute ischemic stroke

International Nuclear Information System (INIS)

Jeong, Won Gi; Yoon, Woong; Yim, Nam Yeol; Jung, Min Young; Jung, Se Hee; Kang, Heoung Keun

2013-01-01

To investigate clinical outcomes following the emergent carotid artery stenting for treatment of acute ischemic stroke. Twenty-eight consecutive patients with acute stroke due to atherosclerotic steno-occlusive diseases of extracranial internal carotid artery underwent emergent carotid artery stenting. Of these, 23 patients had tandem intracranial arterial occlusions. Extracranial carotid stenting was successful in all patients. From the 13 patients who underwent intracranial recanalization procedures, successful recanalization occurred in 84.6% (11/13). 57% of patients (16/28) had a good clinical outcome (modified Rankin Scale 0-2) after 3 months. Patients with successful intracranial/extracranial recanalization had a significantly higher rate of good outcome than those without recanalization after 3 months (75% vs. 33%, p = 0.027). Patients without intracranial tandem occlusions had a more favorable clinical outcome than those with intracranial tandem occlusions (100% vs. 48%, p = 0.033). Symptomatic intracerebral hemorrhage occurred in one patient (3.6%). Mortality rate was 0% (0/28) after 3 months. Emergent carotid artery stenting in setting of acute stroke was a safe and effective treatment modality. Successful recanalization (extracranial and intracranial) and absence of intracranial tandem occlusion are significantly associated with a good outcome for our cohort of patients whom undergone emergent carotid artery stenting.

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

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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)

Carotid Artery Stenting in a Patient With a Continuous-Flow Left Ventricular Assist Device.

Science.gov (United States)

Piazza, Michele; Squizzato, Francesco; Grego, Franco; Bottio, Tommaso; Gerosa, Gino; Antonello, Michele

2016-08-01

To demonstrate the safety and feasibility of carotid artery stenting (CAS) in a patient with a continuous-flow left ventricular assist device (LVAD). A 54-year-old woman with a LVAD was referred for a 90% stenosis of the right internal carotid artery (ICA). The patient was offered CAS, and oral anticoagulant was not discontinued in the periprocedural period. Because of absent arterial pulses, percutaneous transfemoral access was obtained under ultrasound guidance. Particular attention was paid to cannulation of the innominate artery; a 7-F guiding catheter was advanced from the descending aorta into the innominate artery under road-mapping, avoiding maneuvers in the ascending aorta where the outflow Dacron graft of the LVAD was anastomosed. To avoid cerebral flow modifications, the Angioguard RX was used as the cerebral protection device rather than other devices such as the flow reversal or flow-clamping systems. At this point, CAS was performed in a standard fashion using the 7×30-mm Precise ProRX stent. The computed tomography angiogram at 6 months showed patency of the stented right ICA. With adequate planning, CAS appears feasible in patients with a LVAD. © The Author(s) 2016.

Thirty-day outcomes of direct carotid artery stenting with cerebral protection in high-risk patients

International Nuclear Information System (INIS)

Veselka, J.; Cerna, D.; Zimolova, P.; Blasko, P.; Fiedler, J.; Hajek, P.; Maly, M.; Zemanek, D.; Duchonova, R.

2007-01-01

Implantation of a carotid artery stent after predilation is a standard approach in the endovascular treatment of carotid artery stenoses. Stenting without predilation may be an alternative approach in a certain subset of patients. The present prospective, single-center registry was designed to evaluate the feasibility and safety of direct carotid artery stenting (DCAS) in high-risk patients. Symptomatic patients with stenosis >50% and asymptomatic patients with stenosis >70% were eligible for enrolment. Criteria for high-risk patients included: need or history of open heart surgery, history of myocardial infarction, multivessel coronary artery disease, left ventricular dysfunction (ejection fraction ≤40%), severe pulmonary or renal disease, significant contralateral carotid disease, previous endarterectomy, and age ≥80 years. All procedures were performed using a filter protection device. Patients underwent complete clinical examination before and after DCAS and at 30-day follow-up. A total of 83 consecutive patients (45 males, 68±9 years, 33% symptomatic) underwent 100 procedures and 103 stents were deployed successfully. The technical success rate of stenting was 100%. Predilation of carotid stenosis was necessary in 1 (1%) procedure. Carotid-artery stenoses before and after DCAS were 80±9% and 7±9%, respectively. The median fluoroscopic time for DCAS was 7 min. The overall rate of in-hospital major adverse cerebrovascular events (death, stroke, myocardial infarction) was 5% (2 minor strokes, 3 transient attacks). There was 1 (1%) minor stroke within the 30-day follow-up. DCAS is feasible and can be performed with an acceptable risk in high-risk patients. (author)

New treatment of iliac artery disease: focus on the Absolute Pro® Vascular Self-Expanding Stent System

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Gates L

2013-09-01

Full Text Available Lindsay Gates, Jeffrey Indes Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT, USA Abstract: Management of iliac artery disease has evolved over the years, from a surgical-only approach to a primarily endovascular-only approach as the first line treatment option. This has been continuously improved upon with the advent of new devices and applied technologies. Most recently in particular, the literature has shown good, reliable outcomes with the use of self-expandable stents in iliac artery atherosclerotic lesions. Nevertheless, no device is without its limitations, and the Absolute Pro® Vascular Self-Expanding Stent System was designed with the intent of overcoming some of the shortcomings of other available stents while maintaining acceptable postprocedural outcomes. Based on preliminary industry-acquired data, it has achieved these goals and appears to be an emergent competitor for the treatment of both focal and complex iliac artery lesions. Keywords: Absolute-Pro®, iliac stent, self-expanding stents, atherosclerotic disease

Self-Expanding Nitinol Renal Artery Stents: Comparison of Safety and Efficacy of Bare Versus Polyzene-F Nanocoated Stents in a Porcine Model

International Nuclear Information System (INIS)

Kurz, P.; Stampfl, U.; Christoph, P.; Henn, C.; Satzl, S.; Radeleff, B.; Berger, I.; Richter, G. M.

2011-01-01

Objective: To investigate the safety and efficacy of a Polyzene-F nanocoat on new low-profile self-expandable nitinol stents in minipig renal arteries. Materials and Methods: Ten bare nitinol stents (BNS) and 10 stents coated with a 50 nm-thin Polyzene-F coating were randomly implanted into renal arteries of 10 minipigs (4- and 12-week follow-up, 5 animals/group). Thrombogenicity, on-stent surface endothelialization, vessel wall injury, late in-stent stenosis, and peristrut vessel wall inflammation were determined by quantitative angiography and postmortem histomorphometry. Results: In 6 of 10 BNS, >50% stenosis was found, but no stenosis was found in stents with a nanothin Polyzene-F coating. Histomorphometry showed a statistically significant (p < 0.05) different average maximum luminal loss of 55.16% ± 8.43% at 12 weeks in BNS versus 39.77% ± 7.41% in stents with a nanothin Polyzene-F coating. Stents with a nanothin Polyzene-F coating had a significantly (p < 0.05) lower inflammation score after 12 weeks, 1.31 ± 1.17 versus 2.17 ± 0.85 in BNS. The results for vessel wall injury (0.6 ± 0.58 for Polyzene-F-coated stents; 0.72 ± 0.98 for BNS) and re-endothelialization, (1.16 ± 0.43 and 1.23 ± 0.54, respectively) were not statistically significant at 12-week follow-up. No thrombus deposition was observed on the stents at either follow-up time point. Conclusion: Nitinol stents with a nanothin Polyzene-F coating successfully decreased in-stent stenosis and vessel wall inflammation compared with BNS. Endothelialization and vessel wall injury were found to be equal. These studies warrant long-term pig studies (≥120 days) because 12 weeks may not be sufficient time for complete healing; thereafter, human studies may be warranted.

Reperfusion hemorrhage following superior mesenteric artery stenting.

LENUS (Irish Health Repository)

Moore, Michael

2012-02-03

Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We describe both spontaneous cessation of bleeding and treatment with coil embolization.

Metallic stent implantation combined with intra-arterial chemotherapy for the treatment of malignant gastric and duodenal obstruction

International Nuclear Information System (INIS)

Cao Jun; Liu Hongqiang; He Yang; Xia Ning; Zhang Honglei; Qiao Delin

2011-01-01

Objective: To investigate the clinical effect of metallic stent implantation together with intra-arterial chemotherapy in treating malignant gastric and duodenal obstruction. Methods: A total of 32 patients with malignant gastric and duodenal obstruction were enrolled in this study. The obstructed sites were located at the gastric sinus and pylorus part (n=16), at the gastroduodenal anastomotic stoma (n=6) or at the descending part of duodenum (n=10). Under DSA guidance and with the additional help of endoscopy, a guide-wire was orally placed in the gastroduodenal obstructed site, which was followed by the implantation of the self-expanding metallic stent (Ni-Ti alloy). Postoperative intra-arterial chemotherapy via the tumor-feeding arteries was carried out in 16 patients (dual interventional therapy). The clinical results were analyzed. Results: Successful stent insertion was achieved in all 32 patients (100%). After stent implantation the obstructive symptoms were markedly relieved and the food intake was improved. No serious complications occurred. The median survival time for the 16 patients who had received dual interventional therapy was 9.3 months, while the median survival time for the other 16 patients who had received simple stenting therapy was 5.7 months. Conclusion: For the treatment of inoperable malignant gastroduodenal obstruction, the implantation of metallic self-expanding stents is a technically simple, clinically safe and effective palliative measure. Combined with postoperative intra-arterial chemotherapy, the metal stent implantation can control the tumor growth and elongate the survival time. (authors)

Functional angiography of arteries near the knee joint: Consequences for stent implantation. Funktionsangiographie der kniegelenknahen Arterien: Konsequenzen fuer die Stentimplantation

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Zocholl, G; Zapf, S; Schild, H; Thelen, M [Mainz Univ. (Germany, F.R.). Inst. fuer Klinische Strahlenkunde

1990-12-01

Angiographic studies of the arteries adjoining the knee in 25 patients show extensive kinking and stenoses of the popliteal artery and less frequently of the distal femoral artery during flexion of the knee joint. This is due to the loss of elasticity with increasing age forcing the vessel into a tortuous course during shortening of the pathway of the popliteal artery with knee flexion. Independent of the principle of the different stents available they probably will not increase the contractility of the stented vessel in the longitudinal axis. It is to expect that after implantation of stents into the original artery kinking will occur predominantly in the original segments of the vessel and at the transitions to the stented segments leading to intimal damage by shear forces thus propagating local progress of atherosclerosis. (orig.).

Dual-Source CT Angiography of Peripheral Arterial Stents: In Vitro Evaluation of 22 Different Stent Types

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Michael Köhler

2011-01-01

Full Text Available Purpose. To test different peripheral arterial stents using four image reconstruction approaches with respect to lumen visualization, lumen attenuation and image noise in dual-source multidetector row CT (DSCT in vitro. Methods and Materials. 22 stents (nitinol, steel, cobalt-alloy, tantalum, platinum alloy were examined in a vessel phantom. All stents were imaged in axial orientation with standard parameters. Image reconstructions were obtained with four different convolution kernels. To evaluate visualization characteristics of the stent, the lumen diameter, intraluminal density and noise were measured. Results. The mean percentage of the visible stent lumen diameter from the nominal stent diameter was 74.5% ± 5.7 for the medium-sharp kernel, 72.8% ± 6.4 for the medium, 70.8% ± 6.4 for the medium-smooth and 67.6% ± 6.6 for the smooth kernel. Mean values of lumen attenuation were 299.7HU ± 127 (medium-sharp, 273.9HU ± 68 (medium, 270.7HU ± 53 (medium-smooth and 265.8HU ± 43. Mean image noise was: 54.6 ± 6.3, 20.5 ± 1.7, 16.3 ± 1.7, 14.0 ± 2 respectively. Conclusion. Visible stent lumen diameter varies depending on stent type and scan parameters. Lumen diameter visibility increases with the sharpness of the reconstruction kernel. Smoother kernels provide more realistic density measurements inside the stent lumen and less image noise.

Impact of diabetes mellitus on outcome of renal artery stenting

International Nuclear Information System (INIS)

Song Li; Tong Xiaoqiang; Wang Jian; Yang Min; Lv Yongxing; Zou Yinghua

2007-01-01

Objective: To investigate the impact of diabetes mellitus on outcome of renal artery stenting. Methods: 85 consecutive cases of renal artery stenosis received renal angioplasty were retrospectively analyzed. 25 patients with related history were selected into diabetic group (DM), and 60 patients without diabetics into control group(NDM). Pre- and post- procedure serum creatinine and blood pressure between the 2 groups were collected and analyzed. Results: The average serum creatinine pre-intervention and post-intervention were(132.24 ± 33.71) μmol/L, (126.32 ± 29.65) μmol/L for DM group, and(125.02 ± 48.13) μmol/L, (118.31 ± 39.58) μmol/L for NDM group respectively with no significant statistical difference (P > 0.05). The blood pressure was controlled satisfactorily for both groups after the procedure, with statistical significance (P<0.05), but no difference between the two groups. Conclusions: The procedure with renal artery stenting is effective to maintain renal function and control hypertension, showing equal efficiency for both DM and NDM patients. (authors)

Heparin-bonded, expanded polytetrafluoroethylene-lined stent graft in the treatment of femoropopliteal artery disease: 1-year results of the VIPER (Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease) trial.

Science.gov (United States)

Saxon, Richard R; Chervu, Arun; Jones, Paul A; Bajwa, Tanvir K; Gable, Dennis R; Soukas, Peter A; Begg, Richard J; Adams, John G; Ansel, Gary M; Schneider, Darren B; Eichler, Charles M; Rush, Michael J

2013-02-01

To evaluate the performance of a heparin-bonded, expanded polytetrafluoroethylene (ePTFE)-lined nitinol endoprosthesis in the treatment of long-segment occlusive disease of the femoropopliteal artery (FPA) and to identify factors associated with loss of patency. In a single-arm, prospective, 11-center study (VIPER [Gore Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease] trial), 119 limbs (113 patients; 69 men; mean age, 67 y), including 88 with Rutherford category 3-5 disease and 72 with Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) C or D lesions of the FPA, underwent stent graft implantation. The mean lesion length was 19 cm; 56% of lesions were occlusions. Follow-up evaluations included color duplex ultrasonography in all patients, with patency defined as a peak systolic velocity ratio20% was 70% (P = .047). Primary patency was not significantly affected by device diameter (5 vs 6 vs 7 mm) or lesion length (≤20 cm vs>20 cm). The 30-day major adverse event rate was 0.8%. The heparin-bonded, ePTFE/nitinol stent graft provided clinical improvement and a primary patency rate of 73% at 1 year in the treatment of long-segment FPA disease. Careful sizing of the device relative to vessel landing zones is essential for achieving optimal outcomes. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

The SPIRIT V study: a clinical evaluation of the XIENCE V everolimus-eluting coronary stent system in the treatment of patients with de novo coronary artery lesions.

Science.gov (United States)

Grube, Eberhard; Chevalier, Bernard; Smits, Peter; Džavík, Vladimir; Patel, Tejas M; Mullasari, Ajit S; Wöhrle, Jochen; Stuteville, Marrianne; Dorange, Cécile; Kaul, Upendra

2011-02-01

The SPIRIT V (A Clinical Evaluation of the XIENCE V Everolimus-Eluting Coronary Stent System in the Treatment of Patients With De Novo Coronary Artery Lesions) study is a post-market surveillance experience of the XIENCE V (Abbott Vascular, Santa Clara, California) everolimus-eluting stent (EES) in patients with higher-risk coronary anatomy. Previous pre-approval studies have shown the safety and efficacy of EES in highly selected groups of patients. The SPIRIT V trial is a prospective, open label, single arm, multicenter study. Two thousand seven hundred patients with multiple de novo coronary artery lesions suitable for treatment with a planned maximum of 4 EES were enrolled at 93 centers in Europe, Asia Pacific, Canada, and South Africa. Lesions had a reference vessel diameter between 2.25 and 4.0 mm and a length of ≤ 28 mm by visual estimation. An independent clinical events committee adjudicated all end point-related events. The primary end point was the composite rate of all death, myocardial infarction (MI), and target vessel revascularization at 30 days. Secondary end points included stent thrombosis and acute success (clinical device and procedure success). At 30 days, the primary composite end point of all death, MI, and target vessel revascularization was 2.7%. At 1 year, rates of cardiac death, overall MI, and target lesion revascularization were 1.1%, 3.5%, and 1.8%, respectively. The cumulative rate of definite and probable stent thrombosis was low at 0.66% at 1 year. Use of EES in patients with multiple, complex de novo lesions yielded 1-year major adverse cardiac events, stent thrombosis, and target lesion revascularization rates that are comparable to those of the more controlled SPIRIT II and SPIRIT III trials-which included patients with restricted inclusion/exclusion criteria-and other all-comer population, physician-initiated studies like the X-SEARCH (Xience Stent Evaluated At Rotterdam Cardiology Hospital) and COMPARE (A Randomized

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).

Preliminary clinical application in the cranial internal carotid artery of covered stents specially designed for intracranial vasculature

International Nuclear Information System (INIS)

Li Minghua; Luo Qiyi; Fang Chun; Xie Zhiyong; Cheng Yingsheng; Gao Bulang; Li Yu; Zhang Beilei; Xie Jian; Wang Yongli

2007-01-01

Objective: To investigate the flexibility of both the covered stents specially designed for use in intracranial vasculature and the delivering system in passing through the bone tube and the physiological curves of the cranial internal carotid artery (CICA) to reach the targeted area, the performance (adherence) of the covered stents in occluding vascular wall diseases and the impact on the vascular branches of the covered segment. Methods: The covered stents specially designed for use in intracranial vasculature were used to treat 13 patients with CICA diseases using endovascular techniques. There were 4 huge pseudoaneurysms, 4 giant aneurysms, 3 small wide-necked aneurysms, 1 giant pseudoaneurysm with concurrent internal carotid cavernous fistula (CCF), and 1 CCF. Prior to the detachment of the covered stents, balloon occlusion test (BOT) of the internal carotid artery on the diseased side and whole-brain digital subtraction angiography (DSA) were performed in all the patients. Three to 16 months following procedure, DSA and clinical follow-ups were performed. Results: Thirteen patients all tolerated the BOT well with the DSA demonstrating well-opened anterior and posterior communicating arteries. The covered stents and the delivering systems all successfully passed CICA to reach the targeted diseased area, with the diseased segments of the internal carotid artery including C3-C4 in 4 cases, C4-C5 in 4 and C6-C7 in 5. Immediately following the detachment of the covered stents, DSA demonstrated that 7 aneurysms were completely occluded, 4 aneurysms had slight endoleak, and 1 CCF had markedly-decreased blood flow through the fistula. In the patient with concurrent pseudoaneurysm and CCF, the pseudoaneurysm disappeared and the blood flow through the fistula was markedly-reduced immediately following the stenting procedure. Apart from one patient with aneurysmal subarachnoid hemorrhage who died due to extensive vascular spasm on the 9th day following the stenting

Clinical benefits of drug-eluting stent implantation in septuagenarians with coronary artery disease

International Nuclear Information System (INIS)

Fang Yuehua; Shen Weifeng; Zhang Ruiyan; Zhang Jiansheng; Hu Jian; Zhang Xian; Zheng Aifang

2005-01-01

Objective: This study evaluated the safety and long-term outcomes of drug-eluting stents in septuagenarians with coronary artery disease. Methods: Two hundred and thirty-nine consecutive patients with coronary artery disease underwent drug-eluting stenting, including 88 patients aged ≥70 years (group A) and 151 aged <70 years (group B). Baseline clinical characteristics, procedural success rate, occurrence of cardiac events during follow-up were recorded and compared between the two groups. Results: Procedural success rate and complications were similar for the two groups. During follow-up, group A had higher recurrence rate of chest pain than group B (23.9% vs. 7.3%, P<0.001), and occurrence of cardiac events was higher in group A than in group B (5.7% vs. 2.7%, P<0.296). There was no significant difference in the frequency of restenosis between the two groups. Conclusions: Drug-eluting stent implantation for septuagenarians with coronary artery disease is safe but may have more recurrence of angina than younger ones during long-term follow-up. (authors)

Spontaneous coronary artery dissection: complete angiographic resolution without stenting

Directory of Open Access Journals (Sweden)

Alexandre Abizaid

2007-09-01

Full Text Available A case of spontaneous coronary artery dissection in a 49-year-oldwoman is presented. She did not present the classical cardiovascular riskfactors. Etiology and treatment are discussed. She underwent primarypercutaneous coronary intervention of the left anterior descendingartery with no stenting and had complete angiographic resolution.

Evaluation of XIENCE V everolimus-eluting and Taxus Express2 paclitaxel-eluting coronary stents in patients with jailed side branches from the SPIRIT IV trial at 2 years.

