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

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

2014-01-01

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autobiography, statements of Grüntzig’s former colleagues and contemporary witnesses, and have included hitherto unpublished historic photographs and links to archive recordings and historic materials.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

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

International Nuclear Information System (INIS)

Tanaka, Ryoichi; Higashi, Masahiro; Naito, Hiroaki

2007-01-01

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

In vitro analysis of balloon cuffing phenomenon: inherent biophysical properties of catheter material or mechanics of catheter balloon deflation?

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Chung, Eric; So, Karina

2012-06-01

To investigates the different methods of balloon deflation, types of urinary catheters and exposure to urine media in catheter balloon cuffing. Bardex®, Bard-Lubri-Sil®, Argyle®, Releen® and Biocath® were tested in sterile and E.Coli inoculated urine at 0, 14 and 28 days. Catheter deflation was performed with active deflation; passive deflation; passive auto-deflation; and excision of the balloon inflow channel. Balloon cuffing was assessed objectively by running the deflated balloon over a plate of agar and subjectively by 3 independent observers. Bardex®, Argyle® and Biocath® showed greater degree of catheter balloon cuffing (p deflation was the worst method (p 0.05). Linear regression model analysis confirmed time as the most significant factor. The duration of catheters exposure, different deflation methods and types of catheters tested contributed significantly to catheter balloon cuffing (p < 0.01).

OCT evaluation of directional atherectomy compared to balloon angioplasty.

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Marmagkiolis, Konstantinos; Lendel, Vasili; Cilingiroglu, Mehmet

2015-09-01

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

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.

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

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Hasan Mottaghi Moghadam

2017-12-01

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

Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

NARCIS (Netherlands)

Muinck, Ebo Derk de

1994-01-01

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

Angiographic assessment of initial balloon angioplasty results.

Science.gov (United States)

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

2004-10-01

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

Post-marketing surveillance in the published medical and grey literature for percutaneous transluminal coronary angioplasty catheters: a systematic review.

Science.gov (United States)

Polisena, Julie; Forster, Alan J; Cimon, Karen; Rabb, Danielle

2013-10-10

Post-marketing surveillance (PMS) may identify rare serious incidents or adverse events due to the long-term use of a medical device, which was not captured in the pre-market process. Percutaneous transluminal coronary angioplasty (PTCA) is a non-surgical procedure that uses a balloon-tipped catheter to enlarge a narrowed artery. In 2011, 1,942 adverse event reports related to the use of PTCA catheters were submitted to the FDA by the manufacturers, an increase from the 883 reported in 2008. The primary research objective is to conduct a systematic review of the published and grey literature published between 2007 and 2012 for the frequency of incidents, adverse events and malfunctions associated with the use of PTCA catheters in patients with coronary artery disease (CAD). Grey literature has not been commercially published. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and PubMed for medical literature on PMS for PTCA catheters in patients with CAD published between January 2007 and July 2012. We also searched the grey literature. This review included 11 studies. The in-hospital adverse events reported were individual cases of myocardial infarction and hematoma. In studies of patients with coronary perforation, more patients with balloon angioplasty were identified compared with patients who required stenting. Our systematic review illustrates that the volume and quality of PMS studies associated with the use of PTCA catheters in patients with CAD are low in the published and grey literature, and may not be useful sources of information for decisions on safety. In most studies, the objectives were not to monitor the long-term safety of the use of PTCA catheters in clinical practice. Future studies can explore the strengths and limitations of PMS databases administered by regulatory authorities.

Cryo-balloon catheter localization in fluoroscopic images

Science.gov (United States)

Kurzendorfer, Tanja; Brost, Alexander; Jakob, Carolin; Mewes, Philip W.; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

2013-03-01

Minimally invasive catheter ablation has become the preferred treatment option for atrial fibrillation. Although the standard ablation procedure involves ablation points set by radio-frequency catheters, cryo-balloon catheters have even been reported to be more advantageous in certain cases. As electro-anatomical mapping systems do not support cryo-balloon ablation procedures, X-ray guidance is needed. However, current methods to provide support for cryo-balloon catheters in fluoroscopically guided ablation procedures rely heavily on manual user interaction. To improve this, we propose a first method for automatic cryo-balloon catheter localization in fluoroscopic images based on a blob detection algorithm. Our method is evaluated on 24 clinical images from 17 patients. The method successfully detected the cryoballoon in 22 out of 24 images, yielding a success rate of 91.6 %. The successful localization achieved an accuracy of 1.00 mm +/- 0.44 mm. Even though our methods currently fails in 8.4 % of the images available, it still offers a significant improvement over manual methods. Furthermore, detecting a landmark point along the cryo-balloon catheter can be a very important step for additional post-processing operations.

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

Science.gov (United States)

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

2016-01-01

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

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

Science.gov (United States)

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

1989-10-01

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

Development of a New Coaxial Balloon Catheter System for Balloon-Occluded Retrograde Transvenous Obliteration (B-RTO)

International Nuclear Information System (INIS)

Tanoue, Shuichi; Kiyosue, Hiro; Matsumoto, Shunro; Hori, Yuzo; Okahara, Mika; Kashiwagi, Junji; Mori, Hiromu

2006-01-01

Purpose. To develop a new coaxial balloon catheter system and evaluate its clinical feasibility for balloon-occluded retrograde transvenous obliteration (B-RTO). Methods. A coaxial balloon catheter system was constructed with 9 Fr guiding balloon catheter and 5 Fr balloon catheter. A 5 Fr catheter has a high flexibility and can be coaxially inserted into the guiding catheter in advance. The catheter balloons are made of natural rubber and can be inflated to 2 cm (guiding) and 1 cm (5 Fr) maximum diameter. Between July 2003 and April 2005, 8 consecutive patients (6 men, 2 women; age range 33-72 years, mean age 55.5 years) underwent B-RTO using the balloon catheter system. Five percent ethanolamine oleate iopamidol (EOI) was used as sclerosing agent. The procedures, including maneuverability of the catheter, amount of injected sclerosing agent, necessity for coil embolization of collateral draining veins, and initial clinical results, were evaluated retrospectively. The occlusion rate was assessed by postcontrast CT within 2 weeks after B-RTO. Results. The balloon catheter could be advanced into the proximal potion of the gastrorenal shunt beyond the collateral draining vein in all cases. The amount of injected EOI ranged from 3 to 34 ml. Coil embolization of the collateral draining vein was required in 2 cases. Complete obliteration of gastric varices on initial follow-up CT was obtained in 7 cases. The remaining case required re-treatment that resulted in complete obstruction of the varices after the second B-RTO. No procedure-related complications were observed. Conclusion. B-RTO using the new coaxial balloon catheter is feasible. Gastric varices can be treated more simply by using this catheter system

Balloon catheter dilatation in esophageal achalasia: long term follow-up

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Shin, Cheol Yong; Park, Hyun Mee; Kim, So Eun; Lee, Shin Hyung; Kim, Seung Hyeon; Lee, Chang Joon [National Medical Center, Seoul (Korea, Republic of)

1994-12-15

To evaluate the clinical efficacy of balloon catheter dilatation in the treatment of esophageal achalasia. Seven patients(three males and four females) with esopha-geal achalasia were treated with balloon catheter dilatation. Balloon catheters of variable sizes were used depending on patient's conditions. The patients were followed up over a period of 12-39 months. Balloon catheter dilatation in esophageal achalasia was successful in all patients without esophageal perforation. All patients were relieved from dysphagia. Recurrence was not found in 5 patients on long term follow-up study, but was seen in 2 patients after 18 and 21 months, respectively. Balloon catheter dilatation was a safe and effective method in the treatment of esophageal achalasia with low recurrence rate of 29% on follow-up study.

Balloon catheter dilatation in esophageal achalasia: long term follow-up

International Nuclear Information System (INIS)

Shin, Cheol Yong; Park, Hyun Mee; Kim, So Eun; Lee, Shin Hyung; Kim, Seung Hyeon; Lee, Chang Joon

1994-01-01

To evaluate the clinical efficacy of balloon catheter dilatation in the treatment of esophageal achalasia. Seven patients(three males and four females) with esopha-geal achalasia were treated with balloon catheter dilatation. Balloon catheters of variable sizes were used depending on patient's conditions. The patients were followed up over a period of 12-39 months. Balloon catheter dilatation in esophageal achalasia was successful in all patients without esophageal perforation. All patients were relieved from dysphagia. Recurrence was not found in 5 patients on long term follow-up study, but was seen in 2 patients after 18 and 21 months, respectively. Balloon catheter dilatation was a safe and effective method in the treatment of esophageal achalasia with low recurrence rate of 29% on follow-up study

Preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty for the treatment of chronic occlusive arterial disorders of lower extremities

International Nuclear Information System (INIS)

Zhang Fuxian; Zhang Changming; Hu Lu; Feng Yaping; Liang Gangzhu; Zhang Huan

2010-01-01

Objective: To evaluate the safety and efficacy of preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty in treating chronic occlusive arterial disorders of lower extremities. Methods: From January 2008 to December 2009, preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty was performed in 12 patients with chronic occlusive arterial disorders of lower extremities, including 8 males and 4 females with an average age of 56.3 years (within a range of 38-71 years). All 12 patients had a history of chronic ischemia of lower limb,the mean ill duration was 19.3 months (3-48 months). All patients complained of intermittent claudication with a mean distance of 125 m (50-200 m). Rest pain occurred in 5 patients (42%), toe necrosis was seen in 3 patients (25%) and critically ischemic limb in 4 patients (33%). Ankle-brachial index (ABI) was 0.00 0.65 with a mean of 0.33. In all 12 patients catheter-directed thrombolysis with rt-PA or urokinase was initially carried out, which was followed by endovascular angioplasty (balloon dilatation or stent placement) in two days. The clinical data and the therapeutic results were analyzed. Results: Technical success was achieved in all 12 patients. The mean time of thrombolysis was 48 hours. Of 12 patients, rt-PA was employed in 4 and urokinase in 8. The occluded length of the diseased arteries before the treatment was 60-150 mm, with a mean of 80 mm. After catheter-directed thrombolysis,the occluded length decreased to 10-50 mm (mean of 30 mm). Endovascular angioplasty was successfully completed in all patients after thrombolysis therapy. Postoperative ABI was 0.64-1.0 (mean of 0.86), which was increased by 0.53 when compared to the preoperative figure. During the perioperative period neither complications needed to be surgically treated nor death occurred. All patients were followed up, and the arteries remained open after one year in all cases. Conclusion

Percutaneous untying of a knot in a retained Swan-Ganz catheter

International Nuclear Information System (INIS)

Bhatti, Waqar A.; Sinha, Sankar; Rowlands, Peter

2000-01-01

A patient was referred to us with a tightly knotted Swan-Ganz catheter. The catheter could not be removed by conventional simple methods. We describe a minimally invasive means of removal of the catheter using an Amplatz gooseneck snare and an angioplasty balloon. This allowed the Catheter to be removed without trauma.

CO laser angioplasty system: efficacy of manipulatable laser angioscope catheter

Science.gov (United States)

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

1992-08-01

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

Segmentally enclosed thrombolysis in percutaneous transluminal angioplasty for femoropopliteal occlusions

DEFF Research Database (Denmark)

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

1991-01-01

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

Dosimetry of beta emitting radionuclides for use in balloon angioplasty

International Nuclear Information System (INIS)

Fox, R.A.

1997-01-01

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

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

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

2013-12-15

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

Balloon catheter dilation of benign esophageal stenosis in children

International Nuclear Information System (INIS)

Fan Guoping; Yu Juming; Zhong Weixing; Zhu Ming; Wu Yeming; Shi Chengren

2001-01-01

Objective: To evaluate the methods and effect of balloon catheter dilation of benign esophageal stenosis in children. Methods: 9 cases had an anastomotic stenosis after surgical correction of esophageal atresia; 11 cases of esophageal stenosis due to ingestion of caustics; one case had an lower esophageal stenosis after Nissen surgery and one case after gastro-esophagoplasty. Age ranged from 17 days to 7 years. Each case had a barium esophagram before balloon dilation. The balloon size varied from 3 to 10 mm in diameter. Results: 21 cases were successful after dilation of balloon catheter. There were no esophageal perforation and complications. The satisfactory results maintained from six months to thirty months. Conclusions: Balloon catheter dilation is a simple, safe and reliable method for the treatment of benign esophageal strictures in children as the first choice

[Coronary angioplasty simultaneous with the "kissing" technique in a bifurcation lesion: use of a guidewire, and 2 monorail systems of rapid interchange].

Science.gov (United States)

Escudero, X

1996-01-01

Coronary branch occlusion complicating percutaneous coronary angioplasty has been recognized in certain bifurcation lesions. The utilization of double angioplasty systems simultaneously has been called "kissing" because the image of contact between balloons, and has been utilized as an alternative to protect the jeopardized branch or prevent snowplow lesion of the principal artery. The technological advance with the use of wide lumen catheters and low profile dilation balloons make the application of this technique possible in those type of lesions using a single guiding catheter. The present paper describes one case treated with this technique using conventional angioplasty systems in a complex bifurcating lesion of the circumflex artery. Some technical considerations about the procedure are made.

Double balloon esophageal catheter for diagnosis of tracheo-esophageal fistula

International Nuclear Information System (INIS)

Kiyan, Guersu; Dagli, Tolga E.; Tugtepe, Halil; Kodalli, Nihat

2003-01-01

Congenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children. (orig.)

Femoral artery recanalisation with percutaneous angioplasty and segmentally enclosed plasminogen activator

DEFF Research Database (Denmark)

Jørgensen, B; Tønnesen, K H; Bülow, J

1989-01-01

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

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

International Nuclear Information System (INIS)

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

2003-01-01

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

Peripheral Applications of Drug-Coated Balloons: Past, Present and Future

Energy Technology Data Exchange (ETDEWEB)

Krokidis, Miltiadis, E-mail: mkrokidis@hotmail.com; Spiliopoulos, Stavros, E-mail: stavspiliop@upatras.gr; Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Sabharwal, Tarun, E-mail: tarun_sabharwal@yahoo.co.uk [Guy' s and St. Thomas' Hospitals, NHS Foundation Trust, Department of Radiology (United Kingdom)

2013-04-15

Drug-coated balloon (DCB) technologies represent the latest and hottest development in the field of endovascular treatment of peripheral arterial disease. Initial experience with paclitaxel-coated balloon use in the femoral artery has demonstrated lower mid-term restenosis and superior mid-term clinical outcomes in terms of improved wound healing and reduced repeat angioplasty rates compared with standard balloon angioplasty. Many companies are presently developing and/or improving DCB catheters and therefore ongoing, technical improvements of the already existing platforms, new drugs, and innovative carriers are expected. The ongoing basic research studies and various multicenter randomized, controlled trials that are currently in progress will offer valuable scientific insights regarding the long-term effectiveness and other crucial issues, such as efficacy in various vascular beds, optimal balloon dosage, and post angioplasty antiplatelet therapy. Future applications of these devices also could include in-stent restenosis, anastomotic stenosis of surgical bypass, and benign stenoses of the central venous system. The authors envision that DCB angioplasty will evolve to a major paradigm shift in the endovascular treatment of occlusive vascular diseases.

Peripheral Applications of Drug-Coated Balloons: Past, Present and Future

International Nuclear Information System (INIS)

Krokidis, Miltiadis; Spiliopoulos, Stavros; Katsanos, Konstantinos; Sabharwal, Tarun

2013-01-01

Drug-coated balloon (DCB) technologies represent the latest and hottest development in the field of endovascular treatment of peripheral arterial disease. Initial experience with paclitaxel-coated balloon use in the femoral artery has demonstrated lower mid-term restenosis and superior mid-term clinical outcomes in terms of improved wound healing and reduced repeat angioplasty rates compared with standard balloon angioplasty. Many companies are presently developing and/or improving DCB catheters and therefore ongoing, technical improvements of the already existing platforms, new drugs, and innovative carriers are expected. The ongoing basic research studies and various multicenter randomized, controlled trials that are currently in progress will offer valuable scientific insights regarding the long-term effectiveness and other crucial issues, such as efficacy in various vascular beds, optimal balloon dosage, and post angioplasty antiplatelet therapy. Future applications of these devices also could include in-stent restenosis, anastomotic stenosis of surgical bypass, and benign stenoses of the central venous system. The authors envision that DCB angioplasty will evolve to a major paradigm shift in the endovascular treatment of occlusive vascular diseases.

Intravascular Ultrasound Imaging of Peripheral Arteries as an Adjunct to Balloon Angioplasty and Atherectomy

International Nuclear Information System (INIS)

Korogi, Yukunori; Hirai, Toshinori; Takahashi, Mutsumasa

1996-01-01

This article reviews many of the applications of intravascular ultrasound (US) imaging for peripheral arterial diseases. In vitro studies demonstrate an excellent correlation between ultrasound measurements of lumen and plaque crossectional area compared with histologic sections. In vivo clinical studies reveal the enhanced diagnostic capabilities of this technology compared with angiography. Intravascular US imaging can provide valuable information on the degree, eccentricity, and histologic type of stenosis before intervention, and on the morphological changes in the arterial wall and the extent of excision after intervention. Intravascular US may also serve as a superior index for gauging the diameter of balloon, stent, laser probe, and/or atherectomy catheter appropriate for a proposed intervention. Significant new insights into the mechanisms of balloon angioplasty and atherectomy have been established by intravascular US findings. Intravascular US imaging has been shown to be a more accurate method than angiography for determining the cross-sectional area of the arterial lumen, and for assessing severity of stenosis. Quantitative assessment of the luminal cross-sectional area after the balloon dilatation should be more accurate than angiography as intimal tears or dissections produced by the dilatation may not be accurately evaluated with angiography. At the present time, intravascular US is still a controversial imaging technique. Outcome studies are currently being organized to assess the clinical value and cost effectiveness of intravascular ultrasound in the context of these interventional procedures

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

Science.gov (United States)

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

1991-05-01

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

Cutting-balloon angioplasty of resistant ureteral stenosis as bridge to stent insertion

Energy Technology Data Exchange (ETDEWEB)

Iezzi, R., E-mail: iezzir@virgilio.it [Department of Bioimaging and Radiological Sciences, Institute of Radiology, ' A. Gemelli' Hospital - Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Di Stasi, C.; Simeone, A.; Bonomo, L. [Department of Bioimaging and Radiological Sciences, Institute of Radiology, ' A. Gemelli' Hospital - Catholic University, L.go A Gemelli 8, 00168 Rome (Italy)

2011-07-15

Ureteral stenting is a routine, minimally invasive procedure performed for relief of benign or malignant obstruction. In case of ureteral stenosis, to allow a correct insertion of the stent, a predilatation of the ureter stenosis with a conventional balloon catheter can be necessary. In exceptional cases, it can be difficult to advance an 7-8 Fr JJ-catheter over a tight resistant ureter stenosis following unsuccessful high-pressure balloon dilatation. In the present report, we describe two cases of resistant ureter stenosis successfully dilated by a cutting-balloon following the failure of high-pressure balloon dilatation, allowing a correct and uncomplicated antegrade stent insertion.

Cutting-balloon angioplasty of resistant ureteral stenosis as bridge to stent insertion

International Nuclear Information System (INIS)

Iezzi, R.; Di Stasi, C.; Simeone, A.; Bonomo, L.

2011-01-01

Ureteral stenting is a routine, minimally invasive procedure performed for relief of benign or malignant obstruction. In case of ureteral stenosis, to allow a correct insertion of the stent, a predilatation of the ureter stenosis with a conventional balloon catheter can be necessary. In exceptional cases, it can be difficult to advance an 7-8 Fr JJ-catheter over a tight resistant ureter stenosis following unsuccessful high-pressure balloon dilatation. In the present report, we describe two cases of resistant ureter stenosis successfully dilated by a cutting-balloon following the failure of high-pressure balloon dilatation, allowing a correct and uncomplicated antegrade stent insertion.

Double-Balloon Catheter for Isolated Liver Perfusion: An Experimental Study

International Nuclear Information System (INIS)

Cwikiel, Wojciech; Bergqvist, Lennart; Harnek, Jan

2001-01-01

Purpose: Further development of a previously described interventional method for isolated liver perfusion (ILP) with a new double-lumen balloon catheter, and evaluation of the side-effects of such isolation.Methods: In six pigs a double-balloon occlusion catheter was placed via the transjugular approach with its tip in the portal vein. One of the balloons was positioned in the inferior vena cava (IVC), cranial to the origin of the hepatic veins and the other balloon in the portal vein. By the transfemoral approach, a single-balloon occlusion catheter was placed in the IVC caudal to the origin of the hepatic veins. A third catheter was placed by the transfemoral route with the occlusion balloon in the proper hepatic artery. After inflation of all balloons 99 Tc m -labelled human serum albumin was recirculated through the liver. The isolation was evaluated by repeated measurement of radioactivity levels in peripheral blood. Laboratory tests of liver and pancreas function, and hemoglobin, were taken before, at the end of, and 3 days after the procedure. Blood gases were tested at the beginning and end of the procedure.Results: One pig died during the procedure due to technical failure and was excluded from the study. In the other pigs leakage from the isolated liver to the systemic circulation increased slowly, up to 9.7% (mean) during 30 min of recirculation of the perfusate through the liver. Laboratory tests were normal in all pigs except insignificant acidosis directly after the procedure and the slight elevation of s-ALAT after 3 days.Conclusions: Only minor leakage from the liver to the systemic circulation was noted during ILP performed with a new, double-balloon catheter. There were no serious side effects

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

Science.gov (United States)

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

2013-01-01

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

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

International Nuclear Information System (INIS)

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

2004-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2004-12-01

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

Balloon catheter dilatation of esophageal strictures in children and an infant

International Nuclear Information System (INIS)

Yeon, Kyung Mo; Choe, Yeon Hyeon; Kim, In One

1986-01-01

Severe postoperative strictures in two children and an infant and mild postoperative stricture in a child were treated with balloon catheter. A child with post-fundoplication stricture showed symptomatic improvement. Anastomotic strictures after esophageal atresia repair in an infant and a child were successfully dilated with improved luminal diameter and symptoms. In a child with mild postoperative stricture, balloon dilatation was performed to prevent stricture of the anastomotic site. Radiological esophageal dilatation using balloon catheters is a safe effective method for dilating symptomatic esophageal strictures which obviates surgery and allows subsequent standard bougienage.

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

Science.gov (United States)

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

2013-09-01

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

CT arterial portography and CT arteriography with a triple-lumen balloon catheter

International Nuclear Information System (INIS)

Murakami, T.; Oi, H.; Hori, M.; Kim, T.; Takahashi, S.; Matsushita, M.; Narumi, Y.; Nakamura, H.

1997-01-01

Purpose: To evaluate the usefulness of the triple-lumen balloon catheter in the serial performance of CT arterial portography (CT-AP) and CT arteriography (CT-A). Material and Methods: A combined CT-AP and CT-A examination of 58 patients was carried out in which a cobra-type triple-lumen balloon catheter was used. CT-AP was performed by injecting contrast medium either into the splenic artery through a side-hole in the catheter proximal to the balloon inflated in the common hepatic artery, or into the superior mesentric artery through an end-hole in the catheter. Then CT-A was serially performed by delivering contrast medium either to the common hepatic artery or the proper hepatic artery from the end-hole, or to the accessory right hepatic artery through a side-hole proximal to the inflated balloon. Results: Sufficient CT-APs were obtained in 53 of the 58 patients (91%), CT-A in 42 (72%), and both in 42 (72%). Incomplete CT-AP was due to technical failure or anatomical anomaly, as was incomplete CT-A. No complications were seen. (orig.)

Clinical application of Inoue-balloon in percutaneous transluminal angioplasty for Budd-Chiari syndrome

International Nuclear Information System (INIS)

Mei Jian; Qu Jian; Zhu Yaoqing; Wang Lei; Liu Cheng

2007-01-01

Objective: To investigate the feasibility and effect of recanalization of inferior vena cava with percutaneous transluminal angioplasty(PTA)by Inoue-balloon. Methods: Eighty-nine patients with Budd-chiari syndrome (BCS )were treated with PTA by Inoue-balloon. Results: After PTA, the median (interquartile range)diameter of hepatic segment inferior vena cava increased from 0.00 (0.20-0.00) cm to 1.90 (2.00 1.47)cm; (P < 0.001), and the mean pressure of inferior vena cava reduced from (20.63 ± 7.22) mmHg to (12.13 ± 5.60) mmHg; (P < 0.001); with only less serious complications as rupture in two cases and without need of prior minor diameter balloon dilation in Inoue-balloon PTA. Conclusion: The advantages of Inoue- balloon PTA for BCS are more reliable and facile than those of polyethylene balloon, and may take the place in the foreseen future. (authors)

Innovations in Balloon Catheter Technology in Rhinology.

Science.gov (United States)

D'Anza, Brian; Sindwani, Raj; Woodard, Troy D

2017-06-01

Since being introduced more than 10 years ago, balloon catheter technology (BCT) has undergone several generations of innovations. From construction to utilization, there has been a myriad of advancements in balloon technology. The ergonomics of the balloon dilation systems have improved with a focus on limiting the extra assembly. "Hybrid" BCT procedures have shown promise in mucosal preservation, including treating isolated complex frontal disease. Multiple randomized clinical trials report improved long-term outcomes in stand-alone BCT, including in-office use. The ever-expanding technological innovations ensure BCT will be a key component in the armamentarium of the modern sinus surgeon. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of Reactor-Produced Radioisotopes for Prevention Restenosis After Angioplasty

International Nuclear Information System (INIS)

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

1999-01-01

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

Percutaneous transluminal coronary angioplasty

International Nuclear Information System (INIS)

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

1984-01-01

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

Acute occlusion of the coronary artery after transluminal balloon coronary angioplasty

International Nuclear Information System (INIS)

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

1995-01-01

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

Diffusion-weighted magnetic resonance imaging in carotid angioplasty and stenting with balloon embolic protection devices

International Nuclear Information System (INIS)

Asakura, Fumio; Kawaguchi, Kenji; Sakaida, Hiroshi; Toma, Naoki; Matsushima, Satoshi; Kuraishi, Keita; Tanemura, Hiroshi; Miura, Yoichi; Taki, Waro; Maeda, Masayuki

2006-01-01

We compared the results of two procedures to protect against distal embolism caused by embolic debris from carotid angioplasty with stent deployment (CAS) using diffusion-weighted magnetic resonance imaging (MRI). The study group comprised 39 men and 3 women (42 and 3 CAS procedures, respectively) with severe carotid stenosis (average age 70.0±6.6 years). During 20 CAS procedures the internal carotid artery was protected with a single balloon. A PercuSurge GuardWire was used for temporary occlusion. During 25 CAS procedures the internal and external carotid arteries were simultaneously temporarily occluded with a PercuSurge GuardWire and a Sentry balloon catheter, respectively. Diffusion-weighted MRI was performed 1 to 3 days after CAS. Data from 26 patients undergoing conventional angiography for diagnosis of cerebral ischemic disease, cerebral aneurysm or brain tumors were included as controls. Diffusion-weighted MRI after conventional diagnostic angiography showed ischemic spots in 3 of the 26 controls (11.5%). Ischemic spots were observed during 11 of 20 CAS procedures with the internal carotid artery protected with a single balloon (55.0%), and were observed during 9 of 25 CAS procedures with both the internal and external carotid arteries protected (36.0%). This difference was significant (P=0.0068). Ischemic lesions appeared not only ipsilateral to the carotid stenosis but also in the contralateral carotid artery (31.9%) and vertebrobasilar territory (25.3%). Better protection was obtained with simultaneous double occlusion of both the internal and external carotid artery than with single protection of the internal carotid artery during CAS. (orig.)

Balloon-tipped flow-directed catheters

International Nuclear Information System (INIS)

Ganz, P.; Swan, H.J.C.; Ganz, W.

1986-01-01

Diagnostic catheterization of the right side of the heart with semirigid cardiac catheters requires fluoroscopic guidance and substantial skill. Abnormal positions of the heart chambers and of the great vessels associated with cardiac dilatation or with congenital malformation present difficulties even to experienced laboratory cardiologists. These problems have been largely overcome by the introduction of balloon tipped flow directed catheters, which allow for rapid and relatively safe catheterization of the pulmonary artery without fluoroscopy. It was through the application of these catheters in the intensive care unit that the many pitfalls in the clinical assessment of hemodynamic disturbances became apparent. Although S3 gallop sounds may be useful in the clinical recognition of chronic ventricular failure, their presence or absence has limited predictive value in estimating left ventricular filling pressure in myocardial infarction. Information derived from right heart catheterization is often pivotal in the evaluation of hemodynamic disorders, in directing treatment, and in monitoring the results of therapy in critically ill patients

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

DEFF Research Database (Denmark)

Verheye, Stefan; Vrolix, Mathias; Kumsars, Indulis

2017-01-01

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

Clinical impact and risk stratification of balloon angioplasty for femoropopliteal disease in nitinol stenting era: Retrospective multicenter study using propensity score matching analysis

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Taketsugu Tsuchiya

2016-07-01

Full Text Available Objective: Nitinol stenting could bring the better outcome in endovascular therapy for femoropopliteal disease. However, it might be expected that recent marked advances in both device technology and operator technique had led to improved efficacy of balloon angioplasty even in this segment. The aims of this study were to evaluate the clinical impact of balloon angioplasty for femoropopliteal disease and make risk stratification clear by propensity score matching analysis. Methods: Based on the multicenter retrospective data, 2758 patients (balloon angioplasty: 729 patients and nitinol stenting: 2029 patients, those who underwent endovascular therapy for femoropopliteal disease, were analyzed. Results: The propensity score matching procedure extracted a total of 572 cases per group, and the primary patency rate of balloon angioplasty and nitinol stenting groups after matching was significantly the same (77.2% vs 82.7% at 1 year; 62.2% vs 64.3% at 3 years; 47.8% vs 54.3% at 5 years. In multivariate Cox hazard regression analysis, significant predictors for primary patency were diabetes mellitus, regular dialysis, cilostazol use, chronic total occlusion, and intra-vascular ultra-sonography use. The strategy of balloon angioplasty was not evaluated as a significant predictor for the primary patency. After risk stratification using five items (diabetes mellitus, regular dialysis, no use of intra-vascular ultra-sonography, chronic total occlusion, and no use of cilostazol: the DDICC score, the estimated primary patency rates of each group (low, DDICC score 0–2; moderate, DDICC score 3; high risk, DDICC score 4–5 were 88.6%, 78.3%, and 63.5% at 1 year; 75.2%, 60.7%, and 39.8% at 3 years; and 66.0%, 47.1%, and 26.3% at 5 years (p < 0.0001. The primary patency rate of balloon angioplasty and nitinol stenting groups was significantly the same in each risk stratification. Conclusion: This study suggests that balloon angioplasty does

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

International Nuclear Information System (INIS)

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

2007-01-01

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

Angioplasty and stent - heart - discharge

Science.gov (United States)

Drug-eluting stents - discharge; PCI - discharge; Percutaneous coronary intervention - discharge; Balloon angioplasty - discharge; Coronary angioplasty - discharge; Coronary artery angioplasty - discharge; Cardiac ...

Removing Nasal Packing in Epistaxis: What to Do in the Case of an Undeflatable Foley Catheter Balloon

Directory of Open Access Journals (Sweden)

Gaspar-Sobrinho, Fernando Pena

2014-01-01

Full Text Available Introduction Undeflatable Foley catheter balloons adapted for use as nasal packing in epistaxis represent a possible complication. Case Reports We report on three cases in which Foley catheter balloons adapted for use as posterior nasal packing in epistaxis failed to deflate. In one patient, deflation was achieved by simply using the fingertips to massage the segment of the catheter collapsed by the fixation device. In the second case, the Foley balloon was removed by the oral route after sectioning the catheter. In the third patient, the Foley catheter was successfully deflated after sectioning. Discussion The probable causes of the undeflatable balloons in these cases were a blockage or lumen collapse of the balloon or a malfunction in the valve system. Although no definitive method has been established for dealing with this complication, the options proposed are the following: manipulation to restore the permeability of the segment of the catheter collapsed by the fixation device, if this is the case; sectioning the catheter or inserting a stiletto catheter; bursting the balloon; or removing it by the oral route. The latter option is apparently the most appropriate for the otolaryngologist in cases unrelated to simple collapse caused by the fixation device.

Successful Venous Angioplasty of Superior Vena Cava Syndrome after Heart Transplantation

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Thomas Strecker

2014-01-01

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

New developments in the clinical use of drug-coated balloon catheters in peripheral arterial disease

Directory of Open Access Journals (Sweden)

Naghi J

2016-06-01

Full Text Available Jesse Naghi, Ethan A Yalvac, Ali Pourdjabbar, Lawrence Ang, John Bahadorani, Ryan R Reeves, Ehtisham Mahmud, Mitul Patel Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, CA, USA Abstract: Peripheral arterial disease (PAD involving the lower extremity is a major source of morbidity and mortality. Clinical manifestations of PAD span the spectrum from lifestyle limiting claudication to ulceration and gangrene leading to amputation. Advancements including balloon angioplasty, self-expanding stents, drug-eluting stents, and atherectomy have resulted in high technical success rates for endovascular therapy in patients with PAD. However, these advances have been limited by somewhat high rates of clinical restenosis and clinically driven target lesion revascularization. The recent introduction of drug-coated balloon technology shows promise in limiting neointimal hyperplasia induced by vascular injury after endovascular therapies. This review summarizes the contemporary clinical data in the emerging area of drug-coated balloons. Keywords: drug-coated balloons, endovascular, percutaneous transluminal angioplasty, paclitaxel, peripheral arterial disease

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

NARCIS (Netherlands)

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

1999-01-01

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

Absence of Bacteria on Coronary Angioplasty Balloons from Unselected Patients

DEFF Research Database (Denmark)

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

2015-01-01

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

Retrograde prostatic urethroplasty with balloon catheter

International Nuclear Information System (INIS)

Castaneda, F.; Reddy, P.; Hulbert, J.; Letourneau, J.G.; Hunter, D.W.; Castaneda-Zuniga, W.R.; Amplatz, K.

1987-01-01

The authors performed retrograde prostatic urethroplasty in 18 patients using a 25-mm urethroplasty balloon catheter. The procedure was performed on an outpatient basis under local anesthesia. Voiding cystourethrography, retrograde urethrography, rectal US, and MRE imaging were performed before and immediately after the procedure and at 2 weeks and 3, 6, 12, and 18 months. Long-term results at 18 months and possible clinical implications are discussed

Does water-perfused catheter overdiagnose anismus compared to balloon probe?

Science.gov (United States)

Savoye, G; Leroi, A M; Bertot-Sassigneux, P; Touchais, J Y; Devroede, G; Denis, P

2002-12-01

The purpose of this study was to compare the manometric assessment of straining effort as if to defecate and rectoanal inhibitory reflex obtained with a rectosphincteric balloon probe and with a water-perfused catheter in the same subject. Twelve healthy volunteers underwent two manometric assessments of anal sphincter function and electromyographic (EMG) surface recordings. one with a rectosphincteric balloon and one with a water-perfused catheter, 7 days apart in random order. Increased EMG activity in the external anal sphincter in the midst of the rectoanal inhibitory reflex (P anismus, particularly if pelvic floor EMG is only taken into account for the diagnosis of anismus.

[Valvuloplasty with balloon catheter in biologic prosthesis. Reality or illusion].

Science.gov (United States)

Ledesma Velasco, M; Verdín Vázquez, R; Acosta Valdez, J L; Munayer Calderón, J; Salgado Escobar, J L; Arias Monroy, L; Flores Mendoza, J

1989-01-01

We performed catheter balloon valvuloplasty (CBV) on 8 stenotic operatively-excised bioprosthetic valves (2 Hancock and 6 Ionescu Shiley). Pathology of valves before CBV included degenerative changes: commissural fusion by mounds of calcific deposits (2 valves), fibrotic and focally calcified leaflets (7 valves) and stiff and thick valves (1 valve). Inflation of the balloon resulted in commissural splitting (2 valves), leaflet cracks and fractures (3 valves). Removal of the deflated balloon catheter was associated with debris dislodgement (3 valves). In one case the valve was unable to close with potential for acute regurgitation. Thus, CBV of bioprosthetic valves can split fused commissures by similar mechanisms as in native valves. CBV may fracture calcific deposits causing acute emboli. It can also disrupt the leaflets causing acute insufficiency. The findings suggest a limited role of CBV in the treatment of stenotic bioprosthetic valves in mitral and aortic position.

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

Science.gov (United States)

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

1995-03-01

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

REcanalisation and Balloon-Oriented Puncture for Re-Insertion of Dialysis Catheter in Nonpatent Central Veins (REBORN)

International Nuclear Information System (INIS)

Too, Chow Wei; Sayani, Raza; Lim, Elvin Yuan Ting; Leong, Sum; Gogna, Apoorva; Teo, Terence K.

2016-01-01

PurposeTo describe a technique involving REcanalisation and Balloon-Oriented puncture for Re-insertion of dialysis catheter in Nonpatent central veins (REBORN) and to report long-term results.Materials and MethodsThis is a retrospective study of ten subjects in whom dialysis catheters were inserted using the REBORN technique from March 2012 to October 2014 and followed up till April 2016. Data on the duration of catheter usage, complications and reasons for removal were obtained. Seven patients had partially occluded lower internal jugular veins (IJV) recanalised in an antegrade fashion via a more cranial puncture. The balloon was then inflated at usual puncture site with an 18G needle. The collapsed balloon was cannulated with a guide wire, and both balloon and guide wire were advanced together into the superior vena cava. This was followed by tunnelled catheter placement using standard techniques. Two patients had catheters placed in the subclavian vein using a similar antegrade technique, and one patient had catheter placed via the left IJV following retrograde recanalisation from a right femoral puncture.ResultsMean duration of catheter use was 278 days (range 32–503). Three catheters were removed due to matured arteriovenous accesses. Four patients had successful catheter change over the same subcutaneous track due to catheter malfunction. One catheter was removed after 7 months because of sepsis. No complications were reported.ConclusionThe REBORN technique allows for the preservation of central veins for future haemodialysis access, which can be challenging in patients requiring long-term dialysis.