Science.gov (United States)

Forrest, John K; Lansky, Alexandra J; Meller, Stephanie M; Hou, Liming; Sood, Poornima; Applegate, Robert J; Wang, John C; Skelding, Kimberly A; Shah, Aakar; Kereiakes, Dean J; Sudhir, Krishnankutty; Cristea, Ecaterina; Yaqub, Manejeh; Stone, Gregg W

2013-06-01

The aim of this study was to determine whether patients from the Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Patients With de Novo Native Coronary Artery Lesions (SPIRIT) IV trial who underwent percutaneous coronary intervention, who had target lesions with jailed side branches, had improved clinical outcomes when treated with the XIENCE V versus Taxus Express(2) drug-eluting stent. In the SPIRIT III randomized trial, patients with target lesions with jailed side branches after XIENCE V compared with Taxus Express(2) implantation had lower 2-year rates of major adverse cardiac events. The SPIRIT IV trial represents a larger more diverse patient population compared with SPIRIT III. In the large-scale, prospective, multicenter, randomized SPIRIT IV trial, 3,687 patients who underwent coronary stenting with up to 3 de novo native coronary artery lesions were randomized 2:1 to receive XIENCE V versus Taxus Express(2) stents. Two-year clinical outcomes of patients with or without jailed side branches after stenting were compared. A jailed side branch was defined as any side branch >1.0 mm in diameter within the target segment being stented, excluding bifurcations deemed to require treatment. Of the 3,687 patients in SPIRIT IV, a total of 1,426 had side branches that were jailed during angioplasty of the target lesion. Patients with jailed side branches after XIENCE V compared with Taxus Express(2) implantation had significantly lower 2-year rates of target lesion failure (6.5% vs 11.9%, p = 0.001), major adverse cardiac events (6.6% vs 12.2%, p = 0.0008), ischemia-driven target vessel revascularization (4.1% vs 7.9%, p = 0.004), and stent thrombosis (0.6% vs 2.8%, p = 0.001). In conclusion, patients with jailed side branches after stenting with XIENCE V compared to Taxus Express(2) devices had superior clinical outcomes at 2 years in the large-scale randomized SPIRIT IV trial. Copyright © 2013 Elsevier Inc. All

Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

NARCIS (Netherlands)

P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle (Elisabeth); T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

2009-01-01

textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating

Carotid Artery Stenting in a Patient with Spontaneous Recanalization of a Proximal Internal Carotid Artery Occlusion: a Case Report

International Nuclear Information System (INIS)

Kim, Eui Jong; Koh, Jun Seok; Choi, Woo Suk

2006-01-01

We report here on a rare case of carotid artery angioplasty and stenting in a patient with spontaneous recanalization after complete occlusion of the proximal internal carotid artery (ICA). The patient initially showed severe stenosis at the left proximal ICA on MR angiography (MRA). Digital subtraction angiography (DSA) performed three days after MRA showed complete occlusion of the proximal ICA. The follow-up DSA after four weeks showed recanalization of the ICA, and then carotid artery stenting was successfully performed. There has been no neurologic complication during more than one year follow-up. cute internal carotid artery (ICA) occlusions may result in profound disability and death (1). An occluded ICA can spontaneously recanalize, but this doesn't happen frequently, and the natural course of a proximal ICA occlusion and its possibility of recanalization, including the exact time of recanalization after occlusion, are not well known (2, 3). A few studies have reported the incidence of spontaneous recanalization of the proximal internal carotid artery, which has mostly occurred in patients with ICA dissections (4 6). A few limited studies have reported a considerable incidence of spontaneous recanalization in patients with underlying atherosclerotic lesion or atherothombotic diseases (2). The possibility of repeated occlusion and repeated cerebral ischemic infarction may exist for the patients exhibiting spontaneous recanalization of the ICA and underlying atherosclerosis. We report here on a case of carotid artery stenting (CAS) in a patient who exhibited underlying atherosclerosis with spontaneous recanalization after complete occlusion of the proximal ICA

Biodegradable Polymer Biolimus-Eluting Stents Versus Durable Polymer Everolimus-Eluting Stents in Patients With Coronary Artery Disease: Final 5-Year Report From the COMPARE II Trial (Abluminal Biodegradable Polymer Biolimus-Eluting Stent Versus Durable Polymer Everolimus-Eluting Stent).

Science.gov (United States)

Vlachojannis, Georgios J; Smits, Pieter C; Hofma, Sjoerd H; Togni, Mario; Vázquez, Nicolás; Valdés, Mariano; Voudris, Vassilis; Slagboom, Ton; Goy, Jean-Jaques; den Heijer, Peter; van der Ent, Martin

2017-06-26

This analysis investigates the 5-year outcomes of the biodegradable polymer biolimus-eluting stent (BP-BES) and durable polymer everolimus-eluting stent (DP-EES) in an all-comers population undergoing percutaneous coronary intervention. Recent 1- and 3-year results from randomized trials have indicated similar safety and efficacy outcomes of BP-BES and DP-EES. Whether benefits of the biodegradable polymer device arise over longer follow-up is unknown. Moreover, in-depth, prospective, long-term follow-up data on metallic drug-eluting stents with durable or biodegradable polymers are scarce. The COMPARE II trial (Abluminal Biodegradable Polymer Biolimus-Eluting Stent Versus Durable Polymer Everolimus-Eluting Stent) was a prospective, randomized, multicenter, all-comers trial in which 2,707 patients were randomly allocated (2:1) to BP-BES or DP-EES. The pre-specified endpoint at 5 years was major adverse cardiac events, a composite of cardiac death, nonfatal myocardial infarction, or target vessel revascularization. Five-year follow-up was available in 2,657 patients (98%). At 5 years, major adverse cardiac events occurred in 310 patients (17.3%) in the BP-BES group and 142 patients (15.6%) in the DP-EES group (p = 0.26). The rate of the combined safety endpoint all-cause death or myocardial infarction was 15.0% in the BP-BES group versus 14.8% in the DP-EES group (p = 0.90), whereas the efficacy measure target vessel revascularization was 10.6% versus 9.0% (p = 0.18), respectively. Interestingly, definite stent thrombosis rates did not differ between groups (1.5% for BP-BES vs. 0.9% for DP-EES; p = 0.17). The 5-year analysis comparing biodegradable polymer-coated BES and the durable polymer-coated EES confirms the initial early- and mid-term results regarding similar safety and efficacy outcomes in this all-comers percutaneous coronary intervention population. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights

Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note

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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.)

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.)

Pulmonary arterial stent implantation in an adult with Williams syndrome

NARCIS (Netherlands)

Reesink, Herre J.; Henneman, Onno D. F.; van Delden, Otto M.; Biervliet, Jules D.; Kloek, Jaap J.; Reekers, Jim A.; Bresser, Paul

2007-01-01

We report a 38-year-old patient who presented with pulmonary hypertension and right ventricular dysfunction due to pulmonary artery stenoses as a manifestation of Williams syndrome, mimicking chronic thromboembolic pulmonary hypertension. The patient was treated with balloon angioplasty and stent

Angiographic follow-up after carotid artery stenting of bifurcation stenosis; Angiographische Verlaufskontrolle nach Stentimplantation zur Behandlung der Karotisbifurkationsstenose

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Hauth, E.A.; Forsting, M. [Inst. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitaetsklinik Essen (Germany); Jansen, C.; Drescher, R.; Mathias, K. [Radiologische Klinik, Klinikum Dortmund (Germany); Schwarz, M. [Neurologische Klinik, Klinikum Dortmund (Germany); Christmann, A. [Fachbereich Statistik, Univ. Dortmund (Germany); Jaeger, H. [Radiologische Klinik, Klinikum Dortmund (Germany); Marien-Hospital Wesel, Praxis fuer Radiologie, Neuroradiologie and Nuklearmedizin (Germany)

2006-08-15

Purpose: the purpose of this prospective study was to determine the restenosis grade, the intima hyperplasia and the stent expansion via angiographic follow-up six months after carotid artery stenting. Materials and methods: in 100 patients, angiographic follow-up was performed 5.9 months (range: 2.9 - 11.4 months) after carotid artery stenting. The restenosis grade, the intima hyperplasia and the stent expansion were measured by selective angiography of the treated carotid artery. Results: the mean restenosis grade was 16% (range: 0 - 78%). In 6 of 100 patients (6%), a restenosis grade of > 50% was measured. In 4 patients the restenosis grade was 50 - 70%. In 2 patients the restenosis grade was > 70%. In 91 of 100 patients (91%), the restenosis was localized in the former area of stenosis of the carotid artery, and in 9 of 100 patients (9%), the restenosis was localized in the cranial stent end. The mean grade of intima hyperplasia was 31% (range: 2 - 70%). The mean increase in stent expansion at the time of follow-up was 10% (range: 0 - 59%). No correlation was able to be determined between the grade of stenosis and the grade of restenosis (rho = 0,017, range: -0.180 - 0.213), between the grade of residual stenosis and the grade of restenosis (rho = 0,257, range: 0.064 - 0.431) and between intima hyperplasia and the grade of restenosis (rho = 0,476, range: 0.309 - 0.615). Conclusions: carotid artery stenting is associated with a low incidence of high-grade restenosis 6 months after an intervention. The intima hyperplasia, which can be observed in each Wallstent, is partly compensated by the expansion of the self-expandable stent. Without a correlation between the grade of residual stenosis and the grade of restenosis, low-grade residual stenosis can be accepted. Therefore, we recommend undersized postdilation of the Wallstent. (orig.)

High-definition computed tomography for coronary artery stents imaging: Initial evaluation of the optimal reconstruction algorithm.

Science.gov (United States)

Cui, Xiaoming; Li, Tao; Li, Xin; Zhou, Weihua

2015-05-01

The aim of this study was to evaluate the in vivo performance of four image reconstruction algorithms in a high-definition CT (HDCT) scanner with improved spatial resolution for the evaluation of coronary artery stents and intrastent lumina. Thirty-nine consecutive patients with a total of 71 implanted coronary stents underwent coronary CT angiography (CCTA) on a HDCT (Discovery CT 750 HD; GE Healthcare) with the high-resolution scanning mode. Four different reconstruction algorithms (HD-stand, HD-detail; HD-stand-plus; HD-detail-plus) were applied to reconstruct the stented coronary arteries. Image quality for stent characterization was assessed. Image noise and intrastent luminal diameter were measured. The relationship between the measurement of inner stent diameter (ISD) and the true stent diameter (TSD) and stent type were analysed. The stent-dedicated kernel (HD-detail) offered the highest percentage (53.5%) of good image quality for stent characterization and the highest ratio (68.0±8.4%) of visible stent lumen/true stent lumen for luminal diameter measurement at the expense of an increased overall image noise. The Pearson correlation coefficient between the ISD and TSD measurement and spearman correlation coefficient between the ISD measurement and stent type were 0.83 and 0.48, respectively. Compared with standard reconstruction algorithms, high-definition CT imaging technique with dedicated high-resolution reconstruction algorithm provides more accurate stent characterization and intrastent luminal diameter measurement. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Peri-stent aneurysm formation following a stent implant for stenotic intracranial vertebral artery dissection: a technical report of two cases successfully treated with coil embolization.

Science.gov (United States)

Ishimaru, Hideki; Nakashima, Kazuaki; Takahata, Hideaki; Matsuoka, Yohjiro

2013-02-01

Although stenting for stenotic vertebral artery dissection (VAD) improves compromised blood flow, subsequent peri-stent aneurysm (PSA) formation is not well-known. We report two cases with PSA successfully treated with coil embolization. Three patients with stenotic intracranial VAD underwent endovascular angioplasty at our institution because they had acute infarction in posterior circulation territory and clinical evidence of hemodynamic insufficiency. In two of three patients balloon angioplasty at first session failed to relieve the stenosis, and a coronary stent was implanted. Angiography immediately after stenting showed no abnormality in case 1 and minimal slit-like projection at proximal portion of the stent in case 2. Angiography obtained 16 months after the stenting revealed PSA in case 1. In case 2, angiography performed 3 months later showed that the projection at proximal portion enlarged and formed an aneurysm outside the stent. Because follow-up angiographies showed growth of the aneurysm in both cases, endovascular aneurysmal embolization was performed. We advanced a microcatheter into the aneurysm through the strut of existing stent and delivered detachable coils into the aneurysm lumen successfully in both cases. The post-procedural course was uneventful, and complete obliteration of aneurysm was confirmed on angiography in both cases. Stenting for stenotic intracranial VAD may result in delayed PSA; therefore, follow-up angiographies would be necessary after stenting for stenotic intracranial arterial dissection. Coil embolization through the stent strut would be a solution for enlarging PSA.

New stent design for use in small coronary arteries during percutaneous coronary intervention

Directory of Open Access Journals (Sweden)

Juan F Granada

2010-10-01

Full Text Available Juan F Granada1, Barbara A Huibregtse2, Keith D Dawkins21The Jack H Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA; 2Boston Scientific Corporation, Natick, MA, USAAbstract: Patients with diabetes mellitus, of female gender, increased age, and/or with peripheral vascular disease often develop coronary stenoses in small caliber vessels. This review describes treatment of these lesions with the paclitaxel-eluting 2.25 mm TAXUS® Liberté® Atom™ stent. Given the same stent composition, polymer, antirestenotic drug (paclitaxel, and release kinetics as the first-generation 2.25 mm TAXUS® Express® Atom™ stent, the second-generation TAXUS Liberté Atom stent incorporates improved stent design characteristics, including thinner struts (0.0038 versus 0.0052 inches, intended to increase conformability and deliverability. In a porcine noninjured coronary artery model, TAXUS Liberté Atom stent implantation in small vessels demonstrated complete strut tissue coverage compared with the bare metal stent control, suggesting a similar degree of tissue healing between the groups at 30, 90, and 180 days. The prospective, single-armed TAXUS ATLAS Small Vessel trial demonstrated improved instent late loss (0.28 ± 0.45 versus 0.84 ± 0.57 mm, P < 0.001, instent binary restenosis (13.0% versus 38.1%, P < 0.001, and target lesion revascularization (5.8% versus 17.6%, P < 0.001 at nine months with the TAXUS Liberté Atom stent as compared with the bare metal Express stent control, with similar safety measures between the two groups. The TAXUS Liberté Atom also significantly reduced nine-month angiographic rates of both instent late loss (0.28 ± 0.45 versus 0.44 ± 0.61 mm, P = 0.03 and instent binary restenosis (13.0% versus 25.9%, P = 0.02 when compared with the 2.25 mm TAXUS Express Atom control. The observed reduction in target lesion revascularization with the TAXUS

In vitro stent lumen visualisation of various common and newly developed femoral artery stents using MR angiography at 1.5 and 3 tesla.

Science.gov (United States)

Syha, R; Ketelsen, D; Kaempf, M; Mangold, S; Sixt, S; Zeller, T; Springer, F; Schick, F; Claussen, C D; Brechtel, K

2013-02-01

To evaluate stent lumen assessment of various commonly used and newly developed stents for the superficial femoral artery (SFA) using MR angiography (MRA) at 1.5 and 3 T. Eleven nitinol stents and one cobalt-chromium stent were compared regarding stent lumen visualisation using a common three-dimensional MRA sequence. Maximum visible stent lumen width and contrast ratio were analysed in three representative slices for each stent type. A scoring system for lumen visualisation was applied. Nitinol stents showed significantly better performance than the cobalt chromium stent (P stent lumen ranged between 43.4 and 95.5 %, contrast ratio between 7.2 and 110.6 %. Regarding both field strengths, seven of the nitinol stents were classified as "suitable". Three nitinol stents were "limited", and one nitinol stent and the cobalt chromium stent were "not suitable". Intraluminal loss of signal and artefacts of most of the SFA stents do not markedly limit assessment of stent lumen by MRA at 1.5 and 3 T. MRA can thus be considered a valid technique for detection of relevant in-stent restenosis. Applied field strength does not strongly influence stent lumen assessment in general, but proper choice of field strength might be helpful.

Symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting

Energy Technology Data Exchange (ETDEWEB)

Wang, Zi-Liang [Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (China); Gao, Bu-Lang [Department of Medical Research Shijiazhuang First Hospital, Hebei Medical University (China); Li, Tian-Xiao, E-mail: litianxiaod@163.com [Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (China); Cai, Dong-Yang; Zhu, Liang-Fu; Bai, Wei-Xing; Xue, Jiang-Yu; Li, Zhao-Shuo [Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (China)

2015-09-15

Highlights: • Symptomatic vertebral artery stenosis can be treated with intracranial stenting. • Stenting for intracranial vertebral artery stenosis is safe and effective. • Stenting for intracranial vertebral artery stenosis can prevent long-term stroke. - Abstract: Purpose: To investigate the safety, effect and instent restenosis rate of Wingspan stenting in treating patients with intracranial vertebral artery atherosclerotic stenosis (70–99%) concurrent with contralateral vertebral artery atherosclerotic diseases. Materials and methods: Eighty-eight patients with severe symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) combined with contralateral vertebral artery atherosclerotic diseases were treated with the Wingpsan stent. All the baseline, cerebral angiography, success rate, perioperative complications, clinical and imaging follow-up data were prospectively analyzed. Results: The success rate of stenting was 100%, and the mean stenotic rate was reduced from prestenting (84.9 ± 6.8)% to poststenting (17.2 ± 5.9)%. The perioperative stroke rate was 1.1%. Among eighty patients (90.9%) with clinical follow-up 8-62 months (mean 29.3 ± 17.2) poststenting, five (6.3%) had posterior circulation TIA only, three (3.8%) had mild stroke in the posterior circulation but recovered completely, and another five patients greater than 70 years old died of non-ischemic stroke. Imaging follow-up in 46 patients (52.3%) 5–54 months (mean 9.9 ± 9.9) following stenting revealed instent restenosis in 12 patients (26.1%) including 7 (58.3%) symptomatic restenosis. Age and residual stenosis were the two factors to significantly (P < 0.05) affect instent restenosis. Conclusion: Wingspan stenting in the intracranial vertebral artery atherosclerotic stenosis combined with contralateral vertebral artery atherosclerotic diseases has a low perioperative stroke rate and a good preventive effect on long-term ischemic stroke, but the instent restenosis

High-definition computed tomography for coronary artery stents imaging: Initial evaluation of the optimal reconstruction algorithm

Energy Technology Data Exchange (ETDEWEB)

Cui, Xiaoming, E-mail: mmayzy2008@126.com; Li, Tao, E-mail: litaofeivip@163.com; Li, Xin, E-mail: lx0803@sina.com.cn; Zhou, Weihua, E-mail: wangxue0606@gmail.com

2015-05-15

Highlights: • High-resolution scan mode is appropriate for imaging coronary stent. • HD-detail reconstruction algorithm is stent-dedicated kernel. • The intrastent lumen visibility also depends on stent diameter and material. - Abstract: Objective: The aim of this study was to evaluate the in vivo performance of four image reconstruction algorithms in a high-definition CT (HDCT) scanner with improved spatial resolution for the evaluation of coronary artery stents and intrastent lumina. Materials and methods: Thirty-nine consecutive patients with a total of 71 implanted coronary stents underwent coronary CT angiography (CCTA) on a HDCT (Discovery CT 750 HD; GE Healthcare) with the high-resolution scanning mode. Four different reconstruction algorithms (HD-stand, HD-detail; HD-stand-plus; HD-detail-plus) were applied to reconstruct the stented coronary arteries. Image quality for stent characterization was assessed. Image noise and intrastent luminal diameter were measured. The relationship between the measurement of inner stent diameter (ISD) and the true stent diameter (TSD) and stent type were analysed. Results: The stent-dedicated kernel (HD-detail) offered the highest percentage (53.5%) of good image quality for stent characterization and the highest ratio (68.0 ± 8.4%) of visible stent lumen/true stent lumen for luminal diameter measurement at the expense of an increased overall image noise. The Pearson correlation coefficient between the ISD and TSD measurement and spearman correlation coefficient between the ISD measurement and stent type were 0.83 and 0.48, respectively. Conclusions: Compared with standard reconstruction algorithms, high-definition CT imaging technique with dedicated high-resolution reconstruction algorithm provides more accurate stent characterization and intrastent luminal diameter measurement.

FiberNet--a new embolic protection device for carotid artery stenting.

Science.gov (United States)

Bauer, C; Franke, J; Bertog, S C; Woerner, V; Ghasemzadeh-Asl, S; Sievert, H

2014-05-01

Though distal filter protection during carotid stenting reduces the risk of cerebrovascular events, periprocedural stroke remains a risk despite their broad usage. This observation may be related to the pore size of common filters. The FiberNet distal filter system is unique by its very small pore size (40 µm) as well as its low profile and flexibility. Little data is available regarding the clinical performance and safety of this device. The aim was the evaluation of the safety of the FiberNet embolic protection system during carotid artery stenting. All consecutive patients treated with carotid stenting at our institution using the FiberNet device were systematically followed. Primary endpoint was the rate of all death and stroke within 30 days of the procedure. Carotid artery stenting using the FiberNet embolic protection system was performed in 54 patients. The procedure was technical successful in all patients. Three patients (5.5%) had a TIA. Amauosis fugax occurred in two patients (3.7%). One patient (1.9%) had a minor stroke with hemiparesis of the left arm and face which resolved completely within 48 hr after the procedure. No patient died or suffered a major stroke. The safety and feasibility of the FiberNet distal protection system appears to be at least equivalent to that reported in studies using conventional distal filter protection. Copyright © 2013 Wiley Periodicals, Inc.

Balloon-Expandable Stent Graft for Treating Uretero-Iliac Artery Fistula

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Guntau, Moritz, E-mail: guntau@med.uni-marburg.de [Philipps University, Department of Diagnostic and Interventional Radiology, Marburg University Hospital (Germany); Hegele, Axel [Philipps University, Department of Urology and Pediatric Urology, Marburg University Hospital (Germany); Rheinheimer, Stephan [Philipps University, Department of Diagnostic and Interventional Radiology, Marburg University Hospital (Germany); Hofmann, Rainer [Philipps University, Department of Urology and Pediatric Urology, Marburg University Hospital (Germany); Mahnken, Andreas H. [Philipps University, Department of Diagnostic and Interventional Radiology, Marburg University Hospital (Germany)

2017-06-15

PurposeTo evaluate the safety, efficacy and outcome of percutaneous balloon-expandable covered stent graft placement for uretero-iliac artery fistula (UAF) treatment.MethodsThis retrospective study evaluated the single-center experience of percutaneous balloon-expandable covered stent graft placement (ADVANTA™, Atrium Hudson, NH, USA) in UAF. Data were obtained from a prospective institutional database. Patient follow-up included complications, symptoms recurrence and mortality rate.ResultsTen UAFs in eight patients (3 males; 5 females) with a mean age of 64.5 (35–77) years were identified. All patients had a history pelvic malignancy, extirpative surgery (n = 6), long-term ureteral stenting (n = 7) and pelvic radiation (n = 5). All procedures were completed successfully without complications. Thirty-day mortality rate was zero. At a median follow-up of 6 (1–60) months, one patient suffered recurrent hematuria requiring a secondary stent graft placement 26 months after the initial treatment. During follow-up, five patients died of the underlying disease (43, 66, 105, and 183 and 274 days after the last procedure).ConclusionPercutaneous balloon-expandable stent graft placement in UAF is a safe and effective treatment option. Implantation of stent grafts should be considered as treatment of choice in UAF.

A novel application of the culotte stent technique to bail out a jailed common iliac artery

Directory of Open Access Journals (Sweden)

Hideto Sangen, MD

2017-12-01

Full Text Available Implanting a self-expandable stent at the ostium of the common iliac artery (CIA may lead to coverage of the orifice of the contralateral CIA. Here, we describe a novel application of the culotte stent technique using a balloon-expandable stent to bail out an ostial stenotic legion of a jailed CIA due to prior self-expandable stent placement. The bilateral CIAs were revascularized by culotte stenting, and patency of the stents was confirmed 3 years after the procedure. The culotte stent technique was successfully applied to an ostial stenotic lesion of a jailed CIA.

Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

Energy Technology Data Exchange (ETDEWEB)

Alzamora, M.G.; Klisch, J. [Section of Neuroradiology, Neurocenter, University of Freiburg (Germany); Rosahl, S.K.; Lehmberg, J. [Department of Neurosurgery, Neurocenter, University of Freiburg (Germany)

2005-04-01

The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel.

Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

International Nuclear Information System (INIS)

Alzamora, M.G.; Klisch, J.; Rosahl, S.K.; Lehmberg, J.

2005-01-01

The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel

Endovascular repair of renal artery aneurysm with the multilayer stent – a short report

Directory of Open Access Journals (Sweden)

Vojko Flis

2012-10-01

in the main left renal artery involving all three major branches of the renal artery. Via a percutaneous femoral approach a multilayer stent was deployed without complications. Blood flow inside the sac was immediately and significantly reduced. All the renal branches remained patent. Conclusion: New multilayer fluid modulating stent concept appears to be a very useful and attractive alternative to surgery or other endovascular techniques for those RAA involving or very close to major branch vessels, especially in patients with very high risk of loosing the only viable kidney, as in our case.

Endovascular treatment of penetrating arterial trauma with stent grafts.

Science.gov (United States)

Biagioni, Rodrigo Bruno; Burihan, Marcelo Calil; Nasser, Felipe; Biagioni, Luisa Ciucci; Ingrund, José Carlos

2018-02-01

The endovascular management of arterial injuries has resulted in reduced operating time, blood loss, hospital mortality, lower incidence of sepsis, and decrease in mortality rates. For penetrating trauma, however, the benefits of endovascular therapy are questionable. Data were obtained by retrospective analysis of electronic medical records. All patients with vascular trauma seeking care at our institution from January 2010 to December 2015 were reviewed. A total of 223 vascular trauma patients were enrolled. Of these, 18 patients (8 %) were treated with endovascular techniques. The data related to clinical presentation, patient characteristics, technical aspects of the treatment, and follow-up were analysed. The mean patient age was 35.4 ± 17.8 years, 94 % were male. The mean injury severity score was 10.4 ± 2.5. The most commonly observed trauma mechanism was a gunshot in 10 cases (55 %), followed by lesions provoked by arterial catheter misplacement in five cases (27 %), and stab wounds in three cases (16.6 %). The main injury site was the subclavian artery, accounting for eight cases (44 %), followed by the superficial femoral artery and the tibiofibular trunk in two cases, respectively (18 %). The anterior tibial, fibular artery, axillary, common carotid, superior mesenteric, and profunda femoris were each affected once. Arteriovenous fistula was detected in nine cases (50 %), pseudoaneurysms in nine cases (50 %), and short occlusion in two cases (11 %). The mean follow-up duration was 753 days. The primary patency rate was 92.3 and 61.5 % after one and two years, respectively. The survival rate was 94.4 % after one and two years. Infection of the stents or limb amputations were not identified at follow-up. The endovascular treatment of penetrating arterial injuries with covered stents is feasible. However, the criteria used to choose the best method must be individualized.

Zotarolimus-eluting Resolute Integrity versus everolimus-eluting Xience Xpedition stents in the management of very long (>30 mm) de novo coronary artery stenosis

Energy Technology Data Exchange (ETDEWEB)

Patra, Soumya, E-mail: dr_soumyapatra@rediffmail.com; Chakraborty, Rabindra Nath; Pande, Arindam; Banerjee, Suvro; Jena, Manabhanjan; Mandal, Prakash Chandra; De, Swapan Kumar; Khan, Aftab; Das, Sankha Suvro; Ghosh, Debashish; Nag, Raja

2017-04-15

mm was used. These stents are used most frequently in our country. • Likewise previous study, we did not find any significant difference in the clinical outcome at 12 months. • Male-dominated patient population was also in similar kind from previous trial though the percentage was more than that of previous study. • Our study patients have less complex coronary artery disease than those from previous trials.

Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial

NARCIS (Netherlands)

Bonati, Leo H.; Dobson, Joanna; Featherstone, Roland L.; Ederle, Jörg; van der Worp, H. Bart; de Borst, Gert J.; Mali, Willem P. Th M.; Beard, Jonathan D.; Cleveland, Trevor; Engelter, Stefan T.; Lyrer, Philippe A.; Ford, Gary A.; Dorman, Paul J.; Brown, Martin M.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Hacke, W.; Halliday, A.; Malik, I.; Mas, J. L.; McGuire, A. J.; Sidhu, P.; Venables, G.; Clifton, A.; Gaines, P.; Collins, R.; Molyneux, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Coward, L.; Dobson, J.; Doig, D.; Ederle, J.; Featherstone, R. F.; Kennedy, F.; Tindall, H.; Turner, E.; McCabe, D. J. H.; Wallis, A.; Brooks, M.; Chambers, B.; Koelemay, M. J. W.; Nederkoorn, P. J.; Reekers, J. A. A.; Roos, Y. B. W. E. M.

2015-01-01

Background Stenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments. Methods Patients with symptomatic carotid stenosis

Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial

NARCIS (Netherlands)

Bonati, L.H.; Dobson, J.; Featherstone, R.L.; Ederle, J.; Worp, H.B. van der; Borst, G.J. de; Mali, W.P.; Beard, J.D.; Cleveland, T.; Engelter, S.T.; Lyrer, P.A.; Ford, G.A.; Dorman, P.J.; Brown, M.M.; Leeuw, F.E. de; et al.,

2015-01-01

BACKGROUND: Stenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments. METHODS: Patients with symptomatic carotid

Mechanical behavior of peripheral stents and stent-vessel interaction: A computational study

Science.gov (United States)

Dottori, Serena; Flamini, Vittoria; Vairo, Giuseppe

2016-05-01

In this paper stents employed to treat peripheral artery disease are analyzed through a three-dimensional finite-element approach, based on a large-strain and large-displacement formulation. Aiming to evaluate the influence of some stent design parameters on stent mechanics and on the biomechanical interaction between stent and arterial wall, quasi-static and dynamic numerical analyses are carried out by referring to computational models of commercially and noncommercially available versions of both braided self-expandable stents and balloon-expandable stents. Addressing isolated device models, opening mechanisms and flexibility of both opened and closed stent configurations are numerically experienced. Moreover, stent deployment into a stenotic peripheral artery and possible postdilatation angioplasty (the latter for the self-expandable device only) are simulated by considering different idealized vessel geometries and accounting for the presence of a stenotic plaque. Proposed results highlight important differences in the mechanical response of the two types of stents, as well as a significant influence of the vessel shape on the stress distributions arising upon the artery-plaque system. Finally, computational results are used to assess both the stent mechanical performance and the effectiveness of the stenting treatment, allowing also to identify possible critical conditions affecting the risk of stent fracture, tissue damage, and/or pathological tissue response.

Everolimus-eluting bioresorbable stent vs. durable polymer everolimus-eluting metallic stent in patients with ST-segment elevation myocardial infarction

DEFF Research Database (Denmark)

Sabaté, Manel; Windecker, Stephan; Iñiguez, Andres

2015-01-01

AIMS: Patients with ST-segment elevation myocardial infarction (STEMI) feature thrombus-rich lesions with large necrotic core, which are usually associated with delayed arterial healing and impaired stent-related outcomes. The use of bioresorbable vascular scaffolds (Absorb) has the potential...... to overcome these limitations owing to restoration of native vessel lumen and physiology at long term. The purpose of this randomized trial was to compare the arterial healing response at short term, as a surrogate for safety and efficacy, between the Absorb and the metallic everolimus-eluting stent (EES...... was the 6-month optical frequency domain imaging healing score (HS) based on the presence of uncovered and/or malapposed stent struts and intraluminal filling defects. Main secondary endpoint included the device-oriented composite endpoint (DOCE) according to the Academic Research Consortium definition...

Accidental Coverage of Both Renal Arteries during Infrarenal Aortic Stent-Graft Implantation: Cause and Treatment

Directory of Open Access Journals (Sweden)

Umberto Marcello Bracale

2014-01-01

Full Text Available The purpose of this paper is to report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR of an infrarenal abdominal aortic aneurysm (AAA. A 72-year-old female with a 6 cm infrarenal abdominal aortic aneurysm was treated by endovascular means with a standard bifurcated graft. Upon completing an angiogram, both renal arteries were found to be accidentally occluded. Through a left percutaneous brachial approach, the right renal artery was catheterized and a chimney stent was deployed; however this was not possible for the left renal artery. A retroperitoneal surgical approach was therefore carried out with a retrograde chimney stent implanted to restore blood flow. After three months, both renal arteries were patent and renal function was not different from the baseline. Both endovascular with percutaneous access via the brachial artery and open retroperitoneal approaches with retrograde catheterization are feasible rescue techniques to recanalize the accidentally occluded renal arteries during EVAR.

Covered stents for endovascular repair of iatrogenic injuries of iliac and femoral arteries

Energy Technology Data Exchange (ETDEWEB)

Kufner, Sebastian, E-mail: kufners@dhm.mhn.de [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); Cassese, Salvatore; Groha, Philipp; Byrne, Robert A. [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); Schunkert, Heribert; Kastrati, Adnan [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich (Germany); Ott, Ilka; Fusaro, Massimiliano [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany)

2015-04-15

Background: The growing number of complex endovascular procedures is expected to increase the risk of iatrogenic injuries of peripheral arteries. A strategy of percutaneous transluminal angioplasty (PTA) with covered stent (CS) may represent a valuable alternative to open surgery. However, systematic evaluations of CS in this setting represent a scientific gap. In the present study, we investigate the procedural and clinical outcomes associated with PTA and CS implantation to repair iatrogenic injuries of peripheral arteries. Methods: All patients undergoing PTA with CS for endovascular repair of iatrogenic injuries of peripheral arteries between August 2010 and July 2013 at our Institution were retrospectively analyzed. The primary endpoint was the technical success. Secondary endpoints were in-hospital mortality and cumulative death, target lesion revascularization (TLR), amputation and major stroke at 12-month follow-up. Results: During the period of observation, a total of 30 patients underwent PTA with either self-expandable (43.3%) or balloon-expandable CS (56.7%) for iatrogenic injuries of peripheral arteries. Injuries consisted of perforation/rupture (76.7%), arteriovenous fistula (16.7%) and pseudoaneurysm (6.7%) of iliac–femoral arteries. Technical success was achieved in all cases. Median follow-up was 409 days [210–907]. The incidence of in-hospital mortality was 10.0%. At 12-month follow-up, the incidence of death, TLR, amputation and major stroke was 20.0%, 17.0%, 3.3% and 6.7%, respectively. Conclusion: The use of covered stents for endovascular repair of iatrogenic injuries of peripheral arteries shows a high technical success and may be alternative to surgery. Further studies with larger populations are needed to confirm these preliminary findings. - Highlights: • The growing number of complex endovascular procedures is expected to increase the risk of iatrogenic injuries of peripheral arteries. • Percutaneous transluminal angioplasty with

Coronary artery bypass surgery or coronary stenting in diabetic patients: too soon to make a statement?

Energy Technology Data Exchange (ETDEWEB)

Rodriguez, Alfredo E., E-mail: arodriguez@centroceci.com.ar

2014-11-15

Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. However, almost simultaneously with this data, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in adverse cardiac events compared to 1st generation DES in patients with diabetes. In this editorial we review the old and new randomized data in diabetic patients and conclude that there are many unresolved issues to make a definitive statement regarding which is the best revascularization preference in diabetic patients and the measured final efficacy of PCI and CABG will not be reached until the arrival of RCT using next generation DES, including complete absorbable scaffolds. - Highlights: • Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. • In recent years, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in

Coronary artery bypass surgery or coronary stenting in diabetic patients: too soon to make a statement?

International Nuclear Information System (INIS)

Rodriguez, Alfredo E.

2014-01-01

Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. However, almost simultaneously with this data, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in adverse cardiac events compared to 1st generation DES in patients with diabetes. In this editorial we review the old and new randomized data in diabetic patients and conclude that there are many unresolved issues to make a definitive statement regarding which is the best revascularization preference in diabetic patients and the measured final efficacy of PCI and CABG will not be reached until the arrival of RCT using next generation DES, including complete absorbable scaffolds. - Highlights: • Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. • In recent years, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in

Bioabsorbable polymer-coated sirolimus-eluting stent implantation preserves coronary vasomotion: A DESSOLVE II trial sub-study.

Science.gov (United States)

Rusinaru, Dan; Vrolix, Mathias; Verheye, Stefan; Chowdhary, Saqib; Schoors, Danny; Di Mario, Carlo; Desmet, Walter; Donohoe, Dennis J; Ormiston, John A; Knape, Charlene; Bezerra, Hiram; Lansky, Alexandra; Wijns, William

2015-12-01

We studied coronary vasomotion in patients treated with the Mistent(®) absorbable polymer sirolimus-eluting stent (APSES) and in patients implanted with the Endeavor(®) zotarolimus-eluting stent (ZES). First generation (1st-gen) drug-eluting stents (DES) induce persistent vasomotor dysfunction in the treated coronary artery. It is unknown whether and to what extent the implantation of an absorbable polymer DES impairs coronary vasomotion. This sub-study of the DESSOLVE II trial included 19 APSES Mistent(®) and 10 ZES Endeavor(®) patients. Incremental atrial pacing and quantitative coronary angiography were used to assess vasomotion proximal and distal to the stent and in a reference segment at 9 months after implantation. Percent changes in vessel diameter with pacing versus baseline were calculated and compared. Vasomotor response of the APSES group was also compared with changes observed in a historical group of 17 patients implanted with a 1st-gen sirolimus-eluting stent (SES). Normal vasomotion (vasodilatation) was preserved and of comparable magnitude in the APSES and in the ZES group both proximally (P = 0.34) and distally (P = 0.38) to the stent. This finding was not observed in the 1st-gen SES group showing marked pacing-induced vasoconstriction at both stent edges (P absorbable polymer sirolimus-eluting stent is associated with preserved coronary vasomotion, comparable to that observed after implantation of the Endeavor(®) ZES, and distinct from 1st-gen SES which induce coronary vasomotor dysfunction. © 2015 Wiley Periodicals, Inc.

Long-term forecasting and comparison of mortality in the Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II.

Science.gov (United States)

Campos, Carlos M; van Klaveren, David; Farooq, Vasim; Simonton, Charles A; Kappetein, Arie-Pieter; Sabik, Joseph F; Steyerberg, Ewout W; Stone, Gregg W; Serruys, Patrick W

2015-05-21

To prospectively validate the SYNTAX Score II and forecast the outcomes of the randomized Evaluation of the Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) Trial. Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization is a prospective, randomized multicenter trial designed to establish the efficacy and safety of percutaneous coronary intervention (PCI) with the everolimus-eluting stent compared with coronary artery bypass graft (CABG) surgery in subjects with unprotected left-main coronary artery (ULMCA) disease and low-intermediate anatomical SYNTAX scores (EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for mortality were computed using simulation with bootstrap resampling (10 000 times). For the entire study cohort, the 4-year predicted mortalities were 8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR) 0.79; 95% PI 0.43-1.50). In subjects with low (≤22) anatomical SYNTAX scores, the predicted OR was 0.69 (95% PI 0.34-1.45); in intermediate anatomical SYNTAX scores (23-32), the predicted OR was 0.93 (95% PI 0.53-1.62). Based on 4-year mortality predictions in EXCEL, clinical characteristics shifted long-term mortality predictions either in favour of PCI (older age, male gender and COPD) or CABG (younger age, lower creatinine clearance, female gender, reduced left ventricular ejection fraction). The SYNTAX Score II indicates at least an equipoise for long-term mortality between CABG and PCI in subjects with ULMCA disease up to an intermediate anatomical complexity. Both anatomical and clinical characteristics had a clear impact on long-term mortality predictions and decision making between CABG and PCI. Published on behalf of the European Society of Cardiology. All rights reserved. © The

Dose-Dependent Effect of Statin Pretreatment on Preventing the Periprocedural Complications of Carotid Artery Stenting.

Science.gov (United States)

Hong, Jeong-Ho; Sohn, Sung-Il; Kwak, Jaehyuk; Yoo, Joonsang; Chang, Hyuk Won; Kwon, O-Ki; Jung, Cheolkyu; Chung, Inyoung; Bae, Hee-Joon; Lee, Ji Sung; Han, Moon-Ku

2017-07-01

We investigated whether statin pretreatment can dose dependently reduce periprocedural complications in patients undergoing carotid artery stenting because of symptomatic carotid artery stenosis. We enrolled a consecutive series of 397 symptomatic carotid artery stenosis (≥50% stenosis on conventional angiography) treated with carotid artery stenting at 2 tertiary university hospitals over a decade. Definition of periprocedural complications included any stroke, myocardial infarction, and death within 1 month after or during the procedure. Statin pretreatment was divided into 3 categories according to the atorvastatin equivalent dose: none (n=158; 39.8%), standard dose (statin use were 12.0%, 4.5%, and 1.2%. After adjustment, a change in the atorvastatin dose category was associated with reduction in the odds of periprocedural complications for each change in dose category (standard-dose statin: odds ratio, 0.24; 95% confidence interval, 0.07-0.81; high-dose statin: odds ratio, 0.11; 95% confidence interval, 0.01-0.96; P for trend=0.01). Administration of antiplatelet drugs was also an independent factor in periprocedural complications (OR, 0.18; 95% CI, 0.05-0.69). This study shows that statin pretreatment may reduce the incidence of periprocedural complications dose dependently in patients with symptomatic carotid artery stenting. © 2017 American Heart Association, Inc.

Comparison of enterprise and neuroform stent-assisted coil embolization of distal internal carotid artery aneurysms: Midterm results from a single-center experience

International Nuclear Information System (INIS)

Choi, Won Jin; Baik, Seung Kug; Yeom, Jeong A; Kim, Young Soo; Lee, Sang Weon

2014-01-01

To compare the mid-term follow-up angiographic findings in distal internal carotid artery (ICA) aneurysms treated by stent-assisted coil embolization using the Enterprise or Neuroform stent. We included 68 patients with 70 aneurysms: 31 cases with Enterprise and 39 cases with Neuroform. Inclusion criteria were 1) location of the stent within the distal ICA, including the carotid siphon; 2) follow-up angiogram after > 6 months, and 3) single use of the stent for 1 parent artery. The patients' mean age was 54.9 years (16 male and 52 female). Mean follow-up duration was 9.1 months. At follow-up, there were intraluminal filling defects of the parent artery in 19.4% of the Enterprise group and no filling defect in the Neuroform group. There was no significant in-stent stenosis in either group. Straightening of the parent artery was seen in 35.5% of the Enterprise group and 20.5% of the Neuroform group. Two Enterprise cases showed delayed migration. The Enterprise showed statistically significant intraluminal filling defects of the parent artery compared with the Neuroform. The rates of significant in-stent stenosis and straightening of the parent artery were not significantly different between the Enterprise and the Neuroform groups.

Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis

Science.gov (United States)

Stortecky, Stefan; Stefanini, Giulio G; daCosta, Bruno R; Rutjes, Anne Wilhelmina; Di Nisio, Marcello; Siletta, Maria G; Maione, Ausilia; Alfonso, Fernando; Clemmensen, Peter M; Collet, Jean-Philippe; Cremer, Jochen; Falk, Volkmar; Filippatos, Gerasimos; Hamm, Christian; Head, Stuart; Kappetein, Arie Pieter; Kastrati, Adnan; Knuuti, Juhani; Landmesser, Ulf; Laufer, Günther; Neumann, Franz-Joseph; Richter, Dimitri; Schauerte, Patrick; Sousa Uva, Miguel; Taggart, David P; Torracca, Lucia; Valgimigli, Marco; Wijns, William; Witkowski, Adam; Kolh, Philippe; Juni, Peter

2014-01-01

Objective To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease. Design Bayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials while maintaining randomisation. Eligibility criteria for selecting studies A strategy of initial medical treatment compared with revascularisation by coronary artery bypass grafting or Food and Drug Administration approved techniques for percutaneous revascularization: balloon angioplasty, bare metal stent, early generation paclitaxel eluting stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent, and new generation everolimus eluting stent, and zotarolimus eluting (Resolute) stent among patients with stable coronary artery disease. Data sources Medline and Embase from 1980 to 2013 for randomised trials comparing medical treatment with revascularisation. Main outcome measure All cause mortality. Results 100 trials in 93 553 patients with 262 090 patient years of follow-up were included. Coronary artery bypass grafting was associated with a survival benefit (rate ratio 0.80, 95% credibility interval 0.70 to 0.91) compared with medical treatment. New generation drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus (Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to 1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to 1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with improved survival compared with medical treatment. Coronary artery bypass grafting reduced the risk of myocardial infarction compared with medical treatment (0.79, 0.63 to 0.99), and everolimus eluting stents showed a trend towards a reduced risk of myocardial infarction (0.75, 0.55 to 1.01). The risk of subsequent revascularisation was noticeably

Conformally integrated stent cell resonators for wireless monitoring of peripheral artery disease

KAUST Repository

Viswanath, Anupam

2013-01-01

This paper presents the design and in vitro evaluation of magnetoelastic sensors intended for wireless monitoring of tissue accumulation in peripheral artery stents. The sensors, shaped like stent cells, are fabricated from 28-μm thick foils of magnetoelastic Ni-Fe alloy and are conformally integrated with the stent. The typical sensitivity to viscosity is 427 ppm/cP over a 1.1-8.6 cP range. The sensitivity to mass loading is typically 63,000-65000 ppm/mg with resonant frequency showing an 8.1% reduction for an applied mass that is 15% of the unloaded mass of the sensor. © 2013 IEEE.