REcanalisation and Balloon-Oriented Puncture for Re-Insertion of Dialysis Catheter in Nonpatent Central Veins (REBORN)

Energy Technology Data Exchange (ETDEWEB)

Too, Chow Wei, E-mail: toochowwei@gmail.com [Singapore General Hospital (Singapore); Sayani, Raza [Aga Khan University Hospital (Pakistan); Lim, Elvin Yuan Ting; Leong, Sum; Gogna, Apoorva [Singapore General Hospital (Singapore); Teo, Terence K. [Mount Elizabeth Novena Hospital (Singapore)

2016-08-15

PurposeTo describe a technique involving REcanalisation and Balloon-Oriented puncture for Re-insertion of dialysis catheter in Nonpatent central veins (REBORN) and to report long-term results.Materials and MethodsThis is a retrospective study of ten subjects in whom dialysis catheters were inserted using the REBORN technique from March 2012 to October 2014 and followed up till April 2016. Data on the duration of catheter usage, complications and reasons for removal were obtained. Seven patients had partially occluded lower internal jugular veins (IJV) recanalised in an antegrade fashion via a more cranial puncture. The balloon was then inflated at usual puncture site with an 18G needle. The collapsed balloon was cannulated with a guide wire, and both balloon and guide wire were advanced together into the superior vena cava. This was followed by tunnelled catheter placement using standard techniques. Two patients had catheters placed in the subclavian vein using a similar antegrade technique, and one patient had catheter placed via the left IJV following retrograde recanalisation from a right femoral puncture.ResultsMean duration of catheter use was 278 days (range 32–503). Three catheters were removed due to matured arteriovenous accesses. Four patients had successful catheter change over the same subcutaneous track due to catheter malfunction. One catheter was removed after 7 months because of sepsis. No complications were reported.ConclusionThe REBORN technique allows for the preservation of central veins for future haemodialysis access, which can be challenging in patients requiring long-term dialysis.

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

Science.gov (United States)

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

2016-01-01

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

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

NARCIS (Netherlands)

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

2001-01-01

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

Measurement of hepatic venous pressure gradient revisited: Catheter wedge vs balloon wedge techniques

Directory of Open Access Journals (Sweden)

S Timothy Chelliah

2011-01-01

Full Text Available Aims: To evaluate the accuracy of measurement of hepatic venous pressure gradient by catheter wedge as compared to balloon wedge (the gold standard. Materials and Methods: Forty-five patients having a clinical diagnosis of intrahepatic portal hypertension were subjected to the two different types of pressure measurements (catheter wedge and balloon wedge during transjugular liver biopsy under fluoroscopic guidance. Statistical Analysis: Spearman′s rank correlation coefficient, Bland-Altman plot for agreement, and single measure intraclass correlation were used for analysis of data. Results: There was a close correlation between the results obtained by both the techniques, with highly significant concordance (P < 0.0001. Hepatic venous pressure gradients as measured by the catheter wedge technique were either equal to or less than those obtained by the balloon wedge technique. Conclusions: The difference in hepatic venous pressure gradients measured by the two techniques is insignificant.

Critical appraisal of paclitaxel balloon angioplasty for femoral–popliteal arterial disease

Directory of Open Access Journals (Sweden)

Herten M

2016-08-01

Full Text Available Monika Herten,1 Giovanni B Torsello,1,2 Eva Schönefeld,3 Stefan Stahlhoff2 1Department of Vascular and Endovascular Surgery, University Hospital Münster, 2Department of Vascular Surgery, St Franziskus Hospital, Münster, 3Institute for Education and Student Affairs, University Hospital Münster, Münster, Germany Abstract: Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis. This article reviews the results of DCB treatments of femoropopliteal and infrapopliteal lesions in comparison to standard angioplasty with uncoated balloons. A systematic literature search was performed in 1 medical journals (ie, MEDLINE, 2 international registers for clinical studies (ie, www.clinicaltrials.gov, and 3 abstracts of scientific sessions. Several controlled randomized trials with follow-up periods of up to 5 years demonstrated the efficacy of paclitaxel –DCB technology. However, calcified lesions seem to affect the efficacy of DCB. Combinations of preconditioning methods with DCBs showed promising results. Although the mechanical abrasion of calcium via atherectomy or laser ablation showed favorable periprocedural results, the long-term impact on restenosis and clinical outcome has to be demonstrated. Major advantages of the DCBs are the rapid delivery of drug at uniform concentrations with a single dose, their efficacy in areas wherein stents have been

Emergent intracranial balloon angioplasty and bailout self-expandable stent placement in acute large vessel occlusion of the anterior circulation: Experience of a single institution

International Nuclear Information System (INIS)

Heo, Young Jin; Seo, Jung Hwa; Jeong, Hae Woong

2017-01-01

To evaluate the outcomes of angioplasty for recanalization after acute ischemic stroke (AIS). The study population was selected from 134 patients who underwent endovascular revascularization therapy (ERT) for AIS between October 2011 and May 2014. Of those 134 patients, 39 who underwent balloon angioplasty with or without stent insertion were included in this study. Balloon angioplasty was the primary treatment for nine patients and a rescue method for 30 patients. The revascularization rate at 7 days, procedure-related complications, and clinical outcomes at 3 months were analyzed. The occlusion sites were the middle cerebral artery (n = 26), intracranial internal carotid artery (n = 10), and middle cerebral artery branch (n = 3). Angioplasty achieved successful revascularization (Thrombolysis in Cerebral Ischemia grade 2b–3) in 76.9% of patients. Computed tomography angiography performed 7 days post-procedure revealed a maintained reperfusion in 82.8% of successful cases. Only two patients had symptomatic intracerebral hemorrhage. At the 3-month follow-up, 18 (48.6%) and 10 (27.0%) patients showed good and poor functional outcomes, respectively (modified Rankin Scale scores, 0–2 and 5–6). Emergent balloon angioplasty and bailout self-expandable stent placement may be safe and effective for achieving successful revascularization in acute large vessel occlusion of the anterior circulation. It could be a feasible rescue method as well as a primary method for ERT

Emergent intracranial balloon angioplasty and bailout self-expandable stent placement in acute large vessel occlusion of the anterior circulation: Experience of a single institution

Energy Technology Data Exchange (ETDEWEB)

Heo, Young Jin; Seo, Jung Hwa; Jeong, Hae Woong [Busan Paik Hospital, Inje University, Busan (Korea, Republic of)

2017-06-15

To evaluate the outcomes of angioplasty for recanalization after acute ischemic stroke (AIS). The study population was selected from 134 patients who underwent endovascular revascularization therapy (ERT) for AIS between October 2011 and May 2014. Of those 134 patients, 39 who underwent balloon angioplasty with or without stent insertion were included in this study. Balloon angioplasty was the primary treatment for nine patients and a rescue method for 30 patients. The revascularization rate at 7 days, procedure-related complications, and clinical outcomes at 3 months were analyzed. The occlusion sites were the middle cerebral artery (n = 26), intracranial internal carotid artery (n = 10), and middle cerebral artery branch (n = 3). Angioplasty achieved successful revascularization (Thrombolysis in Cerebral Ischemia grade 2b–3) in 76.9% of patients. Computed tomography angiography performed 7 days post-procedure revealed a maintained reperfusion in 82.8% of successful cases. Only two patients had symptomatic intracerebral hemorrhage. At the 3-month follow-up, 18 (48.6%) and 10 (27.0%) patients showed good and poor functional outcomes, respectively (modified Rankin Scale scores, 0–2 and 5–6). Emergent balloon angioplasty and bailout self-expandable stent placement may be safe and effective for achieving successful revascularization in acute large vessel occlusion of the anterior circulation. It could be a feasible rescue method as well as a primary method for ERT.

In Vitro Urethra Model to Characterize The Frictional Properties of Urinary Catheters

DEFF Research Database (Denmark)

Røn, Troels; Lee, Seunghwan

2016-01-01

conformal sliding contacts with the catheter and high relevance to clinical catherization. With the proposed urethra model assembled in texture analyzer, the lubricity of catheters lubricated in different modes was tested. In comparison with conventional pin-on-disk tribometry, the coefficients of friction......, frictional properties of tubular devices such as catheters, endoscopes, and angioplasty balloons are particularly challenging to characterize because of non-standard shape and contact configuration. In this study, we propose that fabrication of in vitro urethra model with castable elastomers can provide...... of sliding contacts with the urethra model with unlubricated and lubricated catheters were determined. Impact of the improved bio-relevance of friction testing methods on the evaluation of various catheter materials and surface modification methods is discussed in detail....

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

LENUS (Irish Health Repository)

Forde, J C

2012-03-01

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

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.

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

International Nuclear Information System (INIS)

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

2005-01-01

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

Magnetic Particle / Magnetic Resonance Imaging: In-Vitro MPI-Guided Real Time Catheter Tracking and 4D Angioplasty Using a Road Map and Blood Pool Tracer Approach.

Science.gov (United States)

Salamon, Johannes; Hofmann, Martin; Jung, Caroline; Kaul, Michael Gerhard; Werner, Franziska; Them, Kolja; Reimer, Rudolph; Nielsen, Peter; Vom Scheidt, Annika; Adam, Gerhard; Knopp, Tobias; Ittrich, Harald

2016-01-01

In-vitro evaluation of the feasibility of 4D real time tracking of endovascular devices and stenosis treatment with a magnetic particle imaging (MPI) / magnetic resonance imaging (MRI) road map approach and an MPI-guided approach using a blood pool tracer. A guide wire and angioplasty-catheter were labeled with a thin layer of magnetic lacquer. For real time MPI a custom made software framework was developed. A stenotic vessel phantom filled with saline or superparamagnetic iron oxide nanoparticles (MM4) was equipped with bimodal fiducial markers for co-registration in preclinical 7T MRI and MPI. In-vitro angioplasty was performed inflating the balloon with saline or MM4. MPI data were acquired using a field of view of 37.3×37.3×18.6 mm3 and a frame rate of 46 volumes/sec. Analysis of the magnetic lacquer-marks on the devices were performed with electron microscopy, atomic absorption spectrometry and micro-computed tomography. Magnetic marks allowed for MPI/MRI guidance of interventional devices. Bimodal fiducial markers enable MPI/MRI image fusion for MRI based roadmapping. MRI roadmapping and the blood pool tracer approach facilitate MPI real time monitoring of in-vitro angioplasty. Successful angioplasty was verified with MPI and MRI. Magnetic marks consist of micrometer sized ferromagnetic plates mainly composed of iron and iron oxide. 4D real time MP imaging, tracking and guiding of endovascular instruments and in-vitro angioplasty is feasible. In addition to an approach that requires a blood pool tracer, MRI based roadmapping might emerge as a promising tool for radiation free 4D MPI-guided interventions.

Magnetic Particle / Magnetic Resonance Imaging: In-Vitro MPI-Guided Real Time Catheter Tracking and 4D Angioplasty Using a Road Map and Blood Pool Tracer Approach.

Directory of Open Access Journals (Sweden)

Johannes Salamon

Full Text Available In-vitro evaluation of the feasibility of 4D real time tracking of endovascular devices and stenosis treatment with a magnetic particle imaging (MPI / magnetic resonance imaging (MRI road map approach and an MPI-guided approach using a blood pool tracer.A guide wire and angioplasty-catheter were labeled with a thin layer of magnetic lacquer. For real time MPI a custom made software framework was developed. A stenotic vessel phantom filled with saline or superparamagnetic iron oxide nanoparticles (MM4 was equipped with bimodal fiducial markers for co-registration in preclinical 7T MRI and MPI. In-vitro angioplasty was performed inflating the balloon with saline or MM4. MPI data were acquired using a field of view of 37.3×37.3×18.6 mm3 and a frame rate of 46 volumes/sec. Analysis of the magnetic lacquer-marks on the devices were performed with electron microscopy, atomic absorption spectrometry and micro-computed tomography.Magnetic marks allowed for MPI/MRI guidance of interventional devices. Bimodal fiducial markers enable MPI/MRI image fusion for MRI based roadmapping. MRI roadmapping and the blood pool tracer approach facilitate MPI real time monitoring of in-vitro angioplasty. Successful angioplasty was verified with MPI and MRI. Magnetic marks consist of micrometer sized ferromagnetic plates mainly composed of iron and iron oxide.4D real time MP imaging, tracking and guiding of endovascular instruments and in-vitro angioplasty is feasible. In addition to an approach that requires a blood pool tracer, MRI based roadmapping might emerge as a promising tool for radiation free 4D MPI-guided interventions.

Angioplasty: MedlinePlus Health Topic

Science.gov (United States)

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

Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: New Horizons in the Interventional Management of Pulmonary Embolism.

Science.gov (United States)

Rivers-Bowerman, Michael D; Zener, Rebecca; Jaberi, Arash; de Perrot, Marc; Granton, John; Moriarty, John M; Tan, Kong T

2017-09-01

Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed potential complication of acute or recurrent pulmonary thromboembolic disease. Multiple studies suggest that up to 5% of patients with acute pulmonary thromboembolic disease go on to develop CTEPH. The prognosis of untreated CTEPH is poor, but advances in medical and surgical treatments over the past few decades have improved patient outcomes. The gold standard and curative treatment for CTEPH is pulmonary endarterectomy; however, some patients are inoperable and others who have undergone pulmonary endarterectomy experience persistent or recurrent pulmonary hypertension despite medical therapy. In recent years, balloon pulmonary angioplasty has emerged as a primary and adjunctive treatment for these CTEPH patients at expert or specialized centers. This review outlines an approach to balloon pulmonary angioplasty for CTEPH, including clinical presentation and evaluation; patient selection and indications; treatment planning; equipment and technique; overcoming technical challenges; recognition and management of complications; postprocedural care and clinical follow-up; and expected outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Transcervical double-balloon catheter as an alternative and salvage method for medical termination of pregnancy in midtrimester

Directory of Open Access Journals (Sweden)

Yi-An Tu

2017-02-01

Conclusion: There was no significant additional benefit of using a double-balloon catheter in midtrimester termination of pregnancy, although the technique was considered simple and generally well-tolerated. Placing a transcervical double-balloon catheter could be the primary method, or one of the alternative medical methods if the patient and/or obstetrician prefers no operation.

Liquid- and air-filled catheters without balloon as an alternative to the air-filled balloon catheter for measurement of esophageal pressure.

Science.gov (United States)

Beda, Alessandro; Güldner, Andreas; Carvalho, Alysson R; Zin, Walter Araujo; Carvalho, Nadja C; Huhle, Robert; Giannella-Neto, Antonio; Koch, Thea; de Abreu, Marcelo Gama

2014-01-01

Measuring esophageal pressure (Pes) using an air-filled balloon catheter (BC) is the common approach to estimate pleural pressure and related parameters. However, Pes is not routinely measured in mechanically ventilated patients, partly due to technical and practical limitations and difficulties. This study aimed at comparing the conventional BC with two alternative methods for Pes measurement, liquid-filled and air-filled catheters without balloon (LFC and AFC), during mechanical ventilation with and without spontaneous breathing activity. Seven female juvenile pigs (32-42 kg) were anesthetized, orotracheally intubated, and a bundle of an AFC, LFC, and BC was inserted in the esophagus. Controlled and assisted mechanical ventilation were applied with positive end-expiratory pressures of 5 and 15 cmH2O, and driving pressures of 10 and 20 cmH2O, in supine and lateral decubitus. Cardiogenic noise in BC tracings was much larger (up to 25% of total power of Pes signal) than in AFC and LFC (<3%). Lung and chest wall elastance, pressure-time product, inspiratory work of breathing, inspiratory change and end-expiratory value of transpulmonary pressure were estimated. The three catheters allowed detecting similar changes in these parameters between different ventilation settings. However, a non-negligible and significant bias between estimates from BC and those from AFC and LFC was observed in several instances. In anesthetized and mechanically ventilated pigs, the three catheters are equivalent when the aim is to detect changes in Pes and related parameters between different conditions, but possibly not when the absolute value of the estimated parameters is of paramount importance. Due to a better signal-to-noise ratio, and considering its practical advantages in terms of easier calibration and simpler acquisition setup, LFC may prove interesting for clinical use.

Liquid- and air-filled catheters without balloon as an alternative to the air-filled balloon catheter for measurement of esophageal pressure.

Directory of Open Access Journals (Sweden)

Alessandro Beda

Full Text Available BACKGROUND: Measuring esophageal pressure (Pes using an air-filled balloon catheter (BC is the common approach to estimate pleural pressure and related parameters. However, Pes is not routinely measured in mechanically ventilated patients, partly due to technical and practical limitations and difficulties. This study aimed at comparing the conventional BC with two alternative methods for Pes measurement, liquid-filled and air-filled catheters without balloon (LFC and AFC, during mechanical ventilation with and without spontaneous breathing activity. Seven female juvenile pigs (32-42 kg were anesthetized, orotracheally intubated, and a bundle of an AFC, LFC, and BC was inserted in the esophagus. Controlled and assisted mechanical ventilation were applied with positive end-expiratory pressures of 5 and 15 cmH2O, and driving pressures of 10 and 20 cmH2O, in supine and lateral decubitus. MAIN RESULTS: Cardiogenic noise in BC tracings was much larger (up to 25% of total power of Pes signal than in AFC and LFC (<3%. Lung and chest wall elastance, pressure-time product, inspiratory work of breathing, inspiratory change and end-expiratory value of transpulmonary pressure were estimated. The three catheters allowed detecting similar changes in these parameters between different ventilation settings. However, a non-negligible and significant bias between estimates from BC and those from AFC and LFC was observed in several instances. CONCLUSIONS: In anesthetized and mechanically ventilated pigs, the three catheters are equivalent when the aim is to detect changes in Pes and related parameters between different conditions, but possibly not when the absolute value of the estimated parameters is of paramount importance. Due to a better signal-to-noise ratio, and considering its practical advantages in terms of easier calibration and simpler acquisition setup, LFC may prove interesting for clinical use.

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

NARCIS (Netherlands)

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

1993-01-01

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

Observation and nursing of complications due to high re-perfusion injury occurring after balloon angioplasty for diabetic vascular diseases of lower extremity

International Nuclear Information System (INIS)

Zhang Lingling; Zhu Yueqi; Mou Ling

2011-01-01

Objective: To evaluate the symptomatic nursing in treating the complications caused by high re-perfusion which develops after balloon angioplasty for the treatment of diabetic vascular diseases of lower extremity. Methods: Eighteen patients with lower limb ischemia caused by diabetes mellitus developed high re-perfusion injury complications after receiving balloon angioplasty. The patients were randomly and equally divided into study group and control group. The special nursing measures designed by the author's department, including raising the diseased lower limb, enforcing the flexion and extension movement of the leg, cold compress, wound exposure, etc. were carried out for patients of study group, while no special nursing measures were adopted for patients of control group. The clinical results, such as limb pain, swelling and subcutaneous petechia after re-perfusion injury, were evaluated and compared between two groups. Results: After the treatment, the limb pain, swelling and subcutaneous petechia due to high re-perfusion injury in study group were relieved more markedly than that in control group, the difference in evaluation score between two groups was statistically significant (P<0.01). Conclusion: The special symptomatic nursing measures are very effective in relieving the high re-perfusion injury after balloon angioplasty for the treatment of diabetic lower limb ischemia. (authors)

A Simple Radiological Technique for Demonstration of Incorrect Positioning of a Foley Catheter with Balloon Inflated in the Urethra of a Male Spinal Cord Injury Patient

Directory of Open Access Journals (Sweden)

Subramanian Vaidyanathan

2006-01-01

Full Text Available In a male patient with cervical spinal cord injury, the urinary bladder may go into spasm when a urethral catheter is removed and a new Foley catheter is inserted. Before the balloon is inflated, the spastic bladder may push the Foley catheter out or the catheter may slip out of a small-capacity bladder. An inexperienced health professional may inflate the balloon of a Foley catheter in the urethra without realizing that the balloon segment of the catheter is lying in the urethra instead of the urinary bladder. When a Foley balloon is inflated in the urethra, a tetraplegic patient is likely to develop autonomic dysreflexia. This is a medical emergency and requires urgent treatment. Before the incorrectly placed Foley catheter is removed, it is important to document whether the balloon has been inflated in the urinary bladder or not. The clinician should first use the always available tools of observation and palpation at the bedside without delays of transportation. A misplaced balloon will often be evident by a long catheter sign, indicating excessive catheter remaining outside the patient. Radiological diagnosis is not frequently required and, when needed, should employ the technique most readily available, which might be a body and pelvic CT without intravenous contrast. An alternative radiological technique to demonstrate the position of the balloon of the Foley catheter is described. Three milliliters of nonionic X-ray contrast medium, Ioversol (OPTIRAY 300, is injected through the side channel of the Foley catheter, which is used for inflating the balloon. Then, with a catheter-tip syringe, 30 ml of sterile Ioversol is injected through the main lumen of the Foley catheter. Immediately thereafter, an X-ray of the pelvis (including perineum is taken. By this technique, both the urinary bladder and balloon of the Foley catheter are visualized by the X-ray contrast medium. When a Foley catheter has been inserted correctly, the balloon of the

Target ballon-assisted antegrade and retrograde approach for recanalization of thrombosed fem-pop bypass graft using the outbreak catheter

International Nuclear Information System (INIS)

Kwak, Jung Won; Chung, Hwan Hoon; Lee, Seung Hwa; Yeom, Suk Keu; Cha, Sang Hoon

2016-01-01

The subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) technique is reportedly effective in severe peripheral vascular disease that cannot be treated with standard endovascular techniques including subintimal angioplasty. In this report, we used a target balloon with the Outback catheter to recanalize a thrombosed bypass graft that could not be treated successfully with SAFARI

Target ballon-assisted antegrade and retrograde approach for recanalization of thrombosed fem-pop bypass graft using the outbreak catheter

Energy Technology Data Exchange (ETDEWEB)

Kwak, Jung Won; Chung, Hwan Hoon; Lee, Seung Hwa; Yeom, Suk Keu; Cha, Sang Hoon [Dept. of Radiology, Korea University College of Medicine, Ansan Hospital, Ansan (Korea, Republic of)

2016-01-15

The subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) technique is reportedly effective in severe peripheral vascular disease that cannot be treated with standard endovascular techniques including subintimal angioplasty. In this report, we used a target balloon with the Outback catheter to recanalize a thrombosed bypass graft that could not be treated successfully with SAFARI.

A rectal balloon catheter as internal immobilization device for conformal radiotherapy of prostate cancer

International Nuclear Information System (INIS)

Gerstner, N.; Wachter, S.; Dorner, D.; Goldner, G.; Colotto, A.; Poetter, R.

1999-01-01

Background: As known from the literature, prostate motion depends on different bladder and/or rectum fillings. The aim of this study was to analyze the influence of a rectum balloon catheter, used as an internal immobilization device, on prostate and rectum motion during the treatment course. Moreover we have analysed if the balloon enables an increase of the distance between the prostate and the posterior rectum wall. Results: An increase of the distance between the prostate and the posterior rectal wall of 8 mm was observed at the base of the prostate when using the rectum balloon. Moreover prostate motion in the ventrodorsal direction ≥4 mm (1 SD) was reduced from 6/10 patients (60%) to 1/10 patients (10%) using the rectal balloon. In general, deviations in the latero-lateral and cranio-caudal directions were less (mean ≤ 2 mm, 1 SD), no difference between both examination series (with and without balloon) was observed. Conclusion: Rectal balloon catheter offers a possibility to reduce prostate motion and rectum filling variations during treatment course. In addition it enables an increase in the distance between prostate and posterior rectal wall, which could enable an improved protection of the posterior rectal wall. (orig./AJ) [de

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

Directory of Open Access Journals (Sweden)

Aiko eOgawa

2015-02-01

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

Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: Final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472)

Energy Technology Data Exchange (ETDEWEB)

Kitrou, Panagiotis M., E-mail: panoskitrou@gmail.com [Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion 26504 (Greece); Katsanos, Konstantinos [Department of Interventional Radiology, Guy' s and St. Thomas’ Hospitals, NHS Foundation Trust, King' s Health Partners, London SE1 7EH (United Kingdom); Spiliopoulos, Stavros; Karnabatidis, Dimitris; Siablis, Dimitris [Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion 26504 (Greece)

2015-03-15

Highlights: •1-Year target lesion primary patency significantly higher after PCB application compared to plain balloon angioplasty in the failing dialysis access. •Significant difference in favor of PCB in cumulative primary patency of AVGs at 1 year. •No significant difference in cumulative primary patency of AVFs treated with PCB at 1 year. •Cost effectiveness analysis performed. •Paclitaxel-coated balloon angioplasty proves to be a cost-effective option for treating dialysis access. -- Abstract: Objective: To report the final results and cost-effectiveness analysis of a prospective randomized controlled trial investigating drug-eluting balloon (DEB) versus plain balloon angioplasty (BA) for the treatment of failing dialysis access ( (NCT01174472)). Methods: 40 patients were randomized to angioplasty with either DEB (n = 20) or BA (n = 20) for treatment of significant venous stenosis causing a failing dialysis access. Both arteriovenous fistulas (AVF) and synthetic arteriovenous grafts (AVG) were included. Angiographic follow up was scheduled every two months. Primary endpoints were technical success and target lesion primary patency at 1 year. Cumulative and survival analysis was performed. Incremental net benefit (INB) and incremental cost effectiveness ratio (ICER) were calculated and the cost-effectiveness acceptability curve (CEAC) was drawn. Results: Baseline variables were equally distributed between the two groups. At 1 year, cumulative target lesion primary patency was significantly higher after DEB application (35% vs. 5% after BA, p < 0.001). Overall, median primary patency was 0.64 years in case of DEB vs. 0.36 years in case of BA (p = 0.0007; unadjusted HR = 0.27 [95%CI: 0.13–0.58]; Cox adjusted HR = 0.23 [95%CI: 0.10–0.50]). ICER was 2198 Euros (€) per primary patency year of dialysis access gained. INB was 1068€ (95%CI: 31–2105€) for a willingness-to-pay (WTP) threshold of 5000€ (corresponding acceptability probability >97

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

Directory of Open Access Journals (Sweden)

Karthikeyan Damodharan

2016-01-01

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

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.)

Suppressive activities and mechanisms of ugonin J on vascular smooth muscle cells and balloon angioplasty-induced neointimal hyperplasia.

Science.gov (United States)

Pan, Chun-Hsu; Li, Pei-Chuan; Chien, Yi-Chung; Yeh, Wan-Ting; Liaw, Chih-Chuang; Sheu, Ming-Jyh; Wu, Chieh-Hsi

2018-02-01

Neointimal hyperplasia (or restenosis) is primarily attributed to excessive proliferation and migration of vascular smooth muscle cells (VSMCs). In this study, we investigated the inhibitory effects and mechanisms of ugonin J on VSMC proliferation and migration as well as neointimal formation. Cell viability and the cell-cycle distribution were, respectively, analyzed using an MTT assay and flow cytometry. Cell migration was examined using a wound-healing analysis and a transwell assay. Protein expressions and gelatinase activities were, respectively, measured using Western blot and gelatin zymography. Balloon angioplasty-induced neointimal formation was induced in a rat carotid artery model and then examined using immunohistochemical staining. Ugonin J induced cell-cycle arrest at the G 0 /G 1 phase and apoptosis to inhibit VSMC growth. Ugonin J also exhibited marked suppressive activity on VSMC migration. Ugonin J significantly reduced activations of focal adhesion kinase, phosphoinositide 3-kinase, v-akt murine thymoma viral oncogene homolog 1, and extracellular signal-regulated kinase 1/2 proteins. Moreover, ugonin J obviously reduced expressions and activity levels of matrix metalloproteinase-2 and matrix metalloproteinase-9. In vivo data indicated that ugonin J prevented balloon angioplasty-induced neointimal hyperplasia. Our study suggested that ugonin J has the potential for application in the prevention of balloon injury-induced neointimal formation. Copyright © 2017 John Wiley & Sons, Ltd.

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

Science.gov (United States)

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

2002-06-01

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

Deflation of the ′obstinate′ Foley′s urinary catheter balloon : a new technique.

Directory of Open Access Journals (Sweden)

Ramakantan R

1989-01-01

Full Text Available We have successfully deflated "obstinate" Foley′s urinary catheter balloons in 15 cases in the last six months with the help of a simple bedside procedure using an angiographic guide-wire.

A system for visualization and automatic placement of the endoclamp balloon catheter

Science.gov (United States)

Furtado, Hugo; Stüdeli, Thomas; Sette, Mauro; Samset, Eigil; Gersak, Borut

2010-02-01

The European research network "Augmented Reality in Surgery" (ARIS*ER) developed a system that supports minimally invasive cardiac surgery based on augmented reality (AR) technology. The system supports the surgical team during aortic endoclamping where a balloon catheter has to be positioned and kept in place within the aorta. The presented system addresses the two biggest difficulties of the task: lack of visualization and difficulty in maneuvering the catheter. The system was developed using a user centered design methodology with medical doctors, engineers and human factor specialists equally involved in all the development steps. The system was implemented using the AR framework "Studierstube" developed at TU Graz and can be used to visualize in real-time the position of the balloon catheter inside the aorta. The spatial position of the catheter is measured by a magnetic tracking system and superimposed on a 3D model of the patient's thorax. The alignment is made with a rigid registration algorithm. Together with a user defined target, the spatial position data drives an actuator which adjusts the position of the catheter in the initial placement and corrects migrations during the surgery. Two user studies with a silicon phantom show promising results regarding usefulness of the system: the users perform the placement tasks faster and more accurately than with the current restricted visual support. Animal studies also provided a first indication that the system brings additional value in the real clinical setting. This work represents a major step towards safer and simpler minimally invasive cardiac surgery.

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

Science.gov (United States)

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

1990-04-01

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

Novel paclitaxel-coated angioplasty balloon catheter based on cetylpyridinium salicylate: Preparation, characterization and simulated use in an in vitro vessel model

Energy Technology Data Exchange (ETDEWEB)

Petersen, Svea, E-mail: svea.petersen@uni-rostock.de [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany); Kaule, Sebastian [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany); Stein, Florian [Institute for Chemistry, Analytical and Technical Chemistry University of Rostock, Albert-Einstein-Straße 3a, 18059 Rostock (Germany); Minrath, Ingo; Schmitz, Klaus-Peter [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany); Kragl, Udo [Institute for Chemistry, Analytical and Technical Chemistry University of Rostock, Albert-Einstein-Straße 3a, 18059 Rostock (Germany); Sternberg, Katrin [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany)

2013-10-15

Drug-coated balloons (DCB), which have emerged as therapeutic alternative to drug-eluting stents in percutaneous cardiovascular intervention, are well described with regard to clinical efficiency and safety within a number of clinical studies. In vitro studies elucidating the correlation of coating method and composition with DCB performance are however rare but considered important for the understanding of DCB requirements and the improvement of established DCB. In this context, we evaluated the applicability of a pipetting, dip-coating, and spray-coating process for the establishment of DCB based on paclitaxel (PTX) and the ionic liquid cetylpyridinium salicylate (Cetpyrsal) as novel innovative additive in three different compositions. Among tested methods and compositions, the pipetting process with 50 wt.% PTX resulted in most promising coatings as drug load was less controllable by the other processes and higher PTX contents led to considerable drug crystallization, as visualized by electron microscopy, accelerating PTX loss during short-term elution. Applying these conditions, homogeneous coatings could be applied on balloon catheter, whose simulated use in an in vitro vessel model revealed percental drug losses of 36 and 28% during transit and percental drug transfers of 12 and 40% under expansion for coatings applied in expanded and folded balloon condition, respectively. In comparison to literature values, these results support the high potential of Cetpyrsal as novel DCB matrix regarding low drug loss and efficient drug transfer. - Highlights: • We provide detailed in vitro data for definition of DCB coating requirements. • An in vitro vessel model for evaluating drug delivery from DCB is presented. • Innovative ionic liquid-based coatings for DCB are developed. • The coating shows low drug loss and efficient drug transfer.

Novel paclitaxel-coated angioplasty balloon catheter based on cetylpyridinium salicylate: Preparation, characterization and simulated use in an in vitro vessel model

International Nuclear Information System (INIS)

Petersen, Svea; Kaule, Sebastian; Stein, Florian; Minrath, Ingo; Schmitz, Klaus-Peter; Kragl, Udo; Sternberg, Katrin

2013-01-01

Drug-coated balloons (DCB), which have emerged as therapeutic alternative to drug-eluting stents in percutaneous cardiovascular intervention, are well described with regard to clinical efficiency and safety within a number of clinical studies. In vitro studies elucidating the correlation of coating method and composition with DCB performance are however rare but considered important for the understanding of DCB requirements and the improvement of established DCB. In this context, we evaluated the applicability of a pipetting, dip-coating, and spray-coating process for the establishment of DCB based on paclitaxel (PTX) and the ionic liquid cetylpyridinium salicylate (Cetpyrsal) as novel innovative additive in three different compositions. Among tested methods and compositions, the pipetting process with 50 wt.% PTX resulted in most promising coatings as drug load was less controllable by the other processes and higher PTX contents led to considerable drug crystallization, as visualized by electron microscopy, accelerating PTX loss during short-term elution. Applying these conditions, homogeneous coatings could be applied on balloon catheter, whose simulated use in an in vitro vessel model revealed percental drug losses of 36 and 28% during transit and percental drug transfers of 12 and 40% under expansion for coatings applied in expanded and folded balloon condition, respectively. In comparison to literature values, these results support the high potential of Cetpyrsal as novel DCB matrix regarding low drug loss and efficient drug transfer. - Highlights: • We provide detailed in vitro data for definition of DCB coating requirements. • An in vitro vessel model for evaluating drug delivery from DCB is presented. • Innovative ionic liquid-based coatings for DCB are developed. • The coating shows low drug loss and efficient drug transfer

Proximal balloon deflation technique: a novel method to retrieve retained or entrapped equipment from the coronary system.

Science.gov (United States)

Ashikaga, Takashi; Inagaki, Hiroshi; Satoh, Yasuhiro; Isobe, Mitsuaki

2012-01-01

Complications of retained or entrapped equipment in the coronary system are still encountered during angioplasty procedures. Although these complications are rare, it is extremely difficult to retrieve such equipments. We report on two cases that a retained IVUS catheter or an entrapped filter wire were retrieved from the coronary system using more simplified technique that does not involve in the usage of snare or any other retrieval tool. After placing an additional guidewire and balloon alongside an equipment, it was easily retrieved from the coronary system just after the proximal balloon deflation. Copyright © 2012. Published by Elsevier Inc.

Virtual 5-French intra-aortic pumping using a Glidesheath Slender and 6-French intra-aortic balloon catheter

Energy Technology Data Exchange (ETDEWEB)

Takahashi, Akihiko, E-mail: a-takahashi@wine.ocn.ne.jp; Taniguchi, Norimasa; Mizuguchi, Yukio; Yamada, Takeshi; Nakajima, Shunsuke; Hashimoto, Sho; Hata, Tetsuya

2015-07-15

Objectives: The aim of this study was to evaluate the feasibility and safety of the 6-Fr Glidesheath Slender, which has equivalent outer size to the conventional 5-Fr sheath, for use with the 6-Fr intra-aortic balloon pump (IABP) catheter. Methods: Between May 2014 and March 2015, 24 patients with acute coronary syndrome underwent percutaneous coronary intervention using a 6-Fr IABP catheter through a 6-Fr Glidesheath Slender for support. The adverse events, including access site complications, kinking of the sheath during the procedure, and any evidence of balloon pump failure, were retrospectively investigated. Results: Insertion of the IABP catheter through either the femoral or brachial artery was successful in all patients. The mean support time was 32.4 ± 22.0 h. No major hemorrhagic event or severe limb ischemia was observed. Kinking of the shaft occurred during insertion in one patient; however, the subsequent balloon pumping was well maintained and did not require exchange of the sheath or IABP catheter. No kind of IABP failure was observed. Conclusion: Although this sheath was originally designed to allow radial access, our results suggest that the use of the Glidesheath Slender is feasible for insertion of the 6-Fr IABP catheter through the brachial and femoral arteries, and may reduce vascular complications in patients who undergo percutaneous coronary intervention.

Embolization of carotid-cavernous fistula using a silicone balloon and a tracker-catheter system

International Nuclear Information System (INIS)

Kim, Sun Yong; Cho, Kil Ho; Park, Bok Hwan

1992-01-01

With the recent introduction and development of the detachable balloon system, it has become the treatment of choice in the management of carotid cavernous fistulas(CCFs). But, since most delivery systems for embolization of CCF mainly depend on flow guidance for balloon delivery, in case of small fistula, pseudo aneurysm and arterialized venous collaterals, failure of balloon embolization can occur. To overcome these limitation, the authors designed and used a new versatile, steerable, and flow-guided detachable balloon system by using a Tracker catheter system with silicone or latex balloons. Using this maneuver, we could get successful fistula occlusion in 7 out of 8 patients (silicone balloon). But in one case, we had to occlude the internal carotid artery at the fistula site, proximal and distal cervical portions of the internal carotid artery. This balloon delivery system proved to provide high selectivity for fistula and relatively ease of handing

Prospective multi-centre randomised trial comparing induction of labour with a double-balloon catheter versus dinoprostone

DEFF Research Database (Denmark)

Løkkegaard, E; Lundstrøm, M; Kjær, Michael

2015-01-01

This randomised controlled study compared the efficacy of double-balloon catheter versus vaginal prostaglandin E2 (dinoprostone) for induction of labour. In total, 825 pregnant women with cephalic presentation and an unfavourable cervix undergoing induction for conventional indications were...... randomised to double-balloon or vaginal dinoprostone (3 mg) groups. There was a significantly higher failure rate for labour induction in the balloon group (relative risk: 1.25, 95% confidence interval [CI]: 1.02-1.49). Median induction time was 27.3 h in the balloon group and 29.8 h in the dinoprostone...

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

Science.gov (United States)

Ogawa, Aiko; Matsubara, Hiromi

2018-04-25

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

Restenosis after hot-tip laser-balloon angioplasty: histologic evaluation of the samples removed by Simpson atherectomy

Science.gov (United States)

Barbieri, Enrico; Tanganelli, Pietro; Taddei, Giuseppe; Perbellini, Antonio; Attino, Vito; Destro, Gianni; Zardini, Piero

1991-05-01

Laser balloon angioplasty has been used in recent years to treat peripheral artery disease. Despite a primary success the technique is plagued by a high restenosis rate. Directional atherectomy was performed in a small group of patients affected by primitive stenosis or restenosis after an invasive procedure. Light microscopy, immunohistochemistry, and transmission electron microscopy have identified the cellular component of intimal hyperplasia as smooth muscle cells in an active synthetic phenotype. The arterial healing process after invasive procedures seems to develop similarly independently of the device employed.

Balloon sinuplasty

OpenAIRE

Ahmad, Zahoor

2010-01-01

Balloon sinuplasty is a technique in endoscopic sinus surgery that involves minimally invasive procedures to dilate the obstructed or stenosed anatomical sinus pathways. Procedure is derived from the well-recognized techinique of angioplasty. This article highlights the procedural methods with review of literature and my personal experience in balloon sinupalsty.