In vitro imaging of coronary artery stents: Are there differences between 16- and 64-slice CT scanners?

International Nuclear Information System (INIS)

Wolf, Florian; Feuchtner, Gudrun M.; Homolka, Peter; Langenberger, Herbert; Stadler, Alfred; Bader, Till R.; Weber, Michael; Lammer, Johannes; Loewe, Christian

2008-01-01

Purpose: To compare the performance of 64-slice with 16-slice CT scanners for the in vitro evaluation of coronary artery stents. Methods and materials: Twelve different coronary artery stents were placed in the drillings of a combined heart and chest phantom, which was scanned with a 16- and 64-slice CT scanner. Coronal reformations were evaluated for artificial lumen narrowing, intraluminal attenuation values, and false widening of the outer stent diameter as an indicator of artifacts outside the stent. Results: Mean artificial lumen narrowing was not significantly different between the 16- and 64-slice CT scanner (44% versus 39%; p = 0.408). The differences between the Hounsfield Units (HU) measurements inside and outside the stents were significantly lower (p = 0.001) with 64- compared to 16-slice CT. The standard deviation of the HU measurements inside the stents was significantly (p = 0.002) lower with 64- than with 16-slice CT. Artifacts outside the stents were not significantly different between the scanners (p = 0.866). Conclusion: Visualization of the in-stent lumen is improved with 64-slice CT when compared with 16-slice CT as quantified by significantly lesser intraluminal image noise and less artificial rise in intraluminal HU measurement, which is the most important parameter for the evaluation of stent patency in vivo

Comparison of Self-Expanding Polyethylene Terephthalate and Metallic Stents Implanted in Porcine Iliac Arteries

International Nuclear Information System (INIS)

Wilczek, Krzysztof; Scheerder, Ivan de; Wang Kai; Verbeken, Eric; Piessens, Jan

1996-01-01

Purpose: Comparison of the biocompatibility of self-expanding polyethylene terephthalate (PET) stents with self-expanding metallic stents (Wallstents). Methods: Diameter- and length-matched PET stents and Wallstents were symmetrically implanted in the paired iliac arteries of 13 crossbred domestic swine. Stent deployment was studied angiographically and with intravascular ultrasound immediately after stent implantation. The angiographic stented lumen diameter was measured using quantitative vessel analysis before, immediately after stenting, and at 6-week follow-up. Cross-section histopathology and area morphometry were performed. Results: Immediately poststenting, intravascular ultrasound revealed proximal dislocation of 5 of the 13 PET stents, whereas all metal stents were firmly embedded at the implantation site. At 6-week follow-up, three of the remaining PET stents were totally or subtotally occluded by organized thrombus, whereas all metal stents were patent. Compared with immediately poststenting, the angiographic lumen diameter within the five remaining PET stents was reduced by 30%, and that of the metallic stents was virtually unaltered (p < 0.02). This observation was confirmed by postmortem morphometry, wherein the PET-stented vessel segments a diameter stenosis of 40% was measured vs only 9% in the metallic stents (p < 0.0001). Conclusion: PET-stent deployment is difficult to control due to the lack of radiopacity of this stent. PET stents seem to be more thrombogenic and lead to significantly more neointimal proliferation than metallic stents

Under X-ray guidance stent implantation through retrograde popliteal artery puncturing for the treatment of superficial femoral artery occlusion: the initial results in nine cases

International Nuclear Information System (INIS)

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

2011-01-01

Objective: To discuss the application of retrograde popliteal artery puncturing under X-ray guidance in the interventional therapy for superficial femoral artery occlusion. Methods: Retrograde popliteal artery puncturing under X-ray guidance was carried out in nine patients with long-segment occlusion of superficial femoral artery as antegrade recanalization via femoral artery approach had failed in them. After retrograde route was successfully established, the balloon dilation and subsequent stent placement for occluded vessel were performed. Results: The technical success was obtained in all patients. The occluded superficial femoral arteries were reopened and the symptoms of intermittent claudication disappeared. No serious complications such as injuries of adjacent nerves or vessels occurred. The ankle-brachial index (ABI) increased from preoperative (0.38±0.13) to postoperative (0.92±0.11) with the difference being statistically significant (P<0.01). A follow-up period lasting for 2-16 months was conducted. Eleven months after the treatment, intermittent claudication recurred in one case, and CT angiography showed that the distal part of the stent was narrowed. The symptoms were improved after percutaneous transcatheter angioplasty was performed again. Conclusion: Retrograde popliteal artery puncturing under X-ray guidance is an effective and safe technique for the treatment of superficial femoral artery long-segment occlusion with stent placement, especially for patients in whom antegrade recanalization via femoral artery approach fails. (authors)

Late presenting, contained rupture of the superficial femoral artery following atherectomy and stenting: case report and literature review.

Science.gov (United States)

Clegg, Stacey; Aghel, Arash; Rogers, R Kevin

2014-08-01

Excisional atherectomy alone or followed by stenting is considered an appropriate treatment strategy for patients with lifestyle-limiting claudication due to obstructive infra-inguinal peripheral arterial disease (Ramaiah et al., J Endovasc Ther 2006;13:592-6021). We present a case of a 69-year-old man with eccentric severely calcified disease of the superficial femoral artery (SFA) treated with excisional atherectomy followed by stenting with an interwoven nitinol stent. The procedure was complicated by extravascular stent migration associated with a contained rupture presenting 30 days after the intervention. The complication was successfully treated with a stent graft. Although rare, pseudoaneurysms have been reported at the site of prior atherectomy; however, this case is the first description of a contained rupture post atherectomy associated with erosion of a nitinol stent into an extra-luminal position. The mechanism and management of this complication are discussed. © 2014 Wiley Periodicals, Inc.

Nine-month Angiographic and Two-year Clinical Follow-up of Novel Biodegradable-polymer Arsenic Trioxide-eluting Stent Versus Durable-polymer Sirolimus-eluting Stent For Coronary Artery Disease

Directory of Open Access Journals (Sweden)

Li Shen

2015-01-01

Full Text Available Background: Despite great reduction of in-stent restenosis, first-generation drug-eluting stents (DESs have increased the risk of late stent thrombosis due to delayed endothelialization. Arsenic trioxide, a natural substance that could inhibit cell proliferation and induce cell apoptosis, seems to be a promising surrogate of sirolimus to improve DES performance. This randomized controlled trial was to evaluate the efficacy and safety of a novel arsenic trioxide-eluting stent (AES, compared with traditional sirolimus-eluting stent (SES. Methods: Patients with symptoms of angina pectoris were enrolled and randomized to AES or SES group. The primary endpoint was target vessel failure (TVF, and the second endpoint includes rates of all-cause death, cardiac death or myocardial infarction, target lesion revascularization (TLR by telephone visit and late luminal loss (LLL at 9-month by angiographic follow-up. Results: From July 2007 to 2009, 212 patients were enrolled and randomized 1:1 to receive either AES or SES. At 2 years of follow-up, TVF rate was similar between AES and SES group (6.67% vs. 5.83%, P = 0.980. Frequency of all-cause death was significantly lower in AES group (0 vs. 4.85%, P = 0.028. There was no significant difference between AES and SES in frequency of TLR and in-stent restenosis, but greater in-stent LLL was observed for AES group (0.29 ± 0.52 mm vs. 0.10 ± 0.25 mm, P = 0.008. Conclusions: After 2 years of follow-up, AES demonstrated comparable efficacy and safety to SES for the treatment of de novo coronary artery lesions.

Guidelines for patient selection and performance of carotid artery stenting.

Science.gov (United States)

Bladin, Christopher; Chambers, Brian; New, Gishel; Denton, Michael; Lawrence-Brown, Michael

2010-06-01

The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy remains the benchmark in terms of procedural mortality and morbidity. At present, there are no consensus Australasian guidelines for the safe performance of CAS. We applied a modified Delphi consensus method of iterative consultation between the College representatives on the Carotid Stenting Guidelines Committee (CSGC). Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria and cannot be directly extrapolated from clinical indicators for carotid endarterectomy (CEA). Randomized controlled trials (including pooled analyses of results) comparing CAS with CEA for treatment of symptomatic stenosis have demonstrated that CAS is more hazardous than CEA. On current evidence, the CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. The evidence for CAS in patients with symptomatic severe carotid stenosis who are considered medically high risk is weak, and there is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomized controlled trials, carotid and aortic arch anatomy and pathology, clinical stroke syndromes, the differing treatment options for stroke and carotid atherosclerosis, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuro-imaging and an independent, standardized neurological assessment before and after the procedure. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and

A new kind of 32P stent used for prevention of the restenosis after PTCA in rabbit iliac arteries

International Nuclear Information System (INIS)

Gao Dongsheng; Chen Runfen; Mao Jialiang; Huang Dingjiu

2003-01-01

Objective: To evaluate the effect and the mechanism of a new kind of 32 P stents used for prevention of the restenosis after percutaneous transluminal coronary angioplasty (PTCA); to observe the 'edge effect' caused by radioactive stents. Methods: Six 32 P-β-emitting stents made by compound plating, paired with 6 31 P nonradioactive(control) stents, were placed separately, one in one iliac artery in 6 rabbits, respectively. Animals were sacrificed after 30 d. Angiography, morphometry and immunohistochemistry work-up were performed. Results: There were no aneurysm or thrombosis in the arteries with stents placed. Morphometric measurements demonstrated that the mean minimum lumen diameter (MLD) was greater in 32 P stents than that in control stents (P 32 P stents was greater than that in control stents, but the later had marked neointimal area than the former (P 32 P-β-emitting stents made by compound plating could prevent in-stent restenosis significantly by inhibiting the neointimal growth even with low radioactivity; and it is safe, cheap and easy to make. But an unexpected increase in neointimal response, the so-called 'edge effect', was observed in the study

Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal cardiovascular events

DEFF Research Database (Denmark)

Valgimigli, Marco; Sabaté, Manel; Kaiser, Christoph

2014-01-01

eluting stents with bare metal stents were selected. The principal investigators whose trials met the inclusion criteria provided data for individual patients. PRIMARY OUTCOMES: The primary outcome was cardiac mortality. Secondary endpoints were myocardial infarction, definite stent thrombosis, definite...... a significant reduction of cardiac mortality (hazard ratio 0.67, 95% confidence interval 0.49 to 0.91; P=0.01), myocardial infarction (0.71, 0.55 to 0.92; P=0.01), definite stent thrombosis (0.41, 0.22 to 0.76; P=0.005), definite or probable stent thrombosis (0.48, 0.31 to 0.73; P... coronary syndrome v stable coronary artery disease), diabetes mellitus, female sex, use of glycoprotein IIb/IIIa inhibitors, and up to one year v longer duration treatment with dual antiplatelets. CONCLUSIONS: This meta-analysis offers evidence that compared with bare metal stents the use of cobalt...

Current status of infrapopliteal artery stenting in patients with critical limb ischemia Estado atual do uso de stents na artéria infrapolítea em pacientes com isquemia crítica do membro

Directory of Open Access Journals (Sweden)

Marc Bosiers

2008-09-01

Full Text Available Due to the fear that early thrombosis and late luminal loss resulting from intimal hyperplasia might impede sustained patency of small-caliber arteries, such as those of the infrapopliteal bed, stent implantation in below-knee vessels remains controversial and is generally reserved for cases with a suboptimal outcome after percutaneous transluminal angioplasty (i.e. > 50% residual stenosis, flow-limiting dissection. Although evidence starts to build, favoring the use of stenting in the tibial area, results of well-conducted randomized controlled trials have to be awaited to change this strategy. Because of diameter similarities with coronary arteries, the first stents applied in the infrapopliteal vessels were all coronary devices. Once the feasibility of the stenting approach with these coronary products was shown, device manufacturers started to develop a dedicated infrapopliteal product range. To date, a broad spectrum of stent types has been used and investigated for the given indication. This article overviews the available literature and results of different balloon-expandable (bare metal, passive coated, drug eluting, self-expanding and absorbable stent types available for below-the-knee application and gives recommendations for future device technology advancements.Devido ao receio de que a trombose precoce ou a estenose tardia por hiperplasia intimal possam impedir a manutenção da perviedade em vasos de pequeno calibre, o uso de stents pós-angioplastia no leito arterial infrapoplíteo permanece controverso e geralmente é reservado aos casos de resultado subótimo após angioplastia transluminal percutânea (isto é, estenose residual > 50% ou dissecção com limitação do fluxo. Apesar de evidências começarem a favorecer o uso de stents no segmento tibial, é necessário aguardar o resultado de ensaios controlados, randomizados e bem conduzidos para mudar esta estratégia. Sendo estes vasos infrapoplíteos de diâmetro similar �

Enterprise stenting for intracranial aneurysm treatment induces dynamic and reversible age-dependent stenosis in cerebral arteries.

Science.gov (United States)

Gao, Bulang; Safain, Mina G; Malek, Adel M

2015-04-01

Although intracranial stenting has been associated with in-stent stenosis, the vascular response of cerebral vessels to the deployment of the Enterprise vascular reconstruction device is poorly defined. To evaluate the change in parent vessel caliber that ensues after Enterprise stent placement. Seventy-seven patients with 88 aneurysms were treated using Enterprise stent-assisted coil embolization and underwent high-resolution three-dimensional rotational angiography followed by three-dimensional edge-detection filtering to remove windowing-dependence measurement artifact. Orthogonal diameters and cross-sectional areas (CSAs) were measured proximal and distal on either side of the leading stent edge (points A, B), trailing stent edge (points D, E), and at mid-stent (point C). Enterprise stent deployment caused an instant increase in the parent artery CSA by 8.98% at D, which was followed 4-6 months later by significant in-stent stenosis (15.78% at A, 27.24% at B, 10.68% at C, 32.12% at D, and 28.28% at E) in the stented artery. This time-dependent phenomenon showed resolution which was complete by 12-24 months after treatment. This target vessel stenosis showed significant age dependence with greater response in the young. No flow-limiting stenosis requiring treatment was observed in this series. Use of the Enterprise stent is associated with a significant dynamic and spontaneously resolvable age-dependent in-stent stenosis. Further study is warranted on the clinical impact, if any, of this occurrence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Engineering Radioactive Stents for the Prevention of Restenosis

International Nuclear Information System (INIS)

Bruce Thomadsen; Nickles, Robert J.; Larry DeWerd; Douglass Henderson; Jonathan Nye; Wes Culberson; Stephen Peterson; Michael Meltsner; Liyong Lin

2004-01-01

Radiation has become an accepted treatment for the prevention of restenosis (re-blockage) of coronary arteries following angioplasty. Radioactive stents could be the easiest method of delivery for the radiation, although clinical trials were disappointing. One likely reason was the choice of P-32 as the radionuclide, which fails to match the biological needs of the problem. What radionuclide would perform best remains unknown. This project established the physical infrastructure necessary for a rational investigation to determine the optimum radiological characteristics for radioactive stents in the prevention of restenosis following angioplasty. The project investigated methods to activate coronary stents with radionuclides that spanned a range of energies and radiation types that could provide a mapping of the biological response. The project also provided calibration methods to determine the strength of the stents, an a process to calculate the dose distribution actually delivered to the patient's artery--quantities necessary for any future scientific study to improve the effectiveness of radioactive stents. Such studies could benefit the thousands of patients who receive angioplasty each year

Clinical effectiveness of secondary interventions for restenosis after renal artery stenting

Science.gov (United States)

Simone, Thomas A.; Brooke, Benjamin S.; Goodney, Philip P.; Walsh, Daniel B.; Stone, David H.; Powell, Richard J.; Cronenwett, Jack L.; Nolan, Brian W.

2013-01-01

Objective Secondary interventions for renal artery restenosis (RAS) after renal artery stenting are common, despite limited data about their effectiveness. This study was designed to evaluate the outcomes of endovascular treatment of recurrent RAS. Methods We conducted a retrospective review of patients who underwent renal artery stenting between 2001 and 2011 at Dartmouth-Hitchcock Medical Center. Patients who required secondary interventions were compared with control patients who underwent only primary interventions for RAS. Multivariate regression models were used to identify factors associated with successful outcomes, as measured by changes in blood pressure, estimated glomerular filtration rate, and number of antihypertensive medications required. Results Sixty-five secondary (57 patients) renal interventions were undertaken for recurrent RAS associated with progressive hypertension or renal dysfunction and compared with outcomes after 216 primary (180 patients) renal artery stenting procedures. Patients undergoing primary vs secondary interventions did not differ significantly in the number of preoperative antihypertensive medications used, comorbid conditions, or blood pressure. All primary and secondary interventions were performed with stents and showed no difference in procedural complications. At a mean follow-up of 23 months (range, 1–128 months), similar improvements in renal function and blood pressure were found between patients undergoing primary and secondary interventions, and there was no difference in rates of restenosis or survival between cohorts. Regression models showed that the use of embolic protection devices was associated with improved renal function after primary (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1–3.8; P < .05) and secondary (OR, 4.7; 95% CI, 1.7–12.5; P < .05) interventions, whereas statin therapy was associated with improved renal (OR, 2.0; 95% CI, 1.3–3.2; P < .05) and blood pressure response (OR, 4

Use of Self-Expanding Stents for the Treatment of Vertebral Artery Ostial Stenosis: a Single Center Experience

International Nuclear Information System (INIS)

Chung, Sun Young; Lee, Deok Hee; Choi, Jin Woo; Choi, Byung Se; In, Hyun Sin; Kim, Sun Mi; Choi, Choong Gon; Kim, Sang Joon; Suh, Dae Chul

2010-01-01

To evaluate our early experience using self-expanding stents to treat atherosclerotic vertebral artery ostial stenosis (VAOS), with respect to technical feasibility and clinical and imaging follow-up results. A total of 20 lesions in 20 patients underwent stenting of the VAOS using a self-expanding stent (Precise RX; Cordis Neurovascular, Miami Lakes, FL). Two patients were asymptomatic. We analyzed the technical success rate, causes of technical failure, occurrence of any vascular or neurological event, and the occurrence of any neurological abnormality or in-stent restenosis (ISR) seen on follow-up. The imaging follow-up was performed with Doppler ultrasound (DUS) as a primary screening modality. One instance of technical failure was caused by failure of the guidewire passage. The stent diameter was 5 mm, and post-stenting balloon dilatations were necessary in all cases. Stent misplacement requiring placement of an additional stent occurred in four cases. Following a 14.8 month average clinical follow-up time, two patients showed anterior circulation ischemia, which was not attributed to the VAOS we treated. Following a 13.7 month average DUS follow-up, five patients showed a mild degree of diffuse or focal intimal thickening in the stent lumen; however, none of the stenosis showed luminal loss of more than 50% and no stent fracture was noted. The use of self-expanding stents for treating VAOS was technically feasible and helped to improve artery patency during our limited follow-up interval

Duplex criteria for determination of in-stent stenosis after angioplasty and stenting of the superficial femoral artery.

Science.gov (United States)

Baril, Donald T; Rhee, Robert Y; Kim, Justine; Makaroun, Michel S; Chaer, Rabih A; Marone, Luke K

2009-01-01

Endovascular intervention is considered first-line therapy for most superficial femoral artery (SFA) occlusive disease. Duplex ultrasound (DU) criteria for SFA in-stent stenosis and correlation with angiographic data remain poorly defined. This study evaluated SFA-specific DU criteria for the assessment of SFA in-stent stenosis. From May 2003 to May 2008, 330 limbs underwent SFA angioplasty and stenting and were monitored by serial DU imaging. Suspected stenotic lesions underwent angiography and intervention when appropriate. Data pairs of DU and angiographically estimated stenosis or=50% in-stent stenosis, a PSV >or=190 had 88% sensitivity, 95% specificity, a 98% positive predictive value (PPV), and a 72% negative predictive value (NPV); for Vr, a ratio of >1.50 had 93% sensitivity, 89% specificity, a 96% PPV, and a 81% NPV. To detect >or=80% in-stent stenosis, a PSV >or=275 had 97% sensitivity, 68% specificity, a 67% PPV, and a 97% NPV; a Vr ratio >or=3.50 had 74% sensitivity, 94% specificity, a 77% PPV, and a 88% NPV. Combining a PSV >or=275 and a Vr >or=3.50 to determine >or=80% in-stent stenosis had 74% sensitivity, 94% specificity, a 88% PPV, and a 85% NPV; odds ratio was 42.17 (95% confidence interval, 10.20-174.36, P or=80% in-stent stenosis. A significant drop in ABI (>0.15) correlated with a >62% in-stent stenosis, although the adjusted correlation coefficients was low (R(2) = 0.31, P = .02). PSV and Vr appear to have a significant role in predicting in-stent stenosis. To determine >or=80% stenosis, combining PSV >or=275 cm/s and Vr >or=3.50 is highly specific and predictive.

Intravascular ultrasound evaluation of a pseudolesion created by stent placement in the right artery.