Balloon catheter disruption of thrombus in conjunction with thrombolysis for the treatment of acute middle cerebral artery occlusion

International Nuclear Information System (INIS)

Liu Zhensheng; Wang Wei; Zhang Xinjiang; Fu Changbiao; Zhou Longjiang

2009-01-01

Objective: To assess the feasibility, safety, and efficacy of balloon disruption of thrombus by using a deflated balloon catheter combined with intra-arterial thrombolysis for the treatment of acute middle cerebral artery (MCA) occlusion. Methods: Five consecutive patients with acute MCA occlusion underwent balloon disruption combined with intra-arterial thrombolysis. The microballoon was inflated in the distal carotid artery and then deflated and advanced just distal to the occlusion site in the MCA. Thereafter, intra- arterial thrombolysis of the MCA was applied and the maximum dosage of urokinase was 500,000 U. Results: Complete recanalization was achieved in 3 patients and partial recanalization in 2. All patients got favourable clinical outcome. There was no major intracerebral hemorrhage. Conclusion: The penetration of the MCA with a deflated balloon catheter combined with an intra-arterial thrombolysis may be a safe and effective treatment for acute ischemic stroke. (authors)

Coronary stenting as an adjunct to balloon angioplasty

NARCIS (Netherlands)

B.H. Strauss (Bradley)

1991-01-01

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

Balloon-Assisted Chemoembolization Using a Micro-Balloon Catheter Alongside a Microcatheter for a Hepatocellular Carcinoma with a Prominent Arterioportal Shunt: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Hoshiai, Sodai, E-mail: hoshiai@sb4.so-net.ne.jp; Mori, Kensaku; Ishiguro, Toshitaka; Konishi, Takahiro; Uchikawa, Yoko [University of Tsukuba Hospital, Department of Diagnostic and Interventional Radiology (Japan); Fukuda, Kuniaki [University of Tsukuba Hospital, Department of Gastroenterology (Japan); Minami, Manabu [University of Tsukuba Hospital, Department of Diagnostic and Interventional Radiology (Japan)

2017-04-15

Although transcatheter arterial chemoembolization is one of the established treatments for hepatocellular carcinoma (HCC), it is difficult to treat HCCs with prominent arterioportal (AP) shunts because anticancer drugs and embolic materials migrate into the non-tumorous liver through the AP shunts and may cause liver infarction. We developed a novel method of balloon-assisted chemoembolization using a micro-balloon catheter alongside a microcatheter simultaneously inserted through a single 4.5-Fr guiding sheath, comprising proximal chemoembolization with distal arterial balloon occlusion. We applied this method to treat an HCC with a prominent distal AP shunt induced by previous proton beam therapy and achieved successful chemoembolization without non-tumorous liver infarction under temporal balloon occlusion of a distal AP shunt.

Stent-assisted angioplasty for intracranial atherosclerosis

International Nuclear Information System (INIS)

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

2002-01-01

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

[Application of injection test in confirming the ideal position of esophageal balloon catheter].

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Chen, Han; Xu, Ming; Yang, Yanlin; He, Xuan; Zhou, Jianxin

2017-09-01

To evaluate the safety and feasibility of injection test which is used to locate esophageal balloon catheter. A prospective study was conducted. The patients undergoing invasive mechanical ventilation (MV) admitted to general intensive care unit (ICU) of Beijing Tiantan Hospital Affiliated to Capital Medical University from May 2015 and March 2017 were enrolled. The commercially available esophageal balloon catheter was modified to perform injection test. The catheter was withdrawn step by step and the injection test was repeated until the presence disturbance wave presented, which indicated that the balloon had just entered the esophagus. The position where disturbance wave appears was named 0 cm. End-expiratory occlusions were performed at the positions of +15, +10, +5, 0, -5, -10 and -15 cm, respectively, and the changes of esophageal pressure (Pes) and airway pressures (Paw) were measured in the spontaneous breathing and passive ventilation, and the ratio between the changes (ΔPes/ΔPaw) was calculated. A total of 20 patients were enrolled, of which 15 patients finished both the spontaneous and the passive ventilation parts, and 2 patients finished only the spontaneous part and 3 patients finished only passive part. (1) Disturbance waves could be induced by injection test in all patients. The average depth of disturbance wave in spontaneous breathing was deeper than that in passive ventilation (cm: 42.4±3.8 vs. 41.8±3.3), but there was no significant difference between the two ventilation settings (P = 0.132). No adverse events occurred during the study period. (2) Pes increased with the stepwise withdraw of esophageal catheter, reached the maximal value at +5 cm, and then decreased when the catheter was further withdrawn, no matter in the spontaneous or the passive ventilation. In spontaneous breathing, the ΔPes/ΔPaw was within the ideal range (0.8-1.2) at the positions of 0, -5 and -10 cm. The ΔPes/ΔPaw was closest to unity at the positions of 0 cm (0

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

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

1993-09-01

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

Balloon dacryocystoplasty study in the management of adult epiphora.

LENUS (Irish Health Repository)

Fenton, S

2012-02-03

PURPOSE: To determine the efficacy of dacryocystoplasty with balloon dilation in the treatment of acquired obstruction of the nasolacrimal system in adults. METHODS: Balloon dacryocystoplasty was performed in 52 eyes of 42 patients under general anaesthetic. A Teflon-coated guidewire was introduced through the canaliculus and manipulated through the nasolacrimal system and out of the nasal aperture. A 4 mm wide 3 cm coronary angioplasty balloon catheter was threaded over the guidewire in a retrograde fashion and dilated at the site of obstruction. RESULTS: There was complete obstruction in 30% of cases and partial obstruction in 70%. The most common site of obstruction was the nasolacrimal duct. The procedure was technically successful in 94% of cases. The overall re-obstruction rate was 29% within 1 year of the procedure. There was an anatomical failure rate of 17% for partial obstruction and 69% for complete obstruction within 1 year. CONCLUSIONS: Balloon dacryocystoplasty has a high recurrence rate. There may be a limited role for this procedure in partial obstructions. Further refinements of the procedure are necessary before it can be offered as a comparable alternative to a standard surgical dacryocystorhinostomy.

Comparative dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for brain tumors

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Brandao, Samia de Freitas, E-mail: samiabrandao@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Departamento de Engenharia Nuclear; Campos, Tarcisio Passos Ribeiro de [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil)

2013-06-15

Objective: comparative analysis of dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for treatment of brain tumors. Materials and methods: simulations of intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT were performed with the MCNP5 code, modeling the treatment of a brain tumor on a voxel computational phantom representing a human head. Absorbed dose rates were converted into biologically weighted dose rates. Results: intracavitary balloon catheter brachytherapy with I-125 produced biologically weighted mean dose rates of 3.2E-11, 1.3E-10, 1.9E-11 and 6.9E-13 RBE.Gy.h{sup -1}.p{sup -1}.s, respectively, on the healthy tissue, on the balloon periphery and on the /{sub 1} and /{sub 2} tumor infiltration zones. On the other hand, Cf-252 brachytherapy combined with BNCT produced a biologically weighted mean dose rate of 5.2E-09, 2.3E-07, 8.7E-09 and 2.4E-09 RBE.Gy.h{sup -1}.p{sup -1}.s, respectively on the healthy tissue, on the target tumor and on the /{sub 1} and /{sub 2} infiltration zones. Conclusion: Cf-252 brachytherapy combined with BNCT delivered a selective irradiation to the target tumor and to infiltration zones, while intracavitary balloon catheter brachytherapy with I-125 delivered negligible doses on the tumor infiltration zones. (author)

Comparative dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for brain tumors

Directory of Open Access Journals (Sweden)

Samia de Freitas Brandao

2013-07-01

Full Text Available Objective Comparative analysis of dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for treatment of brain tumors. Materials and Methods Simulations of intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT were performed with the MCNP5 code, modeling the treatment of a brain tumor on a voxel computational phantom representing a human head. Absorbed dose rates were converted into biologically weighted dose rates. Results Intracavitary balloon catheter brachytherapy with I-125 produced biologically weighted mean dose rates of 3.2E-11, 1.3E-10, 1.9E-11 and 6.9E-13 RBE.Gy.h-1.p-1.s, respectively, on the healthy tissue, on the balloon periphery and on the I 1 and I 2 tumor infiltration zones. On the other hand, Cf-252 brachytherapy combined with BNCT produced a biologically weighted mean dose rate of 5.2E-09, 2.3E-07, 8.7E-09 and 2.4E-09 RBE.Gy.h-1.p-1.s, respectively on the healthy tissue, on the target tumor and on the I 1 and I 2 infiltration zones. Conclusion Cf-252 brachytherapy combined with BNCT delivered a selective irradiation to the target tumor and to infiltration zones, while intracavitary balloon catheter brachytherapy with I-125 delivered negligible doses on the tumor infiltration zones.

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

Science.gov (United States)

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

2008-08-01

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

Cerebral intolerance during flow arrested carotid angioplasty.

Science.gov (United States)

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

2012-01-01

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

Radiation recall secondary to adjuvant docetaxel after balloon-catheter based accelerated partial breast irradiation

International Nuclear Information System (INIS)

Wong, Nathan W.; Wong, William W.; Karlin, Nina J.; Gray, Richard J.

2010-01-01

For early stage breast cancer, wide local excision and post-operative whole breast irradiation is a standard treatment. If adjuvant chemotherapy is recommended, radiation is usually given after completion of chemotherapy. In recent years, accelerated partial breast irradiation (APBI) with balloon-cathetered based brachytherapy has become an option for selected patients. For these patients, adjuvant chemotherapy would have to be administered after radiation. The sequence of treatment with radiation followed by chemotherapy results in increased risk of radiation recall reaction (RRD) in these patients. Docetaxel is becoming a more commonly used drug as adjuvant treatment for breast cancer. Here we report a case of docetaxel induced RRD after APBI with balloon-cathetered based brachytherapy. Such reaction would have an adverse impact on the cosmetic outcome and quality of life of the patient. For patients who develop an intense skin reaction after the administration of docetaxel following APBI, RRD should be considered in the differential diagnosis.

Circumferential optical coherence tomography angiography imaging of the swine esophagus using a micromotor balloon catheter.

Science.gov (United States)

Lee, Hsiang-Chieh; Ahsen, Osman Oguz; Liang, Kaicheng; Wang, Zhao; Cleveland, Cody; Booth, Lucas; Potsaid, Benjamin; Jayaraman, Vijaysekhar; Cable, Alex E; Mashimo, Hiroshi; Langer, Robert; Traverso, Giovanni; Fujimoto, James G

2016-08-01

We demonstrate a micromotor balloon imaging catheter for ultrahigh speed endoscopic optical coherence tomography (OCT) which provides wide area, circumferential structural and angiographic imaging of the esophagus without contrast agents. Using a 1310 nm MEMS tunable wavelength swept VCSEL light source, the system has a 1.2 MHz A-scan rate and ~8.5 µm axial resolution in tissue. The micromotor balloon catheter enables circumferential imaging of the esophagus at 240 frames per second (fps) with a ~30 µm (FWHM) spot size. Volumetric imaging is achieved by proximal pullback of the micromotor assembly within the balloon at 1.5 mm/sec. Volumetric data consisting of 4200 circumferential images of 5,000 A-scans each over a 2.6 cm length, covering a ~13 cm(2) area is acquired in <18 seconds. A non-rigid image registration algorithm is used to suppress motion artifacts from non-uniform rotational distortion (NURD), cardiac motion or respiration. En face OCT images at various depths can be generated. OCT angiography (OCTA) is computed using intensity decorrelation between sequential pairs of circumferential scans and enables three-dimensional visualization of vasculature. Wide area volumetric OCT and OCTA imaging of the swine esophagus in vivo is demonstrated.

Mid-term outcomes of orbital atherectomy combined with drug-coated balloon angioplasty for treatment of femoropopliteal disease.

Science.gov (United States)

Foley, T Raymond; Cotter, Ryan P; Kokkinidis, Damianos G; Nguyen, Daniel D; Waldo, Stephen W; Armstrong, Ehrin J

2017-05-01

To assess the intraprocedural and mid-term outcomes of orbital atherectomy (OA) combined with drug-coated balloon (DCB) angioplasty for the treatment of calcified femoropopliteal disease. In this single-center cohort, 89 patients (139 lesions) were treated with DCB angioplasty for claudication or critical limb ischemia (CLI). Angiographic characteristics and procedural outcomes were reviewed for patients treated with or without adjunctive OA. Lesion calcification was graded using two previously published scoring systems, the angiographic calcium score (ACS) and the peripheral artery calcification scoring system (PACSS). Among 139 lesions, 40 (29%) were treated with OA + DCB. Mean lesion length was 135 ± 100 mm for lesions treated with OA + DCB and 139 ± 100 mm for DCB alone (P = 0.9). Moderate to severe calcification was present in 83% of patients treated with OA, compared to 42% of patients treated with DCB alone (P < 0.001). Lesions treated with OA + DCB were less likely to require bailout stenting (18% vs. 39%, P =0.01). Rates of embolization (0% in OA + DCB vs. 2% in DCB only, P = 0.4), dissection (13% vs. 14%, P = 0.8), and perforation (0%) did not differ significantly between groups. The freedom from TLR at 1 year was 82% in both groups (P = 0.6) while primary patency was 81% in-patients treated with DCB alone and 77% in-patients treated with DCB with concomitant OA (P = 0.8). In this single-center analysis of patients undergoing DCB angioplasty for claudication or CLI, OA was most often used for the treatment of severely calcified lesions. These lesions were more likely to be treated with scoring balloons and less likely to require bailout stenting. At 1 year, target lesion revascularization and primary patency was similar in patients treated with and without adjunctive OA, despite the higher lesion complexity among those receiving the combination procedure. © 2017 Wiley Periodicals, Inc. © 2017 Wiley

The balloon dilatation and large profile catheter maintenance method for the management of the bile duct stricture following liver transplantation

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Choo, Sung Wook; Shin, Sung Wook; Do, Young Soo; Park, Kwang Bo; Sung, Yon Mi; Choo, In Wook [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Liu, Wei Chiang [Sungae General Hospital, Seoul (Korea, Republic of)

2006-03-15

We wanted to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and large profile catheter maintenance method for the management of patients with anastomotic biliary strictures following liver transplant. From May 1999 to June 2003, 12 patients with symptomatic benign biliary stricture complicated by liver transplantation were treated with the percutaneous balloon dilatation and large profile catheter maintenance method (1-6 months). The patients were eight males and four females, and their ages ranged from 20 to 62 years (mean age: 44 years). Ten patients underwent living donor liver transplantation and two underwent cadaveric liver transplantation. Postoperative biliary strictures occurred from two to 21 months (mean age: 18 months) after liver transplantation. The initial technical success rate was 92%. Patency of the bile duct was preserved for eight to 40 months (mean period: 19 months) in 10 of 12 (84%) patients. When reviewing two patients (17%), secondary balloon dilatations were needed for treating the delayed recurrence of biliary stricture. In one patients, no recurrent stenosis was seen during the further 10 months follow-up after secondary balloon dilatation. Another patient did not response to secondary balloon dilatation, and he was treated by surgery. Eleven of 12 patients (92%) showed good biliary patency for 8-40 months (mean period: 19 months) of follow-up. The percutaneous balloon dilatation and large profile catheter maintenance method is an effective therapeutic alterative for the treatment of most biliary strictures that complicate liver transplantation. It has a high success rate and it should be considered before surgery.

Unusual Complication of Suprapubic Cystostomy in a Male Patient with Tetraplegia: Traction on Foley Catheter Leading to Extrusion of Foley Balloon from Urinary Bladder and Suprapubic Urinary Fistula – Importance of Securely Anchoring Suprapubic Catheter with Adhesive Tape or BioDerm Tube Holder

Directory of Open Access Journals (Sweden)

Subramanian Vaidyanathan

2007-01-01

Full Text Available Suprapubic cystostomy is recommended to patients with neuropathic bladder to prevent complications of long-term urethral catheter drainage. We present a 50-year-old male patient with tetraplegia who had long-term urethral catheter drainage. Following flexible cystoscopy, he developed a urine leak from the right side of the scrotum. Suprapubic cystostomy was performed. After suprapubic cystostomy, the urinary fistula healed completely. A follow-up cystourethrogram confirmed an intact urethra with no leak of contrast. Six weeks later, this patient presented with a hole below the suprapubic cystostomy through which a small amount of urine was leaking. A keyhole dressing had been applied around the suprapubic catheter and the catheter was hanging loosely, thus permitting traction on the catheter, especially when the urine bag was full. Computerised tomography of the pelvis showed extrusion of the Foley balloon from the urinary bladder, but the tip of the catheter was still located within the bladder. The extruded catheter was removed and a Foley catheter was inserted, ensuring that the balloon was inflated within the urinary bladder. The suprapubic catheter was secured firmly to the anterior abdominal wall with a BioDerm Tube Holder, thus preventing any traction on the catheter or Foley balloon. The urine leak through the hole below the suprapubic cystostomy stopped and the sinus healed. This case illustrates the need to anchor the suprapubic catheter securely to the anterior abdominal wall with adhesive tape or BioDerm Tube Holder to prevent traction and consequent displacement of the catheter or Foley balloon.

[A clinical observation of percutaneous balloon dilation and maintenance percutaneous transhepatic cholangial catheter drainage for treatment of 21 patients with benign biliary strictures and difficult endoscopy].

Science.gov (United States)

Pan, Jie; Shi, Hai-feng; Li, Xiao-guang; Zhang, Xiao-bo; Liu, Wei; Jin, Zheng-yu; Hong, Tao; Yang, Ai-ming; Yang, Ning

2012-06-01

To investigate the value of percutaneous balloon dilation and percutaneous transhepatic cholangial drainage (PTCD) catheter maintenance in the treatment of benign biliary strictures. The clinical data of 21 patients with benign biliary strictures at Peking Union Medical College Hospital from June 2005 to June 2011 were retrospectively studied, in which 12 patients in severe stricture (stenosis > 70%) were treated with percutaneous balloon dilation and PTCD catheter placed across the stricture, while another 9 patients in median stricture (stenosis stenosis was seen in 2 patients. A severe complication with biliary artery branch rupture and massive hemobilia was seen in 1 patient during balloon dilation. Of the 9 patients only treated with 1 - 12 months (median: 6 months) of PTCD catheter placement, 7 patients had the catheter successfully removed. In the follow-up of 5 - 18 months (median: 8 months), patency of bile duct was preserved in 5 of 7 patients, and recurrent stenosis was seen in 2 patients. No severe complication occurred. When endoscopy therapy is failed or the patient can't undergo endoscopy therapy, the percutaneous balloon dilation and PTCD catheter maintenance method is an effective alternative therapeutic approach in the treatment of benign biliary strictures. The moderate benign biliary stricture may be effectively treated only by the PTCD catheter maintenance method.

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

Science.gov (United States)

Weinstock, Barry; Dattilo, Raymond; Diage, Tiffini

2014-01-01

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

Rectal dose sparing with a balloon catheter and ultrasound localization in conformal radiation therapy for prostate cancer

International Nuclear Information System (INIS)

Patel, Rakesh R.; Orton, Nigel; Tome, Wolfgang A.; Chappell, Rick; Ritter, Mark A.

2003-01-01

Background and purpose: To compare the rectal wall and bladder volume in the high dose region with or without the use of a balloon catheter with both three-dimensional (3D)-conformal and intensity modulated radiation therapy (CRT, IMRT) approaches in the treatment of prostate cancer. Material and methods: Five patients with a wide range of prostate volumes and treated with primary external beam radiation therapy for localized prostate cancer were selected for analysis. Pinnacle TM treatment plans were generated utilizing a 3D conformal six-field design and an IMRT seven coplanar-field plan with a novel, three-step optimization and with ultrasound localization. Separate plans were devised with a rectal balloon deflated or air inflated with and without inclusion of the seminal vesicles (SV) in the target volume. The prescription dose was 76 Gy in 38 fractions of 2 Gy each. Cumulative dose-volume histograms (DVHs) were analyzed for the planning target volume (PTV), rectal wall, and bladder with an inflated (60 cc air) or deflated balloon with and without SV included. The volumes of rectal wall and bladder above 60, 65, and 70 Gy with each treatment approach were evaluated. Results: Daily balloon placement was well-tolerated with good patient positional reproducibility. Inflation of the rectal balloon in all cases resulted in a significant decrease in the absolute volume of rectal wall receiving greater than 60, 65, or 70 Gy. The rectal sparing ratio (RSR), consisting of a structure's high dose volume with the catheter inflated, divided by the volume with the catheter deflated, was calculated for each patient with and without seminal vesicle inclusion for 3D-CRT and IMRT. For 3D-CRT, RSRs with SV included were 0.59, 0.59, and 0.56 and with SV excluded were 0.60, 0.58, and 0.54 at doses of greater than 60, 65, and 70 Gy, respectively. Similarly, for IMRT, the mean RSRs were 0.59, 0.59, and 0.63 including SV and 0.71, 0.66, and 0.67 excluding SV at these same dose levels

Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions

International Nuclear Information System (INIS)

Nogueira, Raul G.; Schwamm, Lee H.; Buonanno, Ferdinando S.; Koroshetz, Walter J.; Yoo, Albert J.; Rabinov, James D.; Pryor, Johnny C.; Hirsch, Joshua A.

2008-01-01

The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke. We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score ≤2), dependent (mRS score 3-5), or dead (mRS score 6). Included in the study were 12 patients (mean age 66±17 years, range 31-88 years; mean baseline National Institutes of Health stroke scale score 17±3, range 12-23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9±3.9 h (anterior circulation) and 11.0±7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care). Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and glycoprotein IIb

State of the art of CO laser angioplasty system

Science.gov (United States)

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

1994-07-01

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

Severe Hemorrhage from Cervical Cancer Managed with Foley Catheter Balloon Tamponade

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Tomohiro Sonoo

2015-10-01

Full Text Available A 67-year-old woman complaining of continuous fresh vaginal hemorrhage came to our emergency department in a pre-shock state. Examinations revealed an irregularly shaped mass in the uterus and active arterial bleeding. Emergent hysterectomy and interventional radiology were not immediately available. Foley catheter with 20mL water was inserted into the uterine cavity, then the balloon was pulled to obstruct the uterus output (Figure. Her vital signs became stabilized, and she was transferred to another hospital two days later.

Early outcome of high energy Laser (Excimer) facilitated coronary angioplasty ON hARD and complex calcified and balloOn-resistant coronary lesions: LEONARDO Study

International Nuclear Information System (INIS)

Ambrosini, Vittorio; Sorropago, Giovanni; Laurenzano, Eugenio; Golino, Luca; Casafina, Alfredo; Schiano, Vittorio; Gabrielli, Gabriele; Ettori, Federica; Chizzola, Giuliano; Bernardi, Guglielmo; Spedicato, Leonardo; Armigliato, Pietro; Spampanato, Carmine; Furegato, Martina

2015-01-01

Aim: An innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) has been recently used for the treatment of complex coronary lesions, as calcified stenosis, chronic total occlusions and non-compliant plaques. Such complex lesions are difficult to adequately treat with balloon angioplasty and/or intracoronary stenting. The aim of this study was to examine the acute outcome of this approach on a cohort of patients with coronary lesions. Methods and Results: Eighty patients with 100 lesions were enrolled through four centers, and excimer laser coronary angioplasty was performed on 96 lesions (96%). Safety and effectiveness data were compared between patients treated with standard laser therapy and those treated with increased laser therapy. Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success in was obtained in 87 lesions (90.6%). There was no perforation, major side branch occlusion, spasm, no-reflow phenomenon, dissection nor acute vessel closure. Increased laser parameters were used successfully for 49 resistant lesions without complications. Conclusions: This study suggests that laser-facilitated coronary angioplasty is a simple, safe and effective device for the management of complex coronary lesions. Furthermore, higher laser energy levels delivered by this catheter improved the device performance without increasing complications. - Highlights: • We planned this multicenter study to examine the acute outcome of an innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) for treatment of complex coronary lesions. • We enrolled 80 patients with 100 lesions and performed excimer laser coronary angioplasty in 96 lesions (96%). • Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success was obtained in 87 lesions (90.6%). • Increased laser parameters were used successfully for 49 resistant

Early outcome of high energy Laser (Excimer) facilitated coronary angioplasty ON hARD and complex calcified and balloOn-resistant coronary lesions: LEONARDO Study

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Ambrosini, Vittorio; Sorropago, Giovanni; Laurenzano, Eugenio [Montevergine Clinic, Mercogliano (Italy); Golino, Luca, E-mail: lucagolino.jazz@alice.it [Montevergine Clinic, Mercogliano (Italy); Moriggia-Pelascini Hospital, Gravedona, Como (Italy); Casafina, Alfredo; Schiano, Vittorio [Montevergine Clinic, Mercogliano (Italy); Gabrielli, Gabriele [University Hospital Ospedali Riuniti, Ancona (Italy); Ettori, Federica; Chizzola, Giuliano [Spedali Civili University Hospital, Brescia (Italy); Bernardi, Guglielmo; Spedicato, Leonardo [University Hospital S. Maria Misericordia, Udine (Italy); Armigliato, Pietro [Istituto Italiano Ricerche Mediche, Verona (Italy); Spampanato, Carmine [Telethon Institute of Genetics and Medicine (TIGEM), Naples (Italy); Furegato, Martina [Istituto Italiano Ricerche Mediche, Verona (Italy)

2015-04-15

Aim: An innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) has been recently used for the treatment of complex coronary lesions, as calcified stenosis, chronic total occlusions and non-compliant plaques. Such complex lesions are difficult to adequately treat with balloon angioplasty and/or intracoronary stenting. The aim of this study was to examine the acute outcome of this approach on a cohort of patients with coronary lesions. Methods and Results: Eighty patients with 100 lesions were enrolled through four centers, and excimer laser coronary angioplasty was performed on 96 lesions (96%). Safety and effectiveness data were compared between patients treated with standard laser therapy and those treated with increased laser therapy. Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success in was obtained in 87 lesions (90.6%). There was no perforation, major side branch occlusion, spasm, no-reflow phenomenon, dissection nor acute vessel closure. Increased laser parameters were used successfully for 49 resistant lesions without complications. Conclusions: This study suggests that laser-facilitated coronary angioplasty is a simple, safe and effective device for the management of complex coronary lesions. Furthermore, higher laser energy levels delivered by this catheter improved the device performance without increasing complications. - Highlights: • We planned this multicenter study to examine the acute outcome of an innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) for treatment of complex coronary lesions. • We enrolled 80 patients with 100 lesions and performed excimer laser coronary angioplasty in 96 lesions (96%). • Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success was obtained in 87 lesions (90.6%). • Increased laser parameters were used successfully for 49 resistant

[Clinical application of ultrasound guided Fogarty balloon catheter in arterial crisis].

Science.gov (United States)

Li, Xiaodong; Wang, Pei; Yu, Changyu; Yan, Xiaowei; Yin, Jing

2017-10-01

To explore the effectiveness of arterial crisis after replantation of limb treated by ultrasound guided Fogarty balloon catheter. Between January 2012 and July 2016, 27 patients suffered from arterial crisis after replantation of limb were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic anticoagulant. There were 18 males and 9 females with the age of 19-51 years (mean, 32 years). The limb mutilation position was at knee joint in 3 cases, lower limb in 9 cases, ankle joint in 6 cases, elbow joint in 2 cases, forearm in 4 cases, and wrist joint in 3 cases. The arterial crisis happened at 2.5-18 hours (mean, 7.5 hours) after limb replantation surgery. Color doppler ultrasonography was used to diagnose the arterial thrombosis, finally the anastomotic thrombosis were found in 16 cases, non-anastomotic thrombosis in 7 cases, and combined thrombosis in 4 cases. All the thrombosis were deteced in the arteries with the length of 0.8-3.9 cm. No complication such as vascular perforation, rupture, air embolism, thromboembolism, wound infection, or sepsis happened after operation. Arterial crisis occurred again in 3 cases at 1.5-13.5 hours after limb replantation and treated by arterial exploration, 1 case was treated successfully; 2 cases had arterial occlusion and partial necrosis of limb, and got amputation treatment at last. The rest 24 cases survived with the incision healing by first stage. In the 24 cases, 1 case suffered from acute myonephropathic metabolic syndrome and corrected after hemodialysis; 1 case suffered from acute liver functional damage and corrected by comprehensive treatment of internal medicine. The 24 patients were followed up 7-38 months (mean, 11 months). At last follow-up, blood supply of the limb was good with normal skin temperature and improved sense of feeling, activity, and swelling. According to Chinese Medical Association of hand surgery to the upper extremity function assessment standard, the results were

Effect of percutaneous transluminal angioplasty on the stenosis of autogenous radiocephalic ateriovenous fistula for hemodialysis

Energy Technology Data Exchange (ETDEWEB)

Jeong, Sun Min; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin MMo; Choi, Sang Tae; Kim, Jong Woo; Kim, Hyung Sik; Choi, Hye Young [Gachon University Gil Medical Center, Incheon (Korea, Republic of); Park, Jae Hyung [Dept. of Radiology, Seonam University College of Medicine, Myongji Hospital, Goyang (Korea, Republic of)

2016-02-15

The purpose of this study was to evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) on stenosis of autogenous radiocephalic arteriovenous fistula (RCF) for hemodialysis and to determine the factors influencing patency. This retrospective study included 136 patients referred for PTA of RCF stenosis between March 2005 and July 2014. The technical success rate, complications, and patency rate were evaluated. The following factors were analyzed as they might influence patency: age, gender, site and duration of arteriovenous fistula, underlying disease, body mass index, hypercholesterolemia, smoking, peripheral artery or coronary artery occlusive disease, stenosis length/grade, cutting balloon, and balloon size. The initial technical success rate was 91.9% (125/136). Complications included vessel rupture (n = 2) and vessel dissection (n = 2). The patency rates at 6, 12, 24, and 48 months after PTA were 81.9, 67.1, 52.7, and 42.3%, respectively. The patency rate was higher in cases with longer (> 3 cm) stenosis (p = 0.04). Use of cutting balloon and larger size of balloon catheter made the patency longer, but this difference was not statistically significant (p = 0.637, 0.258). PTA is a safe and effective way to manage stenosis in RCF. The length of stenosis was the only factor which affected the patency rate in this study.

Balloon angioplasty in acute and chronic coronary artery disease

International Nuclear Information System (INIS)

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

1989-01-01

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

Feasibility of Endovascular Radiation Therapy Using Holmium-166 Filled Balloon Catheter in a Swine Hemodialysis Fistula Model: Preliminary Results

Energy Technology Data Exchange (ETDEWEB)

Won, Jong Yun; Lee, Kwang Hun; Lee, Do Yun [Dept. of Radiology, Research Institute of Radiological Science, Yensei University College of Medicine, Seoul (Korea, Republic of); Kim, Myoung Soo [Dept. of Radiology, Yensei University College of Medicine, Seoul (Korea, Republic of); Kang, Byung Chul [Dept. of Radiology, Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of); Kim, Seung Jung [Dept. of Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of)

2011-08-15

To describe how to make a swine hemodialysis fistula model and report our initial experience to test the feasibility of endovascular radiation therapy with Holmium-166 filled balloon catheters. The surgical formation of arterio-venous fistula (AVF) was performed by end-to-side anastomosis of the bilateral jugular vein and carotid artery of 6 pigs. After 4 weeks, angiograms were taken and endovascular radiation was delivered to the venous side of AVF with Holmium-166 filled balloon catheters. Pigs were sacrificed 4 weeks after the radiation and AVFs were harvested for histological examination. All animals survived without any morbidity during the experimental periods. The formation of fistula on the sides of necks was successful in 11 of the 12 pigs (92%). One AVF failed from the small jugular vein. On angiograms, 4 of the 11 AVFs showed total occlusion or significant stenosis and therefore, endovascular radiation could not be performed. Of 7 eligible AVFs, five underwent successful endovascular radiation and two AVFs did not undergo radiation for the control. Upon histologic analysis, one non-radiated AVF showed total occlusion and others showed intimal thickening from the neointimal hyperplasia. Formation of the swine carotid artery-jugular vein hemodialysis fistula model was successful. Endovascular radiation using a Holmium-166 filled balloon catheter was safe and feasible.

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

Science.gov (United States)

Sultan, Sherif; Tawfick, Wael; Hynes, Niamh

2013-04-01

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

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

Science.gov (United States)

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

2012-08-01

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

Central venous stenosis in haemodialysis patients without a previous history of catheter placement.

Science.gov (United States)

Oguzkurt, Levent; Tercan, Fahri; Yildirim, Sedat; Torun, Dilek

2005-08-01

To evaluate dialysis history, imaging findings and outcome of endovascular treatment in six patients with central venous stenosis without a history of previous catheter placement. Between April 2000 and June 2004, six (10%) of 57 haemodialysis patients had stenosis of a central vein without a previous central catheter placement. Venography findings and outcome of endovascular treatment in these six patients were retrospectively evaluated. Patients were three women (50%) and three men aged 32-60 years (mean age: 45 years) and all had massive arm swelling as the main complaint. The vascular accesses were located at the elbow in five patients and at the wrist in one patient. Three patients had stenosis of the left subclavian vein and three patients had stenosis of the left brachiocephalic vein. The mean duration of the vascular accesses from the time of creation was 25.1 months. Flow volumes of the vascular access were very high in four patients who had flow volume measurement. The mean flow volume was 2347 ml/min. One of three patients with brachiocephalic vein stenosis had compression of the vein by the brachiocephalic artery. All the lesions were first treated with balloon angioplasty and two patients required stent placement on long term. Number of interventions ranged from 1 to 4 (mean: 2.1). Symptoms resolved in five patients and improved in one patient who had a stent placed in the left BCV. Central venous stenosis in haemodialysis patients without a history of central venous catheterization tends to occur or be manifested in patients with a proximal permanent vascular access with high flow rates. Balloon angioplasty with or without stent placement offers good secondary patency rates in mid-term.

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

International Nuclear Information System (INIS)

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

2008-01-01

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

Management of Non- Deflating Foley Suprapubic Catheters - A ...

African Journals Online (AJOL)

The procedure described uses a 10 ml syringe and needle passed through the lumen of the catheter to puncture the inner surface of the catheter balloon and thus deflate it. Because the catheter balloon does not burst in this procedure there is no risk of balloon fragmentation or subsequent stone formation. The technique is ...

Directional Atherectomy With Antirestenotic Therapy vs Drug-Coated Balloon Angioplasty Alone for Isolated Popliteal Artery Lesions.

Science.gov (United States)

Stavroulakis, Konstantinos; Schwindt, Arne; Torsello, Giovanni; Stachmann, Arne; Hericks, Christiane; Bosiers, Michel J; Beropoulis, Efthymios; Stahlhoff, Stefan; Bisdas, Theodosios

2017-04-01

To report a single-center study comparing drug-coated balloon (DCB) angioplasty vs directional atherectomy with antirestenotic therapy (DAART) for isolated lesions of the popliteal artery. Seventy-two patients were treated with either DCB angioplasty alone (n=31) or with DAART (n=41) for isolated popliteal artery stenotic disease between October 2009 and December 2015. The majority of patients presented with lifestyle-limiting claudication (74% vs 86%, respectively). Vessel calcification (29% vs 29%, respectively), mean lesion length (47 vs 42 mm, respectively), and number of runoff vessels were comparable between the groups. The primary outcome measure was primary patency; secondary outcomes were technical success (<30% residual stenosis or bailout stenting), secondary patency, and freedom from clinically driven target lesion revascularization (TLR). The technical success rate following DCB was 84% vs 93% (p=0.24) after DAART. The 12-month primary patency rate was significantly higher in the DAART group (65% vs 82%; hazard ratio 2.64, 95% confidence interval 1.09 to 6.37, p=0.021), while freedom from TLR did not differ between the 2 treatment strategies (82% vs 94%, p=0.072). Secondary patency at 12 months was identical for both groups (96% vs 96%). Although not statistically significant, bailout stenting was more common after DCB angioplasty (16% vs 5% for DAART, p=0.13) and aneurysmal degeneration of the popliteal artery was seen more often after DAART (7% vs 0% for DCB alone, p=0.25). Popliteal artery injury was observed in 2 patients treated using DAART (5% vs 0% for DCB alone, p=0.5), whereas distal embolization rates were comparable between the groups (3% for DCB alone vs 5% for DAART, p=0.99). In this study, the use of DAART was associated with a higher primary patency rate compared with DCB angioplasty for isolated popliteal lesions. Nonetheless, both treatment options were associated with excellent 12-month secondary patency. Aneurysmal degeneration of

Combined Use of an Occlusion Balloon Catheter and a Microcatheter for Embolization of the Unselectable Right Inferior Phrenic Artery Supplying Hepatocellular Carcinoma

International Nuclear Information System (INIS)

Miyayama, Shiro; Matsui, Osamu; Taki, Keiichi; Minami, Tetsuya; Ito, Chiharu; Shinmura, Rieko; Takamatsu, Shigeyuki; Kobayashi, Miki; Notsumata, Kazuo

2004-01-01

We report the combined use of an occlusion balloon catheter and a microcatheter for transcatheter arterial embolization (TAE) of hepatocellular carcinoma (HCC) fed by the unselectable right inferior phrenic artery (IPA). In one case, HCC was fed by the reconstructed right IPA via a small branch arising from the proximate portion of the celiac artery. In another, the tumor was fed by the right IPA that had been previously embolized with coils. TAE was successfully performed through a microcatheter placed in the celiac artery immediately proximal to the occluding balloon catheter of the celiac trunk and coil embolization of the left gastric artery

Balloon catheter dilatation in the treatment of the subclavian steal syndrome

International Nuclear Information System (INIS)

Arlart, I.P.

1988-01-01

The present paper reports on the results of PTA in the treatment of subclavian steal syndrome and significant proximal subclavian artery stenosis in thirteen patients. In all cases, it was possible to dilate the stenoses successfully and without complications. Cerebral symptoms caused by the steal phenomenon (seven patients) were relieved in all cases and ischaemic symptoms in the arms produced by exercise were cured in ten out of eleven patients. Balloon catheter dilatation of proximal subclavian stenosis in symptomatic patients is the treatment of choice, as judged by our own experience and the data in the literature. (orig.) [de

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

International Nuclear Information System (INIS)

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

2005-01-01

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

Local Intravascular Drug Delivery: In Vitro Comparison of Three Catheter Systems

International Nuclear Information System (INIS)

Alfke, Heiko; Wagner, Hans-Joachim; Calmer, Christian; Klose, Klaus Jochen

1998-01-01

Purpose: The aim of this in vitro study was to compare different catheter systems for local drug delivery with respect to the penetration depth of a biotin marker solution delivered into the vessel wall. Methods: Post-mortem carotid arteries from pigs were locally infused with a biotin solution using three different catheter systems. With all catheters (microporous balloon catheter, hydrogel-coated balloon catheter, and spiral balloon catheter) we used the same pressure of 405 kPa (4 atm) and infusion times of 60, 90, and 300 sec. After infusion the arteries were histologically prepared and stained using a biotin-specific method. With a light microscope an observer, blinded to the catheter type, scored the amount of biotin within the vessel wall, measured as staining intensity, and the penetration depth of the biotin. Results: Delivery with the hydrogel-coated balloon catheter was limited to the intima and the innermost parts of the media. The spiral balloon and microporous balloon catheter showed both a deeper penetration and a larger amount of delivered biotin compared with the hydrogel catheter, with a slightly deeper penetration using the microporous catheter. The penetration depth showed a correlation with infusion time for the spiral balloon and microporous catheters, but not for the hydrogel-coated catheter. Conclusion: Different catheter designs lead to different patterns of local drug delivery. The differences in penetration depth and amount of the substance delivered to the vessel wall should be known and might be useful for targeting specific areas within the vessel wall

Mechanism of prostatic urethroplasty with balloon catheter

International Nuclear Information System (INIS)

Castaneda, F.; Maynar, M.; Hulbert, J.

1988-01-01

A series of 60 patients have undergone prostatic urethroplasty with balloon catheters at our institution. The follow-up of these patients has ranged from more than 3 years to not less than 6 months. The preliminary results have been excellent, with a success rate of 75% in patients with predominant lateral lobe hypertrophy. This success rate drops to 25% in patients with predominant middle lobe hypertrophy. In previous communications the authors have proposed that the mechanism of prostatic urethral relief of obstruction is due to stretching of the prostatic capsule, tissue compression, and possible subsequent atrophy, as suggested by findings of transrectal US, MR imaging, voiding and retrograde urethrography, and urinary flow studies. Recent clinical information that has led to further animal research has shown that in addition to the previously supposed mechanism of action, separation of the prostatic lobes occurs by splitting of the anterior and posterior commissures of the prostatic gland tissue. This separation of the prostatic lobes is therefore the goal of the procedure. As more experience is gained, the already high success rate can probably be improved

Balloon catheter dilatation of benign urethral strictures

International Nuclear Information System (INIS)

Perini, L.; Cavallo, A.; Perin, B.; Bighi, G.

1988-01-01

The authors report their experience of benign urethral stricture dilatation by balloon catheter in 11 male patients. Ten posterior and 2 anterior urethral strictures were treated; in 1 patients several narrowings coexisted at various levels. Etiology was inflammatory in 4 cases, iatrogen in 3, post-traumatic in 2, and equivocal in 2. The patients were studied both before and soon after dilatation by means of retrograde and voiding cystourethrogram and uroflowgraphy; the follow-up (2-14 months) was performed by urodynamic alone. In all cases, dilatation was followed by the restoration of urethral gauge, together with prompt functional improvement of urodynamic parameters. The latter result subsisted in time in 9 patients. In 2 cases recurrences were observed demonstrated at once by clinics and urodynamics. Both lesions were successfully re-treated. Neither early not late complication occurred. In spite of the limited material, the valuable results obtained, together with the absence of complications, the peculiar morphology of recurrences, and the chance of repeating it make the procedure advisable as a valid alternative to conventional techniques for these pathologies

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

International Nuclear Information System (INIS)

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

1998-01-01

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

Experimental examinations with a new percutaneously insertable, expandable vascular endoprosthesis

International Nuclear Information System (INIS)

Strecker, E.P.; Berg, G.; Weber, H.; Bohl, M.; Dietrich, B.; Freiburg Univ.; Karlsruhe Univ.

1987-01-01

Restenosis and occlusion are the most common reasons why transluminal balloon angioplasty may fail to provide long-term benefit. To prevent restonosis and occlusion of diseased arteries after angioplasty an arterial endoprosthesis has been developed which is positioned to the balloon of an angioplasty catheter and which consists of a stainless steel pliable and elastic tube. With the inflation of the balloon the endoprosthesis will dilate and give the arterial wall a new mechanical support. This new device has been implanted in 12 experimental dogs in arteries of different size and lumen. The longest patency rate of nine months was observed with the completely developed method. (orig.) [de

Central venous stenosis in haemodialysis patients without a previous history of catheter placement

International Nuclear Information System (INIS)

Oguzkurt, Levent; Tercan, Fahri; Yildirim, Sedat; Torun, Dilek

2005-01-01

Objective: To evaluate dialysis history, imaging findings and outcome of endovascular treatment in six patients with central venous stenosis without a history of previous catheter placement. Material and methods: Between April 2000 and June 2004, six (10%) of 57 haemodialysis patients had stenosis of a central vein without a previous central catheter placement. Venography findings and outcome of endovascular treatment in these six patients were retrospectively evaluated. Patients were three women (50%) and three men aged 32-60 years (mean age: 45 years) and all had massive arm swelling as the main complaint. The vascular accesses were located at the elbow in five patients and at the wrist in one patient. Results: Three patients had stenosis of the left subclavian vein and three patients had stenosis of the left brachiocephalic vein. The mean duration of the vascular accesses from the time of creation was 25.1 months. Flow volumes of the vascular access were very high in four patients who had flow volume measurement. The mean flow volume was 2347 ml/min. One of three patients with brachiocephalic vein stenosis had compression of the vein by the brachiocephalic artery. All the lesions were first treated with balloon angioplasty and two patients required stent placement on long term. Number of interventions ranged from 1 to 4 (mean: 2.1). Symptoms resolved in five patients and improved in one patient who had a stent placed in the left BCV. Conclusion: Central venous stenosis in haemodialysis patients without a history of central venous catheterization tends to occur or be manifested in patients with a proximal permanent vascular access with high flow rates. Balloon angioplasty with or without stent placement offers good secondary patency rates in mid-term

Arterioureteral Fistula: Treatment of a Hemorrhagic Shock with Massive Hematuria by Placing a Balloon Catheter

Science.gov (United States)

Riquet, Hervé; Nicolacopoulos, Ioannis; Alame, Abbas

2017-01-01

Arterioureteral fistulas (AUF) are serious diseases with increasing incidence. This case report relates the management of AUF in a patient with a history of abdominal oncological surgery, pelvic radiotherapy, and a double J stent in place. The fistula was discovered during a hemorrhagic shock with massive hematuria. The bleeding was controlled by a balloon catheter which led to endovascular treatment consisting of a covered stent. PMID:28465857

Aorto-iliac angioplasty

International Nuclear Information System (INIS)

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

1990-01-01

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

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

Science.gov (United States)

Weinstock, Barry; Dattilo, Raymond; Diage, Tiffini

2014-01-01

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

Arterioureteral Fistula: Treatment of a Hemorrhagic Shock with Massive Hematuria by Placing a Balloon Catheter

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Nicolas Merzeau

2017-01-01

Full Text Available Arterioureteral fistulas (AUF are serious diseases with increasing incidence. This case report relates the management of AUF in a patient with a history of abdominal oncological surgery, pelvic radiotherapy, and a double J stent in place. The fistula was discovered during a hemorrhagic shock with massive hematuria. The bleeding was controlled by a balloon catheter which led to endovascular treatment consisting of a covered stent.

The impact of balloon catheter dilation on frequency of sinus surgery in the United States

Directory of Open Access Journals (Sweden)

Holy CE

2014-04-01

Full Text Available Chantal E Holy,1 John M Ellison,1 Charles Schneider,1 Howard L Levine2,3 1Health Economics and Reimbursement, 2Medical Affairs, Acclarent Inc., a Johnson & Johnson Company, Menlo Park, CA, USA; 3Cleveland Nasal-Sinus and Sleep Center, Cleveland, OH, USA Purpose: Endoscopic sinus surgery for patients with chronic rhinosinusitis (CRS unresponsive to medical therapy has traditionally been performed under general anesthesia and in the operating room. Balloons for catheter dilation of paranasal sinuses were introduced in 2005, allowing sinus surgery to be safely performed either in the operating room or the office care setting, under local anesthesia. This change in care setting has raised concerns of overuse or expanded indications for sinus surgery. This study was thus designed to evaluate changes in surgical volumes in the United States, for the period 2006–2011, and to evaluate the impact of the sinus balloons on surgical practice. Methods: The MarketScan® Commercial Claims and Encounter Database was queried for the period 2006 to 2011 using CRS International Classification of Diseases, Ninth Revision codes (473.X and sinus surgery US-based Common Procedural Terminology (CPT codes (endoscopic sinus surgery: CPT codes 31254–31294 and 31299; balloon catheter dilation: CPT codes 31295–31297. MarketScan's projection methodology was applied to estimate the nationwide prevalence of CRS and the incidence of sinus surgery. Procedural case mix and total average payment per surgery were analyzed. Results: From 2006 to 2011, the yearly prevalence of CRS and sinus surgery volume remained flat with ~430 patients with CRS per 100,000 in the employer-sponsored insured population, of which ~117/100,000 underwent surgery. In 2006, 2.69 paranasal sinuses (95% confidence interval [95% CI]: 2.65–2.71 were treated during each individual sinus surgery, with an additional 1.11 nasal procedures (95% CI: 1.08–1.13 performed concurrently. By 2011, the

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

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

2010-01-01

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

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

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

2001-11-01

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

Balloon pulmonary angioplasty: applicability of C-Arm CT for procedure guidance

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Hinrichs, Jan B. [Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany); Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover (Germany); Renne, Julius; Wacker, Frank K.; Meyer, Bernhard C. [Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany); Hoeper, Marius M.; Olsson, Karen M. [Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany)

2016-11-15

To investigate the feasibility of and compare two C-Arm CT (CACT) guidance methods during balloon pulmonary angioplasty (BPA). Forty-two BPAs [27 CTEPH patients (nine males, 70 ± 14y)] targeting 143 pulmonary arteries were included. Twenty-two BPAs were guided by contrast-enhanced CACT acquired immediately before BPA (G3D). In another 20 BPAs (G2D), two orthogonal fluoroscopy images of the chest where acquired to compute a registration of a previously acquired CACT. Volume rendering-based graphic representations (VRT guidance) were generated indicating the origin and course of the vessels. Based on VRT guidance, the intervention was planned. Procedure durations and radiation exposure data were compared between the two groups (Wilcoxon test). The overall intervention time was approximately 2 h in both groups (p = 0.31). BPA was successfully performed in G3D 91 % and G2D 94 %. No significant difference was found concerning the mean dose area product (DAP) related to fluoroscopy (p = 0.38), while DAP related to DSA was slightly higher in G3D (p = 0.048). Overall, DAP was significantly higher in G3D (p = 0.002). The use of CACT for procedure guidance in patients undergoing BPA is feasible and accurate. Image fusion of a pre-acquired CACT can be used to decrease radiation exposure due to multiple BPA sessions. (orig.)

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.

How to perform combined cutting balloon and high pressure balloon valvuloplasty for dogs with subaortic stenosis.

Science.gov (United States)

Kleman, Mandi E; Estrada, Amara H; Maisenbacher, Herbert W; Prošek, Robert; Pogue, Brandon; Shih, Andre; Paolillo, Joseph A

2012-01-01

Subvalvular aortic stenosis (SAS) is one of the most common congenital cardiac malformations in dogs. Unfortunately, the long term success rate and survival data following either open heart surgery or catheter based intervention has been disappointing in dogs with severe subaortic stenosis. Medical therapy is currently the only standard recommended treatment option. A cutting balloon dilation catheter has been used successfully for resistant coronary artery and peripheral pulmonary arterial stenoses in humans. This catheter is unique in that it has the ability to cut, or score, the stenotic region prior to balloon dilatation of the stenosis. The use of cutting balloon valvuloplasty combined with high pressure valvuloplasty for dogs with severe subaortic stenosis has recently been reported to be a safe and feasible alternative therapeutic option. The following report describes this technique, outlines the materials required, and provides some 'tips' for successful percutaneous subaortic balloon valvuloplasty. Copyright © 2012 Elsevier B.V. All rights reserved.

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

International Nuclear Information System (INIS)

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

1996-01-01

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

A fragment of Foley catheter balloon as a cause of Bladder stone in woman

Science.gov (United States)

Aziz, El Majdoub; Amrani, Mouad; Abdelhak, Khallouk; Hassan, Farih Moulay

2015-01-01

Urinary bladder calculi are rarely seen in women and any history of previous pelvic surgery must, therefore, raise suspicion of an iatrogenic etiology. According to the literature, fewer than 2% of all bladder calculi occur in female subjects and, thus, their presence should provoke careful assessment of the etiology. We report one case of a fragment of Foley catheter balloon as a cause of Bladder stone in 28 years old woman. Weanalyzed the diagnosis, aspect and therapeutic management of this case which is the first described in literature to our knowledge. PMID:26587134

Quantification of Horseradish Peroxidase Delivery into the Arterial Wall In Vivo as a Model of Local Drug Treatment: Comparison Between a Porous and a Gel-Coated Balloon Catheter

International Nuclear Information System (INIS)

Dick, Armin; Kromen, Wolfgang; Juengling, Eberhard; Grosskortenhaus, Stephanie; Kammermeier, Helmut; Vorwerk, Dierk; Guenther, Rolf W.

1999-01-01

Purpose: To quantify horseradish peroxidase (HRP) delivery into the arterial wall, as a model of local drug delivery, and to compare two different percutaneous delivery balloons. Methods: Perforated and hydrophilic hydrogel-coated balloon catheters were used to deliver HRP in aqueous solution into the wall of porcine iliac arteries in vivo. HRP solutions of 1 mg/ml were used together with both perforated and hydrophilic hydrogel-coated balloon catheters and 40 mg/ml HRP solutions were used with the hydrogel-coated balloon only. The amount of HRP deposited in the arterial wall was then determined photospectrometrically. Results: Using the 1 mg/ml HRP solution, the hydrogel-coated balloon absorbed 0.047 mg HRP into the coating. Treatment with this balloon resulted in a mean vessel wall concentration of 7.4 μg HRP/g tissue ± 93% (standard deviation) (n 7). Treatment with the hydrogel-coated balloon that had absorbed 1.88 mg HRP into the coating (using the 40 mg/ml HRP solution) led to a mean vessel wall concentration of 69.5 μg HRP/g tissue ± 74% (n = 7). Treatment with the perforated balloon using 1 mg/ml aqueous HRP solution led to a mean vessel wall concentration of 174 μg/g ± 81% (n = 7). Differences between the hydrogel-coated and perforated balloons (1 mg/g solutions of HRP) and between hydrogel-coated balloons (0.047 mg vs 1.88 mg absorbed into the balloon coating) were significant (p < 0.05; two-sided Wilcoxon test). Conclusions: The use of a perforated balloon catheter allowed the delivery of a higher total amount of HRP compared with the hydrogel-coated balloon, but at the cost of a higher systemic HRP application. To deliver 174 μg HRP per gram of vessel wall with the perforated balloon, 6.5 ± 1.5 mg HRP were lost into the arterial blood (delivery efficiency range = 0.2%-0.3%). With 0.047 mg HRP loaded into the coating of the hydrogel balloon, 7.4 μg HRP could be applied to 1 g of vessel wall (delivery efficiency 1.7%), and with 1.88 mg HRP loaded

Balloon-assisted coiling through a 5-French system

International Nuclear Information System (INIS)

White, J. Bradley; Layton, Kennith F.; Kallmes, David F.; Cloft, Harry J.

2007-01-01

We present a catheter technique that utilizes a 5F system for the purpose of balloon-assisted coiling in the setting of intracranial aneurysms. A standard 5F short sheath is placed in the common femoral artery, and a 5F diagnostic catheter is placed through the sheath and used for selective vessel angiography. When endovascular intervention is pursued, the diagnostic catheter is placed in the appropriate vessel and systemic heparinization is ensured. Over an exchange length wire, the 5F vertebral catheter and 5F short sheath are exchanged for a 5F Shuttle (Cook) sheath. We then routinely place a 10, 14 or 18 microcatheter over an appropriately gauged microguidewire into the aneurysm. As needed, balloon catheters are then placed across the neck of the aneurysm for remodeling purposes. During the course of the procedure, control angiography is performed through the Shuttle sheath. Following the placement of coils, the microcatheter and balloon catheter are removed and a final biplane image is obtained via the 5F Shuttle sheath. This technique has been employed in 15 patients who required balloon-assisted coiling of an intracranial aneurysm. There were no technical difficulties or arterial access site complications from the procedures. Catheter mobility and torque were not affected, nor was the quality of our imaging. We conclude that this small-diameter system provides ample ''room'' for catheter placement and interventional treatment while reducing the known risks of postprocedural complications. Angiographic images remain excellent and are comparable to those obtained by larger catheters. (orig.)

Modification of conservative treatment of heterotopic cervical pregnancy by Foley catheter balloon fixation with cerclage sutures at the level of the external cervical os: a case report

Directory of Open Access Journals (Sweden)

Vujisic Sanja

2010-07-01

Full Text Available Abstract Introduction Conservative treatment of a heterotopic cervical pregnancy was performed with a modification of the fixation of a Foley catheter at the level of the external cervical os, followed by the ligature of the descending cervical branches of the uterine arteries and systemic methotrexate application. Case presentation A 34-year-old Caucasian woman was diagnosed with double gestation after 6 weeks of in vitro fertilization treatment. A gynecological examination and color Doppler ultrasound scan revealed intra-uterine and cervical gestational sacs both containing live fetuses. A Foley catheter balloon was inserted into the cervical canal, inflated and fixed by a cerclage suture at the level of the external cervical os, followed by ligation of the descending cervical branches of the uterine arteries. Systemic methotrexate was applied. Three days after removal of the Foley catheter, an evacuation of the intra-uterine gestational sac was performed. Hemorrhage from the implantation site was controlled immediately and a pregnancy termination was successfully performed. The procedure was uneventful and our patient was discharged with a preserved uterus. Conclusions Conservative treatment of cervical pregnancy using a Foley catheter balloon is more efficacious if the Foley catheter balloon is attached in the correct position with a cerclage suture at the level of the external os, followed by ligation of the descending cervical branches of the uterine arteries, thereby exerting maximal pressure on the bleeding vessels.

Cutting Balloon Angioplasty (CBA) for the Treatment of Renal Artery Fibromuscular Dysplasia (FMD) in Six Patients: 5-Year Long-Term Results

International Nuclear Information System (INIS)

Cotroneo, Antonio Raffaele; Amoroso, Luigi; Giammarino, Alberto; Galasso, Daniele; Taglialatela, Francesco; Timpani, Carmine; Gabrielli, Daniela

2017-01-01

PurposeTo evaluate long-term outcomes in terms of hypertension control, recurrent stenosis, and reinterventions from patients who underwent cutting balloon angioplasty (CBA) for symptomatic renal artery fibromuscular dysplasia (FMD).Materials and MethodsFrom 2011, six consecutive renal artery FMD women underwent CBA for poorly controlled hypertension, despite antihypertensive therapy. Follow-up consisted of blood pressure monitoring and duplex ultrasonography at 1, 6, and 12 months and thereafter annually for 5 years.ResultsAll treatments were technically successful. Recurrence of hypertension was found in two patients within 12 months, and reinterventions were performed using CBA.ConclusionResults show the efficacy of CBA for renal artery FMD.

Cutting Balloon Angioplasty (CBA) for the Treatment of Renal Artery Fibromuscular Dysplasia (FMD) in Six Patients: 5-Year Long-Term Results

Energy Technology Data Exchange (ETDEWEB)

Cotroneo, Antonio Raffaele [“G. d’Annunzio” University, Chieti-Pescara, Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division (Italy); Amoroso, Luigi [“G. d’Annunzio” University, Chieti-Pescara, Nephrology Clinical Institute, Department of Medicine (Italy); Giammarino, Alberto; Galasso, Daniele; Taglialatela, Francesco; Timpani, Carmine; Gabrielli, Daniela, E-mail: d.gabrielli@rad.unich.it [“G. d’Annunzio” University, Chieti-Pescara, Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division (Italy)

2017-04-15

PurposeTo evaluate long-term outcomes in terms of hypertension control, recurrent stenosis, and reinterventions from patients who underwent cutting balloon angioplasty (CBA) for symptomatic renal artery fibromuscular dysplasia (FMD).Materials and MethodsFrom 2011, six consecutive renal artery FMD women underwent CBA for poorly controlled hypertension, despite antihypertensive therapy. Follow-up consisted of blood pressure monitoring and duplex ultrasonography at 1, 6, and 12 months and thereafter annually for 5 years.ResultsAll treatments were technically successful. Recurrence of hypertension was found in two patients within 12 months, and reinterventions were performed using CBA.ConclusionResults show the efficacy of CBA for renal artery FMD.

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

NARCIS (Netherlands)

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

1993-01-01

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

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

NARCIS (Netherlands)

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

1993-01-01

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

Upper gastrointestinal strictures: The results of balloon dilatation

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Lee, Kil Woo; Lim, Hyo Keun; Choo, In Wook; Bae, Sang Hoon; Yoon, Jong Sup [Hallym University College of Medicine, Seoul (Korea, Republic of); Yoo, Hyung Sik [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1990-12-15

Balloon catheter dilatation of upper gastrointestinal strictures is an accepted mode of therapy. The authors report the balloon dilatation in 11 consecutive patients. The lesions treated included 10 benign strictures, and 1 esophageal cancer. Esophageal balloon were ranged from 2 mm in diameter, 4 cm in length, to 30 mm in diameter, 8 cm in length. Inflation was held for from 30 to 60 seconds and then repeated two or three times during each session. The balloons were inflated to pressure of from 2 to 12 atmospheres. There were from 1 to 13 dilatations. Two esophageal perforations were occurred in one esophagitis patient and other lye stricture patient. Two perforations were not required any surgical repair. All dilatation were performed without anesthesia. All strictures were responded immediately to dilatation. Prolonged course of treatment were needed with chronic severe esophagitis, lye stricture, gastrojejunostomy with chemotherapy, as a result, all patients, except esophageal cancer, could take regular diet after balloon catheter dilatation. Balloon catheter dilatation of upper gastrointestinal stenosis was effective and safe. It should be considered before other methods of treatment applicable.

Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography.

Science.gov (United States)

Ogo, Takeshi; Fukuda, Tetsuya; Tsuji, Akihiro; Fukui, Shigefumi; Ueda, Jin; Sanda, Yoshihiro; Morita, Yoshiaki; Asano, Ryotaro; Konagai, Nao; Yasuda, Satoshi

2017-04-01

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized. We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment. We collected clinical and hemodynamic data, including procedural complications, before BPA and at 3 months and 1year after BPA. Three hundred eight-five BPA sessions (4.8 sessions/patient) were performed for the lesions of subsegmental arteries (1155 lesions), segmental arteries (738 lesions), and lobar arteries (4 lesions) identified by CBCT or ECG-gated ADCT. Significant improvements in the symptoms, 6-min walk distance, brain natriuretic peptide level, exercise capacity, and haemodynamics were observed 3 months and 1year after BPA. No cases of death or cardiogenic shock with a low rate of severe wire perforation (0.3%) and severe reperfusion oedema (0.3%) were observed. BPA guided by CBCT or ECG-gated ADCT is effective and remarkably safe in patients with CTEPH . These new advanced CT techniques may be useful in pre-BPA target lesion assessment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evaluation of the Pullback Atherectomy Catheter in the Treatment of Lower Limb Vascular Disease

International Nuclear Information System (INIS)

Grubnic, Sisa; Heenan, Susan D.; Buckenham, Timothy M.; Belli, Anna-Maria

1996-01-01

Purpose: To evaluate prospectively the Pullback Atherectomy Catheter (PAC) in terms of its technical success and 1-year patency in the treatment of lower limb vascular disease. Methods: Thirty-nine PAC procedures were performed in 34 patients to treat atherosclerotic disease (occlusive in 51%) of the femoropopliteal arteries, including four cases of graft neointimal hyperplasia and three dissection flaps. Follow-up was by ankle - brachial indices at 24 hr and 1 month, and arteriography at 6 and 12 months. Results: Technical success was achieved in 38 of 39 procedures (97.4%). There was a reduction in mean stenosis from 89.4% to 12.1%, but 69.2% of procedures required additional balloon dilatation to achieve an adequate arterial lumen. Complications followed 15.4% of procedures, a third of which required surgery. Conclusion: The PAC is an easy and relatively safe catheter to use, but does not provide a satisfactory arterial lumen without additional percutaneous transluminal angioplasty (PTA). It proved to be effective, however, in the treatment of graft neointimal hyperplasia and in the resection of obstructive intimal flaps following PTA

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

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

2005-09-15

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

Combined Directional Atherectomy and Drug-Eluting Balloon Angioplasty for Isolated Popliteal Artery Lesions in Patients With Peripheral Artery Disease.

Science.gov (United States)

Stavroulakis, Konstantinos; Bisdas, Theodosios; Torsello, Giovanni; Stachmann, Arne; Schwindt, Arne

2015-12-01

To evaluate the midterm results of combined directional atherectomy (DA) and drug-eluting balloon (DEB) angioplasty for atherosclerotic lesions of the popliteal artery. In a single-arm, prospective study, 21 patients (mean age 63±16 years; 16 men) with isolated popliteal artery lesions were enrolled and underwent treatment with combined DA and DEB angioplasty under filter protection between October 2009 and February 2014. The majority (18, 86%) presented with lifestyle-limiting intermittent claudication and 3 with critical limb ischemia. Fifteen (71%) target sites were de novo lesions; 4 were occlusions. The main outcome was primary patency; secondary outcomes were technical success, secondary patency, and early and midterm morbidity and mortality. The TurboHawk atherectomy device was used in 15 (71%) patients and the SilverHawk peripheral plaque excision system in the remaining 6 patients. The In.Pact Admiral/Pacific DEB was used in the majority of cases (15, 71%). The technical success rate was 90% (n=19). One flow-limiting dissection was treated with bailout stenting. Complications included a perforation of the popliteal artery and 2 puncture site hematomas; there was no distal embolic event. The mean follow-up was 18±12 months. Two restenoses were retreated successfully. Kaplan-Meier estimates of primary patency at 12 and 18 months were 95% and 90%, respectively; the secondary patency was 100%. One (5%) patient died in follow-up. None of the patients had an amputation. In this prospective single-arm study, the combined therapy of DA and DEB angioplasty for popliteal artery lesions showed promising midterm performance. The combination of DA and DEB may, in highly selected patients, overcome the challenges presented by the mobility of the knee joint. © The Author(s) 2015.

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

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Weinstock B

2014-03-01

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

The Relationship Between Neutrophil–Lymphocyte Ratio and Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Arteriovenous Fistula Stenosis When Using Conventional and Drug-Eluting Balloons

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Çildağ, Mehmet Burak, E-mail: mbcildag@yahoo.com [Adnan Menderes University, Department of Diagnostic and Interventional Radiology (Turkey); Çildağ, Songül, E-mail: songulcildag@yahoo.com [Adnan Menderes University, Department of Immunology and Allergy (Turkey); Köseoğlu, Ömer Faruk Kutsi, E-mail: kutsikoseoglu@yahoo.com [Adnan Menderes University, Department of Diagnostic and Interventional Radiology (Turkey)

2016-12-15

ObjectiveThe aim of this study is to investigate the potential association of neutrophil–lymphocyte ratio (NLR) between primary patency of percutaneous transluminal angioplasty (PTA) in hemodialysis arteriovenous fistula stenosis and type (Conventional and Drug-Eluting) of balloons used in PTA.Material-MethodThis retrospective study consists of 78 patients with significant arteriovenous fistulas stenosis who were treated with PTA by using Drug-Eluting Balloon (DEB) (n = 29) or Conventional Balloon (CB) (n = 49). NLR was calculated from preinterventional blood samples. All patients were classified into two groups. Group A; primary patency <12 months (43/78), Group B; primary patency ≥12 months (35/78). Cox regression analysis and Kaplan–Meier method were used to determine respectively independent factors affecting the primary patency and to compare the primary patency for the two balloon types.ResultsNLR ratio and balloon type of the two groups were significantly different (p = 0.002, p = 0.010). The cut-off value of NLR was 3.18 for determination of primary patency, with sensitivity of 81.4 % and specificity of 51.4 %. Primary patency rates between PTA with DEB and CB displayed statistically significant differences (p < 0.05). The cut-off value was 3.28 for determination of 12-month primary patency with the conventional balloon group; sensitivity was 81.8 % and specificity was 81.3 %. There was no statistical relation between NLR levels and the drug-eluting balloon group in 12-month primary patency (p = 0.927).ConclusionIncreased level of NLR may be a risk factor in the development of early AVF restenosis after successful PTA. Preferring Drug-Eluting Balloon at an increased level of NLR can be beneficial to prolong patency.

Membranous obstruction of inferior vena cava(MOIVC): treatment with percutaneous transluminal angioplasty(PTA) and self expandable metallic stent

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Lee, Ki Yeol; Kim, Baek Hyun; Cha, In Ho; Lee, Nam Joon; Kim, Yun Hwan; Kim, Jung Hyuk [College of Medicine, Korea University, Seoul (Korea, Republic of)

1994-03-15

Percutaneous transluminal angioplasty(PTA) with a balloon catheter is a standard method of treatment for membranous obstruction of inferior vena cava(MOIVC). But, correct therapeutic approach has not been established for MOIVC patients whose lesion is associated with extensive thrombotic IVC occlusion. We tried to treat MOIVC associated with or without thrombus. We treated 13 cases of MOIVC(associated with thrombus in 7 cases, no thrombus in 6 cases) with PTA, thrombolysis and self-expandable metallic stents. PTA was successful in 8 cases, but failed in 5 cases. The recurred cases were retreated with PTA, but follow-up study revealed recoiling restenosis in 4 cases and intimal hyperplasia in 1 case at previous PTA site which could be overcome with a self-expandable metallic stent. The complication were occurred in 3 cases which were hemothorax, hemopericardium, and hemoperitoneum respectively. However, those were resolved by conservative treatment only. Recanalization and dilatation could be done in MOIVC patients with or without thrombosis for improvement of patient's symptom. Gianturco self-expandable metallic stent is useful in treatment of recurred MOIVC after balloon dilatation and preventing reocclusion of the IVC after PTA.

Restoration of Failed Renal Graft Function After Successful Angioplasty of Pressure-Resistant Renal Artery Stenosis Using a Cutting Balloon: A Case Report

International Nuclear Information System (INIS)

Peregrin, J. H.; Buergelova, M.

2009-01-01

This study is the report of a 37-year-old male with a transplanted kidney from a 3.5-year-old donor: the graft had two arteries transplanted with an aortic patch to an external iliac artery. Four months after transplantation, the graft function deteriorated, together with the development of hypertension. Stenosis of both graft arteries was detected and the patient was referred for angioplasty. The angiographic result was suboptimal, nevertheless, the graft function improved and was more or less stable (serum creatinine, 160-200 μmol/l) for 4 years, along with persistently difficult-to-control hypertension. Five years after transplantation, the graft function deteriorated again and severe graft artery restenosis was detected. The restenosis did not respond to dilatation, graft function failed, hypertension decompensated, and left ventricular failure developed. The patient required dialysis. A cutting balloon angioplasty opened the artery, and kidney function was restored after a few days: the serum creatinine level dropped to 140-160 μmol/l, and the glomerular filtration rate (creatinine clearance) to 0.65 ml/min/1.73 m 2 . The graft function has now been stable for more than 2 years, however, the hypertension is still difficult to control.

The quest for durable lesions in catheter ablation of atrial fibrillation - technological advances in radiofrequency catheters and balloon devices.

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Maurer, Tilman; Kuck, Karl-Heinz

2017-08-01

Atrial fibrillation is the most common cardiac arrhythmia and represents a growing clinical, social and economic challenge. Catheter ablation for symptomatic atrial fibrillation has evolved from an experimental procedure into a widespread therapy and offers a safe and effective treatment option. A prerequisite for durable PVI are transmural and contiguous circumferential lesions around the pulmonary veins. However, electrical reconnection of initially isolated pulmonary veins remains a primary concern and is a dominant factor for arrhythmia recurrence during long-term follow up. Areas covered: This article discusses the physiology of lesion formation using radiofrequency-, cryo- or laser- energy for pulmonary vein isolation and provides a detailed review of recent technological advancements in the field of radiofrequency catheters and balloon devices. Finally, future directions and upcoming developments for the interventional treatment of atrial fibrillation are discussed. Expert commentary: Durable conduction block across deployed myocardial lesions is mandatory not only for PVI but for any other cardiac ablation strategy as well. A major improvement urgently expected is the intraprocedural real-time distinction of durable lesions from interposed gaps with only transiently impaired electrical conduction. Furthermore, a simplification of ablation tools used for PVI is required to reduce the high technical complexity of the procedure.

Randomized trial of Legflow® paclitaxel eluting balloon and stenting versus standard percutaneous transluminal angioplasty and stenting for the treatment of intermediate and long lesions of the superficial femoral artery (RAPID trial): Study protocol for a randomized controlled trial

NARCIS (Netherlands)

A. Karimi; S.W. de Boer (Sanne W.); D.A.F. Van Den Heuvel; B. Fioole (Bram); D. Vroegindeweij (Dammis); J.M.M. Heyligers (Jan); P.N.M. Lohle (Paul N.M.); O.E. Elgersma (Otto E.); R.P.T. Nolthenius (Rudolf ); J.A. Vos (Jan Albert); J.-P.P.M. de Vries (Jean-Paul)

2013-01-01

textabstractBackground: Restenosis after percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) may occur in 45% of patients at 2 years follow-up. Paclitaxel-coated balloons have been found to reduce neointimal hyperplasia, and thus reduce restenosis. Recently, the

Contura Multi-Lumen Balloon Breast Brachytherapy Catheter: Comparative Dosimetric Findings of a Phase 4 Trial

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Arthur, Douglas W., E-mail: darthur@mcvh-vcu.edu [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia (United States); Vicini, Frank A. [Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, Michigan (United States); Todor, Dorin A. [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia (United States); Julian, Thomas B. [Allegheny General Hospital, Temple University School of Medicine, Pittsburgh, Pennsylvania (United States); Cuttino, Laurie W.; Mukhopadhyay, Nitai D. [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia (United States)

2013-06-01

Purpose: Final dosimetric findings of a completed, multi-institutional phase 4 registry trial using the Contura Multi-Lumen Balloon (MLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) in patients with early-stage breast cancer are presented. Methods and Materials: Three dosimetric plans with identical target coverage were generated for each patient for comparison: multilumen multidwell (MLMD); central-lumen multidwell (CLMD); and central-lumen single-dwell (CLSD) loading of the Contura catheter. For this study, a successful treatment plan achieved ideal dosimetric goals and included the following: ≥95% of the prescribed dose (PD) covering ≥95% of the target volume (TV); maximum skin dose ≤125% of the PD; maximum rib dose ≤145% of the PD; and V150 ≤50 cc and V200 ≤10 cc. Results: Between January 2008 and February 2011, 23 institutions participated. A total of 318 patients were available for dosimetric review. Using the Contura MLB, all dosimetric criteria were met in 78.93% of cases planned with MLMD versus 55.38% with the CLMD versus 37.66% with the CLSD (P≤.0001). Evaluating all patients with the full range of skin to balloon distance represented, median maximum skin dose was reduced by 12% and median maximum rib dose by 13.9% when using MLMD-based dosimetric plans compared to CLSD. The dosimetric benefit of MLMD was further demonstrated in the subgroup of patients where skin thickness was <5 mm, where MLMD use allowed a 38% reduction in median maximum skin dose over CLSD. For patients with rib distance <5 mm, the median maximum rib dose reduction was 27%. Conclusions: Use of the Contura MLB catheter produced statistically significant improvements in dosimetric capabilities between CLSD and CLMD treatments. This device approach demonstrates the ability not only to overcome the barriers of limited skin thickness and close rib proximity, but to consistently achieve a higher standard of dosimetric planning goals.

Contura Multi-Lumen Balloon breast brachytherapy catheter: comparative dosimetric findings of a phase 4 trial.

Science.gov (United States)

Arthur, Douglas W; Vicini, Frank A; Todor, Dorin A; Julian, Thomas B; Cuttino, Laurie W; Mukhopadhyay, Nitai D

2013-06-01

Final dosimetric findings of a completed, multi-institutional phase 4 registry trial using the Contura Multi-Lumen Balloon (MLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) in patients with early-stage breast cancer are presented. Three dosimetric plans with identical target coverage were generated for each patient for comparison: multilumen multidwell (MLMD); central-lumen multidwell (CLMD); and central-lumen single-dwell (CLSD) loading of the Contura catheter. For this study, a successful treatment plan achieved ideal dosimetric goals and included the following: ≥ 95% of the prescribed dose (PD) covering ≥ 95% of the target volume (TV); maximum skin dose ≤ 125% of the PD; maximum rib dose ≤ 145% of the PD; and V150 ≤50 cc and V200 ≤ 10 cc. Between January 2008 and February 2011, 23 institutions participated. A total of 318 patients were available for dosimetric review. Using the Contura MLB, all dosimetric criteria were met in 78.93% of cases planned with MLMD versus 55.38% with the CLMD versus 37.66% with the CLSD (P ≤.0001). Evaluating all patients with the full range of skin to balloon distance represented, median maximum skin dose was reduced by 12% and median maximum rib dose by 13.9% when using MLMD-based dosimetric plans compared to CLSD. The dosimetric benefit of MLMD was further demonstrated in the subgroup of patients where skin thickness was <5 mm, where MLMD use allowed a 38% reduction in median maximum skin dose over CLSD. For patients with rib distance <5 mm, the median maximum rib dose reduction was 27%. Use of the Contura MLB catheter produced statistically significant improvements in dosimetric capabilities between CLSD and CLMD treatments. This device approach demonstrates the ability not only to overcome the barriers of limited skin thickness and close rib proximity, but to consistently achieve a higher standard of dosimetric planning goals. Copyright © 2013 Elsevier Inc. All rights

Balloon sheaths for gastrointestinal guidance and access: a preliminary phantom study

International Nuclear Information System (INIS)

He, Xu; Shin, Ji Hoon; Kim, Hyo Cheol; Woo, Cheol Woong; Woo, Sung Ha; Choi, Won Chan; Kim, Jong Gyu; Lim, Jin Oh; Kim, Tae Hyung; Yoon, Chang Jin; Song, Ho Young; Kang, Wee Chang

2005-01-01

We wanted to evaluate the feasibility and usefulness of a newly designed balloon sheath for gastrointestinal guidance and access by conducting a phantom study. The newly designed balloon sheath consisted of an introducer sheath and a supporting balloon. A coil catheter was advanced over a guide wire into two gastroduodenal phantoms (one was with stricture and one was without stricture); group I was without a balloon sheath, group II was with a deflated balloon sheath, and groups III and IV were with an inflated balloon and with the balloon in the fundus and body, respectively. Each test was performed for 2 minutes and it was repeated 10 times in each group by two researchers, and the positions reached by the catheter tip were recorded. Both researchers had better performances with both phantoms in order of group IV, III, II and I. In group IV, both researchers advanced the catheter tip through the fourth duodenal segment in both the phantoms. In group I, however, the catheter tip never reached the third duodenal segment in both the phantoms by both the researchers. The numeric values for the four study groups were significantly different for both the phantoms (ρ < 0.001). A significant difference was also found between group III and IV for both phantoms (ρ < 0.001). The balloon sheath seems to be feasible for clinical use, and it has good clinical potential for gastrointestinal guidance and access, particularly when the inflated balloon is placed in the gastric body

Six-year clinical follow-up after treatment of diffuse in-stent restenosis with cutting balloon angioplasty followed by intracoronary brachytherapy with liquid rhenium-188-filled balloon via transradial approach

International Nuclear Information System (INIS)

Hang Chiling; Wu Chiungjen; Hsieh Bortsung

2010-01-01

Long-term follow-up studies revealed a significant decline in the benefits of intracoronary radiation for in-stent restenosis. A total of 25 study and 25 contemporaneous control patients with diffuse in-stent restenosis who underwent cutting balloon angioplasty (CBA) transradially, followed by subsequent intracoronary irradiation with a liquid β-emitter Rhenium-188 ( 188 Re)-filled balloon were enrolled in the study. The mean clinical follow-up durations were 64.9±13.0 and 66.3±13.8 months for the irradiated and control patients, respectively. Six-month angiographic restenosis was observed in 16% (4 of 25) of the patients in the irradiated group and 48% (12 of 25) of the patients in the control groups (P=0.03). The 6-month major adverse cardiac events (MACE) rate was 12% and 44%, respectively (P=0.025). The 3-year follow-up angiography was performed in 16 of 21 (76%) irradiated patients and in 4 of 13 (31%) control patients who had no significant restenosis at the 6-month angiographic follow-up. Restenosis occurred in 1 of 16 (7%) irradiated patients and 2 of 4 (50%) control patients. Late target lesion revascularization was performed in 1 irradiated and 2 control patients. The MACE rate within 6 years was significantly reduced in the irradiated group (20% vs. 56%, P=0.019). Brachytherapy using 188 Re-filled balloon following CBA for diffuse in-stent restenotic native coronary arteries is effective in reducing target lesion restenosis and improving long-term outcomes. (author)

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

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

2005-07-01

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

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

International Nuclear Information System (INIS)

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

2005-01-01

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

Randomized trial of Legflow((R)) paclitaxel eluting balloon and stenting versus standard percutaneous transluminal angioplasty and stenting for the treatment of intermediate and long lesions of the superficial femoral artery (RAPID trial): study protocol for a randomized controlled trial

NARCIS (Netherlands)

Karimi, A.; Boer, S.W. de; Heuvel, D.A. Van Den; Fioole, B.; Vroegindeweij, D.; Heyligers, J.M.M; Lohle, P.N.; Elgersma, O.; Nolthenius, R.P.T.; Vos, J.A.; Vries, J.P. de

2013-01-01

BACKGROUND: Restenosis after percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) may occur in 45% of patients at 2 years follow-up. Paclitaxel-coated balloons have been found to reduce neointimal hyperplasia, and thus reduce restenosis. Recently, the Legflow((R))

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

The dilatations with the balloon catheter in treatment of the patients with the benign oesophageal stenoses

International Nuclear Information System (INIS)

Valek, V.; Benda, K.; Hrobar, P.; Mrazova, J.; Prasek, J.; Bilicky, J.; Vomela, J.; Hep, A.; Muenzova, H.