Science.gov (United States)

Zientek, D M; Rodgers, G P

1999-10-01

The creation of a pseudolesion after guidewire placement in tortuous arterial segments is a well recognized phenomenon. Intravascular ultrasound has been useful in assessing deployment of intracoronary stents and equivocal angiographic findings. We present a case in which a pseudolesion was not observed until after placement of an intracoronary stent. Intravascular ultrasound demonstrated no dissection or significant lesion; however, there was focal calcification just distal to the stent providing a substrate for the distorted vessel architecture. The lesion resolved with removal of the guidewire.

Metallic Limus-Eluting Stents Abluminally Coated with Biodegradable Polymers: Angiographic and Clinical Comparison of a Novel Ultra-Thin Sirolimus Stent Versus Biolimus Stent in the DESTINY Randomized Trial.

Science.gov (United States)

Lemos, Pedro A; Abizaid, Alexandre A C; Meireles, George C; Sarmento-Leite, Rogério; Prudente, Mauricio; Cantarelli, Marcelo; Dourado, Adriano D; Mariani, Jose; Perin, Marco A; Costantini, Costantino; Costa, Ricardo A; Costa, José Ribamar; Chamie, Daniel; Campos, Carlos A; Ribeiro, Expedito

2015-12-01

To evaluate the outcomes of patients treated with a new drug-eluting stent formulation with low doses of sirolimus, built in an ultra-thin-strut platform coated with biodegradable abluminal coating. This study is a randomized trial that tested the main hypothesis that the angiographic late lumen loss of the novel sirolimus-eluting stent is noninferior compared with commercially available biolimus-eluting stent. A final study population comprising 170 patients with one or two de novo lesions was randomized in the ratio 2:1 for sirolimus-eluting stent or biolimus-eluting stent, respectively. The primary endpoint was 9-month angiographic in-stent late lumen loss. Adverse clinical events were prospectively collected for 1 year. After 9 months, the novel sirolimus-eluting stent was shown noninferior compared with the biolimus stent for the primary endpoint (angiographic in-stent late lumen loss: 0.20 ± 0.29 mm vs. 0.15 ± 0.20 mm, respectively; P value for noninferiority <0.001). The 1-year incidence of death, myocardial infarction, repeat revascularization, and stent thrombosis remained low and not significantly different between the groups. The present randomized trial demonstrates that the tested novel sirolimus-eluting stent was angiographically noninferior in comparison with a last-generation biolimus-eluting stent. © 2015 John Wiley & Sons Ltd.

EFFECT OF STENT ABSORBED c-myc ANTISENSE OLIGODEOXYNUCLEOTIDE ON SMOOTH MUSCLE CELLS APOPTOSIS IN RABBIT CAROTID ARTERY

Institute of Scientific and Technical Information of China (English)

张新霞; 崔长琮; 李江; 崔翰斌; 徐仓宝; 朱参战

2002-01-01

Objective To investigate the effect of gelatin coated Platinium-Iridium stent absorbed c-myc antisense oligodeoxynucleotide (ASODN) on smooth muscle cells apoptosis in a normal rabbit carotid arteries. Methods Gelatin coated Platinium-Iridium stents were implanted in the right carotid arteries of 32 rabbits under vision. Animals were randomly divided into control group and treated group receiving c-myc ASODN (n=16, respectively). On 7, 14, 30 and 90 days following the stenting procedure ,morphometry for caculation of neointimal area and mean neointimal thickness were performed.The expression of c-myc protein was detected by immunohistochemical method. Apoptotic smooth muscle cells was detected by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL). Results At 7 and 14 days after stenting,there were no detectable apoptotic cells in both groups. The apoptotic cells occurred in the neointima 30 and 90 days after stenting, and the number of apoptotic cells at 30 days were less [4.50±1.29 vs 25.75±1.89 (number/0.1mm2)] than that at 90 days [13.50±1.91 vs 41.50±6.46 (number/0.1mm2)]. Meanwhile c-myc ASODN induced more apoptotic cells than the control group(P<0.0001). c-myc protein expression was weak positive or negative in treated group and positive in control group.Conclusion c-myc ASODN can induce smooth muscle cells apoptosis after stenting in normal rabbit carotid arteries,and it can be used to prevent in-stent restenosis.

Cognitive changes after carotid artery stenting

International Nuclear Information System (INIS)

Grunwald, I.Q.; Politi, M.; Struffert, T.; Krick, C.; Backens, M.; Supprian, T.; Falkai, P.; Reith, W.

2006-01-01

We aimed to test changes in cognitive performance after carotid artery stenting (CAS). Ten patients were neuropsychologically tested at least 24 h before and 48 h after CAS. To diminish thromboembolic events, we used a proximal protection device. The following neuropsychological tests were selected: The Mini Mental State Examination (MMSE), symbol digit test and subtests of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery (verbal fluency, constructional practice, word list memory and delayed recall). Affective state was determined by the Beck Depression Score (BDS). No patient suffered from depression (BDS <1) or dementia (MMSE 29.9±1.5). Nine of the ten patients (P=0.12) showed increased speed in the Number Connection Test (NCT) (corresponding to trail making test). Most patients showed better or similar results concerning delayed recall (P=0.31). No change was observed in the symbol digit test, word list memory, verbal fluency or constructional practice. Better results concerning NCT and delayed recall after carotid stenting might be due to improved brain perfusion. After CAS, cognitive and memory performance seem to improve. Further studies with different time intervals and more refined testing, as well as perfusion-weighted imaging, are needed. (orig.)

Satisfactory arterial repair 1 year after ultrathin strut biodegradable polymer sirolimus-eluting stent implantation: an angioscopic observation.

Science.gov (United States)

Ishihara, Takayuki; Awata, Masaki; Iida, Osamu; Fujita, Masashi; Masuda, Masaharu; Okamoto, Shin; Nanto, Kiyonori; Kanda, Takashi; Tsujimura, Takuya; Uematsu, Masaaki; Mano, Toshiaki

2018-01-15

The ultrathin strut biodegradable polymer sirolimus-eluting stent (Orsiro, O-SES) exhibits satisfactory clinical outcomes. However, no report to date has documented the intravascular status of artery repair after O-SES implantation. We examined 5 O-SES placed in 4 patients (age 65 ± 12 years, male 75%) presenting with stable angina pectoris due to de novo lesions in native coronary arteries. Coronary angioscopy was performed immediately after percutaneous coronary intervention and 1 year later. Angioscopic images were analyzed to determine the following: (1) dominant grade of neointimal coverage (NIC) over the stent; (2) maximum yellow plaque grade; and (3) existence of thrombus. Yellow plaque grade was evaluated both immediately after stent implantation and at the time of follow-up observation. The other parameters were evaluated at the time of follow-up examination. NIC was graded as: grade 0, stent struts exposed; grade 1, struts bulging into the lumen, although covered; grade 2, struts embedded in the neointima, but translucent; grade 3, struts fully embedded and invisible. Yellow plaque severity was graded as: grade 0, white; grade 1, light yellow; grade 2, yellow; and grade 3, intensive yellow. Angioscopic findings at 1 year demonstrated the following: dominant NIC grade 1, grade 2, and grade 3 in 1, 2, and 2 stents, respectively; all stents were covered to some extent; focal thrombus adhesion was observed in only 1 stent. Yellow plaque grade did not change from immediately after stent implantation to follow-up. O-SES demonstrated satisfactory arterial repair 1 year after implantation.

Coronary Artery Bypass Surgery Versus Drug-Eluting Stent Implantation for Left Main or Multivessel Coronary Artery Disease: A Meta-Analysis of Individual Patient Data.

Science.gov (United States)

Lee, Cheol Whan; Ahn, Jung-Min; Cavalcante, Rafael; Sotomi, Yohei; Onuma, Yoshinobu; Suwannasom, Pannipa; Tenekecioglu, Erhan; Yun, Sung-Cheol; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Park, Seong-Wook; Serruys, Patrick W; Park, Seung-Jung

2016-12-26

The authors undertook a patient-level meta-analysis to compare long-term outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in 3,280 patients with left main or multivessel coronary artery disease (CAD). The relative efficacy and safety of CABG versus PCI with DES for left main or multivessel CAD remain controversial. Data were pooled from the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease), PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery vs. Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease), and SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trials. The primary outcome was a composite of all-cause death, myocardial infarction, or stroke. The median follow-up was 60 months, and follow-up was completed for 96.2% of patients. The rate of primary outcome was significantly lower with CABG than with PCI (13.0% vs. 16.0%; hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.69 to 1.00; p = 0.046). The difference was mainly driven by reduction in myocardial infarction (HR: 0.46; 95% CI: 0.33 to 0.64; p patients with multivessel CAD (p = 0.001), but no between-group difference in those with left main CAD (p = 0.427). The rates for all-cause death and stroke were similar between the 2 groups. By contrast, the need for repeat revascularization was significantly lower in the CABG group compared with the PCI group. CABG, as compared with PCI with DES, reduced long-term rates of the composite of all-cause death, myocardial infarction, or stroke in patients with left main or multivessel CAD. The advantage of CABG over PCI with DES was particularly pronounced in those with multivessel CAD. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights

Assessment of a Polyester-Covered Nitinol Stent in the Canine Aorta and Iliac Arteries

International Nuclear Information System (INIS)

Castaneda, Flavio; Ball-Kell, Susan M.; Young, Kate; Li Ruizong

2000-01-01

Purpose: To evaluate the patency and healing characteristics of a woven polyester fabric-covered stent in the canine model.Methods: Twenty-four self-expanding covered stents were placed in the infrarenal aorta and bilateral common iliac arteries of eight dogs and evaluated at 1 (n = 2), 3 (n = 2), and 6 (n = 4) months. Stent assessment was done using angiography prior to euthanasia, and light and scanning electron microscopy.Results: Angiographically, just prior to euthanasia, 8 of 8 aortic and 14 of 16 iliac endovascular covered stents were patent. Histologically, the stented regions showed complete endothelialization 6 months after graft implantation. A neointima had formed inside the stented vessel regions resulting in complete encasement of the fabric-covered stent by 3 months after graft implantation. Medial compression with smooth muscle cell atrophy was present in all stented regions. Explanted stent wires, examined by scanning electron microscopy, showed pitting but no cracks or breakage.Conclusion: The covered stent demonstrated predictable healing and is effective in preventing stenosis in vessels 10.0 mm or greater in diameter but does not completely preclude stenosis in vessels 6.0 mm or less in diameter

Direct Stenting in Patients with Acute Lower Limb Arterial Occlusions: Immediate and Long-Term Results

International Nuclear Information System (INIS)

Galanakis, Nikolaos; Kontopodis, Nikolaos; Peteinarakis, Ioannis; Kehagias, Elias; Ioannou, Christos V.; Tsetis, Dimitrios

2017-01-01

PurposeThe purpose of this study is to accentuate the efficacy of direct stenting (stent placement without predilatation of the lesion) in patients with acute lower limb arterial ischemia (ALLI).Materials and MethodsBetween January 2010 and September 2015, 16 patients (11 men and 5 women) underwent direct stenting of acute arterial occlusions. All patients had contraindication for surgical revascularization or catheter-directed thrombolysis. According to SVS/ISCVS Classification, six patients had IIa and ten patients IIb ALLI. The occlusions were located in CIA, EIA, SFA, or popliteal artery. Mean follow-up time with clinical examination and color Duplex ultrasonography was 37.6 months (range 1–72). We analyzed the technical and clinical outcomes of the procedures, as well the complications and patency rates.ResultsTechnical success was achieved in all patients (16/16) and there was significant clinical improvement in 15 patients. There was neither distal embolization nor procedure-related complications. During the 6 years of follow-up, four patients died due to non-procedure-related causes and there were two minor and one major amputations. The primary patency rates and the amputation-free survival rates were 93.7 and 87% at 1 year, 75.2 and 71.2% at 3 years, and 75.2 and 62.3%, respectively, at 6 years.ConclusionsDirect stenting may be a valuable alternative procedure for acute arterial occlusions in selected cases with high technical success and significant clinical improvement.Level of EvidenceLevel 4, Case Series.

Direct Stenting in Patients with Acute Lower Limb Arterial Occlusions: Immediate and Long-Term Results

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Galanakis, Nikolaos [University of Crete Medical School, Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion (Greece); Kontopodis, Nikolaos [University of Crete Medical School, Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion (Greece); Peteinarakis, Ioannis; Kehagias, Elias [University of Crete Medical School, Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion (Greece); Ioannou, Christos V. [University of Crete Medical School, Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion (Greece); Tsetis, Dimitrios, E-mail: tsetis@med.uoc.gr [University of Crete Medical School, Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion (Greece)

2017-02-15

PurposeThe purpose of this study is to accentuate the efficacy of direct stenting (stent placement without predilatation of the lesion) in patients with acute lower limb arterial ischemia (ALLI).Materials and MethodsBetween January 2010 and September 2015, 16 patients (11 men and 5 women) underwent direct stenting of acute arterial occlusions. All patients had contraindication for surgical revascularization or catheter-directed thrombolysis. According to SVS/ISCVS Classification, six patients had IIa and ten patients IIb ALLI. The occlusions were located in CIA, EIA, SFA, or popliteal artery. Mean follow-up time with clinical examination and color Duplex ultrasonography was 37.6 months (range 1–72). We analyzed the technical and clinical outcomes of the procedures, as well the complications and patency rates.ResultsTechnical success was achieved in all patients (16/16) and there was significant clinical improvement in 15 patients. There was neither distal embolization nor procedure-related complications. During the 6 years of follow-up, four patients died due to non-procedure-related causes and there were two minor and one major amputations. The primary patency rates and the amputation-free survival rates were 93.7 and 87% at 1 year, 75.2 and 71.2% at 3 years, and 75.2 and 62.3%, respectively, at 6 years.ConclusionsDirect stenting may be a valuable alternative procedure for acute arterial occlusions in selected cases with high technical success and significant clinical improvement.Level of EvidenceLevel 4, Case Series.

ANGIOPLASTIA PERCUTÁNEA CON STENT EN EL TRONCO PRINCIPAL DE LA ARTERIA CORONARIA IZQUIERDA / Percutaneous angioplasty with stent in the left main coronary artery

Directory of Open Access Journals (Sweden)

Javier Almeida Gómez

2012-10-01

Full Text Available ResumenIntroducción y objetivos: La afectación significativa del tronco común izquierdo, es la más letal de las presentaciones de la enfermedad arterial coronaria. El tratamiento de elección, es la cirugía de derivación aorto-coronaria. En varios estudios multicéntricos, se sugiere la posibilidad de tratar la enfermedad de tronco mediante el intervencionismo coronario percutáneo con implantación de prótesis endoluminal o stent. El objetivo de esta investigación fue caracterizar la angioplastia percutánea con stent en el tronco principal de la arteria coronaria izquierda. Método: Se realizó un estudio observacional, descriptivo y transversal en 21 pacientes con angioplastia percutánea con stent en el tronco principal de la arteria coronaria izquierda, realizadas en el laboratorio de Hemodinámica y Cardiología Intervencionista del Hospital "Hermanos Ameijeiras", entre enero 2010 y julio 2011. Resultados: No existió diferencia significativa en el sexo. Predominó el grupo de edad entre 50-64 años (47,6 % y el color de la piel blanca (76,19 %. El factor de riesgo cardiovascular más encontrado fue la HTA (85,71 %, seguido de dislipidemia (47,61 %. El diagnóstico más observado fue la angina de esfuerzo estable, 14 casos (66,66 %. La lesión en el cuerpo del tronco (12 pacientes, 57,1 %, fue la más encontrada, seguida de la ostial (8 casos. El tipo de stent más utilizado fue el liberador de fármacos (61,9 %, y solamente 4 pacientes presentaban troncos protegidos quirúrgicamente. Conclusiones: La mayor cantidad de casos fueron electivos, con predominio de los troncos no protegidos. El factor de riesgo coronario más encontrado fue la HTA. Se encontró asociación significativa entre la diabetes mellitus y la localización ostial de la lesión tratada. / AbstractIntroduction and Objectives: Significant impairment of the left main coronary artery is the most lethal presentation of coronary artery disease. The treatment of choice

Toxic vessel reaction to an absorbable polymer-based paclitaxel-eluting stent in pig coronary arteries.

Science.gov (United States)

Jabara, Refat; Chronos, Nicolas; Tondato, Fernando; Conway, Damian; Molema, Warner; Park, Kenneth; Mabin, Tom; King, Spencer; Robinson, Keith

2006-08-01

The goal of this study was to evaluate a new drug-eluting stent (DES) comprising a bioabsorbable polymer eluting a moderate dose of paclitaxel in a clinically relevant animal model. Although DES limit restenosis, adverse vascular pathologies and toxicities continue to be of major concern. Optimization of DES components, especially completely absorbable polymers, may reduce these toxicities. Bare-metal (BM), absorbable polymer coating only (POLY), and polymer-based paclitaxel-eluting (PACL) stents were implanted in porcine coronary arteries using intravascular ultrasound (IVUS) to optimize stent apposition. The dose density of paclitaxel was 0.30-0.35 mcg/mm2, with in vitro elution studies demonstrating a gradual elution over 6-8 weeks. The animals were terminated at 1 week, 1 month and 3 months. Histopathologic and histomorphometric analyses were perform. The arteries with PACL showed extensive smooth muscle cell necrosis at 1 week and poor apposition of stent struts at 1 month (malapposition measured as gap width between strut and internal elastic lamina), with greater gap width compared to the BM and POLY groups (0.22 mm +/- 0.02 vs. 0.03 mm +/- 0.02 and 0.02 mm +/- 0.01, respectively; p stent malapposition and late neointimal thickening. Since the therapeutic window for paclitaxel may be narrower than currently inferred, thorough preclinical testing coupled with the polymer development process for stents eluting paclitaxel is needed.

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

Treatment of a Left Internal Mammary Artery to Pulmonary Artery Fistula with Polytetrafluoroethylene Covered Stents: A Case Report and Review of the Literature

International Nuclear Information System (INIS)

Abbott, J. Dawn; Brennan, Joseph J.; Remetz, Michael S.

2004-01-01

Internal mammary artery (IMA) to pulmonary artery (PA) fistula is a rare complication of coronary artery bypass grafting (CABG) that may present as myocardial ischemia. We describe a case of left IMA-to-PA fistula treated with balloon expandable coronary polytetrafluoroethylene (PTFE) graft stents and review previously reported cases of this entity

Fluid-attenuated inversion recovery vascular hyperintensities in predicting cerebral hyperperfusion after intracranial arterial stenting

Energy Technology Data Exchange (ETDEWEB)

Wan, Chih-Cheng; Chen, David Yen-Ting; Tseng, Ying-Chi; Lee, Kun-Yu; Chiang, Chen-Hua; Chen, Chi-Jen [Taipei Medical University, Department of Radiology, Shuang-Ho Hospital, New Taipei City (China); Taipei Medical University, School of Medicine, College of Medicine, Taipei (China); Yan, Feng-Xian [Taipei Medical University, Department of Radiology, Shuang-Ho Hospital, New Taipei City (China)

2017-08-15

No reliable imaging sign predicting cerebral hyperperfusion after intracranial arterial stenting (IAS) had been described in the literature. This study evaluated the effect of fluid-attenuated inversion recovery vascular hyperintensities (FVHs), also called hyperintense vessel sign on T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) MR images, in predicting significant increase in cerebral blood flow (CBF) defined by arterial spin labeling (ASL) after IAS. We reviewed ASL CBF images and T2-FLAIR MR images before (D0), 1 day after (D1), and 3 days after (D3) IAS of 16 patients. T1-weighted MR images were used as cerebral maps for calculating CBF. The changes in CBF values after IAS were calculated in and compared among stenting and nonstenting vascular territories. An increase more than 50% of CBF was considered as hyperperfusion. The effect of FVHs in predicting hyperperfusion was calculated. The D1 CBF value was significantly higher than the D0 CBF value in stenting vascular, contralateral anterior cerebral artery, contralateral middle cerebral artery, and contralateral posterior cerebral artery (PCA) territories (all P <.05). The D1 and D3 CBF values were significantly higher than the D0 CBF value in overall vascular (P <.001), overall nonstenting vascular (P <.001), and ipsilateral PCA (P <.05) territories. The rate of more than 50% increases in CBF was significantly higher in patients who exhibited asymmetric FVHs than in those who did not exhibit these findings. FVHs could be a critical predictor of a significant increase in CBF after IAS. (orig.)

Fluid-attenuated inversion recovery vascular hyperintensities in predicting cerebral hyperperfusion after intracranial arterial stenting

International Nuclear Information System (INIS)

Wan, Chih-Cheng; Chen, David Yen-Ting; Tseng, Ying-Chi; Lee, Kun-Yu; Chiang, Chen-Hua; Chen, Chi-Jen; Yan, Feng-Xian

2017-01-01

No reliable imaging sign predicting cerebral hyperperfusion after intracranial arterial stenting (IAS) had been described in the literature. This study evaluated the effect of fluid-attenuated inversion recovery vascular hyperintensities (FVHs), also called hyperintense vessel sign on T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) MR images, in predicting significant increase in cerebral blood flow (CBF) defined by arterial spin labeling (ASL) after IAS. We reviewed ASL CBF images and T2-FLAIR MR images before (D0), 1 day after (D1), and 3 days after (D3) IAS of 16 patients. T1-weighted MR images were used as cerebral maps for calculating CBF. The changes in CBF values after IAS were calculated in and compared among stenting and nonstenting vascular territories. An increase more than 50% of CBF was considered as hyperperfusion. The effect of FVHs in predicting hyperperfusion was calculated. The D1 CBF value was significantly higher than the D0 CBF value in stenting vascular, contralateral anterior cerebral artery, contralateral middle cerebral artery, and contralateral posterior cerebral artery (PCA) territories (all P <.05). The D1 and D3 CBF values were significantly higher than the D0 CBF value in overall vascular (P <.001), overall nonstenting vascular (P <.001), and ipsilateral PCA (P <.05) territories. The rate of more than 50% increases in CBF was significantly higher in patients who exhibited asymmetric FVHs than in those who did not exhibit these findings. FVHs could be a critical predictor of a significant increase in CBF after IAS. (orig.)