1996-01-01

Between January 1989 and June 1995 the authors dilated in the Department of Radiology in University Hospital Bohunice the benign stenosis of the oesophagus with balloon dilatation catheter in 76 of other patients. The aetiology of the stenosis was long-term reflux oesophagitis in the 39 patients (51%), achalasia 14 patients, 18%) postoperative benign stenosis in anastomosis (7 patients, 9%), corrosive stricture (5 patients, 6,5%), post-radiation stricture (5 patients, 6,5%) and epidermolysis bulosa oesophagi (2 patients, 3%). In four patients (5%) the aetiology of the stenosis was unknown. The standing of the dilatation was from 15 second to 6 minutes and dilatation was technically successful in all cases. First the authors used Owman Oesophageal Dilatation Kit (William COOK), before three years they started to used Rigiflex ORW Dilators Kit (Microvasive). In the patients with achalasia the authors currently used Rigiflex ABD Achalasia Balloon Dilator (Microvasive). (authors). 2 tabs., 3 figs., 14 refs

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

Energy Technology Data Exchange (ETDEWEB)

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

2017-02-15

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

Double-balloon catheter for induction of labour in women with a previous cesarean section, could it be the best choice?

Science.gov (United States)

De Bonrostro Torralba, Carlos; Tejero Cabrejas, Eva Lucía; Marti Gamboa, Sabina; Lapresta Moros, María; Campillos Maza, Jose Manuel; Castán Mateo, Sergio

2017-05-01

We analysed the efficacy and safety of double-balloon catheter for cervical ripening in women with a previous cesarean section and which were the most important variables associated with an increased risk of repeated cesarean delivery. We designed an observational retrospective study of 418 women with unfavourable cervices (Bishop Score cesarean delivery, and induction of labour with a double-balloon catheter. Baseline maternal data and perinatal outcomes were recorded for a descriptive, bivariate, and multivariate analysis. A p value cesarean section were dystocia in the previous pregnancy (OR 1.744; CI 95% 1.066-2.846), the absence of previous vaginal delivery (OR 2.590; CI 95% 1.066-6.290), suspected fetal macrosomia (OR 2.410; CI 95% 0.959-6.054), and duration of oxytocin induction period (OR 1.005; CI 95% 1.004-1.006). The area under the curve was 0.789 (p cesarean delivery and unfavourable cervix. In our study, most women could have a vaginal delivery in spite of their risk factors for cesarean delivery. A multivariate model based on some clinical variables has moderate predictive value for intrapartum cesarean section.

Insertion of Self-Expandable Nitinol Stents Without Previous Balloon Angioplasty Reduces Restenosis Compared with PTA Prior to Stenting

International Nuclear Information System (INIS)

Harnek, Jan; Zoucas, Evita; Stenram, Unne; Cwikiel, Wojciech

2002-01-01

Purpose: To compare the development of intimal hyperplasia after deployment of a self-expanding nitinol stent with and without previous percutaneous transluminal balloon angioplasty (PTA), with the results after PTA alone. Methods: In nine healthy pigs, the iliac arteries were divided into three groups: group 1 (n = 6 arteries) was treated with PTA; group 2 n 6)with insertion of self-expanding stents after PTA; and group 3 (n = 6) with stent insertion without previous PTA. After 8 weeks the vessels were examined with intravascular ultrasonography,histologic examination and morphometric analysis. Results: Although the injury index in group 1 (0.17± 0.57) was lower (p <0.05) than in group 2 (0.26 ± 0.06) and group 3 (0.26 ± 0.08), PTA-treated arteries showed significantly (p <0.05) reduced mean luminal gain (0.53 ± 2.84) compared with arteries treated with PTA prior to stenting (2.58 ± 1.38) and compared with stenting alone (4.65 ±5.34). Stenting after PTA resulted in a higher (p<0.05) restenosis index (2.63 ± 1.06) compared with stenting without PTA (1.35 ± 0.59). Group 2 also had a significantly thicker intimap <0.05) and 83% and 74% higher intima/mediaratio (p <0.05) compared with groups 1 and 3, respectively. Conclusion: Insertion of a self-expandable nitinol stent without previous PTA results in less intimalhyperplasia than if PTA is performed prior to stenting, suggesting that direct stenting can be used in angioplasty sessions with a favorable outcome

Transthoracic ultrasound guided balloon dilation of cor triatriatum dexter in 2 Rottweiler puppies.

Science.gov (United States)

Birettoni, F; Caivano, D; Bufalari, A; Giorgi, M E; Miglio, A; Paradies, P; Porciello, F

2016-12-01

Balloon dilation was performed in two Rottweiler puppies with cor triatriatum dexter and clinical signs of ascites using transthoracic echocardiographic guidance. The dogs were positioned on a standard echocardiography table in right lateral recumbency, and guide wires and balloon catheters were imaged by echocardiographic views optimized to allow visualization of the defect. The procedures were performed successfully without complications and clinical signs were resolved completely in both cases. Guide wires and balloon catheters appeared hyperechoic on transthoracic echocardiography image and could be clearly monitored and guided in real-time. These two cases demonstrate that it is possible to perform balloon catheter dilation of cor triatriatum dexter under transthoracic guidance alone. Copyright © 2016 Elsevier B.V. All rights reserved.

Balloon catheter dilatation of esophageal strictures

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Kim, Jeung Sook; Yoon, Yup; Sung, Dong Yook; Choi, Woo Suk; Nam, Kyung Jin; Lim, Jae Hoon [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

1990-07-15

The authors performed 27 fluoroscopically guided balloon dilatation in 12 patients of esophageal stricture during recent 3 years. The causes of esophageal stricture were corrosive esophagitis (N=2) and congenital narrowing (N=1), including postoperative narrowing in achalasia (N=3), esophageal varix (N=3), lye stricture (N=2) and esophageal cancer (N=1). Successful dilatation of the stricture was achieved during the procedure in 10 patients(83%). Major complication such as esophageal rupture was not found. The authors conclude that fluoroscopically guided esophageal balloon dilatation is a safe and effective method for treatment of symptomatic esophageal strictures.

Balloon catheter dilatation of esophageal strictures

International Nuclear Information System (INIS)

Kim, Jeung Sook; Yoon, Yup; Sung, Dong Yook; Choi, Woo Suk; Nam, Kyung Jin; Lim, Jae Hoon

1990-01-01

The authors performed 27 fluoroscopically guided balloon dilatation in 12 patients of esophageal stricture during recent 3 years. The causes of esophageal stricture were corrosive esophagitis (N=2) and congenital narrowing (N=1), including postoperative narrowing in achalasia (N=3), esophageal varix (N=3), lye stricture (N=2) and esophageal cancer (N=1). Successful dilatation of the stricture was achieved during the procedure in 10 patients(83%). Major complication such as esophageal rupture was not found. The authors conclude that fluoroscopically guided esophageal balloon dilatation is a safe and effective method for treatment of symptomatic esophageal strictures

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

International Nuclear Information System (INIS)

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

2000-01-01

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

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

Science.gov (United States)

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

1995-05-01

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

Acute Urinary Obstruction in a Tetraplegic Patient from Misplacement of Catheter in Urethra.

Science.gov (United States)

Vaidyanathan, Subramanian; Singh, Gurpreet; Hughes, Peter L; Soni, Bakul M

2016-01-01

A male tetraplegic patient attended accident and emergency with a blocked catheter; on removing the catheter, he passed bloody urine. After three unsuccessful attempts were made to insert a catheter by nursing staff, a junior doctor inserted a three-way Foley catheter with a 30-mL balloon but inflated the balloon with 10 mL of water to commence the bladder irrigation. The creatinine level was mostly 19 µmol/L (range: 0-135 µmol/L) but increased to 46 µmol/L on day 7. Computerized tomography urogram revealed that the bilateral hydronephrosis with hydroureter was extended down to urinary bladder, the bladder was distended, prostatic urethra was dilated and filled with urine, and although the balloon of Foley catheter was not seen in the bladder, the tip of the catheter was seen lying in the urethra. Following the re-catheterization, the creatinine level decreased to 21 µmol/L. A follow-up ultrasound scan revealed no evidence of hydronephrosis in both kidneys. Flexible cystoscopy revealed inflamed bladder mucosa, catheter reaction, and tiny stones. There was no bladder tumor. This case report concludes that the cause of bilateral hydronephrosis, hydroureter, and distended bladder was inadequate drainage of urinary bladder as the Foley balloon that was under-filled slipped into the urethra resulting in an obstruction to urine flow. Urethral catheterization in tetraplegic patients should be performed by senior, experienced staff in order to avoid trauma and incorrect positioning. Tetraplegic subjects with decreased muscle mass have low creatinine level. Increase in creatinine level (>1.5 times the basal level) indicates acute kidney injury, although peak creatinine level may still be within laboratory reference range. While scanning the urinary tract of spinal cord injury patients with indwelling urinary catheter, if Foley balloon is not seen within the bladder, urethra should be scanned to locate the Foley balloon.

Preparation and characterisation of polyamide 11/montmorillonite (MMT) nanocomposites for use in angioplasty balloon applications

International Nuclear Information System (INIS)

Halim, Khairul Anwar A.; Farrell, Joseph B.; Kennedy, James E.

2013-01-01

With increased demands on catheter balloon functionality, there is an emphasis to blend new materials which can improve mechanical performance. Polymer nanocomposites were prepared by melt blending polyamide 11 (PA 11) with organically modified montmorillonite nanoclay. The effects of incorporating the nanoclay on the short-term mechanical properties of PA 11 were assessed using a design of experiments (DoEs) approach. X-ray diffraction (XRD), transmission electron microscopy (TEM), differential scanning calorimetry (DSC) and dynamic mechanical thermal analysis techniques (DMA) were used to characterise the morphology of the nanocomposites. Design of experiments studies revealed that the optimum nanocomposites properties can be achieved by carefully controlling the melt compounding parameters. XRD and TEM data proved that exfoliated clay morphologies existed within the matrix at low clay loading (2%). Whereas the interaction between the polymer matrix and nanoclay was quantified in the DMA spectra, showed a significant increase in storage modulus (up to 80%). The reinforcing effect of nanoclay within the PA 11 was further investigated using mechanical testing, where significant increases in the ultimate tensile strength and strain at break of reinforced tri-layer balloon tubing were observed. - Highlights: • TEM reveals the coexistence of exfoliated and intercalated nanostructures. • Isothermal crystallisation studies found that the nano-clays reduced the crystallisation time. • Significant increase in the storage modulus was due to the reinforcing effect of the nano-clay platelets. • It was observed that the activation energy values decreased due to the presence of nanoclay

Preparation and characterisation of polyamide 11/montmorillonite (MMT) nanocomposites for use in angioplasty balloon applications

Energy Technology Data Exchange (ETDEWEB)

Halim, Khairul Anwar A. [Department of Polymer Engineering, Athlone Institute of Technology, Athlone (Ireland); School of Materials Engineering, Universiti Malaysia Perlis, Perlis (Malaysia); Farrell, Joseph B. [Department of Polymer Engineering, Athlone Institute of Technology, Athlone (Ireland); Kennedy, James E., E-mail: jkennedy@ait.ie [Department of Polymer Engineering, Athlone Institute of Technology, Athlone (Ireland)

2013-12-16

With increased demands on catheter balloon functionality, there is an emphasis to blend new materials which can improve mechanical performance. Polymer nanocomposites were prepared by melt blending polyamide 11 (PA 11) with organically modified montmorillonite nanoclay. The effects of incorporating the nanoclay on the short-term mechanical properties of PA 11 were assessed using a design of experiments (DoEs) approach. X-ray diffraction (XRD), transmission electron microscopy (TEM), differential scanning calorimetry (DSC) and dynamic mechanical thermal analysis techniques (DMA) were used to characterise the morphology of the nanocomposites. Design of experiments studies revealed that the optimum nanocomposites properties can be achieved by carefully controlling the melt compounding parameters. XRD and TEM data proved that exfoliated clay morphologies existed within the matrix at low clay loading (2%). Whereas the interaction between the polymer matrix and nanoclay was quantified in the DMA spectra, showed a significant increase in storage modulus (up to 80%). The reinforcing effect of nanoclay within the PA 11 was further investigated using mechanical testing, where significant increases in the ultimate tensile strength and strain at break of reinforced tri-layer balloon tubing were observed. - Highlights: • TEM reveals the coexistence of exfoliated and intercalated nanostructures. • Isothermal crystallisation studies found that the nano-clays reduced the crystallisation time. • Significant increase in the storage modulus was due to the reinforcing effect of the nano-clay platelets. • It was observed that the activation energy values decreased due to the presence of nanoclay.

Efficacy of balloon temporary occlusion and intraoperative DSA in surgically difficult aneurysm

International Nuclear Information System (INIS)

Ezura, Masayuki; Mizoi, Kazuo; Yoshimoto, Takashi; Takahashi, Akira.

1993-01-01

A digital subtraction angiographic (DSA) apparatus has been installed in one of our operating rooms since April 1987. We performed intraoperative DSA in 42 aneurysmal surgeries in 38 patients and balloon temporary occlusion in 33 surgeries. The aneurysm was on an internal carotid artery in 26 cases and on the vertebro-basilar system in 16. A heparin-coated catheter (Anthron, Toray, Tokyo), 6 french in diameter, was inserted transfemorally and was put in a parent artery under general anesthesia. A balloon was temporarily inflated to determine inflation volume. The balloon catheter was soon deflated and was drawn back into the introducing catheter to avoid developing microembolus. The patients were not systemically heparinized but the introducing catheters were slowly flushed with heparinized saline during operation. Then a craniotomy was carried out. Next DSA was performed when temporary occlusion or confirmation of clipping was necessary. In cases of balloon temporary occlusion, the operating field was not obstructed as it is when a temporary clip is used, despite adequate flow reduction of the parent artery. After DSA for confirmation of clipping adjustment of it was performed in 12 cases out of 42. No complications occurred due to use of an introducing or a balloon catheter. We conclude that combined intravascular and neurosurgical approach, particularly for the large aneurysms with the difficulty of proximal control, can be a useful method of treatment. (author)

Below-the-ankle Angioplasty and Stenting for Limb Salvage: Anatomical Considerations and Long-term Outcomes

International Nuclear Information System (INIS)

Katsanos, Konstantinos; Diamantopoulos, Athanasios; Spiliopoulos, Stavros; Karnabatidis, Dimitris; Siablis, Dimitris

2013-01-01

PurposeTo report the long-term angiographic and clinical results in a series of below-the-ankle (BTA) angioplasty procedures and to present some biomechanical issues related to the unique anatomical geometry of the ankle.MethodsWe performed a retrospective analysis of BTA angioplasty procedures. Clinical end points included technical success, patient mortality, salvage of the treated foot, and repeat target lesion revascularization. Imaging end points included primary patency, binary restenosis of the target lesion at the 50 % threshold, and stent integrity (stent fracture, deformation, or collapse). Univariate subgroup analysis was performed.ResultsIn total, 40 limbs in 37 patients (age 73.5 ± 8.2 years) with critical limb ischemia were included and 42 inframalleolar lesions (4.2 ± 1.4 cm) were analyzed. Technical success was achieved in 95.2 % (40 of 42). Provisional stent placement was performed in 45.2 % (19 of 42). Two patients died, and two major amputations occurred up to 3 years. At 1 year, overall primary vessel patency was 50.4 ± 9.1 %, lesion binary restenosis rate was 64.1 ± 8.3 %, and repeat intervention-free survival was 93.6 ± 4.3 % according to life table analysis of all treated lesions. Pairwise subgroup analysis showed that BTA self-expanding stents were associated with significantly higher restenosis and poorer primary patency compared to plain balloon angioplasty or sirolimus-eluting balloon-expandable stents. Significant deformation and/or fracture of balloon-expandable stents placed BTA were identified in five of 11. Dynamic imaging showed that the dorsalis pedis artery is kinked during foot dorsiflexion, whereas the distal posterior tibial artery is kinked during plantar flexion of the foot.ConclusionBTA angioplasty for critical limb ischemia treatment is safe and feasible with satisfactory long-term results. BTA stent placement must be reserved for bailout indications

Below-the-ankle Angioplasty and Stenting for Limb Salvage: Anatomical Considerations and Long-term Outcomes

Energy Technology Data Exchange (ETDEWEB)

Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Diamantopoulos, Athanasios; Spiliopoulos, Stavros; Karnabatidis, Dimitris; Siablis, Dimitris [School of Medicine, Patras University Hospital, Department of Interventional Radiology (Greece)

2013-08-01

PurposeTo report the long-term angiographic and clinical results in a series of below-the-ankle (BTA) angioplasty procedures and to present some biomechanical issues related to the unique anatomical geometry of the ankle.MethodsWe performed a retrospective analysis of BTA angioplasty procedures. Clinical end points included technical success, patient mortality, salvage of the treated foot, and repeat target lesion revascularization. Imaging end points included primary patency, binary restenosis of the target lesion at the 50 % threshold, and stent integrity (stent fracture, deformation, or collapse). Univariate subgroup analysis was performed.ResultsIn total, 40 limbs in 37 patients (age 73.5 {+-} 8.2 years) with critical limb ischemia were included and 42 inframalleolar lesions (4.2 {+-} 1.4 cm) were analyzed. Technical success was achieved in 95.2 % (40 of 42). Provisional stent placement was performed in 45.2 % (19 of 42). Two patients died, and two major amputations occurred up to 3 years. At 1 year, overall primary vessel patency was 50.4 {+-} 9.1 %, lesion binary restenosis rate was 64.1 {+-} 8.3 %, and repeat intervention-free survival was 93.6 {+-} 4.3 % according to life table analysis of all treated lesions. Pairwise subgroup analysis showed that BTA self-expanding stents were associated with significantly higher restenosis and poorer primary patency compared to plain balloon angioplasty or sirolimus-eluting balloon-expandable stents. Significant deformation and/or fracture of balloon-expandable stents placed BTA were identified in five of 11. Dynamic imaging showed that the dorsalis pedis artery is kinked during foot dorsiflexion, whereas the distal posterior tibial artery is kinked during plantar flexion of the foot.ConclusionBTA angioplasty for critical limb ischemia treatment is safe and feasible with satisfactory long-term results. BTA stent placement must be reserved for bailout indications.

The sliding rail system (monorail): description of a new technique for intravascular instrumentation and its application to coronary angioplasty.

Science.gov (United States)

Bonzel, T; Wollschläger, H; Kasper, W; Meinertz, T; Just, H

1987-01-01

The sliding rail technique is a new technique for intravascular instrumentation, especially coronary stenosis dilatation. The so-called monorail balloon catheter is the first device which can be used according to this technique. The monorail catheter has a single lumen shaft and only a short central tube within the distal balloon part. With the guidewire inserted into the tube, the balloon can be advanced or retracted on the guidewire as on a sliding rail. The most relevant improvements for coronary dilatation are steerability, contrast flow and rapid and easy exchangeability of balloon catheters and other intracoronary devices. These characteristics are felt to result in a more simple and time- and fluoroscopy-saving dilatation procedure. A special transfusion catheter may also improve procedural safety. The first clinical results in 69 patients with a success rate of 96%, an emergency bypass rate of two patients (one infarction) and a stenosis improvement of 58% confirm the theoretically conceived advantages.

Stroke risk associated with balloon based catheter ablation for atrial fibrillation: Rationale and design of the MACPAF Study

Directory of Open Access Journals (Sweden)

Schultheiss Heinz-Peter

2010-07-01

Full Text Available Abstract Background Catheter ablation of the pulmonary veins has become accepted as a standard therapeutic approach for symptomatic paroxysmal atrial fibrillation (AF. However, there is some evidence for an ablation associated (silent stroke risk, lowering the hope to limit the stroke risk by restoration of rhythm over rate control in AF. The purpose of the prospective randomized single-center study "Mesh Ablator versus Cryoballoon Pulmonary Vein Ablation of Symptomatic Paroxysmal Atrial Fibrillation" (MACPAF is to compare the efficacy and safety of two balloon based pulmonary vein ablation systems in patients with symptomatic paroxysmal AF. Methods/Design Patients are randomized 1:1 for the Arctic Front® or the HD Mesh Ablator® catheter for left atrial catheter ablation (LACA. The predefined endpoints will be assessed by brain magnetic resonance imaging (MRI, neuro(psychological tests and a subcutaneously implanted reveal recorder for AF detection. According to statistics 108 patients will be enrolled. Discussion Findings from the MACPAF trial will help to balance the benefits and risks of LACA for symptomatic paroxysmal AF. Using serial brain MRIs might help to identify patients at risk for LACA-associated cerebral thromboembolism. Potential limitations of the study are the single-center design, the existence of a variety of LACA-catheters, the missing placebo-group and the impossibility to assess the primary endpoint in a blinded fashion. Trial registration clinicaltrials.gov NCT01061931

Development of radioactive 166Ho-coated balloon and its dose estimation

International Nuclear Information System (INIS)

Park, K. B.; Kim, K. H.; Hong, Y. D.; Park, E. W.

2000-01-01

The use of balloon with radioisotope is a promising method to prevent restenosis after transluminal coronary arterial angioplasty or stent implantation. In this study, we have developed a new radioactive coated balloon, which is prepared by coating the surface of existing balloon with 166 Ho instead of being filled with beta sources which emit high energy beta-particles for the purpose of the delivery of sufficient radiation to the vessel wall. To estimate the safety of 166 Ho-coated balloon, leaching test and radiation resistance test of the balloon were performed. The absorbed dose distributions around the 166 Ho-coated balloon were estimated by means of Monte Carlo simulation and the initial activities for optimal therapeutic regimen were determined on the basis of this results

Differences in Endothelial Injury After Balloon Angioplasty, Insertion of Balloon-Expanded Stents or Release of Self-Expanding Stents: An Electron Microscopic Experimental Study

International Nuclear Information System (INIS)

Harnek, Jan; Zoucas, Evita; Carlemalm, Erik; Cwikiel, Wojciech

1999-01-01

Purpose: To evaluate which of six different commonly available stents inserted into an artery without percutaneous transluminal angioplasty (PTA) causes the least endothelial damage. To compare the degree of endothelial injury after insertion of such a stent with injury caused by PTA. Methods: Twelve healthy pigs were used in the experiments. In the first part of the study six different types of stents were inserted into the common iliac arteries. In the second part of the study self-expanding stents with large spaces between the wires were used. PTA was performed in the contralateral iliac artery. The pigs were killed immediately after the procedure and resected specimens examined after fixation, using scanning electron microscopy. Results: All procedures but two were accomplished successfully. More endothelium was preserved after insertion of self-expanding stents with large spaces between the wires, compared with stents with small spaces and balloon-expanded stents. After insertion of self-expanding stents with large spaces, 50.1% ± 16.4% of the endothelium remained intact, compared with only 5.6% ± 7.7% after PTA. The difference was statistically significant (p < 0.001). Conclusion: Self-expanding stents with large spaces between the wires, inserted without PTA, cause less damage to the endothelium than other stents and significantly less damage than PTA

Topical application of β-radiation to reduce intimal hyperplasia after carotid artery balloon injury in rabbit A possible application for brachytherapy in vascular surgery

International Nuclear Information System (INIS)

Rosenthal, David; Stevens, Scott L.; Skillern, C.S.; Wellons, Eric D.; Robinson, Keith; Matsuura, John H.; Gannon, Brian J.

2002-01-01

Purpose: Endovascular brachytherapy for the prevention of intimal hyperplasia (IH) and restenosis after balloon/stent angioplasty has proven effective both in animal preparations and clinical trials. A variety of β-emitting isotopes and catheter-based devices have been developed for the delivery of low-dose radiation in clinical coronary and peripheral trials. No platform, however, has yet been developed for brachytherapy in concert with vascular surgical operations. The purpose of this study was to evaluate the vascular histopathologic response following balloon injury to rabbit carotid arteries with and without topically applied low-dose β-radiation. Methods: The β-emitting isotope strontium-90 (Sr-90) was conjugated onto the matrix of polypropylene (PLYP) mesh. Rabbit carotid arteries were balloon-injured with a no. 2 embolectomy catheter. Six carotid arteries were wrapped with nonradioactive PLYP mesh (controls) and Sr-90 (∼90 μCi) PLYP mesh in order to deliver low-dose radiation to the vessel wall from the external (adventitial) surface. Tissue was harvested at 6 weeks and processed for histologic examination. Results: There was consistent blockade of fibrocellular neointima formation with virtually no neointima present in all treated segments, compared to moderate neointima formation in controls. Medial thinning and smooth muscle cell (SMC) necrosis were also associated with topical brachytherapy. Conclusion: β-Radiation applied by an externally wrapped PLYP mesh labeled with Sr-90 markedly suppressed neointima formation in an animal vascular surgical injury model. Further studies, however, are necessary to determine a suitable isotope and dosage for clinical application

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

International Nuclear Information System (INIS)

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

2003-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2003-08-01

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

A prospective, multi-center study of the chocolate balloon in femoropopliteal peripheral artery disease: The Chocolate BAR registry.

Science.gov (United States)

Mustapha, Jihad A; Lansky, Alexandra; Shishehbor, Mehdi; Miles McClure, John; Johnson, Sarah; Davis, Thomas; Makam, Prakash; Crowder, William; Konstantino, Eitan; Attaran, Robert R

2018-05-01

The Chocolate BAR study is a prospective multicenter post-market registry designed to evaluate the safety and performance of the Chocolate percutaneous transluminal angioplasty balloon catheter in a broad population with symptomatic peripheral arterial disease. The primary endpoint is acute procedural success (defined as ≤30% residual stenosis without flow-limiting dissection); secondary long-term outcomes include freedom from target lesion revascularization (TLR), major unplanned amputation, survival, and patency. A total of 262 patients (290 femoropopliteal lesions) were enrolled at 30 US centers between 2012 and 2014. The primary endpoint of procedure success was achieved in 85.1% of cases, and freedom from stenting occurred in 93.1%. Bail out stenting by independent adjudication occurred in 1.6% of cases and there were no flow limiting dissections. There was mean improvement of 2.1 Rutherford classes (±1.5) at 12-months, with 78.5% freedom from TLR, 97.2% freedom from major amputation, and 93.3% freedom from all-cause mortality. Core Lab adjudicated patency was 64.1% at 12 months. Use of the Chocolate balloon in an "all-comers" population achieved excellent procedural outcomes with low dissection rates and bailout stent use. © 2018 Wiley Periodicals, Inc.

Balloon-assisted catheter directed thrombolysis for acute lower extremity deep vein thrombosis

International Nuclear Information System (INIS)

Li Zhi; Ni Caifang; Jin Yonghai; Zhao Xin; Dong Fenglin; Fan Baorui; Yang Chao; Li Mingming; Hao Hongjun

2012-01-01

Objective: To investigate the efficacy and safety of balloon-assisted catheter directed thrombolysis (CDT) for acute lower extremity deep vein thrombosis (DVT). Methods: From September 2008 to February 2011, 94 patients with acute lower extremity DVT were admitted. The cases in early stage were treated by CDT (Group A, n=50), and the cases in late stage were treated by balloon-assisted CDT (Group B, n=44). The clinical data of these patients were retrospectively analyzed. The circumference difference between normal and affected limbs, scores of venous patency, and rates of venous patency were recorded for judging the efficacy. The total dose of urokinase and retention time of infusion catheter was compared between the two groups. The incidence of pulmonary embolism and bleeding were used to judge the safety of treatment. The venous patency was followed up by ultrasound or/and venography. Measurement data with normal distribution was described by mean + standard, and was analyzed using T test. Measurement data with non-normal distribution was described by M (QL, QU), QL=P25, QU=P75, and was analyzed using Wilcoxon's test. Categorical variable data was analyzed using Chi-Square test. Results: The prior treatment circumference difference between normal and affectéd limbs were (5.37 ±1.97) cm (thigh) and (4.14 ± 1.57) cm (calf) in Group A and (5.41±2.22) cm (thigh) and (4.05 ±1.61) cm (calf) in Group B; and the difference between the groups was insignificant (thigh: t=-0.113, P=0.910; calf: t=0.288, P=0.774). The post treatment correspondences were: (2.96 ± 1.10) cm (thigh) and (1.93 ± 0.84) cm (calf) in Group A and (1.78 ± 1.40) cm (thigh) and (1.41± 1.17) cm (calf) in Group B; the difference between the groups was significant (thigh: t=4.66, P<0.0001; calf: t=2.548, P=0.012). The prior treatment score of venous patency was 9 (8, 10) in Group A and 8.3(7, 10) in Group B without significant difference (Z=-1.5172, P=0.1292). The post treatment score of

Navigation for fluoroscopy-guided cryo-balloon ablation procedures of atrial fibrillation

Science.gov (United States)

Bourier, Felix; Brost, Alexander; Kleinoeder, Andreas; Kurzendorfer, Tanja; Koch, Martin; Kiraly, Attila; Schneider, Hans-Juergen; Hornegger, Joachim; Strobel, Norbert; Kurzidim, Klaus

2012-02-01

Atrial fibrillation (AFib), the most common arrhythmia, has been identified as a major cause of stroke. The current standard in interventional treatment of AFib is the pulmonary vein isolation (PVI). PVI is guided by fluoroscopy or non-fluoroscopic electro-anatomic mapping systems (EAMS). Either classic point-to-point radio-frequency (RF)- catheter ablation or so-called single-shot-devices like cryo-balloons are used to achieve electrically isolation of the pulmonary veins and the left atrium (LA). Fluoroscopy-based systems render overlay images from pre-operative 3-D data sets which are then merged with fluoroscopic imaging, thereby adding detailed 3-D information to conventional fluoroscopy. EAMS provide tracking and visualization of RF catheters by means of electro-magnetic tracking. Unfortunately, current navigation systems, fluoroscopy-based or EAMS, do not provide tools to localize and visualize single shot devices like cryo-balloon catheters in 3-D. We present a prototype software for fluoroscopy-guided ablation procedures that is capable of superimposing 3-D datasets as well as reconstructing cyro-balloon catheters in 3-D. The 3-D cyro-balloon reconstruction was evaluated on 9 clinical data sets, yielded a reprojected 2-D error of 1.72 mm +/- 1.02 mm.

Impact of contrast agent viscosity on coronary balloon deflation times: bench testing results.

Science.gov (United States)

Mogabgab, Owen; Patel, Vishal G; Michael, Tesfaldet T; Kotsia, Anna; Christopoulos, George; Banerjee, Subhash; Brilakis, Emmanouil S

2014-04-01

To assess the impact of viscosity on angioplasty balloon deflation times. Lower contrast viscosity could result in more rapid coronary balloon deflation times. We performed a bench comparison of coronary balloon deflation times using 2 contrast agents with different viscosity (ioxaglate and iodixanol), 3 contrast dilutions, and 2 inflation syringe filling volumes. Ten identical pairs of coronary angioplasty balloons were used to conduct each comparison after balloon inflation to 12 atmospheres. Simultaneous deflations were performed under cineangiography. The time to full contrast extraction and the area of contrast remaining after 5 seconds of deflation (quantified by opaque pixel count) were compared between groups. The mean time to full contrast extraction during balloon deflation was 8.3 ± 2.5 seconds for ioxaglate (lower viscosity) versus 10.1 ± 2.9 seconds for iodixanol (higher viscosity) (17.4% decrease, P = 0.005), with a 35.6% (P = 0.004) reduction in contrast area at 5 seconds. Compared to 1:1 ioxaglate-saline mixture, 1:2 and 1:3 ioxaglate/saline mixes resulted in 26.7% (P deflation time, respectively, but at the expense of decreased balloon opacity. Filling the inflation syringe with 5 versus 15 ml of contrast/saline solution was associated with 7.5% decrease in balloon deflation time (P = 0.005), but no difference in contrast area at 5 seconds (P = 0.749). Use of a lower viscosity contrast agent and higher contrast dilution significantly reduced coronary balloon deflation times, whereas use of lower syringe filling volume had a modest effect. Rapid coronary balloon deflation could improve the safety of interventional procedures. © 2014 Wiley Periodicals, Inc.

Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography

Energy Technology Data Exchange (ETDEWEB)

Ogo, Takeshi, E-mail: ogo.takeshi.hp@mail.ncvc.go.jp [Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Department of Advanced Mediccal Research for Pulmonary Hypertension, National Cerebral and Cardiovascular Centre, Osaka (Japan); Fukuda, Tetsuya [Department of Radiology, National Cerebral and Cardiovascular Centre, Osaka (Japan); Tsuji, Akihiro; Fukui, Shigefumi; Ueda, Jin [Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Sanda, Yoshihiro [Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Morita, Yoshiaki [Department of Radiology, National Cerebral and Cardiovascular Centre, Osaka (Japan); Asano, Ryotaro; Konagai, Nao [Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Yasuda, Satoshi [Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan)

2017-04-15

Highlights: • Recent advancement in CT enables distal CTEpH lesions to be visualized. • We investigated the efficacy and safety of BPA guided by CBCT or ECG-gated area detector CT. • BPA guided by CBCT or ECG-gated area detector CT is effective and safe in patients with CTEpH . • These new advanced CT techniques may be useful in pre-BPA target lesion assessment. - Abstract: Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized. Methods: We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment. We collected clinical and hemodynamic data, including procedural complications, before BPA and at 3 months and 1 year after BPA. Results: Three hundred eight-five BPA sessions (4.8 sessions/patient) were performed for the lesions of subsegmental arteries (1155 lesions), segmental arteries (738 lesions), and lobar arteries (4 lesions) identified by CBCT or ECG-gated ADCT. Significant improvements in the symptoms, 6-min walk distance, brain natriuretic peptide level, exercise capacity, and haemodynamics were observed 3 months and 1 year after BPA. No cases of death or cardiogenic shock with a low rate of severe wire perforation (0.3%) and severe reperfusion oedema (0.3%) were observed. Conclusions: BPA guided by CBCT or ECG-gated ADCT is effective and remarkably safe in patients with CTEPH . These new advanced CT techniques may be useful in pre-BPA target lesion assessment.

Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography

International Nuclear Information System (INIS)

Ogo, Takeshi; Fukuda, Tetsuya; Tsuji, Akihiro; Fukui, Shigefumi; Ueda, Jin; Sanda, Yoshihiro; Morita, Yoshiaki; Asano, Ryotaro; Konagai, Nao; Yasuda, Satoshi

2017-01-01

Highlights: • Recent advancement in CT enables distal CTEpH lesions to be visualized. • We investigated the efficacy and safety of BPA guided by CBCT or ECG-gated area detector CT. • BPA guided by CBCT or ECG-gated area detector CT is effective and safe in patients with CTEpH . • These new advanced CT techniques may be useful in pre-BPA target lesion assessment. - Abstract: Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized. Methods: We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment. We collected clinical and hemodynamic data, including procedural complications, before BPA and at 3 months and 1 year after BPA. Results: Three hundred eight-five BPA sessions (4.8 sessions/patient) were performed for the lesions of subsegmental arteries (1155 lesions), segmental arteries (738 lesions), and lobar arteries (4 lesions) identified by CBCT or ECG-gated ADCT. Significant improvements in the symptoms, 6-min walk distance, brain natriuretic peptide level, exercise capacity, and haemodynamics were observed 3 months and 1 year after BPA. No cases of death or cardiogenic shock with a low rate of severe wire perforation (0.3%) and severe reperfusion oedema (0.3%) were observed. Conclusions: BPA guided by CBCT or ECG-gated ADCT is effective and remarkably safe in patients with CTEPH . These new advanced CT techniques may be useful in pre-BPA target lesion assessment.

3D dosimetry study of 188Re liquid balloon for intravascular brachytherapy using BANG polymer gel dosemeters

International Nuclear Information System (INIS)

Wuu, S.; Schiff, P.B.; Maryanski, M.; Liu, T.; Borzillary, S.; Weinberger, J.

2002-01-01

It has been suggested that the combination of intravascular brachytherapy and coronary stent implantation may result in further reduction of restenosis after percutaneous balloon angioplasty. The use of an angioplasty balloon filled with a P 188 Re liquid beta source for intravascular brachytherapy provides the advantage of accurate source positioning and uniform dose distribution to the coronary vessel wall. The effect of source edge and stent on the dose distribution of the target tissue may be clinically important. In BANG gels, the absorbed radiation produces free-radical chain polymerisation of acrylic monomers that are initially dissolved in the gel. The number of polymer particles is proportional to the absorbed dose. In this study, 3D dose distributions are presented for 188 Re balloons, with and without stents, using a prototype He-Ne laser CT scanner and the proprietary BANG polymer gel dosemeters. (author)

High dose rate brachytherapy for prevention of restenosis after percutaneous transluminal coronary angioplasty: preliminary dosimetric tests of a new source presentation

International Nuclear Information System (INIS)

Popowski, Youri; Verin, Vitali; Papirov, Igor; Nouet, Philippe; Rouzaud, Michel; Grob, Eugene; Schwager, Michael; Urban, Philippe; Rutishauser, Wilhelm; Kurtz, John M.