Auxetic coronary stent endoprosthesis

DEFF Research Database (Denmark)

Amin, Faisal; Ali, Murtaza Najabat; Ansari, Umar

2014-01-01

BACKGROUND: Cardiovascular heart disease is one of the leading health issues in the present era and requires considerable health care resources to prevent it. The present study was focused on the development of a new coronary stent based on novel auxetic geometry which enables the stent to exhibit...... a negative Poisson's ratio. Commercially available coronary stents have isotropic properties, whereas the vascular system of the body shows anisotropic characteristics. This results in a mismatch between anisotropic-isotropic properties of the stent and arterial wall, and this in turn is not favorable...... for mechanical adhesion of the commercially available coronary stents with the arterial wall. It is believed that an auxetic coronary stent with inherent anisotropic mechanical properties and negative Poisson's ratio will have good mechanical adhesion with the arterial wall. METHODS: The auxetic design...

Zotarolimus-eluting stent for the treatment of recurrent, severe carotid artery in-stent stenosis in the TARGET-CAS population.

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Tekieli, Lukasz; Pieniazek, Piotr; Musialek, Piotr; Kablak-Ziembicka, Anna; Przewlocki, Tadeusz; Trystula, Mariusz; Moczulski, Zbigniew; Dzierwa, Karolina; Paluszek, Piotr; Podolec, Piotr

2012-06-01

To evaluate the safety and efficacy of a balloon-mounted drug-eluting stent (DES) for recurrent carotid in-stent stenosis (ISS). As part of our targeted carotid artery stenting (TARGET-CAS) protocol, neurological and ultrasound evaluations have been performed at 3, 6, and 12 months and then annually since 2001 in all carotid stent patients. For angiographically-confirmed >70% ISS, balloon angioplasty was performed as a first-line treatment. Recurrent ISS was treated with a 4.0-mm zotarolimus-eluting coronary stent (ZES) that was postdilated according to intravascular ultrasound imaging. Among the 1350 neuroprotected CAS procedures performed between January 2001 and March 2011, there were 7 (0.52%) patients (5 men; ages 51-72 years), all neurologically asymptomatic, with >70% recurrent ISS that occurred at 5 to 11 months after the initial balloon angioplasty treatment for ISS. ZES implantation under distal embolic protection was technically successful and uncomplicated. Angiographic stenosis was reduced from 84.6%±7.5% to 10.7%±3.6% (p<0.01). In 5 patients with ZES implanted fully within the self-expanding carotid stent, duplex ultrasound follow-up (mean 17 months, range 6-36) revealed no evidence of restenosis or stent fracture/deformation. In the 2 other patients, the ZES had been implanted for distal edge ISS such that the ZES protruded beyond the original carotid stent. This protruding segment of the ZES demonstrated deformation/kinking in both; in one, this led to symptomatic stent occlusion. The use of coronary ZES in the treatment of recurrent carotid ISS is feasible and appears effective provided the ZES is placed entirely within the original stent. Placement of a coronary ZES outside the carotid stent scaffold should be avoided.

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

DEFF Research Database (Denmark)

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

2007-01-01

OBJECTIVES: This study sought to evaluate and compare in vivo acute stent recoil of a novel bioabsorbable stent and a metallic stent. BACKGROUND: The bioabsorbable everolimus-eluting coronary stent (BVS) is composed of a poly-L-lactic acid backbone, coated with a bioabsorbable polymer containing...... the antiproliferative drug, everolimus, and expected to be totally metabolized and absorbed in the human body. Because the BVS is made from polymer, it may have more acute recoil than metallic stents in vivo. METHODS: A total of 54 patients, who underwent elective stent implantation for single de novo native coronary...... artery lesions, were enrolled: 27 patients treated with the BVS and 27 patients treated with the everolimus-eluting cobalt chromium stent (EES). Acute absolute recoil, assessed by quantitative coronary angiography, was defined as the difference between mean diameter of the last inflated balloon...

Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting : A meta-analysis of pooled patient data from four randomised trials

NARCIS (Netherlands)

Howard, George; Roubin, Gary S.; Jansen, Olav; Hendrikse, Jeroen; Halliday, Alison; Fraedrich, Gustav; Eckstein, Hans Henning; Calvet, David; Bulbulia, Richard; Bonati, Leo H.; Becquemin, Jean Pierre; Algra, Ale; Brown, Martin M.; Ringleb, Peter A.; Brott, Thomas G.; Mas, Jean Louis

2016-01-01

Background: Age was reported to be an effect-modifier in four randomised controlled trials comparing carotid artery stenting (CAS) and carotid endarterectomy (CEA), with better CEA outcomes than CAS outcomes noted in the more elderly patients. We aimed to describe the association of age with

Treatment of traumatic internal carotid artery pseudoaneurysms with willis covered stents: a midterm follow-up result

International Nuclear Information System (INIS)

Wang Wu; Li Minghua; Li Yongdong; Gu Binxian; Fang Chun; Tan Huaqiao; Wang Ju; Zhang Peilei

2010-01-01

Objective: To evaluate the efficacy and mid-term follow-up results of endovascular treatment with Willis covered stent for traumatic pseudoaneurysms located in the internal carotid artery (ICA). Methods: ICA angiography was performed in 38 patients with traumatic brain and neck injury. Of the 38 patients, 13 delayed traumatic pseudoaneurysms were found. All the pseudoaneurysms were treated with Willis covered stents. Follow-up angiography was performed at 1, 3, 6 and 12 months after the procedure, and the results were categorized as complete or incomplete occlusion. Clinical manifestations were graded as full recovery, improvement, unchanged and aggravation. Results: Willis covered stent placement was technically successful in all traumatic pseudoaneurysms. No procedure-related complications occurred. The initial angiographic results showed a complete occlusion in 9 patients, and an incomplete occlusion in 4. The angiographic follow-up within 3-12 months exhibited a complete occlusion in 12 patients and the parent arteries remained patency in all patients. The clinical follow-up observation demonstrated that full recovery was obtained in 11 patients, clinical improvement in one, and unchanged condition in one. No morbidity or mortality occurred. Conclusion: Willis covered stent implantation is a feasible and practical treatment for traumatic pseudoaneurysms located in the ICA. This technique can well preserve the parent artery with excellent therapeutic results. (authors)

[Technical feasibility of the implantation of a monorail stent system into the renal arteries without pre-dilatation].

Science.gov (United States)

Neumann, C; Gschwendtner, M; Karnel, F; Mair, J; Dorffner, G; Dorffner, R

2005-01-01

To evaluate the technical feasibility of the implantation of the monorail RX Herculink system into the renal arteries without pre-dilatation. Forty-two patients (mean age 71 years) from four centers with a total of 44 renal artery stenoses underwent implantation of the RX Herculink stent. The mean grade of the stenosis was 83.8 %, the mean length 7.5 mm. The stenoses were ostial in 38 cases and in immediate proximity to the ostium in 6 cases. The mean follow-up-period was 57 weeks (24 - 176 weeks). In 42 cases, the implantation was successful without pre-dilatation. In 2 cases, pre-dilatation was carried out. In none of the cases, detachment of the stent from the balloon was observed. In one stenosis with a length of 17 mm, implantation of two stents was performed. In 9 cases, post-dilatation with a larger balloon or higher balloon pressure was necessary. Residual stenoses exceeding 30 % were not observed. Two patients developed local bleeding at the puncture site. During the follow-up, restenoses were observed in 5 stents after 26 to 126 weeks, which necessitated a second intervention in 3 cases (PTA in 2 cases, re-stenting in 1 case). The primary patency rate after 6 and 12 months was 0.92 +/- 0.056 according to Kaplan-Meier, the secondary patency rate after 6 and 12 months was 1.0 +/- 0.0. Implantation of the RX Herculink stent system into the renal arteries without pre-dilatation is technically feasible and safe. Even without pre-dilatation, the stent-system can be advanced through the stenosis without detachment. The complication rate is low. Our clinical results are comparable to previous studies.

Predictors of antegrade flow at internal carotid artery during carotid artery stenting with proximal protection.

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Harada, Kei; Kakumoto, Kosuke; Oshikata, Shogo; Fukuyama, Kozo

2018-06-01

Carotid artery stenting (CAS) with proximal occlusion effectively prevent distal cerebral embolism by flow arrest at internal carotid artery (ICA); however, the method can expose antegrade flow at ICA due to incomplete flow arrest. The aim of this study was to identify predictors of antegrade flow during CAS with proximal protection. We retrospectively analyzed clinical and angiographic data among 143 lesions treated with CAS with proximal protection by occluding the common carotid artery (CCA) and external carotid artery (ECA). Flow arrest or antegrade flow at ICA was confirmed by contrast injection during proximal protection. Antegrade flow at ICA was observed in 12 lesions (8.4%). Compared with lesions in which flow arrest of ICA was achieved, the diameter of the superior thyroid artery (STA) was significantly larger (2.4 ± 0.34 vs. 1.4 ± 0.68 mm, p protection should be combined with proximal protection for the lesions with antegrade flow to prevent distal migration of the carotid debris.

A Novel Stent Coated with Antibodies to Endoglin Inhibits Neointimal Formation of Porcine Coronary Arteries

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Song Cui

2014-01-01

Full Text Available Endoglin/CD105 is an accessory protein of the transforming growth factor-β receptor system that plays a critical role in proliferation of endothelial cells and neovasculature. Here, we aimed to assess the effect of novel stents coated with antibodies to endoglin (ENDs on coronary neointima formation. Thirty ENDs, thirty sirolimus-eluting stents (SESs, and thirty bare metal stents (BMSs were randomly assigned and placed in the coronary arteries in 30 juvenile pigs. Histomorphometric analysis and scanning electron microscopy were performed after stent implantation. Our results showed that after 7 days, there was no difference in the neointimal area and percent area stenosis in ENDs compared with SMSs or BMSs. After 14 days, the neointima area and percent area stenosis in ENDs were markedly decreased than those in BMSs or SESs (P<0.05. Moreover, the percentage of reendothelialization was significantly higher in ENDs than that in SESs or BMSs (P<0.01 at 7 and 14 days. The artery injury and the inflammation scores were similar in all groups at 7 and 14 days. In conclusion, our results demonstrated for the first time to our knowledge that endoglin antibody-coated stents can markedly reduce restenosis by enhancing reendothelialization in the porcine model and potentially offer a new approach to prevent restenosis.

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

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Menozzi Mila

2012-10-01

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

Metallic stent implantation in patients with iliac artery occlusion: long-term patency rate and factors related to recurrence

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Chung, Seok Kyun; Kim, Jae Kyu; Yoon, Woong; Kim, Jeong; Park, Jin Gyoon; Kang, Heoung Keun; Choi, Soo JinNa [Chonnam National University Hospital School of Medicine, Gwangju (Korea, Republic of)

2003-09-01

To determine the long-term patency rate in 68 patients with iliac artery occlusion who underwent metallic stent implantation, and to analyze the factors related to recurrence. Sixty-eight patients with occlusive disease of the iliac artery underwent implantation of a self-expandable metallic stent. The clinical symptoms were intermittent claudication (n=48), resting pain (n=11), and gangrene (n=9). Stent patency was determined by follow-up angiography and color Doppler imaging, and the cumulative patency rate using the Kaplan-Meier method. Cox's proportional hazard model was used to analyse recurrence-related factors involving clinical symptoms (Fontaine stage), risk factors, and anatomical factors such as lesion location, length, and the development of collaterals. The duration of follow-up varied from 1 day to 73 months (mean, 23.8 months). Arterial occlusion recurred in 16 of 68 patients (23.5%), and the cumulative patency rate was as follows: 95.4% at one month, 93.2% at six months, 80.1% at one year, 73.2% at two years, 68.9% at three years, and 62% at five years. According to a statistical analysis of risk factors, the recurrence (p=0.04) than in those without it, but in patients who smoked, hypertension, DM, and previous cerebrovascular disease were not statistically significant. With regard to anatomical factors, the recurrent rate for lesions involving the external iliac artery was 6.5 times higher (p=0.02) than for those involving the common iliac artery. Variations in the fontaine stage were not statistically significant indicators of recurrence. The recurrence rate after implantation of an iliac artery stent is higher in patients with heart disease than in those without it, and higher for occlusive lesions involving the external iliac artery than for those of the common iliac artery.

Metallic stent implantation in patients with iliac artery occlusion: long-term patency rate and factors related to recurrence

International Nuclear Information System (INIS)

Chung, Seok Kyun; Kim, Jae Kyu; Yoon, Woong; Kim, Jeong; Park, Jin Gyoon; Kang, Heoung Keun; Choi, Soo JinNa

2003-01-01

To determine the long-term patency rate in 68 patients with iliac artery occlusion who underwent metallic stent implantation, and to analyze the factors related to recurrence. Sixty-eight patients with occlusive disease of the iliac artery underwent implantation of a self-expandable metallic stent. The clinical symptoms were intermittent claudication (n=48), resting pain (n=11), and gangrene (n=9). Stent patency was determined by follow-up angiography and color Doppler imaging, and the cumulative patency rate using the Kaplan-Meier method. Cox's proportional hazard model was used to analyse recurrence-related factors involving clinical symptoms (Fontaine stage), risk factors, and anatomical factors such as lesion location, length, and the development of collaterals. The duration of follow-up varied from 1 day to 73 months (mean, 23.8 months). Arterial occlusion recurred in 16 of 68 patients (23.5%), and the cumulative patency rate was as follows: 95.4% at one month, 93.2% at six months, 80.1% at one year, 73.2% at two years, 68.9% at three years, and 62% at five years. According to a statistical analysis of risk factors, the recurrence (p=0.04) than in those without it, but in patients who smoked, hypertension, DM, and previous cerebrovascular disease were not statistically significant. With regard to anatomical factors, the recurrent rate for lesions involving the external iliac artery was 6.5 times higher (p=0.02) than for those involving the common iliac artery. Variations in the fontaine stage were not statistically significant indicators of recurrence. The recurrence rate after implantation of an iliac artery stent is higher in patients with heart disease than in those without it, and higher for occlusive lesions involving the external iliac artery than for those of the common iliac artery

Targeting In-Stent-Stenosis with RGD- and CXCL1-Coated Mini-Stents in Mice.

Science.gov (United States)

Simsekyilmaz, Sakine; Liehn, Elisa A; Weinandy, Stefan; Schreiber, Fabian; Megens, Remco T A; Theelen, Wendy; Smeets, Ralf; Jockenhövel, Stefan; Gries, Thomas; Möller, Martin; Klee, Doris; Weber, Christian; Zernecke, Alma

2016-01-01

Atherosclerotic lesions that critically narrow the artery can necessitate an angioplasty and stent implantation. Long-term therapeutic effects, however, are limited by excessive arterial remodeling. We here employed a miniaturized nitinol-stent coated with star-shaped polyethylenglycole (star-PEG), and evaluated its bio-functionalization with RGD and CXCL1 for improving in-stent stenosis after implantation into carotid arteries of mice. Nitinol foils or stents (bare metal) were coated with star-PEG, and bio-functionalized with RGD, or RGD/CXCL1. Cell adhesion to star-PEG-coated nitinol foils was unaltered or reduced, whereas bio-functionalization with RGD but foremost RGD/CXCL1 increased adhesion of early angiogenic outgrowth cells (EOCs) and endothelial cells but not smooth muscle cells when compared with bare metal foils. Stimulation of cells with RGD/CXCL1 furthermore increased the proliferation of EOCs. In vivo, bio-functionalization with RGD/CXCL1 significantly reduced neointima formation and thrombus formation, and increased re-endothelialization in apoE-/- carotid arteries compared with bare-metal nitinol stents, star-PEG-coated stents, and stents bio-functionalized with RGD only. Bio-functionalization of star-PEG-coated nitinol-stents with RGD/CXCL1 reduced in-stent neointima formation. By supporting the adhesion and proliferation of endothelial progenitor cells, RGD/CXCL1 coating of stents may help to accelerate endothelial repair after stent implantation, and thus may harbor the potential to limit the complication of in-stent restenosis in clinical approaches.

First-in-human evaluation of a bioabsorbable polymer-coated sirolimus-eluting stent: imaging and clinical results of the DESSOLVE I Trial (DES with sirolimus and a bioabsorbable polymer for the treatment of patients with de novo lesion in the native coronary arteries).

Science.gov (United States)

Ormiston, John; Webster, Mark; Stewart, James; Vrolix, Mathias; Whitbourn, Robert; Donohoe, Dennis; Knape, Charlene; Lansky, Alexandra; Attizzani, Guilherme F; Fitzgerald, Peter; Kandzari, David E; Wijns, William

2013-10-01

This first-in-human multicenter study sought to examine prospectively the safety and efficacy of a new, cobalt chromium thin-strut, coronary absorbable polymer-coated, sirolimus-eluting stent. Bioabsorbable polymers on drug-eluting stents may lower the long-term risks of inflammation, delayed healing, and adverse events. We enrolled patients with symptomatic coronary artery disease with stable or unstable angina pectoris and >50% diameter stenosis, amenable to coverage with a ≤23-mm long stent in a vessel 2.5 to 3.5 mm in diameter. All patients received dual antiplatelet therapy after implantation. Patients, in groups of 10, underwent repeat angiography, intravascular ultrasound, and optical coherence tomography at 4, 6, or 8 months, and all patients were seen or contacted at 18 months of follow-up. The median (range) in-stent late lumen loss (LLL) was 0.03 mm (-0.22 to 0.21 mm), 0.10 mm (-0.03 to 1.2 mm), and 0.08 mm (-0.01 to 0.28 mm), at 4, 6, and 8 months, respectively. At 18 months, the median in-stent LLL was 0.08 mm (-0.30 to 0.46 mm). On optical coherence tomography, the proportion of uncovered stent struts decreased from a median of 7.3% (range 0.4% to 46.3%) at 4 months to 0% (range: 0% to 3.4%) at 18 months. The percentage of neointimal volume obstruction by intravascular ultrasound increased from a median of 5.3% to 9.1% between 4 and 6 months and remained nearly unchanged thereafter through 18 months of follow-up. The only recorded major adverse cardiac event was a myocardial infarction. At 18 months of follow-up, this absorbable polymer-coated, cobalt chromium sirolimus-eluting stent was associated with a low and stable in-stent LLL, complete strut coverage, and no stent thrombosis. (First-In-Human Trial of the MiStent Drug-Eluting Stent [DES] in Coronary Artery Disease [DESSOLVE-I]; NCT01247428). Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Stent Thrombosis With Drug-Eluting Stents and Bioresorbable Scaffolds: Evidence From a Network Meta-Analysis of 147 Trials.

Science.gov (United States)

Kang, Si-Hyuck; Chae, In-Ho; Park, Jin-Joo; Lee, Hak Seung; Kang, Do-Yoon; Hwang, Seung-Sik; Youn, Tae-Jin; Kim, Hyo-Soo

2016-06-27

This study sought to perform a systematic review and network meta-analysis to compare the relative safety and efficacy of contemporary DES and BVS. To improve outcomes of patients undergoing percutaneous coronary revascularization, there have been advances in the design of drug-eluting stents (DES), including the development of drug-eluting bioresorbable vascular scaffolds (BVS). Prospective, randomized, controlled trials comparing bare-metal stents (BMS), paclitaxel-eluting stents (PES), sirolimus-eluting stents (SES), Endeavor zotarolimus-eluting stents (E-ZES), cobalt-chromium (CoCr) everolimus-eluting stents (EES), platinum-chromium (PtCr)-EES, biodegradable polymer (BP)-EES, Resolute zotarolimus-eluting stents (R-ZES), BP biolimus-eluting stents (BP-BES), hybrid sirolimus-eluting stents (H [Orsiro]-SES), polymer-free sirolimus- and probucol-eluting stents, or BVS were searched in online databases. The primary endpoint was definite or probable stent thrombosis at 1 year. A total of 147 trials including 126,526 patients were analyzed in this study. All contemporary DES were superior to BMS and PES in terms of definite or probable stent thrombosis at 1 year. CoCr-EES, PtCr-EES, and H-SES were associated with significantly lower risk than BVS. CoCr-EES and H-SES were superior to SES and BP-BES. The risk of myocardial infarction was significantly lower with H-SES than with BVS. There were no significant differences regarding all-cause or cardiac mortality. Contemporary devices including BVS showed comparably low risks of repeat revascularization. Contemporary DES, including biocompatible DP-DES, BP-DES, and polymer-free DES, showed a low risk of definite or probable stent thrombosis at 1 year. BVS had an increased risk of device thrombosis compared with CoCr-EES, PtCr-EES, and H-SES. Data from extended follow-up are warranted to confirm the long-term safety of contemporary coronary devices. Copyright © 2016 American College of Cardiology Foundation. Published by

Successful technical and clinical outcome using a second generation balloon expandable coronary stent for transplant renal artery stenosis: Our experience.

Science.gov (United States)

Salsamendi, Jason; Pereira, Keith; Baker, Reginald; Bhatia, Shivank S; Narayanan, Govindarajan

2015-10-01

Transplant renal artery stenosis (TRAS) is a vascular complication frequently seen because of increase in the number of renal transplantations. Early diagnosis and management is essential to optimize a proper graft function. Currently, the endovascular treatment of TRAS using angioplasty and/or stenting is considered the treatment of choice with the advantage that it does not preclude subsequent surgical correction. Treatment of TRAS with the use of stents, particularly in tortuous transplant renal anatomy presents a unique challenge to an interventional radiologist. In this study, we present three cases from our practice highlighting the use of a balloon-expandable Multi-Link RX Ultra coronary stent system (Abbott Laboratories, Abbott Park, Illinois, USA) for treating high grade focal stenosis along very tortuous renal arterial segments. Cobalt-Chromium alloy stent scaffold provides excellent radial force, whereas the flexible stent design conforms to the vessel course allowing for optimal stent alignment.