1995-01-01

Purpose: Balloon dilatation of coronary artery stenosis has become a standard treatment of atherosclerotic heart disease. Restenosis due to excessive intimal cell proliferation, which subsequently occurs in 20-50% of patients, represents one of the major clinical problems in contemporary cardiology, and no satisfactory method for its prevention has thus far been found. Because modest doses of radiation have proved effective in preventing certain types of abnormal cellular proliferation resulting from surgical trauma, and brachytherapy has already been used successfully after dilatation of peripheral arteries, development of a radioactive source suitable for coronary artery applications would be of great interest. Methods and Materials: Nonradioactive flexible yttrum-89 wires (diameter of 0.15 and 0.26 mm) were activated within the thermal neutron flux of an experimental reactor. Standard angioplasty balloons (2 cm long, 2.5 mm in diameter when inflated) were inserted for dosimetry into a specially manufactured tissue equivalent phantom. Four wells, drilled perpendicular to the axis of the balloon, allowed for the insertion of thermal luminescent dosimeters (TLDs; 2 mm of diameter) and spacers. The angioplasty balloon was inflated with air or with contrast media. Radioactive yttrium-90 wires were left in the central lumen of the balloon for 2 min. Doses at the surface of the balloon, and at 1, 2, and 3 mm were determined from TLD readings. Results: Doses obtained at the surface of the balloon, for a 2-min exposure for the 0.26 mm wire (balloon inflated with air) and the 0.15 mm wire (air or contrast), were 56.5 Gy, 17.8 Gy, 5.4 Gy, respectively. As expected for a beta emitter, the fall-off in dose as a function of depth was rapid. External irradiation from the beta source was negligible. Conclusions: Our experiments indicate that the dose rates attainable at the surface of the angioplasty balloon using this technique allow the doses necessary for the inhibition of

Differences in optical coherence tomographic findings and clinical outcomes between excimer laser and cutting balloon angioplasty for focal in-stent restenosis lesions.

Science.gov (United States)

Nishino, Masami; Lee, Yasuharu; Nakamura, Daisuke; Yoshimura, Takahiro; Taniike, Masayuki; Makino, Nobuhiko; Kato, Hiroyasu; Egami, Yasuyuki; Shutta, Ryu; Tanouchi, Jun; Yamada, Yoshio

2012-10-01

In-stent restenosis (ISR), especially focal ISR, after percutaneous coronary intervention (PCI) remains one of the major clinical problems in the drug-eluting stent (DES) era. Several reports have revealed that excimer laser coronary angioplasty (ELCA) is useful for ISR; however, detailed findings after ELCA are unknown. Therefore, we investigated the condition of the neointima after ELCA for ISR with optical coherence tomography (OCT) and compared the OCT findings and clinical outcome between ELCA and cutting-balloon angioplasty (CBA). Twenty-one consecutive patients with focal ISR who underwent ELCA or CBA were enrolled. All patients underwent 12- to 15-month follow-up coronary angiography. OCT was performed immediately after successful PCI to evaluate the neointimal condition in the ISR lesion. We compared the following OCT parameters between ELCA and CBA groups: maximal thickness of remaining in-stent neointima (MTN), number of tears, minimum lumen dimension (MLD), and minimum lumen area (MLA). We also evaluated clinical outcomes, including target vessel revascularization, acute myocardial infarction, death, and stent thrombosis. MLA in the ELCA group (n = 10) was significantly larger than in the CBA group, and number of tears in the ELCA group was significantly lower than in the CBA group. A trend was shown toward lower TLR with ELCA versus CBA (10.0% vs 45.5%). OCT immediately after ELCA for ISR lesions revealed larger lumen area and smaller number of tears compared with CBA, which may support favorable effects of ELCA for focal ISR.

Intra-arterial digital subtraction angiography of the pulmonary arteries using a flow-directed balloon catheter in the diagnosis of pulmonary embolism

International Nuclear Information System (INIS)

Rooij, W.J.J. van; Heeten, G.J. den

1992-01-01

Selective intra-arterial digital subtraction angiography (IA-DSA) of the pulmonary vessels was performed in 70 patients suspected of acute pulmonary embolism. A flow-directed Swan-Ganz pulmonary angiography catheter was used. The spatial resolution of the equipment used was 3.3 lp/mm for DSA and 6.0 lp/mm for conventional pulmonary angiography (CPA). Image quality of the angiograms was assessed by determining the highest visible branching division of the main pulmonary artery. The mean visible branching division for IA-DSA was 4.71 (range 3-7). In 10 patients where IA-DSA and CPA were performed during the same procedure there was no difference in visualization of peripheral arteries (mean 4.70 visible or for both modalities). IA-DSA makes the procedure rapid, saves on films and contrast material and allows good visualization of areas where exposure is difficult. The spatial resolution of state-of-the-art equipment permits sufficient definition of subsegmental vessels. The use of the flow-directed balloon catheter makes the examination easy to perform and minimizes the risk of catheter induced cardiac arrhythmias. (orig.) [de

Localized-low attenuation of the lung on thin-section CT in experimentally induced pulmonary arterial occlusion with balloon catheter in pigs

International Nuclear Information System (INIS)

Lee, Hyun Ju; Goo, Jin Mo; Im, Jung Gi; Kim, Ji Hye

2008-01-01

To determine whether a localized low-attenuation (LLA) is induced on a thin-section CT (TSCT) during an acute pulmonary arterial occlusion in pigs. In eight pigs, 14 sites of the descending pulmonary artery were obstructed using balloon catheters. The lung TSCTs were obtained immediately after pulmonary artery obstruction (n=13), 10 min (n=10), 30 min (n=14) and 60 min (n=14) after pulmonary artery obstruction at the end of expiration. The TSCTs were also obtained after balloon-deflation at the end of expiration (n=11) and with the balloon-reinflation at inspiration (n=6). Of the 14 sites of pulmonary artery obstruction, 11 (79%) showed LLA. However, LLA progressively became fainter or disappeared on a follow-up CT in seven sites. When the balloon was deflated, 10 of the 11 sites measured showed no change in lung attenuation. After full inspiration, LLA disappeared in three of the six sites. The corresponding areas of LLA on the CT showed a statistically significant increase compared to the baseline CT immediately after inflation (ρ =0.021) and 30 minutes after inflation (ρ = 0.041), and after balloon deflation (ρ = 0.036). LLA was induced by acute pulmonary artery obstruction. However, LLA, gradually faded over the 60 minutes following obstruction. LLAs were maintained despite the restoration of pulmonary arterial flow, but disappeared as a result of a full inspiration. Thus, LLA might be caused by air trapping

Laser-driven short-duration heating angioplasty: dilatation performance in cadaver atherosclerotic femoral arteries

Science.gov (United States)

Shimazaki, Natsumi; Naruse, Sho; Arai, Tsunenori; Imanishi, Nobuaki; Aiso, Sadakazu

2013-03-01

The purpose of this study was to investigate the artery dilatation performance of the short-duration heating balloon catheter in cadaver stenotic arteries. We designed a prototype short-duration heating balloon catheter that can heat artery media to around 60 °C in 15-25 s by a combination of laser-driven heat generation and continuous fluid irrigation in the balloon. We performed ex vivo short-duration heating dilatation in the cadaver atherosclerotic femoral arteries (initial percent diameter stenosis was 36-98%), with the maximum balloon temperature of 65+/-5 °C, laser irradiation duration of 25 s, and balloon dilatation pressure of 3.5 atm. The artery lumen configurations before and after the dilatations were assessed with a commercial IVUS system. After the short-duration heating dilatations, the percent diameter stenosis was reduced below 30% without any artery tears or dissections. We estimated that the artery media temperature was raised to around 60 °C in which plaque thickness was below 0.8 mm by a thermal conduction calculation. The estimated maximum temperature in artery adventitia and surrounding tissue was up to 45 °C. We found that the short-duration heating balloon could sufficiently dilate the cadaver stenotic arteries, without thermal injury in artery adventitia and surroundings.

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

Science.gov (United States)

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

2007-10-01

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

Initial Experience with Computed Tomography and Fluoroscopically Guided Placement of Push-Type Gastrostomy Tubes Using a Rupture-Free Balloon Catheter

International Nuclear Information System (INIS)

Fujita, Takeshi; Tanabe, Masahiro; Yamatogi, Shigenari; Shimizu, Kensaku; Matsunaga, Naofumi

2011-01-01

The purpose of this study was to evaluate the safety and feasibility of percutaneous radiologic gastrostomy placement of push-type gastrostomy tubes using a rupture-free balloon (RFB) catheter under computed tomography (CT) and fluoroscopic guidance. A total of 35 patients (23 men and 12 women; age range 57–93 years [mean 71.7]) underwent percutaneous CT and fluoroscopically guided gastrostomy placement of a push-type gastrostomy tube using an RFB catheter between April 2005 and July 2008. Technical success, procedure duration, and complications were analyzed. Percutaneous radiologic gastrostomy placement was considered technically successful in all patients. The median procedure time was 39 ± 13 (SD) min (range 24–78). The average follow-up time interval was 103 days (range 7–812). No major complications related to the procedure were encountered. No tubes failed because of blockage, and neither tube dislodgement nor intraperitoneal leakage occurred during the follow-up period. The investigators conclude that percutaneous CT and fluoroscopically guided gastrostomy placement with push-type tubes using an RFB catheter is a safe and effective means of gastric feeding when performed by radiologists.

Attitudes on and usage of balloon catheter technology in rhinology: A survey of the American Rhinologic Society.

Science.gov (United States)

Halderman, Ashleigh A; Stokken, Janalee; Momin, Suhael R; Smith, Timothy L; Sindwani, Raj

2015-01-01

Use of balloon catheter dilation in the management of paranasal sinus diseases, including chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis, remains controversial. In an effort to gain some clarity about its evolving role, we surveyed members of the American Rhinologic Society (ARS). Online survey. ARS Members were sent an invitation by e-mail to participate in an online, anonymous 23-item survey. A total of 231 participants completed the survey, for an overall response rate of 25%. Balloon catheter technology (BCT) played no role in the practices of one-third of all the respondents. Of those who did use BCT, more than 50% performed only 1-4 cases per month on average. This did not differ significantly with practice type (p = 0.2988). The overall use of BCT differed between types of practices with those in private practice reporting greater use of the technology for maxillary and sphenoid sinuses (p = 0.0003 and p = 0.0073, respectively). Participants in private practice appeared significantly more impressed with the results of BCT when compared with those in academia (p = 0.0005) and also thought that patients were more satisfied (p = 0.0002). Opinions toward the strength of available evidence also differed significantly between the two groups (p = 0.0007). Thirty-two respondents had experienced a complication with BCT, although the majority of these did not require any intervention. ARS members surveyed used BCT infrequently in their practices. Attitudes on the role of this technology in CRS management differed between academic and private practitioners, but, despite this, the volume of reported BCT use was the same. Surgeons are more accepting of the technology now compared with 5 years ago, and many of them believe that their use of BCT will increase in the future.

Missing left main ostio-proximal coronary artery disease during angiography using tiger catheter

Directory of Open Access Journals (Sweden)

Biswajit Majumder

2016-01-01

Full Text Available Coronary angiography by right radial artery route using Optitorque Tiger catheter is on the rise given the low rate of local complications and feasibility to perform it as a day-care procedure. We report here a case of coronary angiography performed using Optitorque Tiger catheter (5-French which resulted in a diagnostic error, missing the ostio-proximal left main coronary artery disease which was later detected using EBU 3.5 guide catheter (7-French while performing angioplasty.

Induction of labour by balloon catheter with extra-amniotic saline infusion (BCEAS): a randomised comparison with PGE2 vaginal pessaries

DEFF Research Database (Denmark)

Lyndrup, J; Nickelsen, Carsten Nahne Amtof; Weber, Tom

1994-01-01

OBJECTIVE: A new method for induction of labour--balloon catheter with extra-amniotic saline infusion (BCEAS)--is evaluated in randomised comparison with prostaglandin E2 (PGE2) in vaginal pessaries. STUDY GROUP: One-hundred and nine pregnant women with unfavourable cervices. MAJOR OUTCOME MEASURES......: The efficiency of inducing vaginal delivery and the level of 'disadvantages following induction of labour' (DisFIL scorings). RESULTS: Overall, BCEAS was less efficient inducing vaginal delivery than vaginal PGE2 (P women (P ...) primiparous women group, and particularly in the subgroup of these having very low pelvic scores (Lange score,

More than just a urinary catheter — Haemorrhage control by using a Foley catheter in a penetrating aortic root injury

Directory of Open Access Journals (Sweden)

Adel Elmoghrabi

2016-08-01

Full Text Available The prevalence of great vessel injuries in thoracic trauma is reported at 0.3–10%, predominantly due to a penetrating mechanism. Thoracic aortic injuries, more specifically those within proximity of the aortic root are challenging to manage and unceasing bleeding hampers adequate visualisation for performing repair. We report a case of a 31-year-old male that presented to the emergency department 1 h after sustaining a stab wound injury within proximity of the left upper sternal border. Vital signs were stable on presentation. Physical examination revealed a 1.5 cm laceration in the 3rd intercostal space. Chest X-ray revealed a small left pneumothorax, FAST scan was negative, and CT of the chest revealed left sided haemopneumothorax and haemopericardium. The patient was emergently transferred to the operating room where median thoracotomy was performed. A significant amount of bleeding was observed originating from a 1 cm laceration of the aortic root. Bleeding was controlled using a Foley catheter after unsuccessful attempts of digital compression, and the laceration was repaired using pledgeted sutures. Postoperative echocardiography and CT scan of the chest revealed normal cardiac functions with resolution of haemopericardium and haemopneumothorax, and the patient was discharged in a stable condition. High index of suspicion should be maintained for injury to the great vessels in patients with penetrating chest injuries, despite apparent haemodynamic stability. In this case, balloon tamponade using a Foley catheter served as a quick and simple technique that resulted in an almost bloodless field, facilitating adequate visualisation for definitive repair. Although the use of this technique has been previously described, this report serves as a reminder that a Foley catheter can be successfully used for balloon catheter tamponade in injuries to the aortic root. Keywords: Aortic root, Injury, Foley's catheter, Balloon catheter, Aorta

Prevention of Intracranial In-stent Restenoses: Predilatation with a Drug Eluting Balloon, Followed by the Deployment of a Self-Expanding Stent

Energy Technology Data Exchange (ETDEWEB)

Vajda, Zsolt, E-mail: Z.Vajda@klinikum-stuttgart.de; Guethe, Thomas, E-mail: T.Guethe@klinikum-stuttgart.de; Perez, Marta Aguilar, E-mail: M.Aguilar@klinikum-stuttgart.de; Kurre, Wiebke, E-mail: w.kurre@klinikum-stuttgart.de [Klinikum Stuttgart, Katharinenhospital, Klinik fuer Neuroradiologie, Neurozentrum (Germany); Schmid, Elisabeth, E-mail: ESchmid@klinikum-stuttgart.de; Baezner, Hansjoerg, E-mail: H.Baezner@klinikum-stuttgart.de [Klinikum Stuttgart, Klinik fuer Neurologie, Neurozentrum (Germany); Henkes, Hans, E-mail: hhhenkes@aol.com [Klinikum Stuttgart, Katharinenhospital, Klinik fuer Neuroradiologie, Neurozentrum (Germany)

2013-04-15

Stenting in intracranial atherosclerotic disease (ICAD) is increasingly debated, due to issues of procedural safety, technical efficacy, and in-stent recurrent stenoses (ISR). In the present study, feasibility, safety, and efficacy of angioplasty using a drug-eluting balloon (DEB) followed by the implantation of a self-expanding stent (Enterprise) were evaluated for the treatment of ICAD lesions. Fifty-two patients (median age: 71 years; range: 54-86 years; male/female ratio 37:15) underwent stenting of high-grade ICAD lesions between February 2010 and November 2011 in a single center. Angioplasty using a paclitaxel coated SeQuent Please (B. Braun, Germany) or DIOR (Eurocor, Germany) coronary PTCA balloon, followed by the implantation of a self-expanding stent (Enterprise, Codman, USA) was performed in 54 lesions. Angiographic and clinical follow-up was performed at 6 and 12 weeks, 6 and 12 months, and yearly thereafter. Technical success rate, periprocedural complications, occurrence of recurrent ischemic symptoms, and the development of an ISR were analyzed. Angioplasty using a DEB followed by stent implantation was successfully performed in 44 (81 %) cases. DEB insertion failed in 19 % of the cases and angioplasty was finally performed using a conventional PTCA balloon. The combined procedure related permanent neurologic morbidity and mortality rate (stroke, ICH, and subarachnoid hemorrhage) at 30 days and beyond was 5 %. Angiographic and clinical follow-up were obtained in 33 (61 %) lesions in 32 patients. Recurrent stenosis was seen in one (3 %) lesion. Angioplasty and stenting using a DEB is safe and yields encouragingly low ISR rates. Further technical developments to improve lesion accessibility are, nevertheless, mandatory.

Encrusted and incarcerated urinary bladder catheter: what are the ...

African Journals Online (AJOL)

Urinary bladder catheter encrustations are known complications of long-term urinary catheterisation, which is commonly seen in clinical practice. These encrustations can impede deflation of the balloon and therefore cause problems in the removal of the catheter. The options in managing an encrusted and incarcerated ...

Encrusted and incarcerated urinary bladder catheter: what are the ...

African Journals Online (AJOL)

2010-11-25

Nov 25, 2010 ... cases of extraluminal encrusted urethral catheters. Extracorporeal shock wave lithotripsy (ESWL) has been utilised in the treatment of the bladder stones. Borrowing this principle, Kunzman et al. (12) has even used ESWL to fragment the stone-like encrustation over the retained Foley catheter balloon.

Feasibility and efficacy of balloon-based neuroprotection during carotid artery stenting in a single-center setting.

Science.gov (United States)

Schlüter, Michael; Tübler, Thilo; Mathey, Detlef G; Schofer, Joachim

2002-09-04

We sought to prospectively assess the feasibility and in-hospital efficacy of the PercuSurge GuardWire temporary balloon-occlusive system for neuroprotection during carotid angioplasty and stenting (CAS).Carotid angioplasty and stenting harbors a risk of distal embolization. Cerebral protection devices are currently under clinical investigation.Ninety-six consecutive patients with carotid bifurcation disease underwent a total of 102 CAS procedures with the intention to use the GuardWire for neuroprotection. GuardWire deployment was achieved in 99 procedures performed in 93 patients (97%). Device failure (n = 3) and severe neurologic responses to balloon occlusion of the targeted carotid artery (n = 2) accounted for five additional procedures that were essentially concluded without neuroprotection, for a total of 94 procedures completed as intended in 88 patients (92% procedural feasibility rate). Carotid angioplasty and stenting was performed successfully in 94 patients (100 procedures). There were no in-hospital deaths; but three patients (3.1%) sustained strokes, and two patients experienced transient ischemic attacks, for a total periprocedural complication rate of 5.2%. One major stroke occurred with the GuardWire in place, whereas two minor strokes were observed in patients in whom the device could not be deployed. Thus, successful neuroprotected CAS without major neurologic events was achieved in 87 patients (91%). The GuardWire temporary balloon-occlusive system is feasible as an adjunct to CAS in the majority of patients. It is associated with a 3.1% rate of major periprocedural neurologic complications. Adverse neurologic reactions to balloon occlusion may prohibit effective use of the system in about 2% of patients.

TW-01, a piperazinedione-derived compound, inhibits Ras-mediated cell proliferation and angioplasty-induced vascular restenosis

Energy Technology Data Exchange (ETDEWEB)

Lin, Chao-Feng [The Ph.D. Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan (China); Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (China); Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan (China); Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (China); Huang, Han-Li [The Ph.D. Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan (China); Peng, Chieh-Yu [Chinese Medicine Research and Development Center, China Medical University Hospital, Taichung 404, Taiwan (China); School of Pharmacy, College of Pharmacy, China Medical University, Taichung 404, Taiwan (China); Lee, Yu-Ching [The Center of Translational Medicine, Taipei Medical University, Taipei, Taiwan (China); Ph.D. Program for Biotechnology in Medicine, Taipei Medical University, Taipei, Taiwan (China); Wang, Hui-Po [College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan (China); Teng, Che-Ming [College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan (China); Pharmacological Institute, College of Medicine, National Taiwan University, Taipei 100, Taiwan (China); Pan, Shiow-Lin, E-mail: slpan@tmu.edu.tw [The Ph.D. Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan (China); Department of Pharmacology, College of Medicine, Taipei Medical University, Taipei 10031, Taiwan (China)

2016-08-15

Purpose: Vascular smooth muscle cell (VSMC) proliferation plays a critical role in the pathogenesis of atherosclerosis and restenosis. This study investigated piperazinedione derived compound TW-01-mediated inhibitory effects on VSMC proliferation and intimal hyperplasia. Methods: Cell proliferation was determined using [{sup 3}H]-thymidine incorporation and MTT assay; cell cycle distribution was measured using flow cytometry; proteins and mRNA expression were determined using western blotting and RT-PCR analyses; DNA binding activity of nuclear factor-κB (NF-κB), as measured using enzyme-linked immunosorbent assays (ELISA); in vivo effects of TW-01 were determined using balloon angioplasty in the rat. Results: TW-01 significantly inhibited cell proliferation. At the concentrations used, no cytotoxic effects were observed. Three predominant signaling pathways were inhibited by TW-01: (a) extracellular signal-regulated kinase (ERK)1/2 mitogen-activated protein kinase (MAPK) activation and its downstream effectors of c-fos, c-jun, and c-myc; (b) DNA binding activity of nuclear factor-κB (NF-κB); and, (c) Akt/protein kinase B (PKB) and cell cycle progression. Furthermore, TW-01 also inhibited Ras activation, a shared upstream event of each of these signaling cascades. In vascular injury studies, oral administration of TW-01 significantly suppressed intimal hyperplasia induced by balloon angioplasty. Conclusion: The present study suggests that TW-01 might be a potential candidate for atherosclerosis treatment. - Highlights: • TW-01significantly inhibits vascular smooth muscle cell proliferation. • TW-01 inhibits ERK, Akt and Ras pathway and DNA binding activity of NF-κB. • TW-01 significantly suppresses intimal hyperplasia induced by balloon angioplasty. • TW-01 might be a potential candidate for atherosclerosis treatment.

TW-01, a piperazinedione-derived compound, inhibits Ras-mediated cell proliferation and angioplasty-induced vascular restenosis

International Nuclear Information System (INIS)

Lin, Chao-Feng; Huang, Han-Li; Peng, Chieh-Yu; Lee, Yu-Ching; Wang, Hui-Po; Teng, Che-Ming; Pan, Shiow-Lin

2016-01-01

Purpose: Vascular smooth muscle cell (VSMC) proliferation plays a critical role in the pathogenesis of atherosclerosis and restenosis. This study investigated piperazinedione derived compound TW-01-mediated inhibitory effects on VSMC proliferation and intimal hyperplasia. Methods: Cell proliferation was determined using [ 3 H]-thymidine incorporation and MTT assay; cell cycle distribution was measured using flow cytometry; proteins and mRNA expression were determined using western blotting and RT-PCR analyses; DNA binding activity of nuclear factor-κB (NF-κB), as measured using enzyme-linked immunosorbent assays (ELISA); in vivo effects of TW-01 were determined using balloon angioplasty in the rat. Results: TW-01 significantly inhibited cell proliferation. At the concentrations used, no cytotoxic effects were observed. Three predominant signaling pathways were inhibited by TW-01: (a) extracellular signal-regulated kinase (ERK)1/2 mitogen-activated protein kinase (MAPK) activation and its downstream effectors of c-fos, c-jun, and c-myc; (b) DNA binding activity of nuclear factor-κB (NF-κB); and, (c) Akt/protein kinase B (PKB) and cell cycle progression. Furthermore, TW-01 also inhibited Ras activation, a shared upstream event of each of these signaling cascades. In vascular injury studies, oral administration of TW-01 significantly suppressed intimal hyperplasia induced by balloon angioplasty. Conclusion: The present study suggests that TW-01 might be a potential candidate for atherosclerosis treatment. - Highlights: • TW-01significantly inhibits vascular smooth muscle cell proliferation. • TW-01 inhibits ERK, Akt and Ras pathway and DNA binding activity of NF-κB. • TW-01 significantly suppresses intimal hyperplasia induced by balloon angioplasty. • TW-01 might be a potential candidate for atherosclerosis treatment.

Medical Therapy Versus Balloon Angioplasty for CTEPH: A Systematic Review and Meta-Analysis.

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Phan, Kevin; Jo, Helen E; Xu, Joshua; Lau, Edmund M

2018-01-01

A significant number of chronic thromboembolic pulmonary hypertension (CTEPH) patients will have an inoperable disease. Medical therapy and balloon pulmonary angioplasty (BPA) have provided alternate therapeutic options for patients with inoperable CTEPH, although there are a limited number of published studies examining the outcomes. Thus, our study aims to evaluate and compare the efficacy of medical therapy and BPA in patients with inoperable CTEPH. An electronic search of six databases was performed and the search results were screened against established criteria for inclusion into this study. Data was extracted and meta-analytical techniques were used to analyse the data. Pooled data from RCTs revealed that medical therapy, compared with a placebo, was associated with a significant improvement of at least one functional class (p=0.038). With regards to pulmonary haemodynamics, medical therapy also resulted in a significant reduction in both mean pulmonary arterial pressure (mPAP) (p=0.002) and pulmonary vascular resistance (PVR) (pmedical therapy by an average of 22.8% (pmedical therapy for CTEPH (p=0.001). Pooled data from available observational studies of medical therapy or BPA all demonstrated significant improvements in mPAP and PVR for pre versus post intervention comparisons. The improvement in mPAP (p=0.002) and PVR (p=0.002) were significantly greater for BPA intervention when compared to medical therapy. High-quality evidence supports the use of targeted medical therapy in improving haemodynamics in patients with inoperable CTEPH. There is only moderate-quality evidence from observational studies supporting the efficacy of BPA in improving both haemodynamics and exercise capacity. Further RCTs and prospective observational studies comparing medical therapy and BPA in patients with inoperable CTEPH are required. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New

Cerebrospinal Fluid Enhancement on Fluid Attenuated Inversion Recovery Images After Carotid Artery Stenting with Neuroprotective Balloon Occlusions: Hemodynamic Instability and Blood–Brain Barrier Disruption

International Nuclear Information System (INIS)

Ogami, Ryo; Nakahara, Toshinori; Hamasaki, Osamu; Araki, Hayato; Kurisu, Kaoru

2011-01-01

Purpose: A rare complication of carotid artery stenting (CAS), prolonged reversible neurological symptoms with delayed cerebrospinal fluid (CSF) space enhancement on fluid attenuated inversion recovery (FLAIR) images, is associated with blood–brain barrier (BBB) disruption. We prospectively identified patients who showed CSF space enhancement on FLAIR images. Methods: Nineteen patients—5 acute-phase and 14 scheduled—underwent 21 CAS procedures. Balloon catheters were navigated across stenoses, angioplasty was performed using a neuroprotective balloon, and stents were placed with after dilation under distal balloon protection. CSF space hyperintensity or obscuration on FLAIR after versus before CAS indicated CSF space enhancement. Correlations with clinical factors were examined. Results: CSF space was enhanced on FLAIR in 12 (57.1%) cases. Postprocedural CSF space enhancement was significantly related to age, stenosis rate, acute-stage procedure, and total occlusion time. All acute-stage CAS patients showed delayed enhancement. Only age was associated with delayed CSF space enhancement in scheduled CAS patients. Conclusions: Ischemic intolerance for severe carotid artery stenosis and temporary neuroprotective balloon occlusion, causing reperfusion injury, seem to be the main factors that underlie BBB disruption with delayed CSF space enhancement shortly after CAS, rather than sudden poststenting hemodynamic change. Our results suggest that factors related to hemodynamic instability or ischemic intolerance seem to be associated with post-CAS BBB vulnerability. Patients at risk for hemodynamic instability or with ischemic intolerance, which decrease BBB integrity, require careful management to prevent intracranial hemorrhagic and other post-CAS complications.

Percutaneous Transluminal Angioplasty for Complete Membranous Obstruction of Suprahepatic Inferior Vena Cava: Long-Term Results

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Kucukay, Fahrettin, E-mail: fkucukay@hotmail.com [Turkiye Yuksek Ihtisas Hospital, Department of Interventional Radiology (Turkey); Akdogan, Meral, E-mail: akdmeral@yahoo.com [Turkiye Yuksek Ihtisas Hospital, Department of Gastroenterology (Turkey); Bostanci, Erdal Birol, E-mail: ebbostanci@yahoo.com [Turkiye Yuksek Ihtisas Hospital, Department of Gastrointestinal Surgery (Turkey); Ulus, Ahmet Tulga, E-mail: uluss@yahoo.com [Hacettepe University, Department of Cardiovascular Surgery (Turkey); Kucukay, Murat Bulent, E-mail: dr-mbk@hotmail.com [Lokman Hekim Hospital, Department of Internal Medicine (Turkey)

2016-10-15

PurposeTo determine the long-term results of percutaneous transluminal angioplasty (PTA) for a complete membranous obstruction of the suprahepatic inferior vena cava.MethodsPatients (n = 65) who were referred to the interventional unit for PTA for a complete membranous obstruction of the suprahepatic inferior vena cava between January 2006 and October 2014 were included in the study. Thirty-two patients (18 males, 14 females, mean age 35 ± 10.7, range 20–42 years) were treated. The patients presented with symptoms of ascites (88 %), pleural effusion (53 %), varicose veins (94 %), hepatomegaly (97 %), abdominal pain (84 %), and splenomegaly (40 %). Transjugular liver access set and re-entry catheter were used to puncture and traverse the obstruction from the jugular side. PTA balloon dilations were performed. The mean follow-up period was 65.6 ± 24.5 months. The objective was to evaluate technical success, complications, primary patency, and clinical improvement in the symptoms of the patients.ResultsThe technical success rate was 94 %. In two patients, obstruction could not be traversed. These patients underwent cavoatrial graft bypass surgery. There were no procedure-related complications. Clinical improvements were achieved in all patients within 3 months. The primary patency rate at 4 years was 90 %. There was no primary assisted patency. There was no need for metallic stent deployment in the cohort. The secondary patency rate at 4 years was 100 %.ConclusionsPercutaneous transluminal angioplasty for a complete membranous obstruction of the suprahepatic inferior vena cava is safe and effective, and the long-term results are excellent.

Eventos adversos e motivos de descarte relacionados ao reuso de produtos médicos hospitalares em angioplastia coronária Adverse events and reasons for discard related to the reuse of cardiac catheters in percutaneous transluminal coronary angioplasty

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Margarete Ártico Batista

2006-09-01

the brand-new and reuse of medical equipment. METHOD: Sixty patients were studied (48.3% with unstable angina, 45% with acute myocardial infarction and 6.7% with other diagnoses. During the procedure and stay in the Intensive Coronary Unit, the occurrence of fever, hypotension or hypertension, chills, sudoresis, bleeding, nausea and vomits were observed. Seven products were evaluated: catheter introducer, catheter guides (0.35 and 0.014, catheter balloons for angioplasty, indeflators and manifolds. In total, 76 brand-new and 410 reused apparatuses were studied to verify the occurrence of discard, whether this happened before or during the procedure and for what reasons. P-values < 0.05 were considered signicant. RESULTS: Twenty-six patients presented adverse effects. Hypotension was the most common seen in 11(18.3% cases. There was no significant association between this adverse effect and reuse or not of the equipment. Three brand-new products and 55 of the reused products were discarded as they were incomplete. CONCLUSION: The adverse effects presented by patients submitted to coronary vessel angioplasty were not associated to the reuse of the medical equipment. The integrity and functionality were the main reasons of discard.

Cardiological-interventional therapy of coronary artery disease today; Kardiologisch-interventionelle Therapie der koronaren Herzerkrankung heute

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Reynen, K.; Henssge, R. [Technische Univ. Dresden (Germany). Klinik fuer Kardiologie

1999-07-01

The current importance of the interventional therapy of coronary artery disease may be deduced from the exponential increase in procedures performed in Germany in the last decade - at least 125,840 in 1996. Today, by improved catheter and balloon materials as well as by growing experience of the cardiologists, even complex lesions may be treated. Limitations of balloon angioplasty include acute vessel closure and restenosis - newer angioplasty devices like directional or rotational atherectomy or excimer-laser angioplasty did not overcome these limitations; only by coronary stenting, acute vessel closure could be managed and the likelihood of restenosis - at least in particular groups of patients - could be reduced. For a few years, intracoronary brachytherapy of the segments dilated with beta- or gamma-emitters has been seeking to reduce restenosis rate; the department of cardiology of the Dresden Cardiovascular Institute is participating in such a multicentre study using the beta-emitter {sup 188}renium. Further main topics of our department represent primary angioplasty in patients with acute myocardial infarction and invasive diagnostic or interventional procedures by the transradial approach. (orig.)

Cardiological-interventional therapy of coronary artery disease today

International Nuclear Information System (INIS)

Reynen, K.; Henssge, R.

1999-01-01

The current importance of the interventional therapy of coronary artery disease may be deduced from the exponential increase in procedures performed in Germany in the last decade - at least 125,840 in 1996. Today, by improved catheter and balloon materials as well as by growing experience of the cardiologists, even complex lesions may be treated. Limitations of balloon angioplasty include acute vessel closure and restenosis - newer angioplasty devices like directional or rotational atherectomy or excimer-laser angioplasty did not overcome these limitations; only by coronary stenting, acute vessel closure could be managed and the likelihood of restenosis - at least in particular groups of patients - could be reduced. For a few years, intracoronary brachytherapy of the segments dilated with beta- or gamma-emitters has been seeking to reduce restenosis rate; the department of cardiology of the Dresden Cardiovascular Institute is participating in such a multicentre study using the beta-emitter 188 renium. Further main topics of our department represent primary angioplasty in patients with acute myocardial infarction and invasive diagnostic or interventional procedures by the transradial approach. (orig.)

Optimizing logistics for balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices by doing away with the indwelling balloon: concept and techniques.

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Saad, Wael E; Nicholson, David B

2013-06-01

Since the conception of balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices 25 years ago, the placement of an indwelling balloon for hours has been central to the BRTO procedure. Numerous variables and variations of the BRTO procedure have been described, including methods to reduce sclerosant, combining percutaneous transhepatic obliteration, varying sclerosant, and using multiple sclerosants within the same procedure. However, the consistent feature of BRTO has always remained the indwelling balloon. Placing an indwelling balloon over hours for the BRTO procedure is a logistical burden that taxes the interventional radiology team and hospital resources. Substituting the balloon with hardware (coils or Amplatzer vascular plugs [AVPs] or both) is technically feasible and its risks most likely correlate with gastrorenal shunt (GRS) size. The current authors use packed 0.018- or 0.035-in coils or both for small gastric variceal systems (GRS size A and B) and AVPs for GRS sizes up to size E (from size A-E). The current authors recommend an indwelling balloon (no hardware substitute) for very large gastric variceal system (GRS size F). Substituting the indwelling balloon for hardware in size F and potentially size E GRS can also be risky. The current article describes the techniques of placing up to 16-mm AVPs through balloon occlusion guide catheters and then deflating the balloon once it has been substituted with the AVPs. In addition, 22-mm AVPs can be placed through sheaths once the balloon occlusion catheters are removed to further augment the 16-mm Amplatzer occlusion. To date, there are no studies describing, let alone evaluating, the clinical feasibility of performing BRTO without indwelling balloons. The described techniques have been successfully performed by the current authors. However, the long-term safety and effectiveness of these techniques is yet to be determined. Copyright © 2013 Elsevier Inc. All rights reserved.

Paraspinal arteriovenous malformation Onyx embolization via an Ascent balloon.

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Martínez-Galdámez, Mario; Rodriguez-Arias, Carlos A; Utiel, Elena; Arreba, Emilio; Gonzalo, Miguel; Arenillas, Juan F

2014-04-01

Purely extradural lumbar spinal arteriovenous malformations (AVMs) are rare lesions that have diverse presentations and imaging features. The treatment of a symptomatic high flow paraspinal AVM with multiple feeders remains a challenge. We report the first use of an Ascent balloon (dual lumen balloon catheter) to deliver Onyx with excellent penetration to a paraspinal AVM.

Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients.

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Hee Young Cho

Full Text Available The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation.We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL.Sixty-four patients (46.7% required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1% had placenta previa totalis. The overall success rate was 75% (48/64 for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05. The drainage amount over 1 hour was 500 mL (20-1200 mL in the balloon failure group and 60 mL (5-500 mL in the balloon success group (p<0.01.Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.

Detecting DNA synthesis of neointimal formation after catheter balloon injury in GK and in Wistar rats: using 5-ethynyl-2'-deoxyuridine

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Guo Jingsheng

2012-12-01

Full Text Available Abstract Background Neointimal formation plays an important role in the pathogenesis of coronary restenosis after percutaneous coronary intervention (PCI, especially in patients with diabetes mellitus. Recently, some studies have shown that 5-ethynyl-2'-deoxyuridine (EdU incorporation can serve as a novel alternative to the 5-bromo-2'-deoxyuridine (BrdU antibody detection method for detection of DNA synthesis in regenerating avian cochlea, chick embryo and the adult nervous system. However, few studies have been performed to assess the suitability of EdU for detecting DNA synthesis in vascular neointima. Methods The carotid artery balloon injury model was established in Goto-Kakizaki (GK and Wistar rats. A Cell-LightTM EdU Kit was used to detect EdU-labeled cell nuclei of common carotid arteries at day 7 after catheter balloon injury. Different methods of injecting EdU were tested. The protein levels of proliferating cell nuclear antigen (PCNA and p-Akt (Ser473, as well as the mRNA levels of PCNA were evaluated by Western blotting and quantitative real-time PCR (qRT-PCR, respectively. Immunohistochemical staining was also employed to visualize PCNA-positive cells. Results At day 7 after catheter balloon injury, far more EdU-positive and PCNA-positive cells were observed in GK rats. When comparing groups that received different EdU doses, it was found that the percentage of EdU-positive cells at a dose of 100 mg/kg body weight was than at doses of 25 mg/kg and 50 mg/kg. The number of positive cells was significantly higher in the repeated injection group compared to the single injection group. Further, after balloon injury DNA synthesis in GK rats was more notable than in Wistar rats. Neointimal formation in GK rats was more obvious than in Wistar rats. The protein levels of PCNA and p-Akt (Ser473 and the mRNA levels of PCNA were increased in injured rats as compared to uninjured rats, and were significantly higher in GK rats than in Wistar rats

Prevention of Intracranial In-stent Restenoses: Predilatation with a Drug Eluting Balloon, Followed by the Deployment of a Self-Expanding Stent

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Vajda, Zsolt; Güthe, Thomas; Perez, Marta Aguilar; Kurre, Wiebke; Schmid, Elisabeth; Bäzner, Hansjörg; Henkes, Hans

2013-01-01

Stenting in intracranial atherosclerotic disease (ICAD) is increasingly debated, due to issues of procedural safety, technical efficacy, and in-stent recurrent stenoses (ISR). In the present study, feasibility, safety, and efficacy of angioplasty using a drug-eluting balloon (DEB) followed by the implantation of a self-expanding stent (Enterprise) were evaluated for the treatment of ICAD lesions. Fifty-two patients (median age: 71 years; range: 54–86 years; male/female ratio 37:15) underwent stenting of high-grade ICAD lesions between February 2010 and November 2011 in a single center. Angioplasty using a paclitaxel coated SeQuent Please (B. Braun, Germany) or DIOR (Eurocor, Germany) coronary PTCA balloon, followed by the implantation of a self-expanding stent (Enterprise, Codman, USA) was performed in 54 lesions. Angiographic and clinical follow-up was performed at 6 and 12 weeks, 6 and 12 months, and yearly thereafter. Technical success rate, periprocedural complications, occurrence of recurrent ischemic symptoms, and the development of an ISR were analyzed. Angioplasty using a DEB followed by stent implantation was successfully performed in 44 (81 %) cases. DEB insertion failed in 19 % of the cases and angioplasty was finally performed using a conventional PTCA balloon. The combined procedure related permanent neurologic morbidity and mortality rate (stroke, ICH, and subarachnoid hemorrhage) at 30 days and beyond was 5 %. Angiographic and clinical follow-up were obtained in 33 (61 %) lesions in 32 patients. Recurrent stenosis was seen in one (3 %) lesion. Angioplasty and stenting using a DEB is safe and yields encouragingly low ISR rates. Further technical developments to improve lesion accessibility are, nevertheless, mandatory.