Cognitive changes after carotid artery stenting

Energy Technology Data Exchange (ETDEWEB)

Grunwald, I.Q.; Politi, M.; Struffert, T.; Krick, C.; Backens, M. [University of the Saarland, Department for Diagnostic and Interventional Neuroradiology, Homburg (Germany); Supprian, T.; Falkai, P.; Reith, W. [University of the Saarland, Clinic for Psychiatry and Psychotherapy, Homburg (Germany)

2006-05-15

We aimed to test changes in cognitive performance after carotid artery stenting (CAS). Ten patients were neuropsychologically tested at least 24 h before and 48 h after CAS. To diminish thromboembolic events, we used a proximal protection device. The following neuropsychological tests were selected: The Mini Mental State Examination (MMSE), symbol digit test and subtests of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery (verbal fluency, constructional practice, word list memory and delayed recall). Affective state was determined by the Beck Depression Score (BDS). No patient suffered from depression (BDS <1) or dementia (MMSE 29.9{+-}1.5). Nine of the ten patients (P=0.12) showed increased speed in the Number Connection Test (NCT) (corresponding to trail making test). Most patients showed better or similar results concerning delayed recall (P=0.31). No change was observed in the symbol digit test, word list memory, verbal fluency or constructional practice. Better results concerning NCT and delayed recall after carotid stenting might be due to improved brain perfusion. After CAS, cognitive and memory performance seem to improve. Further studies with different time intervals and more refined testing, as well as perfusion-weighted imaging, are needed. (orig.)

Comparison of femoropopliteal artery stents under axial and radial compression, axial tension, bending, and torsion deformations.

Science.gov (United States)

Maleckis, Kaspars; Deegan, Paul; Poulson, William; Sievers, Cole; Desyatova, Anastasia; MacTaggart, Jason; Kamenskiy, Alexey

2017-11-01

High failure rates of Peripheral Arterial Disease (PAD) stenting appear to be associated with the inability of certain stent designs to accommodate severe biomechanical environment of the femoropopliteal artery (FPA) that bends, twists, and axially compresses during limb flexion. Twelve Nitinol stents (Absolute Pro, Supera, Lifestent, Innova, Zilver, Smart Control, Smart Flex, EverFlex, Viabahn, Tigris, Misago, and Complete SE) were quasi-statically tested under bench-top axial and radial compression, axial tension, bending, and torsional deformations. Stents were compared in terms of force-strain behavior, stiffness, and geometrical shape under each deformation mode. Tigris was the least stiff stent under axial compression (6.6N/m axial stiffness) and bending (0.1N/m) deformations, while Smart Control was the stiffest (575.3N/m and 105.4N/m, respectively). Under radial compression Complete SE was the stiffest (892.8N/m), while Smart Control had the lowest radial stiffness (211.0N/m). Viabahn and Supera had the lowest and highest torsional stiffness (2.2μNm/° and 959.2μNm/°), respectively. None of the 12 PAD stents demonstrated superior characteristics under all deformation modes and many experienced global buckling and diameter pinching. Though it is yet to be determined which of these deformation modes might have greater clinical impact, results of the current analysis may help guide development of new stents with improved mechanical characteristics. Copyright © 2017 Elsevier Ltd. All rights reserved.

Peri-procedural complications and associated risk factors in wingspan stent-assistant angioplasty of intracranial artery stenosis

International Nuclear Information System (INIS)

Li Zhaoshuo; Li Tianxiao; Wang Ziliang; Bai Weixing; Xue Jiangyu; Zhu Liangfu; Li Li

2013-01-01

Objective: To retrospectively evaluate the cerebrovascular complications from stenting for symptomatic intracranial stenosis and to detect the factors associated with complications. Methods: Medical records of Wingspan stenting were reviewed for 306 cases with symptomatic intracranial stenosis from July 2007 to February 2012, including transient ischemic attack, ischemic stroke, death and intracranial hemorrhage as clinical in-hospital complications. The location of lesions included middle cerebral artery level M1 (114 lesions), intracranial portion of the internal carotid artery (50 lesions), vertebral artery 4 (75 lesions), venebro-basilar artery (14 lesions), basilar artery (76 lesions). Complications were evaluated and analyzed to find out whether they were associated with patient-or stenosis-related risk factors using χ"2 test. Results: The technical success rate was 99% (303/306). Cerebrovascular complications rate was 6.9% (21/303), with 1.6% (14/303) of disabling stroke events and 0.7% (2/303) of deaths. Hemorrhagic events were consisted of procedure-related events (3 cases), hyperperfusion (3 cases), ischemic events of perforator stroke (8 cases), transient ischemic attack (3 cases), embolization (2 cases), thrombosis in stent (2 cases). Hemorrhagic events were associated with significantly higher morbidity and mortality rates (χ"2 = 2.908, P < 0.05) and occurred more frequently after treatment of middle cerebral artery stenosis than other lesions (χ"2 = 1.168, P < 0.05). Perforating branches were detected to be affected mainly in the basilar artery than other locations (χ"2 = 4.263, P < 0.05). Conclusion: The complication rates in the study are preliminary consistent with the previously published data. Hemorrhagic events are prone to occur in the treatment of middle cerebral artery stenosis, while perforating branches are affected mainly in the basilar artery. (authors)

Extracranial Carotid Artery Stenting in Surgically High-Risk Patients Using the Carotid Wallstent Endoprosthesis:Midterm Clinical and Ultrasound Follow-Up Results

International Nuclear Information System (INIS)

Maleux, Geert; Bernaerts, Pauwel; Thijs, Vincent; Daenens, Kim; Vaninbroukx, Johan; Fourneau, Inge; Nevelsteen, Andre

2003-01-01

The purpose of this study was to evaluate the feasibility, safety and midterm outcome of elective implantation of the Carotid Wallstent (registered) in patients considered to be at high surgical risk. In a prospective study, 54 carotid artery stenoses in 51 patients were stented over a 24-month period. Three patients underwent bilateral carotid artery stenting. Institutional inclusion criteria for invasive treatment of carotid occlusive disease (carotid endarterectomy or carotid artery stenting) are patients presenting with a 70% or more symptomatic stenosis and those with an 80% or more asymptomatic stenosis having a life-expectancy of more than 1 year. All patients treated by carotid artery stenting were considered at high risk for carotid endarterectomy because of a hostile neck (17 patients-31.5%) or because of severe comorbidities (37 patients-68.5%). No cerebral protection device was used. Of the 54 lesions, 33 (61.1%) were symptomatic and 21 (38.8%) were asymptomatic. Follow-up was performed by physical examination and by duplex ultrasonography at 1 month, 6 months, 1 year and 2 years after the procedure. All 54 lesions could be stented successfully without periprocedural stroke. Advert events during follow-up (mean 13.9 ± 5.7 months) were non-stroke-related death in 6 patients (11.1%), minor stroke in 4 stented hemispheres(7.4%), transient ipsilateral facial pain in 1 patient (1.8%),infection of the stented surgical patch in 1 patient (1.8%) and asymptomatic in stent restenosis in 4 patients (7.4%). The percutaneous implantation of the Carotid Wallstent (registered) , even without cerebral protection device, appears to be a safe procedure with acceptable clinical and ultrasonographic follow-up results in patients at high surgical risk. But some late adverse events such as ipsilateral recurrence of non-disabling (minor) stroke or in stent restenosis still remain real challenging problems

[Measurements of blood velocities using duplex sonography in carotid artery stents: analysis of reliability in an in-vitro model and computational fluid dynamics (CFD)].

Science.gov (United States)

Schönwald, U G; Jorczyk, U; Kipfmüller, B

2011-01-01

Stents are commonly used for the treatment of occlusive artery diseases in carotid arteries. Today, there is a controversial discussion as to whether duplex sonography (DS) displays blood velocities (BV) that are too high in stented areas. The goal of this study was to evaluate the effect of stenting on DS with respect to BV in artificial carotid arteries. The results of computational fluid dynamics (CFD) were also used for the comparison. To analyze BV using DS, a phantom with a constant flow (70 cm/s) was created. Three different types of stents for carotid arteries were selected. The phantom fluid consisted of 67 % water and 33 % glycerol. All BV measurements were carried out on the last third of the stents. Furthermore, all test runs were simulated using CFD. All measurements were statistically analyzed. DS-derived BV values increased significantly after the placement of the Palmaz Genesis stent (77.6 ± 4.92 cm/sec, p = 0.03). A higher increase in BV values was registered when using the Precise RX stent (80.1 ± 2.01 cm/sec, p CFD simulations showed similar results. Stents have a significant impact on BV, but no effect on DS. The main factor of the blood flow acceleration is the material thickness of the stents. Therefore, different stents need different velocity criteria. Furthermore, the results of computational fluid dynamics prove that CFD can be used to simulate BV in stented silicone tubes. © Georg Thieme Verlag KG Stuttgart · New York.

Stent impact on the geometry of the carotid bifurcation and the course of the internal carotid artery

International Nuclear Information System (INIS)

Berkefeld, J.; Zanella, F.E.; Rosendahl, H.; Theron, J.G.; Guimaraens, L.; Treggiari-Venzi, M.M.

2002-01-01

A measurement system is proposed to evaluate reconstructive effects of carotid stents on the geometry of the carotid bifurcation and the course of the internal carotid artery. To describe deviations of the stenotic internal carotid artery (ICA) from the extended axis of the common carotid artery (CCA) the CCA-ICA angle is measured between the CCA midaxis and the midaxis of the stenotic ICA segment. Maximal extensions of ICA tortuosities perpendicular to the course of the CCA axis are defined as ICA offset. The measurements were applied to DSA images of 224 carotid stenoses to evaluate variation and correlation between the two parameters. Comparative pre- and post-stent evaluation was performed in two series of 55 and 31 carotid stenoses treated with Wallstents and in a historic control group of 35 stenoses treated with Strecker stents. Straight course of the ICA was associated with low angle and low offset values, whereas tortuous course of the ICA showed larger angle and offset. A moderate linear correlation between the two parameters was found. Corresponding to a straightening of the stented segment, Wallstents reduced mean angle and offset values significantly. In five cases of the second series of Wallstents, transferrals of curves above the distal stent end associated with kinks were observed, and offset remained constant or increased. Strecker stent implantation caused no significant changes of bifurcational geometry. The proposed parameters corresponded to visual aspects of ICA tortuosity and detected reconstructive effects of self-expanding Wallstents on the ICA course. The measurement system may provide a basis for geometric evaluation of different stent types or implantation concepts with the aim: to optimize anatomic recanalization results in tortuous high angle-high offset bifurcations. (orig.)

Technical feasibility of the implantation of a monorail stent system into the renal arteries without pre-dilatation

International Nuclear Information System (INIS)

Neumann, C.; Dorffner, R.; Gschwendtner, M.; Karnel, F.; Mair, J.; Dorffner, G.

2005-01-01

Purpose: to evaluate the technical feasibility of the implantation of the monorail RX Herculink trademark system into the renal arteries without pre-dilatation. Materials and methods: forty-two patients (mean age 71 years) from four centers with a total of 44 renal artery stenoses underwent implantation of the RX Herculink trademark stent. The mean grade of the stenosis was 83.8%, the mean length 7.5 mm. The stenoses were ostial in 38 cases and in immediate proximity to the ostium in 6 cases. The mean follow-up-period was 57 weeks (24 - 176 weeks). Results: in 42 cases, the implantation was successful without pre-dilatation. In 2 cases, pre-dilatation was carried out. In none of the cases, detachment of the stent from the balloon was observed. In one stenosis with a length of 17 mm, implantation of two stents was performed. In 9 cases, post-dilatation with a larger balloon or higher balloon pressure was necessary. Residual stenoses exceeding 30% were not observed. Two patients developed local bleeding at the puncture site. During the follow-up, restenoses were observed in 5 stents after 26 to 126 weeks, which necessitated a second intervention in 3 cases (PTA in 2 cases, re-stenting in 1 case). The primary patency rate after 6 and 12 months was 0.92 ± 0.056 according to Kaplan-Meier, the secondary patency rate after 6 and 12 months was 1.0 ± 0.0. Conclusion: implantation of the RX Herculink trademark stent system into the renal arteries without pre-dilatation is technically feasible and safe. Even without pre-dilatation, the stent-system can be advanced through the stenosis without detachment. The complication rate is low. Our clinical results are comparable to previous studies. (orig.)

Coronary Stents in Diabetic Patients: State of the Knowledge.

Science.gov (United States)

Codner, Pablo; Gurm, Hitinder Singh; Motivala, Apurva

2017-04-01

This review article aims to summarize the findings of the most relevant research that compared the use of paclitaxel vs. "limus" based drug eluting stent (DES) in diabetic patients and to define the current state of knowledge with new stent technologies in this patient population. Since drug eluting stents (DES) were introduced, it has been of great interest to establish whether paclitaxel or sirolimus eluting stents have the same safety and efficacy features for patients with coronary artery disease. The answer to this question is particularly relevant for diabetic patients. Several randomized trials, registry-based studies, and meta-analyses have assessed the performance of these different DES in diabetic patients. The most recently published data favors limus over paclitaxel DES in diabetic patients, but most of these studies compared first vs. second generation DES with the inherent caveats of comparing different platforms, alloys, and drug delivery vehicles. In this literature review, we found that there is robust evidence favoring the use of DES over bare metal stents in diabetic patients with coronary artery disease. We also found that the current state of knowledge is that the everolimus eluting stents have better safety and efficacy than paclitaxel eluting stents in diabetic patients and hence should be the preferred choice. New revascularization strategies including bio-absorbable scaffolds, polymer free stents, and bio-degradable polymers are being studied in diabetic patients with encouraging results.

The Impact of Post-Procedural Asymmetry, Expansion, and Eccentricity of Bioresorbable Everolimus-Eluting Scaffold and Metallic Everolimus-Eluting Stent on Clinical Outcomes in the ABSORB II Trial.

Science.gov (United States)

Suwannasom, Pannipa; Sotomi, Yohei; Ishibashi, Yuki; Cavalcante, Rafael; Albuquerque, Felipe N; Macaya, Carlos; Ormiston, John A; Hill, Jonathan; Lang, Irene M; Egred, Mohaned; Fajadet, Jean; Lesiak, Maciej; Tijssen, Jan G; Wykrzykowska, Joanna J; de Winter, Robbert J; Chevalier, Bernard; Serruys, Patrick W; Onuma, Yoshinobu

2016-06-27

The study sought to investigate the relationship between post-procedural asymmetry, expansion, and eccentricity indices of metallic everolimus-eluting stent (EES) and bioresorbable vascular scaffold (BVS) and their respective impact on clinical events at 1-year follow-up. Mechanical properties of a fully BVS are inherently different from those of permanent metallic stent. The ABSORB II (A bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions) trial compared the BVS and metallic EES in the treatment of a de novo coronary artery stenosis. Protocol-mandated intravascular ultrasound imaging was performed pre- and post-procedure in 470 patients (162 metallic EES and 308 BVS). Asymmetry index (AI) was calculated per lesion as: (1 - minimum scaffold/stent diameter/maximum scaffold/stent diameter). Expansion index and optimal scaffold/stent expansion followed the definition of the MUSIC (Multicenter Ultrasound Stenting in Coronaries) study. Eccentricity index (EI) was calculated as the ratio of minimum and maximum scaffold/stent diameter per cross section. The incidence of device-oriented composite endpoint (DoCE) was collected. Post-procedure, the metallic EES group was more symmetric and concentric than the BVS group. Only 8.0% of the BVS arm and 20.0% of the metallic EES arm achieved optimal scaffold/stent expansion (p 0.30 is an independent predictor of DoCE (hazard ratio: 3.43; 95% confidence interval: 1.08 to 10.92; p = 0.037). BVS implantation is more frequently associated with post-procedural asymmetric and eccentric morphology compared to metallic EES. Post-procedural devices asymmetry were independently associated with DoCE following percutaneous coronary intervention. However, this approach should be viewed as hypothesis generating due to low event rates. (ABSORB II Randomized Controlled Trial [ABSORB II]; NCT01425281). Copyright © 2016 American

Development of radiolabelled compound using reactor producted RI - Evaluation of Ho-166 endovascular therapy to prevent restenosis after PTCA or stenting for occlusive coronary artery disease

Energy Technology Data Exchange (ETDEWEB)

Park, Chan Hee; Choi, Byung Il; Kim, Han Soo [Ajou University, Suwon (Korea)

2000-04-01

Occlusive coronary artery disease is managed successfully by percutaneous transfemoral coronary angioplasty (PTCA) or stenting with 95% success rate. However, restenosis after PTCA is not uncommon and the reported incidence of reocclusion is about 30 {approx} 40%. Therefore, the objective of the research was to develop endovascular brachytherapy using liquid form of Ho-166 in order to inhibit neointimal hyperplasia responsible for restenosis following PTCA or stenting. Our research was carried out in 3 stages: First stage - The effectiveness of radiation was confirmed by using animal model. Following over-sized balloon injury to rat carotid artery and porcine coronary artery, various external radiation doses were delivered. Second stage - For radiation dose distribution within the coronary artery and its surrounding tissues, Gafchromic film was used. In vitro dose distribution of Ho-166 utilizing water phantom and Gafchromic film was measured. Third stage - None uniform dose distribution from Ho-166 within the balloon caused by small air bubbles was eliminated by negative suction method. More accurate dose distribution was also possible using newly developed micrometer by our physicist. Limited number of human trial was performed without adverse effect. 40 refs. (Author)

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.

Bioresorbable Scaffold for Treatment of Coronary Artery Lesions: Intravascular Ultrasound Results From the ABSORB Japan Trial.

Science.gov (United States)

Okada, Kozo; Honda, Yasuhiro; Kitahara, Hideki; Otagiri, Kyuhachi; Tanaka, Shigemitsu; Hollak, M Brooke; Yock, Paul G; Popma, Jeffrey J; Kusano, Hajime; Cheong, Wai-Fung; Sudhir, Krishnankutty; Fitzgerald, Peter J; Kimura, Takeshi

2018-04-09

The aim of this study was to characterize post-procedural intravascular ultrasound (IVUS) findings in the ABSORB Japan trial, specifically stratified by the size of target coronary arteries. Despite overall noninferiority confirmed in recent randomized trials comparing bioresorbable vascular scaffolds (BVS) (Absorb BVS) and cobalt-chromium everolimus-eluting metallic stents (CoCr-EES), higher event rates of Absorb BVS have been reported with suboptimal deployment, especially in small coronary arteries. In the ABSORB Japan trial, 150 patients (2:1 randomization) were scheduled in the IVUS cohort. Small vessel was defined as mean reference lumen diameter strategy, possibly different between polymeric and metallic devices, needs to be established for bioresorbable scaffold technology. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 Absorb™ BVS) in Japanese Population [ABSORB JAPAN]; NCT01844284). Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin

Energy Technology Data Exchange (ETDEWEB)

Pecoraro, Felice, E-mail: felicepecoraro@libero.it; Sabatino, Ermanno R.; Dinoto, Ettore; Rosa, Giuliana La; Corte, Giuseppe; Bajardi, Guido [University of Palermo, Vascular Surgery Unit (Italy)

2015-10-15

A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.

Coronary Artery Bypass Surgery Versus Drug-Eluting Stent Implantation for Left Main or Multivessel Coronary Artery Disease A Meta-Analysis of Individual Patient Data

NARCIS (Netherlands)

Lee, Cheol Whan; Ahn, Jung-Min; Cavalcante, Rafael; Sotomi, Yohei; Onuma, Yoshinobu; Suwannasom, Pannipa; Tenekecioglu, Erhan; Yun, Sung-Cheol; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Park, Seong-Wook; Serruys, Patrick W.; Park, Seung-Jung

2016-01-01

OBJECTIVES The authors undertook a patient-level meta-analysis to compare long-term outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in 3,280 patients with left main or multivessel coronary artery disease (CAD).

Interventional Exclusion of Iliac Artery Aneurysms Using the Flow-Diverting Multilayer Stent

Energy Technology Data Exchange (ETDEWEB)

Pieper, Claus Christian, E-mail: Claus.christian.pieper@ukb.uni-bonn.de; Meyer, Carsten, E-mail: Carsten.Meyer@ukb.uni-bonn.de [University of Bonn, Department of Radiology (Germany); Rudolph, Jens, E-mail: jens.rudolph@ukb.uni-bonn.de; Verrel, Frauke, E-mail: frauke.verrel@ukb.uni-bonn.de [University of Bonn, Department of Surgery (Germany); Schild, Hans Heinz, E-mail: hans.schild@ukb.uni-bonn.de; Wilhelm, Kai E., E-mail: kai.wilhelm@ukb.uni-bonn.de [University of Bonn, Department of Radiology (Germany)

2013-08-01

PurposeThis study was designed to evaluate retrospectively the results of complex iliac artery aneurysm (IAA) exclusion using the Cardiatis-Multilayer-Stent.MethodsBetween October 2010 and August 2012, ten IAAs were treated in eight males (mean age 75 (59-91) years) using the Multilayer Stent. All IAA exceeded a diameter of 3 cm or were symptomatic. Follow-up (FU) examinations included CT or MR angiography, sonography, and clinical assessment up to 2 years.ResultsPrimary stent placement was technically successful in eight of ten cases. In two cases, severe stent retraction during deployment necessitated placement of an additional stent. Immediately after stent placement, a marked reduction of flow within the sac was observed in all cases (peri-interventional mortality 0 %). During FU, there were two thrombotic stent occlusions, making reintervention necessary (primary patency rate 80 %, secondary patency 100 %). Four IAA were completely occluded at FU, whereas the original vessel and covered branches (n = 8) were patent. In four IAA, there was still residual perfusion. In one patient, IAA diameter decreased slightly, while it remained constant in seven (mean imaging FU 195 (range 1-695) days). There were no adverse events on clinical FU (mean FU 467 (range 101-695) days).ConclusionsOther studies showed the Cardiatis-Multilayer-Stent to be a technically relatively simple treatment option for complex IAA with inadequate landing zones, especially in patients with multiple comorbidities to avoid ipsilateral IIA obstruction. However, in our series complication rate was high. Incomplete sac exclusion, stent-shortening, and thrombotic occlusion can complicate treatment, making meticulous patient selection necessary. Close imaging surveillance is mandatory especially in the early postinterventional period.