Embolization of brain arteriovenous malformations using tracker catheter

International Nuclear Information System (INIS)

Kim, Sun Yong; Son, Mi Young; Jang, Jae Chun; Hwang, Mi Soo; Park, Bok Hwan

1990-01-01

With the recent advance in micro catheters, steerable guide wires, balloons, embolic materials and digital subtraction angiography (DSA), as well as technical refinements in endovascular surgery, there has been a revolution in therapeutic strategies for cerebral arteriovenous malformations (AVMs). We have performed super selective angiography and embolization with Tracker micro catheter about 12 cases of brain AVMs for therapeutic and preoperative aims. This micro catheter and guide wire provided high selectivity of feeding artery, greater maneuverability and useful for deliver various embolus materials

Clinical efficacy, safety, and costs of percutaneous occlusive balloon catheter-assisted ureteroscopic lithotripsy for large impacted proximal ureteral calculi: a prospective, randomized study.

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Qi, Shiyong; Li, Yanni; Liu, Xu; Zhang, Changwen; Zhang, Hongtuan; Zhang, Zhihong; Xu, Yong

2014-09-01

To evaluate the clinical efficacy, safety, and costs of percutaneous occlusive balloon catheter-assisted ureteroscopic lithotripsy (POBC-URSL) for large impacted proximal ureteral calculi. 156 patients with impacted proximal ureteral stones ≥1.5 cm in size were randomized to ureteroscopic lithotripsy (URSL), POBC-URSL, and percutaneous nephrolithotomy (PNL) group between May 2010 and May 2013. For URSL, the calculi were disintegrated with the assistance of anti-retropulsion devices. POBC-URSL was performed with the assistance of an 8F percutaneous occlusive balloon catheter. PNL was finished with the combination of an ultrasonic and a pneumatic lithotripter. A flexible ureteroscope and a 200 μm laser fiber were used to achieve stone-free status to a large extent for each group. Variables studied were mean operative time, auxiliary procedure, postoperative hospital stay, operation-related complications, stone clearance rate, and treatment costs. The mean lithotripsy time for POBC-URSL was shorter than URSL, but longer than PNL (42.6±8.9 minutes vs 66.7±15.3 minutes vs 28.1±6.3 minutes, p=0.014). The auxiliary procedure rate and postoperative fever rate for POBC-URSL were significantly lower than URSL and comparable to PNL (pPNL (98.1% vs 75.0% vs 96.2%, pPNL group and similar to URSL group (p=0.016, pPNL.

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

International Nuclear Information System (INIS)

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

2000-01-01

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

Temporary balloon occlusion as therapy for uncontrollable arterial hemorrhage in multiply injured patients

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Rieger, J.; Linsenmaier, U.; Rock, C.; Pfeifer, K.J.; Euler, E.

1999-01-01

Purpose: Presentation of temporary balloon occlusion as an interventional radiological method for managing hemorrhage in multiply injured patients with uncontrollable loss of blood. Method: Temporary, non-selective arterial occlusion by introduction of a balloon catheter contralaterally to the source of bleeding has been performed since 1992 on 7 patients with multiple injuries, hemorrhagic shock requiring reanimation, and angiographic demonstration of an arterial hemorrhage in the supply region of the internal iliac artery with complex pelvic fracture. In each case a PTA balloon catheter was introduced transfemorally, non-selectively positioned proximal to the bleeding source, and left in place for 24-48 h under manometric control. Control angiographies were performed prior to catheter removal. Results: The bleeding was stopped immediately in all 7 patients. The hemodynamic stability made transport and thus further surgical management and/or a short-term treatment in the intensive-care station possible. Control angiographies confirmed that the bleeding had stopped in all patients. Conclusions: We recommend temporary balloon occlusion as a rapid and effective method for the management of bleeding in otherwise uncontrollable traumatic hemorrhages in the supply region of the internal iliac artery. (orig.) [de

Epicardial phrenic nerve displacement during catheter ablation of atrial and ventricular arrhythmias: procedural experience and outcomes.

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Kumar, Saurabh; Barbhaiya, Chirag R; Baldinger, Samuel H; Koplan, Bruce A; Maytin, Melanie; Epstein, Laurence M; John, Roy M; Michaud, Gregory F; Tedrow, Usha B; Stevenson, William G

2015-08-01

Arrhythmia origin in close proximity to the phrenic nerve (PN) can hinder successful catheter ablation. We describe our approach with epicardial PN displacement in such instances. PN displacement via percutaneous pericardial access was attempted in 13 patients (age 49±16 years, 9 females) with either atrial tachycardia (6 patients) or atrial fibrillation triggered from a superior vena cava focus (1 patient) adjacent to the right PN or epicardial ventricular tachycardia origin adjacent to the left PN (6 patients). An epicardially placed steerable sheath/4 mm-catheter combination (5 patients) or a vascular or an esophageal balloon (8 patients) was ultimately successful. Balloon placement was often difficult requiring manipulation via a steerable sheath. In 2 ventricular tachycardia cases, absence of PN capture was achieved only once the balloon was directly over the ablation catheter. In 3 atrial tachycardia patients, PN displacement was not possible with a balloon; however, a steerable sheath/catheter combination was ultimately successful. PN displacement allowed acute abolishment of all targeted arrhythmias. No PN injury occurred acutely or in follow up. Two patients developed acute complications (pleuro-pericardial fistula 1 and pericardial bleeding 1). Survival free of target arrhythmia was achieved in all atrial tachycardia patients; however, a nontargeted ventricular tachycardia recurred in 1 patient at a median of 13 months' follow up. Arrhythmias originating in close proximity to the PN can be targeted successfully with PN displacement with an epicardially placed steerable sheath/catheter combination, or balloon, but this strategy can be difficult to implement. Better tools for phrenic nerve protection are desirable. © 2015 American Heart Association, Inc.

Safety analysis of Wingspan stent angioplasty for symptomatic intracranial arterial stenosis: A report of 109 cases

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Jian-ping DENG

2011-12-01

Full Text Available Objective The present study aims to probe into the feasibility and safety of larger balloons in the self-expandable stent Wingspan system when treating symptomatic intracranial arterial stenosis.Methods The clinical data of 109 symptomatic intracranial arterial stenosis patients,consisting of 68 males and 41 females,were analyzed.These patients were treated via angioplasty using the Wingspan system from March 2007 to June 2010.The ages of the patients ranged from 36 years to 79 years,with an average of 62.4.The patients were divided into two groups according to the sizes of the Gateway balloons they used.The balloon diameter for group A(n=31 was based on 80% of the diameter of the normal blood vessels on both sides of the arterial vessel.Meanwhile,the balloon diameter for group B was based on the average diameter of the vessels on both sides of the arterial vessel.The effects of the treatment and the occurrence of complications in both groups were analyzed and compared.Results The degree of arteriostenosis before operation for group A was 56.0% to 87.8%,with an average of 71.8%,residual stenosis after operation was 0% to 45%,with an average of 24.9%.The degree of ateriostenosis before operation for group B was 68.9% to 98.0%,with an average of 76.0%,residual stenosis after operation was 0% to 21%,with an average of 10.2%.Group A had four cases(12.9% of durability neurological dysfunction.One case was a visual-field defect.In group B,six patients(7.7% experienced complications.The differences were not statistically significant,and no deaths occurred in both groups.Conclusions Wingspan stent angioplasty is a safe and effective treatment for intracranial arterial stenosis,and even the use of larger balloons does not increase the risk in patients.

A Stent-Retrieving into an Aspiration Catheter with Proximal Balloon (ASAP) Technique: A Technique of Mechanical Thrombectomy.

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Goto, Shunsaku; Ohshima, Tomotaka; Ishikawa, Kojiro; Yamamoto, Taiki; Shimato, Shinji; Nishizawa, Toshihisa; Kato, Kyozo

2018-01-01

The best technique for the first attempt at mechanical thrombectomy for acute ischemic stroke is a still matter of debate. In this study, we evaluate the efficacy of a stent-retrieving into an aspiration catheter with proximal balloon (ASAP) technique that uses a series of thrombus extraction by withdrawing the stent retriever into the aspiration catheter and continuous aspiration from the aspiration catheter at the first attempt. We performed a retrospective analysis of 42 consecutive patients with acute ischemic stroke caused by occlusions in the anterior circulation who were treated with the ASAP technique at our institution. Preoperative patient characteristic, including age, thrombus location, Alberta Stroke Program Early CT Score, National Institutions of Health Stroke Scale, and time from onset to puncture; postoperative Thrombolysis in Cerebral Infarction score; modified Rankin Scale score after 3 months; time from puncture to recanalization; the number of passes to achieve recanalization; and procedural complications, including intracranial hemorrhage, embolization to new territory, and distal embolization, were assessed. A Thrombolysis in Cerebral Infarction score of 2B or 3 was achieved in 40/42 patients (95.2%). Average time from puncture to the final recanalization was 21.5 minutes. Recanalization was achieved in a single attempt in 31 patients (77.5%). Embolization to new territory was observed in only 2 patients (4.8%); no patient developed distal embolization or intracranial hemorrhage including asymptomatic subarachnoid hemorrhage. Thirty-two patients (76.2%) achieved modified Rankin Scale scores of 0-2 at 3 months postoperatively. Our ASAP technique showed fast recanalization, minimal complications, and good clinical outcomes in this case series. Copyright © 2017 Elsevier Inc. All rights reserved.

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

International Nuclear Information System (INIS)

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

2008-01-01

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

Dilatação por cateter-balão (dacrioplastia para tratamento das obstruções congênitas do ducto lacrimonasal Balloon-catheter dilatation (dacrioplasty for congenital nasolacrimal duct obstruction treatment

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Roberto Murillo Limongi de Souza Carvalho

2009-10-01

Full Text Available OBJETIVO: Verificar o resultado da técnica, inédita no Brasil, de dilatação do ducto lacrimonasal usando cateter-balão para tratamento da obstrução congênita do ducto lacrimonasal. MÉTODOS: Foram tratadas crianças com idade entre dois e cinco anos, com obstrução congênita de vias lacrimais usando o cateter-balão (Lacricath® para dilatação das vias lacrimais. O cateter foi introduzido pelo ponto lacrimal superior, sob anestesia geral. RESULTADOS: Entre os 27 olhos tratados, 23 apresentaram desaparecimento dos sinais e sintomas de lacrimejamento (taxa de sucesso de 85,2%. Todos os procedimentos foram realizados sem intercorrências e o seguimento pós-operatório mínimo foi de um ano. CONCLUSÃO: A dilatação com balão mostrou-se segura e eficiente como primeiro procedimento para os casos de obstrução congênita das vias lacrimais em crianças com mais de dois anos.Purpose: To verify the results of balloon-catheter dilatation for the treatment of congenital lacrimal duct obstruction. To the best of author's knowledge this procedure has not been previously used in Brazil and deserves scientific studies. METHODS: Children between 2 and 5 years old, with congenital lacrimal duct obstruction, were treated with balloon-catheter dilatation (Lacricath®. Catheter was introduced by the superior lacrimal punctum, under general anesthesia. RESULTS: Twenty-seven eyes were treated and 23 presented total improvement of epiphora signs and symptoms (85.2% success rate. During a one year follow-up, all the procedures had good outcomes, without complications and all the children had 1 year of follow-up. CONCLUSION: Balloon-catheter dilatation is an efficient and safe procedure and might be used for congenital lacrimal duct obstruction treatment in children older than 2 years.

Complex Coronary Interventions with the Novel Mozec™ CTO Balloon: The MOZART Registry.

Science.gov (United States)

Lupi, Alessandro; Rognoni, Andrea; Schaffer, Alon; Secco, Gioel G; Bongo, Angelo S

2015-01-01

Mozec™ CTO is a novel semicompliant rapid-exchange PTCA balloon catheter with specific features dedicated to treat complex coronary lesions like chronic total occlusions (CTOs). However, no data have been reported about the performance of this device in an all-comers population with complex coronary lesions. We evaluated the safety and success rate of Mozec™ CTO balloon in 41 consecutive patients with chronic stable angina and complex coronary lesions (15 severe calcified coronary stenoses, 15 bifurcation lesions with planned two-stent intervention, and 11 CTOs). Safety was assessed reporting the balloon burst rate after inflation exceeding the rated burst pressure (RBP) according to the manufacturer's reference table. Success was defined as the possibility to advance the device further the target lesion. The Mozec™ CTO balloon showed an excellent performance with a 93.3% success in crossing tight and severely calcified lesions (14/15 pts), a 93.3% success in engaging jailed side branches after stent deployment across bifurcations (14/15 pts), and a 90.9% success in crossing CTO lesions (10/11 pts). The burst rate at RBP of the Mozec™ CTO balloon was 6.7% (1/15 balloons) in the tight and severely calcified lesions, 6.7% (1/15 balloons) when dilating jailed vessels, and 9.1% (1/11 balloons) in CTOs. The novel Mozec™ CTO balloon dilatation catheter showed promising results when employed to treat complex lesions in an all-comers population. Further studies should clarify if this kind of balloon might reduce the need of more costly devices like over-the-wire balloons and microcatheters for complex lesions treatment.

A perspective of percutaneous transluminal angioplasty.

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Stanson, A W

1983-01-01

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

Removal of non-deflatable retained foley catheter in the bladder by percutaneous puncture of catheter balloon

International Nuclear Information System (INIS)

Yoo, Jae Duk; Kim, Jae Kyu; Park, Jin Gyun; Chung, Hyon De

1988-01-01

Nondeflatable Foley catheter in the bladder is an uncommon event. We recently experienced a patient in whom the urologist were unable to remove a Foley catheter with cystoscope due to public bone fractures. The procedure, which was successfully carried out, consists of puncturing the ballon under fluoroscope.

Deep venous thrombosis in the lower extremity: catheter-directed thrombolysis

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Roh, Byung Suk; Kim, En A; Park, Ki Han; Yoon, Kwon Ha; So, Byung Jun; Juhng, Seon Kwan; Won, Jin Jong [School of Medicine, Wonkwang University, Iksan (Korea, Republic of)

2000-09-01

To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. Twenty-six consecutive patients (16 male and 10 female; mean age, 55 years) with lower extremity DVT underwent thrombolytic therapy. The duration of symptoms was 1-90 (mean, 17) days: 20 days or less in 16 cases (acute DVT) and less than 20 days in ten (chronic DVT). Catheter-directed infusions of urokinase were administered via ipsilateral popliteal veins, and angioplasty or stent placement was performed after the thrombolytic procedure. Oral medication of warfarin continued for six months, and for the evaluation of venous patency, follow-up ultrasonography was performed. The total dose of infused urokinase was 1,750,000-10,000,000 (mean 4,84,000) IU, and the total procedural time was 25-115 (mean, 64) hours. Lysis was complete in 16 cases (62%, all acute DVT), partial in five (19%, chronic DVT), and failed in five (19%, chronic DVT). Eight patients with venous stenosis and two with occlusion were treated by means of angioplasty (n=3D4) or Wallstent placement (n=3D6). Minor bleeding occurred in six cases and major complications in two (one of pulmonary embolism, and one of multiorgan failure). Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs. (author)

Deep venous thrombosis in the lower extremity: catheter-directed thrombolysis

International Nuclear Information System (INIS)

Roh, Byung Suk; Kim, En A; Park, Ki Han; Yoon, Kwon Ha; So, Byung Jun; Juhng, Seon Kwan; Won, Jin Jong

2000-01-01

To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. Twenty-six consecutive patients (16 male and 10 female; mean age, 55 years) with lower extremity DVT underwent thrombolytic therapy. The duration of symptoms was 1-90 (mean, 17) days: 20 days or less in 16 cases (acute DVT) and less than 20 days in ten (chronic DVT). Catheter-directed infusions of urokinase were administered via ipsilateral popliteal veins, and angioplasty or stent placement was performed after the thrombolytic procedure. Oral medication of warfarin continued for six months, and for the evaluation of venous patency, follow-up ultrasonography was performed. The total dose of infused urokinase was 1,750,000-10,000,000 (mean 4,84,000) IU, and the total procedural time was 25-115 (mean, 64) hours. Lysis was complete in 16 cases (62%, all acute DVT), partial in five (19%, chronic DVT), and failed in five (19%, chronic DVT). Eight patients with venous stenosis and two with occlusion were treated by means of angioplasty (n=3D4) or Wallstent placement (n=3D6). Minor bleeding occurred in six cases and major complications in two (one of pulmonary embolism, and one of multiorgan failure). Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs. (author)

Percutaneous transluminal angioplasty in arteriosclerosis

International Nuclear Information System (INIS)

Chung, Soo Young; Cha, In Ho

1984-01-01

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

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

Science.gov (United States)

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

2011-09-01

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

Foley Catheter for Induction of Labor at Term: An Open-Label, Randomized Controlled Trial.

Directory of Open Access Journals (Sweden)

Ning Gu

Full Text Available This study aimed to determine the optimal Foley catheter balloon volume (30-mL vs. 80-mL and the maximum time for cervical ripening (12 hours vs. 24 hours to improve vaginal delivery rate within 24 hours of induction.We conducted an open-label, randomized controlled trial in a teaching hospital in China. Women with a term singleton pregnancy, cephalic presentation, intact membrane and an unfavorable cervix (Bishop score <6 were randomly allocated, in 1:1:1:1 ratio, to receive either one of the four treatments: (1 30-mL balloon for a maximum of 12 hours, (2 30-mL balloon for a maximum of 24 hours, (3 80-mL balloon for a maximum of 12 hours, and (4 80-mL balloon for a maximum of 24 hours. The primary outcome was vaginal delivery within 24 hours. Secondary outcomes included cesarean section rate and maternal/neonatal morbidity. Data were analyzed on a per-protocol basis.Five hundred and four women were recruited and randomized (126 women in each group; nine women did not receive the assigned intervention. More women achieved vaginal delivery within 24 hours in 12-hour Foley catheter groups than in the 24-hour Foley catheter groups (30-mL/12 hours: 54.5%, 30-mL/24 hours: 33.1%, 80-mL/12 hours: 46.4%, 80-mL/24 hours: 24.0%, p < 0.001. Cesarean section rates and the incidence of chorioaminonitis were comparable among four groups. After adjustment for confounding factors, both ripening time and balloon size did not affect the proportion of women delivered vaginally within 24 hours of induction.For women with an unfavorable cervix at term, induction of labor with a Foley catheter is safe and effective. Higher balloon volume (80-mL vs. 30-mL and longer ripening time (24 hours vs. 12 hours would not shorten induction to delivery interval or reduce cesarean section rate.Chinese Clinical trial registry (ChiCTR-TRC-13003044.

Treatment of diffuse in-stent restenosis with rotational atherectomy followed by radiation therapy with a 188Re-MAG3-filled balloon: six-month clinical and angiographic results of R4 registry

International Nuclear Information System (INIS)

Moon, D. H.; Oh, S. J.; Park, S. W.; Hong, M. K.; Lee, C. H.; Kim, J. Z.; Park, S. J.; Lee, H. K.

2000-01-01

Intracoronary β-irradiation after rotational atherectomy may be a reasonable approach to prevent recurrent in-stent restenosis (ISR). This study was done to evaluate the feasibility and efficacy of β-radiation therapy with a 188 Re-MAG3-filled balloon following rotational atherectomy for ISR. Fifty consecutive patients with diffuse ISR (length >10 mm) in native coronary arteries underwent rotational atherectomy and adjunctive balloon angioplasty followed by β-irradiation using 188 Re-MAG3-filled balloon catheter. The radiation doses was 15 Gy at 1.0 mm deep into vessel wall. Mean length of the lesion and irradiated segment was 25.6±12.7 mm and 37.6±11.2 mm, respectively. The radiation was delivered successfully to all patients, with a mean irradiation time of 20.1±61 7 sec. No adverse event including myocardial infarction, death, or stent thrombosis occurred during the follow-up period (mean 10.3±3.7 mon) and non-target vessel revascularization was needed in one patient. Six-month binary angiographic restenosis rate was 10.4% (2 focal ISR and 3 edge restenosis) and loss index was 0.17±0.31. Irradiation using 188 Re-MAG3-filled balloon following rotational atherectomy for patients with diffuse ISR may improve the clinical and angiographic outcomes. Further prospective randomized trials are warranted to evaluate the synergistic effect of debulking and irradiation in patients with diffuse ISR

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

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

2005-02-01

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

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

International Nuclear Information System (INIS)

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

2005-01-01

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

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

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

2017-05-15

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

Temporary Percutaneous Aortic Balloon Occlusion to Enhance Fluid Resuscitation Prior to Definitive Embolization of Post-Traumatic Liver Hemorrhage

International Nuclear Information System (INIS)

Matsuoka, Shin; Uchiyama, Katsuhiro; Shima, Hideki; Ohishi, Sonomi; Nojiri, Yoko; Ogata, Hitoshi

2001-01-01

We successfully stabilized severe hemorrhagic shock following traumatic liver injury by percutaneous transcarotid supraceliac aortic occlusion with a 5 Fr balloon catheter. Then we were able to perform transfemoral embolization therapy of the hepatic arterial bleeding source. Transient aortic occlusion using a balloon catheter appears to be a useful adjunct in select cases where stabilization of the patient is necessary to allow successful selective embolization of the bleeding source

Treatment of diffuse in-stent restenosis with rotational atherectomy followed by radiation therapy with a {sup 188}Re-MAG3-filled balloon: six-month clinical and angiographic results of R4 registry

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Moon, D. H.; Oh, S. J.; Park, S. W.; Hong, M. K.; Lee, C. H.; Kim, J. Z.; Park, S. J.; Lee, H. K. [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

2000-07-01

Intracoronary {beta}-irradiation after rotational atherectomy may be a reasonable approach to prevent recurrent in-stent restenosis (ISR). This study was done to evaluate the feasibility and efficacy of {beta}-radiation therapy with a {sup 188}Re-MAG3-filled balloon following rotational atherectomy for ISR. Fifty consecutive patients with diffuse ISR (length >10 mm) in native coronary arteries underwent rotational atherectomy and adjunctive balloon angioplasty followed by {beta}-irradiation using {sup 188}Re-MAG3-filled balloon catheter. The radiation doses was 15 Gy at 1.0 mm deep into vessel wall. Mean length of the lesion and irradiated segment was 25.6{+-}12.7 mm and 37.6{+-}11.2 mm, respectively. The radiation was delivered successfully to all patients, with a mean irradiation time of 20.1{+-}61 7 sec. No adverse event including myocardial infarction, death, or stent thrombosis occurred during the follow-up period (mean 10.3{+-}3.7 mon) and non-target vessel revascularization was needed in one patient. Six-month binary angiographic restenosis rate was 10.4% (2 focal ISR and 3 edge restenosis) and loss index was 0.17{+-}0.31. Irradiation using {sup 188}Re-MAG3-filled balloon following rotational atherectomy for patients with diffuse ISR may improve the clinical and angiographic outcomes. Further prospective randomized trials are warranted to evaluate the synergistic effect of debulking and irradiation in patients with diffuse ISR.

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

Science.gov (United States)

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.

Technical note: subclavian artery misplacement of a 12F Shaldon catheter: percutaneous repair with a local closure device under temporary balloon tamponade; Technische Mitteilung: Entfernung eines fehlplatzierten 12F Shaldon Katheters aus der A. subclavia und Abdichtung mittels Verschlusssystem bei temporaerer Ballonblockade

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Wildberger, J.E.; Katoh, M.; Guenther, R.W. [Klinik fuer Radiologische Diagnostik, RWTH Aachen (Germany); Fussen, R. [Anaesthesiologische Klinik, Medizinisches Zentrum Kreis Aachen GmbH (Germany)

2006-06-15

A case of subsequent percutaneous repair using a local closure device with a collagen block (VasoSeal {sup registered}) and temporary balloon tamponade after inadvertent subclavian artery misplacement of a 12F Shaldon catheter is reported. Balloon occlusion safely prevented displacement of collagen into the vascular lumen by occluding the 12F entry site. Furthermore, collagen-induced coagulation was facilitated. (orig.)

Value of modified Foley catheter method in the removal of blunt esophageal foreign bodies

International Nuclear Information System (INIS)

Kim, Kyung In; Cha, Yoo Mi; Han, Heon; Yang, Dal Mo; Kim, Hyung Sik; Lee, Young Seok

1993-01-01

Removal of blunt esophageal foreign bodies using Foley catheter under a fluoroscopic guidance is a well recognized procedure. However, since this procedure is rather cumbersome and uncomfortable to the patient, the authors tried to find an easier and more convenient modified technique. For 10 patients with esophageal foreign body, we tried the method to the patient who is lying in the right lateral decubitus position and 3 assistants hold head, arms, trunk and legs of the patient without tilting the table and without using immobilizer. Foley catheter is inserted through nostril, nasal cavity and pharynx to esophagus. in order to identify the Foley catheter in esophagus, 0.025 inch short wire was inserted in the Foley catheter. The balloon of a Foley catheter was inflated by 10 cc of air, and the syringe was kept attached to the Foley catheter during the procedure. After passage of the foreign body through the upper esophageal sphinter, the balloon was deflated immediately and the foreign body was removed through the mouth. We successfully removed in removing all the blunt esophageal foreign body with ease. This modified method is also fast, safe and efficient

Second-generation endometrial ablation technologies: the hot liquid balloons.

Science.gov (United States)

Vilos, George A; Edris, Fawaz

2007-12-01

Hysteroscopic endometrial ablation (HEA) was introduced in the 1980s to treat menorrhagia. Its use required additional training, surgical expertise and specialized equipment to minimize emergent complications such as uterine perforations, thermal injuries and excessive fluid absorption. To overcome these difficulties and concerns, thermal balloon endometrial ablation (TBEA) was introduced in the 1990s. Four hot liquid balloons have been introduced into clinical practice. All systems consist of a catheter (4-10mm diameter), a silicone balloon and a control unit. Liquids used to inflate the balloons include internally heated dextrose in water (ThermaChoice, 87 degrees C), and externally heated glycine (Cavaterm, 78 degrees C), saline (Menotreat, 85 degrees ) and glycerine (Thermablate, 173 degrees C). All balloons require pressurization from 160 to 240 mmHg for treatment cycles of 2 to 10 minutes. Prior to TBEA, preoperative endometrial thinning, including suction curettage, is optional. Several RCTs and cohort studies indicate that the advantages of TBEA include portability, ease of use and short learning curve. In addition, small diameter catheters requiring minimal cervical dilatation (5-7 mm) and short duration of treatment cycles (2-8 min) allow treatment under minimal analgesia/anesthesia requirements in a clinic setting. Following TBEA serious adverse events, including thermal injuries to viscera have been experienced. To minimize such injuries some surgeons advocate the use of routine post-dilatation hysteroscopy and/or ultrasonography to confirm correct intrauterine placement of the balloon prior to initiating the treatment cycle. After 10 years of clinical practice, TBEA is thought to be the preferred first-line surgical treatment of menorrhagia in appropriately selected candidates. Economic modeling also suggested that TBEA may be more cost-effective than HEA.

Induction of labour by balloon catheter with extra-amniotic saline infusion (BCEAS): a randomised comparison with PGE2 vaginal pessaries

DEFF Research Database (Denmark)

Lyndrup, J; Nickelsen, Carsten Nahne Amtoft; Weber, Tom

1994-01-01

section followed BCEAS than PGE2 (29% and 10%, respectively; P infectious complications were not recorded following BCEAS. No difference was apparent in the status of the neonates (judging from Apgar scores and umbilical artery pH and SBE). The women, delivering vaginally, commented......OBJECTIVE: A new method for induction of labour--balloon catheter with extra-amniotic saline infusion (BCEAS)--is evaluated in randomised comparison with prostaglandin E2 (PGE2) in vaginal pessaries. STUDY GROUP: One-hundred and nine pregnant women with unfavourable cervices. MAJOR OUTCOME MEASURES......: The efficiency of inducing vaginal delivery and the level of 'disadvantages following induction of labour' (DisFIL scorings). RESULTS: Overall, BCEAS was less efficient inducing vaginal delivery than vaginal PGE2 (P

Radiation absorbed doses in the event of balloon rupture (BR) during endovascular brachytherapy (EB) using 188Re-perrhenate

International Nuclear Information System (INIS)

Angelides, S.; Hetherington, E.; Karolis, C.; Walker, B.; Jackson, T.; Knittel, T.; Friend, C.; Pitney, M.; Jepson, N.; Milross, C.; Lonergan, D.

2000-01-01

Full text: endovascular brachytherapy (EB) using liquid or solid radiation sources, is an effective emerging therapy for coronary artery disease. Liquid sources provide uniform radiation dose to the vessel wall. However the radiation burden in the unlikely event of BR is not insignificant. The aims of this study were to determine i) absorbed dose for various 188 Re radiopharmaceuticals in the event of BR, and ii) effects of thyroid uptake blocking agent, Lugol's iodine (Ll) and/or bladder catheterisation (BC). Dose calculations were based on MIRDOSE 3.1 with dynamic bladder model and MIRD Dose Estimate Report No.8 for 99 Tc m -pertechnetate, which has similar biokinetic properties to 188 Re-perrhenate. Normal renal function and a bladder voiding interval of 4.8h (1 minute with catheter) were assumed. BR was simulated ex-vivo by puncturing a Solaris angioplasty balloon filled with normal saline at 4 atm. LI, MAG3 and DTPA substantially reduces the radiation dose following BR, particularly to the thyroid, and BC reduces the bladder wall dose. Only the contents of the balloon leaked; 0.4 ml of the total volume of 1.8ml. As binding of 188 Re to ligands is cumbersome, we opted to use LI. Twenty five patients with in-stent re-stenosis have been treated using 188 Re-perrhenate (8 GBq/ml), with no BR. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

Balloon dilatation of the prostatic urethra

International Nuclear Information System (INIS)

Lee, Yeon Soo; Shim, Hyung Jin; Cha, Kyung Soo; Hong, Ju Hee; Lim, Myung Ah; Kim, Cheol Soo

1991-01-01

We analyzed the result of transurethral balloon dilatation in 11 patients with benign prostatic hypertrophy. The procedures were performed under intravenous sedation and local anesthesia with double lumen balloon catheter at 4 atmosphere for 10 minutes. After dilatation, the prostatism symptom scores improved in 10 out of 11 patients and the mean diameter of the prostatic urethra significantly increased form 4.3 mm to 10.2 mm (ρ < 0.005). The procedures were successful not only in lateral lobe hypertrophy but also in median lobe hypertrophy of the prostate. Postdilatation MRI of 1 patient showed an intact prostatic capsule and no periprostatic hematoma. Complications did not develop except in 1 patient with mild hematuria and incontinence. These preliminary results suggest that transurethral balloon dilatation can be an effective and safe treatment modality for benign prostatic hypertrophy

Percutaneous transluminal angioplasty of stenoses of the proximal subclavian artery

International Nuclear Information System (INIS)

Grote, R.; Freyschmidt, J.; Walterbusch, G.; Medizinische Hochschule Hannover

1983-01-01

Between August 1980 and June 1982, 12 left-sided proximal subclavian stenoses were dilated with balloon catheters. The dilatation was successful in all patients. Differences in blood pressure in the arm could be demonstrated subsequently. Recurrences occurred in two patients after seven and eleven months. Follow-up of nine patients up to 24 months showed them to be symptom-free. (orig.)

Usefulness and safety of a guide catheter extension system for the percutaneous treatment of complex coronary lesions by a transradial approach.

Science.gov (United States)

García-Blas, Sergio; Núñez, Julio; Mainar, Luis; Miñana, Gema; Bonanad, Clara; Racugno, Paolo; Rodríguez, Juan Carlos; Moyano, Patricia; Sanchis, Juan

2015-01-01

The aim of this study was to describe our initial experience with the GuideLiner® catheter (Vascular Solutions Inc.) in the transradial treatment of complex lesions. The clinical, angiographic and procedural data of percutaneous coronary interventions where GuideLiner was used during 2013 were collected. The transradial approach was used in all cases. The indication for its use, efficacy and periprocedural complications were determined. Sixteen consecutive procedures (in 15 patients; 12 males and 3 females) were evaluated. The indication for the use of GuideLiner was a difficulty to advance and properly position a stent through a tortuous and/or calcified artery despite using high-support guide catheters or other useful techniques. Of the 16 angiographic procedures, 14 (87.5%) were successful (stent deployment in 13 cases and a drug-eluting balloon in 1 case). Unsuccessful cases were a chronic total occlusion and a diffusely diseased left anterior descendant artery. A type B dissection of a proximal left circumflex artery was the only periprocedural complication. Use of the GuideLiner was an effective and safe technique for the percutaneous treatment of complex coronary lesions in which the adequate progress of angioplasty devices had failed. GuideLiner was particularly helpful when using the transradial approach. Only one minor complication was recorded. © 2014 S. Karger AG, Basel.

Percutaneous Treatment of Intrahepatic Biliary Leak: A Modified Occlusion Balloon Technique

Energy Technology Data Exchange (ETDEWEB)

Nasser, Felipe; Rocha, Rafael Dahmer, E-mail: rafaeldrocha@gmail.com; Falsarella, Priscila Mina; Motta-Leal-Filho, Joaquim Maurício da; Azevedo, André Arantes; Valle, Leonardo Guedes Moreira; Cavalcante, Rafael Noronha; Garcia, Rodrigo Gobbo; Affonso, Breno Boueri; Galastri, Francisco Leonardo [Hospital Israelita Albert Einstein, Department of Interventional Radiology (Brazil)

2016-05-15

PurposeTo report a novel modified occlusion balloon technique to treat biliary leaks.MethodsA 22-year-old female patient underwent liver transplantation with biliary-enteric anastomosis. She developed thrombosis of the common hepatic artery and extensive ischemia in the left hepatic lobe. Resection of segments II and III was performed and a biliary-cutaneous leak originating at the resection plane was identified in the early postoperative period. Initial treatment with percutaneous transhepatic drainage was unsuccessful. Therefore, an angioplasty balloon was coaxially inserted within the biliary drain and positioned close to the leak.ResultsThe fistula output abruptly decreased after the procedure and stopped on the 7th day. At the 3-week follow-up, cholangiography revealed complete resolution of the leakage.ConclusionThis novel modified occlusion balloon technique was effective and safe. However, greater experience and more cases are necessary to validate the technique.

Endogenous testosterone attenuates neointima formation after moderate coronary balloon injury in male swine.

Science.gov (United States)

Tharp, Darla L; Masseau, Isabelle; Ivey, Jan; Ganjam, Venkataseshu K; Bowles, Douglas K

2009-04-01

Previous studies from our laboratory have demonstrated that testosterone increases coronary smooth muscle protein kinase C delta (PKC delta) both in vivo and in vitro and inhibits coronary smooth muscle proliferation by inducing G(0)/G(1) cell cycle arrest in a PKC delta-dependent manner. The purpose of the present study was to determine whether endogenous testosterone limits coronary neointima (NI) formation in a porcine model of post-angioplasty restenosis. Sexually mature, male Yucatan miniature swine were either left intact (IM), castrated (CM), or castrated with testosterone replacement (CMT; Androgel, 10 mg/day). Angioplasty was performed in both the left anterior descending and left circumflex coronary arteries with balloon catheter overinflation to induce either moderate (1.25-1.3 x diameter; 3 x 30 s) or severe (1.4x diameter; 3 x 30 s) injury, and animals were allowed to recover for either 10 or 28 days. Injured coronary sections were dissected, fixed, stained (Verheoff-Van Gieson, Ki67, PKC delta, p27), and analysed. Vessels without internal elastic laminal rupture were excluded. Following moderate injury, intimal area, intima-to-media ratio (I/M), and I/M normalized to rupture index (RI) were increased in CM compared with IM and CMT. RI, medial area, and intimal/medial thickness (IMT) were not different between groups. NI formation was inversely related to serum testosterone concentration. Conversely, following severe injury, there were no significant differences between the groups. Testosterone inhibited proliferation and stimulated PKC delta and p27(kip1) expression during NI formation (10 days post-injury). These findings demonstrate that endogenous testosterone limits coronary NI formation in male swine and provides support for a protective role for testosterone in coronary vasculoproliferative diseases, such as restenosis and atherosclerosis.

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

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

International Nuclear Information System (INIS)

Nurlaila-Z

2005-01-01

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

Balloon dilatations of esophageal strictures

International Nuclear Information System (INIS)

Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De

1990-01-01

Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used

Balloon dilatations of esophageal strictures

Energy Technology Data Exchange (ETDEWEB)

Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De [Chonnam National University College of Medicine, Seoul (Korea, Republic of)

1990-04-15

Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used.

Preoperative optimization of multi-organ failure following acute myocardial infarction and ischemic mitral regurgitation by placement of a transthoracic intra-aortic balloon pump.