Direct stent puncture technique for intraluminal stent recanalization in the superficial femoral and popliteal arteries in-stent occlusion: Outcomes from a prospective clinical analysis of diabetics with critical limb ischemia

Energy Technology Data Exchange (ETDEWEB)

Palena, Luis Mariano, E-mail: marianopalena@hotmail.com; Manzi, Marco

2013-07-15

Purpose: To evaluate the efficacy and safety of “Direct Stent Puncture” technique for intraluminal stent recanalization in the femoro-popliteal segments. Methods and Materials: A cohort of diabetics who had symptomatic in-stent occlusion of the superficial femoral or popliteal arteries underwent endovascular recanalization. After antegrade failure, direct stent puncture technique was performed. The primary end-point was to efficacy assessment, intended as technical success and clinical improvement. The secondary end-point was safety assessment, intended as free of complication rate. Results: Fifty-four patients (37 men; 73.6 ± 8.5 years) underwent direct stent puncture technique, after several unsuccessful antegrade attempts to cross the occluded stent. Technical success for intraluminal stent recanalization was achieved in 53/54 (98.2%) of cases and failed in 1/54 (1.8%). Clinical improvement was obtained in 51/54 (94.4%) of cases, with regression of the clinical symptoms and improvement of the TcPO{sub 2}, from 3 ± 18 mmHg to 43 ± 11 mmHg after 15 days (p < 0.001). Free of complications rate was 92.5%. In 2/54 (3.7%) of cases distal embolization occurred, in 1/54 (1.9%) case a sudden vessel thrombosis was diagnosed after 12 hours and in 1/54 (1.9%) case hematoma at the stent puncture site was observed. Conclusions: Direct Stent Puncture technique is an efficacy and safety option for intraluminal stent recanalization in the femoro-popliteal segment in-stent occlusion.

The Bolton Treovance abdominal stent-graft: European clinical trial design.

Science.gov (United States)

Chiesa, R; Riambau, V; Coppi, G; Zipfel, B; Llagostera, S; Marone, E M; Kahlberg, A

2012-10-01

Endovascular aortic repair (EVAR) has emerged as a promising, less invasive alternative to conventional open surgery for the treatment of infrarenal abdominal aortic aneurysms (AAAs). In the last 20 years, the application rate of EVAR and its clinical results have significantly improved thanks to the evolution of stent-grafts and endovascular delivery systems. However, further development is still needed to reduce the incidence of complications and secondary re-interventions. The Treovance abdominal aortic stent-graft (Bolton Medical, Barcelona, Spain) is a new-generation endovascular device, developed to increase flexibility, lower profile, improve deployment and sealing mechanisms. In particular, it is provided with some innovative features as a double layer of proximal barbs (suprarenal and infrarenal) for supplemental fixation, dull barbs between modules to avoid potential leg disconnections, detachable outer sheath provided with a new-design hemostatic valve, and a double improved mechanism (slow motion and "pin and pull") for precise stent-graft deployment. A European prospective, non-randomized, multi-institutional, "first-in-human" trial (the ADVANCE trial) was conducted from March to December 2011 to assess the safety and performance of the Treovance stent-graft system before commercialization. Thirty patients with anatomically suitable non-ruptured AAAs were enrolled at five clinical sites in Italy, Spain, and Germany. EVAR was completed successfully in all patients. The stent-graft was delivered and deployed safely even in heavily angulated or calcified anatomies. No 30-day device-related complications nor deaths were observed. Preliminary experience with the Treovance abdominal stent-graft within the ADVANCE trial was satisfactory with regard to technical success and perioperative clinical results. Follow-up data are needed to assess mid- and long-term clinical outcomes, along with durability of this new-generation endovascular device.

Balloon Tamponade Treatment of a Stent-graft Related Rupture with a Splenic Artery Pseudoaneurysm: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Kim, See Hyung; Kim, Young Hwan [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

2009-09-15

An arterial rupture resulting from stent-graft placement of a splenic artery pseudoaneurysm is a life-threatening complication and immediate endovascular or surgical treatment is indicated. We report a case of a stentgraft related splenic artery rupture treated solely with a prolonged balloon catheter tamponade, which resulted in preservation of vessel patency

Endeavour zotarolimus-eluting stent reduces stent thrombosis and improves clinical outcomes compared with cypher sirolimus-eluting stent : 4-year results of the PROTECT randomized trial

NARCIS (Netherlands)

Wijns, William; Steg, Ph. Gabriel; Mauri, Laura; Kurowski, Volkhard; Parikh, Keyur; Gao, Runlin; Bode, Christoph; Greenwood, John P.; Lipsic, Erik; Alamgir, Farqad; Rademaker-Havinga, Tessa; Boersma, Eric; Radke, Peter; van Leeuwen, Frank; Camenzind, Edoardo

2014-01-01

Aims To compare the long-term clinical safety between two drug-eluting stents with different healing characteristics in the Patient Related Outcomes with Endeavour (E-ZES) vs. Cypher (C-SES) Stenting Trial (PROTECT). At 3 years, there was no difference in the primary outcome of definite or probable

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

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

Microfocal X-ray computed tomography post-processing operations for optimizing reconstruction volumes of stented arteries during 3D computational fluid dynamics modeling.

Science.gov (United States)

Ladisa, John F; Olson, Lars E; Ropella, Kristina M; Molthen, Robert C; Haworth, Steven T; Kersten, Judy R; Warltier, David C; Pagel, Paul S

2005-08-01

Restenosis caused by neointimal hyperplasia (NH) remains an important clinical problem after stent implantation. Restenosis varies with stent geometry, and idealized computational fluid dynamics (CFD) models have indicated that geometric properties of the implanted stent may differentially influence NH. However, 3D studies capturing the in vivo flow domain within stented vessels have not been conducted at a resolution sufficient to detect subtle alterations in vascular geometry caused by the stent and the subsequent temporal development of NH. We present the details and limitations of a series of post-processing operations used in conjunction with microfocal X-ray CT imaging and reconstruction to generate geometrically accurate flow domains within the localized region of a stent several weeks after implantation. Microfocal X-ray CT reconstruction volumes were subjected to an automated program to perform arterial thresholding, spatial orientation, and surface smoothing of stented and unstented rabbit iliac arteries several weeks after antegrade implantation. A transfer function was obtained for the current post-processing methodology containing reconstructed 16 mm stents implanted into rabbit iliac arteries for up to 21 days after implantation and resolved at circumferential and axial resolutions of 32 and 50 microm, respectively. The results indicate that the techniques presented are sufficient to resolve distributions of WSS with 80% accuracy in segments containing 16 surface perturbations over a 16 mm stented region. These methods will be used to test the hypothesis that reductions in normalized wall shear stress (WSS) and increases in the spatial disparity of WSS immediately after stent implantation may spatially correlate with the temporal development of NH within the stented region.

European Registry of Carotid Artery Stenting: results from a prospective registry of eight high volume EUROPEAN institutions.

Science.gov (United States)

Stabile, Eugenio; Garg, Pallav; Cremonesi, Alberto; Bosiers, Marc; Reimers, Bernhard; Setacci, Carlo; Cao, Piergiorgio; Schmidt, Andrej; Sievert, Horst; Peeters, Patrick; Nikas, Dimitry; Werner, Martin; de Donato, Gianmarco; Parlani, Giambattista; Castriota, Fausto; Hornung, Marius; Mauri, Laura; Rubino, Paolo

2012-08-01

Carotid endarterectomy (CEA) is the standard revascularization therapy to prevent stroke in patients with carotid artery disease. Carotid artery stenting (CAS) could be considered a potential alternative in patients at high surgical risk. Recent clinical trials have challenged this concept due a relatively high incidence of post-CAS adverse events, which occurred in low volume centers. The aim of this study was to evaluate the outcomes associated with neuroprotected CAS in selected high volume centers. From January 2007 to December 2007, 1,611 patients underwent neuroprotected CAS in eight European Centers. For each patients, clinical, procedural, and one month follow-up data from all patients have been collected. An independent clinical events committee adjudicated the events. Overall in hospital death was 0.06% (one patient), whereas in-hospital stroke was 0.49% (eight patients). Between hospital discharge and 30 days three additional patients died (0.18%) and 10 patients experienced a stroke (0.67%). Overall 30 days mortality was 0.24% (four patients) and stroke incidence 1.12% (18 patients). The 30 day stroke/death rate was 1.36%. CAS is a reasonable alternative to CEA to treat carotid artery atherosclerosis in well-experienced high volume centers. These data suggest that future prospective trials comparing CAS and CEA outcomes should include only centers highly experienced in both treatment modalities. Copyright © 2012 Wiley Periodicals, Inc.

Very late stent thrombosis with second generation drug eluting stents compared to bare metal stents: Network meta-analysis of randomized primary percutaneous coronary intervention trials.

Science.gov (United States)

Philip, Femi; Stewart, Susan; Southard, Jeffrey A

2016-07-01

The relative safety of drug-eluting stents (DES) and bare-metal stents (BMS) in primary percutaneous coronary intervention (PPCI) in ST elevation myocardial infarction (STEMI) continues to be debated. The long-term clinical outcomes between second generation DES and BMS for primary percutaneous coronary intervention (PCI) using network meta-analysis were compared. Randomized controlled trials comparing stent types (first generation DES, second generation DES, or BMS) were considered for inclusion. A search strategy used Medline, Embase, Cochrane databases, and proceedings of international meetings. Information about study design, inclusion criteria, and sample characteristics were extracted. Network meta-analysis was used to pool direct (comparison of second generation DES to BMS) and indirect evidence (first generation DES with BMS and second generation DES) from the randomized trials. Twelve trials comparing all stents types including 9,673 patients randomly assigned to treatment groups were analyzed. Second generation DES was associated with significantly lower incidence of definite or probable ST (OR 0.59, 95% CI 0.39-0.89), MI (OR 0.59, 95% CI 0.39-0.89), and TVR at 3 years (OR 0.50: 95% CI 0.31-0.81) compared with BMS. In addition, there was a significantly lower incidence of MACE with second generation DES versus BMS (OR 0.54, 95% CI 0.34-0.74) at 3 years. These were driven by a higher rate of TVR, MI and stent thrombosis in the BMS group at 3 years. There was a non-significant reduction in the overall and cardiac mortality [OR 0.83, 95% CI (0.60-1.14), OR 0.88, 95% CI (0.6-1.28)] with the use of second generation DES versus BMS at 3 years. Network meta-analysis of randomized trials of primary PCI demonstrated lower incidence of MACE, MI, TVR, and stent thrombosis with second generation DES compared with BMS. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Genous endothelial progenitor cell-capturing stent system: a novel stent technology

NARCIS (Netherlands)

Klomp, Margo; Beijk, Marcel A. M.; de Winter, Robbert J.

2009-01-01

Drug-eluting stents have been demonstrated to significantly reduce clinical and angiographic restenosis in patients with coronary artery disease compared with bare-metal stents. Intuitively, however, a prohealing approach for the prevention of in-stent restenosis by promoting accelerated

Paclitaxel-eluting stents versus everolimus-eluting coronary stents in a diabetic population: two-year follow-up of the TUXEDO-India trial.

Science.gov (United States)

Kaul, Upendra; Bhagwat, Ajit; Pinto, Brian; Goel, Praveen K; Jagtap, Prashant; Sathe, Shireesh; Wander, Gurpreet S; Arambam, Priyadarshini; Bangalore, Sripal

2017-11-20

The aim of this study was to report whether the superiority of the everolimus-eluting stent (EES) vs. the paclitaxel-eluting stent (PES) at one-year follow-up in the Taxus Element versus Xience Prime in a Diabetic Population (TUXEDO)-India trial was sustained at longer-term follow-up. One thousand eight hundred and thirty (1,830) patients with diabetes mellitus and coronary artery disease were randomised to EES vs. PES. Follow-up data up to two years were available in 1,701 (92.9%) patients. The primary endpoint was target vessel failure (TVF), defined as the composite of cardiac death, target vessel myocardial infarction (TV-MI), or ischaemia-driven target vessel revascularisation (TVR). Treatment with EES had a lower two-year rate of TVF (4.3% vs. 6.6%, p=0.03). Of the secondary endpoints, EES significantly reduced any MI (1.6% vs. 3.5%, p=0.01), TV-MI (0.7% vs. 3.1%, p=0.0001), ST (0.4% vs. 2.2%, p=0.001), cardiac death or target vessel MI (2.9% vs. 4.8%, p=0.04) and TLR (1.9% vs. 3.7%, p=0.02), compared with PES. Between one year and two years, no significant differences in the clinical outcomes were observed (pinteraction >0.05). In this adequately powered trial, the benefits of EES vs. PES in a diabetic population seen at one year were maintained at two years.

Short vs prolonged dual antiplatelet treatment upon endovascular stenting of peripheral arteries

Directory of Open Access Journals (Sweden)

Kronlage M

2017-10-01

Full Text Available Mariya Kronlage,1 Maximilian Wassmann,1 Britta Vogel,1 Oliver J Müller,1 Erwin Blessing,2 Hugo Katus,1,3 Christian Erbel1 1Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, 2SRH Klinikum Karlsbad Langensteinbach, Karlsbad, 3DZHK German Center for Cardiovascular Research, Partner Site Heidelberg/Mannheim, Mannheim, Germany Introduction: Peripheral artery disease (PAD is a highly prevalent disorder with a substantial economical burden. Dual antiplatelet treatment (DAPT upon endovascular stenting to prevent acute thrombotic reocclusions is an universally accepted practice for postinterventional management of PAD patients. However, the optimal period of time for DAPT upon endovascular stenting is not known.Methods: In the current nonrandomized, retrospective monocentric study, we evaluated the duration of DAPT upon endovascular stenting. A total of 261 endovascular SFA and iliac stenting procedures were performed on 214 patients and these patients were subdivided into a short (4–6 weeks or a prolonged (8–12 weeks DAPT regime group. More than 65% of the patients included were male, approximately 35% were diabetic, and 61% had a history of smoking. Of all the patients, 90% exhibited a Rutherford stage 2–3, and approximately half of the patients had a moderate-to-severe calcified target lesion with a length of >13 cm. Major safety end points were defined as any bleeding, compartment syndrome, and ischemic events. In addition to this, patency, all-cause mortality, as well as amputation were followed up over a period of 12 months upon intervention.Results: Twelve months after endovascular stenting, primary patency in our cohort was comparable between the groups (83.94% short vs 79.8% long DAPT, P>0.05. Major bleeding occurred in 18 cases without any difference between the groups (P>0.05. In addition, during the 12-month follow-up, 6 (3.4% patients in the short and 3 (3.5% in the prolonged DAPT regime

Comparison of paclitaxel- and sirolimus-eluting stents in everyday clinical practice: the SORT OUT II randomized trial

DEFF Research Database (Denmark)

Galløe, Anders M; Thuesen, Leif; Kelbaek, Henning

2008-01-01

Approval of drug-eluting coronary stents was based on results of relatively small trials of selected patients; however, in routine practice, stents are used in a broader spectrum of patients.......Approval of drug-eluting coronary stents was based on results of relatively small trials of selected patients; however, in routine practice, stents are used in a broader spectrum of patients....

Thoracic aortic stent-graft placement combined with left subclavian artery 'chimney operation': therapeutic analysis of 15 cases with insufficient proximal anchor area

International Nuclear Information System (INIS)

Liu Jiayi; Huang Lianjun; Fan Zhanming; Zhang Zhaoqi

2012-01-01

Objective: To discuss the strategies for the management of insufficient proximal anchoring area during the performance of transluminal stent-graft placement (TSGP), and to evaluate the feasibility of intentional coverage of the left subclavian artery (LSA) together with left subclavian artery stent-graft placement by using 'chimney operation' technique. Methods: A total of 15 patients with thoracic aortic diseases complicated by insufficient proximal anchoring area, who were encountered in authors' hospital during the period from Dec. 2009 to April 2011, were enrolled in this study. The clinical data were retrospectively analyzed. The thoracic aortic diseases included aortic dissection (n=6), aortic pseudoaneurysm (n=1), aortic aneurysm (n=4) and penetrating ulcer (n=4). Of the 15 patients, the distance between the lesion and LSA anchoring site 15 mm in 2. TSGP was carried out. The ostium of LSA was intentionally and completely covered by thoracic aortic stent-graft and left subclavian artery stent-graft placement was subsequently performed. The patients were kept under observation for symptoms of cerebral and upper limb ischemia. The postoperative complications such as endoleak and the patency of LSA were assessed with angiography. Results: Thoracic aortic stent-graft placement was successfully carried out in all 15 patients. In addition, one 'chimney' stent was properly implanted in LSA in each patient. After the procedure, no complications of nervous system or severe ischemia of upper extremity occurred. Follow-up examinations performed between 5 days to 3 months after the treatment revealed that the aortic stent-graft remained in stable condition and no type Ⅰ endoleak occurred, meanwhile the blood flow in 'chimney' stent was unobstructed. Conclusion: Intentional LSA coverage with 'chimney operation' can expand the applicability of TSGP with high tolerability. It is especially useful for patients with left vertebral artery blood supply dominance or with

Drug-eluting stent thrombosis: results from the multicenter Spanish registry ESTROFA (Estudio ESpañol sobre TROmbosis de stents FArmacoactivos).

Science.gov (United States)

de la Torre-Hernández, José M; Alfonso, Fernando; Hernández, Felipe; Elizaga, Jaime; Sanmartin, Marcelo; Pinar, Eduardo; Lozano, Iñigo; Vazquez, Jose M; Botas, Javier; Perez de Prado, Armando; Hernández, Jose M; Sanchis, Juan; Nodar, Juan M Ruiz; Gomez-Jaume, Alfredo; Larman, Mariano; Diarte, Jose A; Rodríguez-Collado, Javier; Rumoroso, Jose R; Lopez-Minguez, Jose R; Mauri, Josepa

2008-03-11

This study sought to assess the incidence, predictors, and outcome of drug-eluting stent(DES) thrombosis in real-world clinical practice. The DES thromboses in randomized trials could not be comparable to those observed in clinical practice, frequently including off-label indications. We designed a large-scale, nonindustry-linked multicentered registry, with 20 centers in Spain. The participant centers provided follow-up data for their patients treated with DES, reporting a detailed standardized form in the event of any angiography-documented DES-associated thrombosis occurring. Of 23,500 patients treated with DES, definite stent thrombosis(ST) developed in 301: 24 acute, 125 subacute, and 152 late. Of the late, 62 occurred >1 year(very late ST). The cumulative incidence was 2% at 3 years. Antiplatelet treatment had been discontinued in 95 cases(31.6%). No differences in incidences were found among stent types. Independent predictors for subacute ST analyzed in a subgroup of 14,120 cases were diabetes, renal failure, acute coronary syndrome, ST-segment elevation myocardial infarction, stent length, and left anterior descending artery stenting, and for late ST were ST-segment elevation myocardial infarction, stenting in left anterior descending artery, and stent length. Mortality at 1-year follow-up was 16% and ST recurrence 4.6%. Older age, left ventricular ejection fraction <45%, nonrestoration of Thrombolysis In Myocardial Infarction flow grade 3, and additional stenting were independent predictors for mortality. The cumulative incidence of ST after DES implantation was 2% at 3 years. No differences were found among stent types. Patient profiles differed between early and late ST. Short-term prognosis is poor, especially when restoration of normal flow fails.

[Changes of brain function and cognitive function after carotid artery stenting].

Science.gov (United States)

Lu, Z X; Deng, G; Wei, H L; Zhao, G F; Wen, L Z; Chen, X

2017-10-24

Objective: To investigate the effect of carotid artery stenting(CAS) on cognitive function and brain function based on changes of a battery of neuropsychological tests and magnetic resonance imaging. Methods: Thirty-three patients were included with 17 in the stent-placement group and 16 in the control group (receiving medical treatment), among whom, the unilateral or bilateral severe internal carotid artery stenosis was confirmed by cerebral vascular angiography in the department of Interventional Radiology and Vascular Surgery of Zhongda Hospital Southeast University from June 2015 to September 2016.Neuropsychological tests and rest-state blood oxygenation level dependent fMRI were performed at the baseline and six months follow-up.The baseline characteristics and follow-up changes were compared in each group. Results: The overall cognitive function of the stent-placement group was statistically significantly improved ( P function, memory, attention and other aspects.The value of amplitude of low-frequency fluctuation(ALFF) showed statistically significant increase ( P left prefrontal cortex ( t =5.861 3, P left superior parietal lobe( t =5.601 2, P left retrosplenial cingulate cortex( t =-5.590 4, P left insular cortex ( t =-6.340 8, P right insular cortex ( t =-8.129 9, P left dorsal anterior cingulate cortex ( t =-5.584 8, P 0.05, Alphasim correction)between baseline and follow-up results in control group.Besides, the ALFF changes of the left insular cortex ( r =-0.591, P =0.033) and bilateral motor cortical area ( r =-0.659, P =0.014) were negatively correlated with auditory verb learning test (AVLT) score changes.The ALFF change of bilateral motor cortical area was negatively correlated with the AVLT-delay score change ( r =-0.588, P =0.034). And the ALFF change on right insular cortex and the frontal assessment battery (FAB) score change was positively correlated ( r =0.638, P =0.025). Conclusions: The overall cognitive function of patients with carotid