Science.gov (United States)

Umakanthan, Ramanan; Dubose, Robert; Byrne, John G; Ahmad, Rashid M

2010-10-01

The management of acute myocardial infarction with resultant acute ischemic mitral regurgitation and acute multi-organ failure can prove to be a very challenging scenario. The presence of concomitant vascular disease can only serve to further compromise the complexity of the situation. We demonstrate a new indication for the transthoracic intra-aortic balloon pump as a preoperative means of unloading the heart and improving clinical outcome in such high-risk patients with severe vascular disease. We present the case of a 75-year-old man with a history of severe vascular disease who was transferred emergently to Vanderbilt University Medical Center with an acute inferolateral wall myocardial infarction resulting in severe acute ischemic mitral regurgitation and acute multi-organ failure. He presented with shock liver (serum glutamic-oxaloacetic transaminase [SGOT] of 958), renal failure (creatinine of 3.0), and respiratory failure with a pH of 7.18. Emergent cardiac catheterization revealed 100% occlusion of the left circumflex artery as well as severe ileofemoral disease. The advanced nature of his ileofemoral disease was such that the arterial access catheter occluded the right femoral artery. The duration of time that the catheter was in the artery led to transient limb ischemia with an elevation of his creatine phosphokinase (CPK) to 10,809. Balloon angioplasty followed by stent placement was successfully performed, which restored flow to the coronary vessel. Given the grave nature of the patient's condition, we were very concerned that immediate operative intervention for his condition would entail prohibitively high risk. In fact, the Society of Thoracic Surgeons predicted risk adjusted mortality was calculated to be 56%. In order to minimize patient mortality and morbidity, it was critical to help restore perfusion and organ recovery. Therefore, we decided that the chances for this patient's survival would improve if his condition could be optimized by

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

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

2015-03-15

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

Creation of transcatheter aortopulmonary and cavopulmonary shunts using magnetic catheters: feasibility study in swine.

Science.gov (United States)

Levi, Daniel S; Danon, Saar; Gordon, Brent; Virdone, Nicky; Vinuela, Fernando; Shah, Sanjay; Carman, Greg; Moore, John W

2009-05-01

Surgical shunts are the basic form of palliation for many types of congenital heart disease. The Glenn shunt (superior cavopulmonary connection) and central shunt (aortopulmonary connection) represent surgical interventions that could potentially be accomplished by transcatheter techniques. We sought to investigate the efficacy of using neodymium iron boron (NdFeB) magnetic catheters to create transcatheter cavopulmonary and aortopulmonary shunts. NdFeB magnets were machined and integrated into catheters. "Target" catheters were placed in the pulmonary arteries (PAs), and radiofrequency "perforation" catheters were placed in either the descending aorta (DAo) for central shunts or the superior vena cava (SVC) for Glenn shunts. The magnet technique or "balloon target" method was used to pass wires from the DAo or the SVC into the PA. Aortopulmonary and cavopulmonary connections were then created using Atrium iCAST covered stents. Magnet catheters were used to perforate the left pulmonary artery from the DAo, thereby establishing a transcatheter central shunt. Given the orientation of the vasculature, magnetic catheters could not be used for SVC-to-PA connections; however, perforation from the SVC to the right pulmonary artery was accomplished with a trans-septal needle and balloon target. Transcatheter Glenn or central shunts were successfully created in four swine.

Thrombus aspiration catheter is a Dottering balloon

Directory of Open Access Journals (Sweden)

D. Sheshagiri Rao

2016-07-01

Full Text Available Coronary angiogram in a young man with history of STEMI with delayed presentation revealed subtotal occlusion of left anterior descending artery (LAD with large thrombotic filling defect distal to the critical lesion. PCI was preferred without delay because of ongoing chest pain. Several runs of thrombus aspiration failed to detect any visible thrombus. However, the immediate angiogram after thrombus aspiration showed complete distal embolization of the thrombus which could have been achieved by Dottering or balloon dilatation. In contrary to the general perception, does thrombus aspiration push more thrombus than it can aspirate?

Collapse of the balloon-expandable stent in the common iliac artery due to minor external compression in a lean patient

International Nuclear Information System (INIS)

Park, Sung Eun; Choi, Ho Cheol; Choi, Dae Seob; Lee, Sang Min; Lee, Jung Eun; Cho, Su Beom; Ahn, Jong Hwa

2017-01-01

A 60-year-old lean man with claudication due to severe stenosis of the right common iliac artery (CIA) underwent balloon-expandable stent deployment. Nineteen months later, claudication and lower limb ischemia in the patient recurred after minor external pressure and computed tomography indicated collapse of the right CIA stent. We performed balloon angioplasty again and self-expandable stent deployment was performed, and the patient's symptoms were relieved. We suggest that the CIA in a lean person could be susceptible to external pressure

Efficacy of stent angioplasty for symptomatic stenoses of the proximal vertebral artery

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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

Benefits of Balloon-Dilatable Bilateral Pulmonary Artery Banding in Patients With Hypoplastic Left Heart Syndrome and Other Complex Cardiac Anomalies.

Science.gov (United States)

Kise, Hiroaki; Suzuki, Shoji; Hoshiai, Minako; Toda, Takako; Koizumi, Keiichi; Hasebe, Yohei; Kono, Yosuke; Honda, Yoshihiro; Kaga, Shigeaki; Sugita, Kanji

2015-12-01

The purpose of this study was to evaluate the potential of balloon-dilatable bilateral pulmonary artery banding (b-PAB) and its impact on the configuration of the pulmonary artery (PA). We have previously used balloon-dilatable b-PAB as first-stage palliation for patients with hypoplastic left heart syndrome (HLHS) and other complex cardiac anomalies. Two pliable tapes were placed around each branch of the PA and tightened with 7-0 polypropylene sutures in a manner that allowed for the subsequent adjustment of PA diameters. We retrospectively examined the adjustability of PA diameters by balloon dilation and the need for surgical PA angioplasty at later stages. From January 2010 to October 2013, we performed b-PAB in 8 patients, including 3 borderline cases between biventricular repair (BVR) and univentricular repair (UVR). The b-PAB procedures were performed at a median age of 6.5 days (range, 2-10 days). Balloon dilations were performed in 10 lesions in 4 patients. All of the procedures were performed safely. Two patients reached definite BVR. The remaining 6 patients underwent open palliative procedures with univentricular physiologies that resulted in 2 deaths unrelated to the initial b-PAB. In all but 1 of the patients, the PA configuration was properly maintained and did not require surgical pulmonary angioplasty. Balloon-dilatable b-PAB can be performed safely and prevents PA distortion at later stages. This technique should be considered for patients with complex cardiac anomalies if uncertainty exists regarding the optimal surgical strategy (BVR or UVR) in early infancy. © 2015, Wiley Periodicals, Inc.

Multiple Coaxial Catheter System for Reliable Access in Interventional Stroke Therapy

International Nuclear Information System (INIS)

Kulcsar, Zsolt; Yilmaz, Hasan; Bonvin, Christophe; Lovblad, Karl O.; Ruefenacht, Daniel A.

2010-01-01

In some patients with acute cerebral vessel occlusion, navigating mechanical thrombectomy systems is difficult due to tortuous anatomy of the aortic arch, carotid arteries, or vertebral arteries. Our purpose was to describe a multiple coaxial catheter system used for mechanical revascularization that helps navigation and manipulations in tortuous vessels. A triple or quadruple coaxial catheter system was built in 28 consecutive cases presenting with acute ischemic stroke. All cases were treated by mechanical thrombectomy with the Penumbra System. In cases of unsuccessful thrombo-aspiration, additional thrombolysis or angioplasty with stent placement was used for improving recanalization. The catheter system consisted of an outermost 8-Fr and an intermediate 6-Fr guiding catheter, containing the inner Penumbra reperfusion catheters. The largest, 4.1-Fr, reperfusion catheter was navigated over a Prowler Select Plus microcatheter. The catheter system provided access to reach the cerebral lesions and provided stability for the mechanically demanding manipulations of thromboaspiration and stent navigation in all cases. Apart from their mechanical role, the specific parts of the system could also provide access to different types of interventions, like carotid stenting through the 8-Fr guiding catheter and intracranial stenting and thrombolysis through the Prowler Select Plus microcatheter. In this series, there were no complications related to the catheter system. In conclusion, building up a triple or quadruple coaxial system proved to be safe and efficient in our experience for the mechanical thrombectomy treatment of acute ischemic stroke.

Catheter directed thrombolysis for deep vein thrombosis during the first trimester of pregnancy: two case report

International Nuclear Information System (INIS)

Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Kwun, Woo Hyung; Suh, Bo Yang; Park, Kyeong Seok

2008-01-01

Anticoagulation with heparin has been the standard management therapy of deep vein thrombosis during pregnancy. Pregnancy is generally considered as a contraindication for thrombolysis. However, anticoagulation therapy alone does not protect the limbs from post-thrombotic syndrome and venous valve insufficiency. Catheter-directed thrombolysis, combined with angioplasty and stenting, can remove the thrombus and restore patency of the veins, resulting in prevention of post-thrombotic syndrome and valve insufficiency. We report successful catheter-directed thrombolysis and stenting in two early gestation patients with a deep vein thrombosis of the left lower extremity

Catheter directed thrombolysis for deep vein thrombosis during the first trimester of pregnancy: two case report

Energy Technology Data Exchange (ETDEWEB)

Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Kwun, Woo Hyung; Suh, Bo Yang [College of Medicine, Yeungnam University, Daegu (Korea, Republic of); Park, Kyeong Seok [Yeungnam University, Medical Center, Daegu (Korea, Republic of)

2008-02-15

Anticoagulation with heparin has been the standard management therapy of deep vein thrombosis during pregnancy. Pregnancy is generally considered as a contraindication for thrombolysis. However, anticoagulation therapy alone does not protect the limbs from post-thrombotic syndrome and venous valve insufficiency. Catheter-directed thrombolysis, combined with angioplasty and stenting, can remove the thrombus and restore patency of the veins, resulting in prevention of post-thrombotic syndrome and valve insufficiency. We report successful catheter-directed thrombolysis and stenting in two early gestation patients with a deep vein thrombosis of the left lower extremity.

Stunning and Right Ventricular Dysfunction Is Induced by Coronary Balloon Occlusion and Rapid Pacing in Humans: Insights From Right Ventricular Conductance Catheter Studies.

Science.gov (United States)

Axell, Richard G; Giblett, Joel P; White, Paul A; Klein, Andrew; Hampton-Til, James; O'Sullivan, Michael; Braganza, Denise; Davies, William R; West, Nick E J; Densem, Cameron G; Hoole, Stephen P

2017-06-06

We sought to determine whether right ventricular stunning could be detected after supply (during coronary balloon occlusion [BO]) and supply/demand ischemia (induced by rapid pacing [RP] during transcatheter aortic valve replacement) in humans. Ten subjects with single-vessel right coronary artery disease undergoing percutaneous coronary intervention with normal ventricular function were studied in the BO group. Ten subjects undergoing transfemoral transcatheter aortic valve replacement were studied in the RP group. In both, a conductance catheter was placed into the right ventricle, and pressure volume loops were recorded at baseline and for intervals over 15 minutes after a low-pressure BO for 1 minute or a cumulative duration of RP for up to 1 minute. Ischemia-induced diastolic dysfunction was seen 1 minute after RP (end-diastolic pressure [mm Hg]: 8.1±4.2 versus 12.1±4.1, P right coronary artery balloon occlusion both cause ischemic right ventricular dysfunction with stunning observed later during the procedure. This may have intraoperative implications in patients without right ventricular functional reserve. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

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

NARCIS (Netherlands)

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

2000-01-01

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

Thrombus aspiration catheter is a Dottering balloon.

Science.gov (United States)

Sheshagiri Rao, D; Barik, Ramachandra; Prasad, Akula Siva

2016-01-01

Coronary angiogram in a young man with history of STEMI with delayed presentation revealed subtotal occlusion of left anterior descending artery (LAD) with large thrombotic filling defect distal to the critical lesion. PCI was preferred without delay because of ongoing chest pain. Several runs of thrombus aspiration failed to detect any visible thrombus. However, the immediate angiogram after thrombus aspiration showed complete distal embolization of the thrombus which could have been achieved by Dottering or balloon dilatation. In contrary to the general perception, does thrombus aspiration push more thrombus than it can aspirate? Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Study design and rationale of the 'Balloon-Expandable Cobalt Chromium SCUBA Stent versus Self-Expandable COMPLETE-SE Nitinol Stent for the Atherosclerotic ILIAC Arterial Disease (SENS-ILIAC Trial) Trial': study protocol for a randomized controlled trial.

Science.gov (United States)

Choi, Woong Gil; Rha, Seung Woon; Choi, Cheol Ung; Kim, Eung Ju; Oh, Dong Joo; Cho, Yoon Hyung; Park, Sang Ho; Lee, Seung Jin; Hur, Ae Yong; Ko, Young Guk; Park, Sang Min; Kim, Ki Chang; Kim, Joo Han; Kim, Min Woong; Kim, Sang Min; Bae, Jang Ho; Bong, Jung Min; Kang, Won Yu; Seo, Jae Bin; Jung, Woo Yong; Cho, Jang Hyun; Kim, Do Hoi; Ahn, Ji Hoon; Kim, Soo Hyun; Jang, Ji Yong

2016-06-25

The self-expandable COMPLETE™ stent (Medtronic) has greater elasticity, allowing it to regain its shape after the compression force reduces, and has higher trackability, thus is easier to maneuver through tortuous vessels, whereas the balloon-expandable SCUBA™ stent (Medtronic) has higher radial stiffness and can afford more accurate placement without geographic miss, which is important in aortoiliac bifurcation lesions. To date, there have been no randomized control trials comparing efficacy and safety between the self-expanding stent and balloon-expandable stent in advanced atherosclerotic iliac artery disease. The purpose of our study is to examine primary patency (efficacy) and incidence of stent fracture and geographic miss (safety) between two different major representative stents, the self-expanding nitinol stent (COMPLETE-SE™) and the balloon-expanding cobalt-chromium stent (SCUBA™), in stenotic or occlusive iliac arterial lesions. This trial is designed as a prospective, randomized, multicenter trial to demonstrate a noninferiority of SCUBA™ stent to COMPLETE-SE™ stent following balloon angioplasty in iliac arterial lesions, and a total of 280 patients will be enrolled. The primary end point of this study is the rate of primary patency in the treated segment at 12 months after intervention as determined by catheter angiography, computed tomography angiography, or duplex ultrasound. The SENS-ILIAC trial will give powerful insight into whether the stent choice according to deployment mechanics would impact stent patency, geographic miss, or stent fracture in patients undergoing stent implantation in iliac artery lesions. National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier: NCT01834495 ), registration date: May 8, 2012.

Initial Experience with Balloon-Occluded Trans-catheter Arterial Chemoembolization (B-TACE) for Hepatocellular Carcinoma

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Maruyama, Mitsunari, E-mail: mitunari@med-shimane.u.ac.jp; Yoshizako, Takeshi, E-mail: yosizako@med.shimane-u.ac.jp; Nakamura, Tomonori, E-mail: t-naka@med.shimane-u.ac.jp; Nakamura, Megumi, E-mail: megumi@med.shimane-u.ac.jp; Yoshida, Rika, E-mail: yoshidar@med.shimane-u.ac.jp; Kitagaki, Hajime, E-mail: kitagaki@med.shimane-u.ac.jp [Shimane University Faculty of Medicine, Department of Radiology (Japan)

2016-03-15

PurposeThis study was performed to evaluate the accumulation of lipiodol emulsion (LE) and adverse events during our initial experience of balloon-occluded trans-catheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC) compared with conventional TACE (C-TACE).MethodsB-TACE group (50 cases) was compared with C-TACE group (50 cases). The ratio of the LE concentration in the tumor to that in the surrounding embolized liver parenchyma (LE ratio) was calculated after each treatment. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Effects (CTCAE) version 4.0.ResultsThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). Only elevation of alanine aminotransferase was more frequent in the B-TACE group, showing a statistically significant difference (Mann–Whitney test: P < 0.05). While B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation, there was no statistically significant difference in incidence between the groups. Multivariate logistic regression analysis suggested that the significant risk factor for liver abscess/infarction was bile duct dilatation (P < 0.05).ConclusionThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation.

Collapse of the balloon-expandable stent in the common iliac artery due to minor external compression in a lean patient

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Park, Sung Eun; Choi, Ho Cheol; Choi, Dae Seob; Lee, Sang Min; Lee, Jung Eun [Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju (Korea, Republic of); Cho, Su Beom; Ahn, Jong Hwa [Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon (Korea, Republic of)

2017-08-15

A 60-year-old lean man with claudication due to severe stenosis of the right common iliac artery (CIA) underwent balloon-expandable stent deployment. Nineteen months later, claudication and lower limb ischemia in the patient recurred after minor external pressure and computed tomography indicated collapse of the right CIA stent. We performed balloon angioplasty again and self-expandable stent deployment was performed, and the patient's symptoms were relieved. We suggest that the CIA in a lean person could be susceptible to external pressure.

The protective effect of bergamot oil extract on lecitine-like oxyLDL receptor-1 expression in balloon injury-related neointima formation.

Science.gov (United States)

Mollace, Vincenzo; Ragusa, Salvatore; Sacco, Iolanda; Muscoli, Carolina; Sculco, Francesca; Visalli, Valeria; Palma, Ernesto; Muscoli, Saverio; Mondello, Luigi; Dugo, Paola; Rotiroti, Domenicantonio; Romeo, Francesco

2008-06-01

Lectin-like oxyLDL receptor-1 (LOX-1) has recently been suggested to be involved in smooth muscle cell (SMC) proliferation and neointima formation in injured blood vessels. This study evaluates the effect of the nonvolatile fraction (NVF), the antioxidant component of bergamot essential oil (BEO), on LOX-1 expression and free radical generation in a model of rat angioplasty. Common carotid arteries injured by balloon angioplasty were removed after 14 days for histopathological, biochemical, and immunohistochemical studies. Balloon injury led to a significant restenosis with SMC proliferation and neointima formation, accompanied by increased expression of LOX-1 receptor, malondialdehyde and superoxide formation, and nitrotyrosine staining. Pretreatment of rats with BEO-NVF reduced the neointima proliferation together with free radical formation and LOX-1 expression in a dose-dependent manner. These results suggest that natural antioxidants may be relevant in the treatment of vascular disorders in which proliferation of SMCs and oxyLDL-related endothelial cell dysfunction are involved.

[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.

An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

International Nuclear Information System (INIS)

Desai, Shamit S.; Konanur, Meghana; Foltz, Gretchen; Malaisrie, S. Chris; Resnick, Scott

2016-01-01

PurposeEntrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed.Materials and MethodsFour cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers.ResultsIn the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary.ConclusionAn endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period

An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

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Desai, Shamit S., E-mail: shamit.desai@northwestern.edu [Northwestern Memorial Hospital, Department of Radiology (United States); Konanur, Meghana [Northwestern University Feinberg School of Medicine (United States); Foltz, Gretchen [Mallinckrodt Institute of Radiology at Washington University, Interventional Radiology (United States); Malaisrie, S. Chris [Northwestern Memorial Hospital, Department of Cardiothoracic Surgery (United States); Resnick, Scott, E-mail: sresnick@northwestern.edu [Northwestern University Feinberg School of Medicine, Department of Radiology, Interventional Radiology, Northwestern Memorial Hospital (United States)

2016-03-15

PurposeEntrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed.Materials and MethodsFour cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers.ResultsIn the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary.ConclusionAn endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.

Simultaneous stent expansion/balloon deflation technique to salvage failed balloon remodeling.

Science.gov (United States)

Ladner, Travis R; He, Lucy; Davis, Brandon J; Froehler, Michael T; Mocco, J

2016-04-01

Herniation, with possible embolization, of coils into the parent vessel following aneurysm coiling remains a frequent challenge. For this reason, balloon or stent assisted embolization remains an important technique. Despite the use of balloon remodeling, there are occasions where, on deflation of the balloon, some coils, or even the entire coil mass, may migrate. We report the successful use of a simultaneous adjacent stent deployment bailout technique in order to salvage coil prolapse during balloon remodeling in three patients. Case No 1 was a wide neck left internal carotid artery bifurcation aneurysm, measuring 9 mm×7.9 mm×6 mm with a 5 mm neck. Case No 2 was a complex left superior hypophyseal artery aneurysm, measuring 5.3 mm×4 mm×5 mm with a 2.9 mm neck. Case No 3 was a ruptured right posterior communicating artery aneurysm, measuring 4 mm×4 mm×4.5 mm with a 4 mm neck. This technique successfully returned the prolapsed coil mass into the aneurysm sac in all cases without procedural complications. The closed cell design of the Enterprise VRD (Codman and Shurtleff Inc, Raynham, Massachusetts, USA) makes it ideal for this bailout technique, by allowing the use of an 0.021 inch delivery catheter (necessary for simultaneous access) and by avoiding the possibility of an open cell strut getting caught on the deflated balloon. We hope this technique will prove useful to readers who may find themselves in a similar predicament. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Balloon Blocking Technique (BBT) for Superselective Catheterization of Inaccessible Arteries with Conventional and Modified Techniques

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Morishita, Hiroyuki, E-mail: hmorif@koto.kpu-m.ac.jp, E-mail: mori-h33@xa2.so-net.ne.jp [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Takeuchi, Yoshito, E-mail: yotake62@qg8.so-net.ne.jp [Kyoto Prefectural University of Medicine, Department of Radiology, North Medical Center (Japan); Ito, Takaaki, E-mail: takaaki@koto.kpu-m.ac.jp [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Hayashi, Natsuko, E-mail: hayashin@koto.kpu-m.ac.jp [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science (Japan); Sato, Osamu, E-mail: osamu-sato@kyoto1-jrc.org [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan)

2016-06-15

PurposeThe purpose of the study was to retrospectively evaluate the efficacy and safety of the balloon blocking technique (BBT).Materials and MethodsThe BBT was performed in six patients (all males, mean 73.5 years) in whom superselective catheterization for transcatheter arterial embolization by the conventional microcatheter techniques had failed due to anatomical difficulty, including targeted arteries originating steeply or hooked from parent arteries. All BBT procedures were performed using Seldinger’s transfemoral method. Occlusive balloons were deployed and inflated at the distal side of the target artery branching site in the parent artery via transfemoral access. A microcatheter was delivered from a 5-F catheter via another femoral access and was advanced over the microguidewire into the target artery, under balloon blockage of advancement of the microguidewire into non-target branches. After the balloon catheter was deflated and withdrawn, optimal interventions were performed through the microcatheter.ResultsAfter success of accessing the targeted artery by BBT, optimal interventions were accomplished in all patients with no complications other than vasovagal hypotension, which responded to nominal therapy.ConclusionThe BBT may be useful in superselective catheterization of inaccessible arteries due to anatomical difficulties.

Balloon dilatation biopsy of the biliary stricture through the percutaneous transhepatic biliary drainage tract: Feasibility and diagnostic accuracy

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Hong, Ji Hoon; Ryeom, Hun Kyu; Jang, Yun Jin; Kim, Gab Chul; Cho, Seung Hyun; Song, Jung Hup [Kyungpook National University Hospital, Daegu (Korea, Republic of)

2016-01-15

To evaluate the feasibility and diagnostic accuracy of the balloon dilatation biopsy for the biliary stricture through the percutaneous transhepatic biliary drainage (PTBD) tract. The study included 35 patients who underwent balloon dilatation biopsy for the biliary stricture through the PTBD tract. Balloon dilatation was done with a balloon catheter of 10-mm or 12-mm diameter. Soft tissue adherent to the retrieved balloon catheter and soft tissue components separated by gauze filtration of evacuated bile were sampled for histopathologic examination. The results were compared with the final diagnosis which was made by clinical and imaging follow-up for mean 989 days (n = 34) and surgery with histopathologic examination (n = 1). Procedure-related complications and diagnostic accuracy were assessed. Tissues suitable for histopathologic examination were obtained in 31 out of 35 patients (88.6%). In 3 patients, self-limiting hemobilia was noted. No major complication was noted. The sensitivity, specificity, diagnostic accuracy, positive and negative predictive values for diagnosis of malignant stricture were 70.0%, 100%, 90.3%, 100%, and 87.5%, respectively. Balloon dilatation biopsy of the biliary stricture through the PTBD tract is a feasible and accurate diagnostic method. It can be a safe alternative to the endoscopic retrograde cholangiography biopsy or forceps biopsy through the PTBD tract.

Percutaneous sharp recanalization of a membranous IVC occlusion with an occlusion balloon as a needle target

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Michael D. Rivers-Bowerman, MD, MSc, FRCPC

2017-09-01

Full Text Available A 50-year-old male with right upper quadrant symptoms and hepatic dysfunction was found to have multiple dilated hepatic veins (HVs with intrahepatic collateralization and membranous occlusion of the intrahepatic inferior vena cava (IVC consistent with primary Budd–Chiari syndrome. Venacavograms depicted drainage of the intrahepatic collaterals through a left-sided HV entering the IVC above the level of the occlusion. Sharp recanalization of the membranous IVC occlusion was performed with an occlusion balloon as a needle target under echocardiographic monitoring followed by balloon angioplasty with restoration of IVC patency. Clinical, laboratory, and venographic procedural success has been demonstrated to 9 months with minimal residual stenosis.

Balloon-Occluded Carbon Dioxide Gas Angiography for Internal Iliac Arteriography and Intervention.

Science.gov (United States)

Kishino, Mitsuhiro; Nakaminato, Shuichiro; Kitazume, Yoshio; Miyasaka, Naoyuki; Kudo, Toshifumi; Saida, Yukihisa; Tateishi, Ukihide

2018-07-01

The usefulness of carbon dioxide (CO 2 ) gas digital subtraction angiography (DSA) has been reported for patients with renal insufficiency and allergy to iodinated contrast agents. However, CO 2 gas cannot replace the iodinated contrast agent in all cases owing to some disadvantages. We describe balloon-occluded CO 2 DSA (B-CO 2 DSA) as an improved CO 2 DSA procedure for interventions in the internal iliac artery (IIA) region and compare the quality of images obtained using conventional CO 2 DSA and B-CO 2 DSA. B-CO 2 DSA-guided embolization was performed for one case of genital bleeding with an acute anaphylactic reaction to the iodinated contrast agent and for three cases of type II endoleaks after endovascular abdominal aortic aneurysm repair with renal dysfunction. A 9-mm occlusion balloon catheter was placed just after the orifice of the IIA. Then, 10-15 ml of CO 2 gas was injected manually via the catheter with and without balloon occlusion. The quality of sequential digital subtraction angiograms was analyzed based on a scoring criterion. In all four cases, image quality was improved with B-CO 2 DSA; the poor quality of images without balloon occlusion was because of reflux of the CO 2 gas. B-CO 2 DSA improves the image quality of CO 2 DSA in the IIA region and is useful for vascular intervention. Level IV.

Balloon dilatation and balloon-expandable stents for PTA of proximal venous stenoses in haemodialysis patients. Dilatation und ballonexpandierbare Stents zur Therapie zentralvenoeser Stenosen bei Dialysepatienten

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Landwehr, P; Lackner, K [Wuerzburg Univ. (Germany, F.R.). Inst. fuer Roentgendiagnostik; Goetz, R [Wuerzburg Univ. (Germany, F.R.). Abt. fuer Nephrologie

1990-09-01

On 10 dialysis patients we performed 12 balloon dilatations, 2 catheter lyses, 6 stent implants (Palmaz stent) and one atherectomy of central venous stenoses or occlusions (v. subclavia, v. brachiocephalica) at the shunt arm of the patient. The primary success rate was, in balloon PTA and lysis, 12/14 interventions, and in stent placement and atherectomy 7/7. The angiographical and clinical primary result after stent implantation was significantly better than after conventional dilatation. After 66% of the balloon dilatations recidivation occurred within the first year; this can be treated by means of repeated PTA. Whether long-term exclusion of recurrence can be achieved by stent implantation, must be established by means of follow-up studies that are at present in progress. (orig.).

A simple method of using a Foley catheter to drain pleural effusion.

Science.gov (United States)

Ben-Nun, Alon; Best, Lael Anson

2008-01-01

Pleural effusion is a common problem, and various techniques of pleural fluid drainage have been described. We report our experience of using a Foley-type catheter to drain pleural effusion. After the injection of local anesthesia, the catheter is inserted, usually through the 7th intercostal space, with the patient sitting upright. The size of the catheter is selected according to the predicted fluid characteristics, and ranges from 18 to 24 F. Once the catheter is positioned in the pleural space, the balloon is inflated with diluted soluble contrast material and connected to a urine collection bag. During the last 10 years, we have used 3500 catheters for this purpose. The catheter site can be used as a port for various procedures, including needle biopsy of the parietal pleura, talc-slurry pleurodesis, and intra-pleural fibrinolysis. This method of pleural drainage is simple, reliable, and inexpensive.

Carotid Angioplasty and Stenting

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

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 ...

Endovascular stent-support angioplasty for cerebral venous sinus stenosis

Directory of Open Access Journals (Sweden)

Xin-feng LI

2011-06-01

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

Correlating Coating Characteristics with the Performance of Drug-Coated Balloons – A Comparative In Vitro Investigation of Own Established Hydrogel- and Ionic Liquid-Based Coating Matrices

Science.gov (United States)

Kaule, Sebastian; Minrath, Ingo; Stein, Florian; Kragl, Udo; Schmidt, Wolfram; Schmitz, Klaus-Peter; Sternberg, Katrin; Petersen, Svea

2015-01-01

Drug-coated balloons (DCB), which have emerged as a therapeutic alternative to drug-eluting stents in percutaneous cardiovascular intervention, are well described with regard to clinical efficacy and safety within a number of clinical studies. In vitro studies elucidating the correlation between coating additive and DCB performance are however rare but considered important for the understanding of DCB requirements and the improvement of established DCB. In this regard, we examined three different DCB-systems, which were developed in former studies based on the ionic liquid cetylpyridinium salicylate, the body-own hydrogel hyaluronic acid and the pharmaceutically well-established hydrogel polyvinylpyrrolidone, considering coating morphology, coating thickness, drug-loss, drug-transfer to the vessel wall, residual drug-concentration on the balloon surface and entire drug-load during simulated use in an in vitro vessel model. Moreover, we investigated particle release of the different DCB during simulated use and determined the influence of the three coatings on the mechanical behavior of the balloon catheter. We could show that coating characteristics can be indeed correlated with the performance of DCB. For instance, paclitaxel incorporation in the matrix can reduce the drug wash-off and benefit a high drug transfer. Additionally, a thin coating with a smooth surface and high but delayed solubility can reduce drug wash-off and decrease particle burden. As a result, we suggest that it is very important to characterize DCB in terms of mentioned properties in vitro in addition to their clinical efficacy in order to better understand their function and provide more data for the clinicians to improve the tool of DCB in coronary angioplasty. PMID:25734818

Balloon angioplasty of infrapopliteal artery in chronic lower limb ischemia with diabetes

International Nuclear Information System (INIS)

Wang Jianbo; Zhao Jungong; Zhu Yueqi; Li Minghua; Cheng Yingsheng; Cheng Yongde; Wang Jue

2008-01-01

Objective: To evaluate the technique, successful rate and perioperative complications together with the therapy and prevention of using PTA in treating diabetic patients with infrapopliteal arterial diseases. Methods: Angiographic and clinical data of 27 patients with diabetic lower limb ischemia treated by PTA from January 2006 to May 2007 were retrospectively reviewed. Rutherf0rd-Becker categories and ankle- brachial index(ABI)were evaluated before and after the treatment. The effects were compared between different lesion types (stenosis or occlusion)and between different ways of balloon technique. The complications were also analyzed, together with the primary, discussion of the therapy and prevention. Results: 24 patients showed improvement of ischemic symptoms, and 3 cases fell in failure. The intra-procedural main complications included acute thrombosis, vascular wall perforation, distal emboli resulting from plaque falling off and dissection. There were statistically significant differences between the effects of two type lesions and between different balloon methods. Conclusions: 1. The condition of lower limb arteries should be assessed carefully before operation. 2. PTA shows safe and good clinical result and ought to be recommended in treating diabetic patients with peripheral arterial diseases, especially the lower extremity ischemia. (authors)

The GuideLiner catheter: A supportive tool in percutaneous coronary intervention of chronic total occlusion

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Jan-Erik Guelker

2018-04-01

Full Text Available Background: Failure of delivering a stent or a balloon across the target lesion during percutaneous coronary intervention (PCI of chronic total occlusion (CTO, especially in arteries with calcified tortuous anatomy, is often due to insufficient backup support from the guiding catheter. The purpose of this study was to assess the feasibility of the GuideLiner (GL catheter use. Methods: We examined 18 patients and used the GL catheter to overcome poor support and excessive friction in standardized antegrade and retrograde CTO procedures. The GL is a coaxial, monorail guiding catheter extension delivered through a standard guiding catheter and is available in different sizes. Results: Almost all lesions were classified as severely calcified (94.4 ± 0.24%. The Japanese CTO score reflecting lesion complexity was 3.56 ± 0.78. All procedures were performed femorally; the retrograde approach was used in 27.8 ± 0.46% of cases. The overall success rate was 88.9 ± 0.32%; there were no relevant complications. Conclusions: The GL catheter is an adjunctive interventional device which enhances and amplifies CTO-PCI. Its use is indicated in cases in which back-up force needs to be strengthened to pass a CTO despite advanced calcification. It can be recommended as an important additional tool in advanced interventional cardiology such as antegrade and retrograde CTO-PCI if other techniques like anchor balloon or anchor wire are not possible. Keywords: Chronic total occlusion, GuideLiner catheter, Percutaneous coronary intervention, Severe calcification

Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction.

Science.gov (United States)

Brunetti, Natale Daniele; Di Pietro, Gaetano; Aquilino, Ambrogio; Bruno, Angela I; Dellegrottaglie, Giulia; Di Giuseppe, Giuseppe; Lopriore, Claudio; De Gennaro, Luisa; Lanzone, Saverio; Caldarola, Pasquale; Antonelli, Gianfranco; Di Biase, Matteo

2014-09-01

We report the preliminary data from a regional registry on ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty in Apulia, Italy; the region is covered by a single public health-care service, a single public emergency medical service (EMS), and a single tele-medicine service provider. Two hundred and ninety-seven consecutive patients with STEMI transferred by regional free public EMS 1-1-8 for primary-PCI were enrolled in the study; 123 underwent pre-hospital electrocardiograms (ECGs) triage by tele-cardiology support and directly referred for primary-PCI, those remaining were just transferred by 1-1-8 ambulances for primary percutaneous coronary intervention (PCI) (diagnosis not based on tele-medicine ECG; already hospitalised patients, emergency-room without tele-medicine support). Time from first ECG diagnostic for STEMI to balloon was recorded; a time-to-balloon primary-PCI). Pre-hospital triage with tele-cardiology ECG in an EMS registry from an area with more than one and a half million inhabitants was associated with shorter time-to-balloon and higher rates of timely treated patients, even in 'rural' areas. © The European Society of Cardiology 2014.

PDGF-D contributes to neointimal hyperplasia in rat model of vessel injury

International Nuclear Information System (INIS)

Chen Jingzhou; Han Yu; Lin Chunxia; Zhen Yisong; Song Xiaodong; Teng Siyong; Chen Chen; Chen Yu; Zhang Yinhui; Hui Rutai

2005-01-01

In this study, we determined the role of PDGF-D, a new member of the PDGF family, in a rat model of balloon injured artery made with a 2F catheter in Sprague-Dawley male rats. PDGF-D expression was studied in the injured and control segments of abdominal aorta. The function of PDGF-D was evaluated in rat vascular smooth muscle cells stably transfected with PDGF-D gene. We found that in normal abdominal aorta, PDGF-D was highly expressed in adventia, moderate in endothelia, and unidentified in media. Stable transfection of PDGF-D gene into vascular smooth muscle cells increased the cell migration by 2.2-fold, and the proliferation by 2.3-fold, respectively, and MMP-2 production and activity as well. These results support the fact that PDGF-D is involved in the formation of neointimal hyperplasia induced by balloon catheter injury and may serve as a target in preventing vascular restenosis after coronary angioplasty

The Accordion Sign in the Transplant Ureter: Ramifications During Balloon Dilation of Strictures

Energy Technology Data Exchange (ETDEWEB)

Kriegshauser, J. Scott, E-mail: skriegshauser@mayo.edu; Naidu, Sailen G. [Mayo Clinic Hospital, Department of Radiology (United States); Chang, Yu-Hui H. [Mayo Clinic, Department of Biostatistics (United States); Huettl, Eric A. [Mayo Clinic Hospital, Department of Radiology (United States)

2015-04-15

PurposeThis study was designed to demonstrate the accordion sign within the transplant ureter and evaluate its ramifications during balloon dilation of strictures.MethodsA retrospective electronic chart and imaging review included demographic characteristics, procedure reports, and complications of 28 renal transplant patients having ureteral strictures treated with percutaneous balloon dilation reported in our transplant nephrology database during an 8-year period. The accordion sign was deemed present or absent on the basis of an imaging review and was defined as present when a tortuous ureter became kinked and irregular when foreshortened after placement of a wire or a catheter. Procedure-related urine leaks were categorized as occurring at the stricture if within 2 cm; otherwise, they were considered away from the stricture.ResultsThe accordion sign was associated with a significantly greater occurrence of leaks away from the stricture (P = 0.001) but not at the stricture (P = 0.34).ConclusionsThe accordion sign is an important consideration when performing balloon dilation procedures on transplant ureteral strictures, given the increased risk of leak away from the stricture. Its presence should prompt additional care during wire and catheter manipulations.

Optimal application of the Contura multilumen balloon breast brachytherapy catheter vacuum port to deliver accelerated partial breast irradiation.

Science.gov (United States)

Tokita, Kenneth M; Cuttino, Laurie W; Vicini, Frank A; Arthur, Douglas W; Todor, Dorin A; Julian, Thomas B; Lyden, Maureen R

2011-01-01

The impact of using the Contura multilumen balloon (MLB) (SenoRx, Inc., Irvine, CA) breast brachytherapy catheter's vacuum port in patients treated with accelerated partial breast irradiation (APBI) was analyzed. Data from 32 patients at two sites were reviewed. Variables analyzed included the seroma fluid (SF):air volume around the MLB before and after vacuum port use and on its ability to improve (1) the eligibility of patients for APBI and (2) dose coverage of the planning target volume for evaluation (PTV_EVAL) in eligible patients. The median SF/air volume before vacuum removal was 6.8 cc vs. 0.8 cc after vacuum removal (median reduction in SF/air volume was 90.5%). Before vacuum port use, the median SF/air volume expressed as percentage of the PTV_EVAL was 7.8% (range, 1.9-26.6) in all patients. After application of the vacuum, this was reduced to 1.2%. Before vacuum port use, 10 (31.3%) patients were not considered acceptable candidates for APBI because the SF/air volume:PTV_EVAL ratio (SF:PTV) was greater than 10% (range, 10.1-26.6%; median, 15.2%). After vacuum port use, the median SF:PTV ratio was 1.6% for a median reduction of 91.5%. In addition, the percentage of the prescribed dose covering greater than or equal to 90% of the PTV_EVAL proportionally increased a median of 8% (range, 3-10%) in eligible patients. Use of the Contura MLB vacuum port significantly improved the conformity of the target tissue to the balloon surface, leading to reproducible dose delivery and increased target volume coverage. In addition, application of the vacuum allowed the safe treatment of unacceptable patients with APBI. Copyright © 2011 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

GuideLiner™ as guide catheter extension for the unreachable mammary bypass graft.

Science.gov (United States)

Vishnevsky, Alec; Savage, Michael P; Fischman, David L

2018-03-09

Percutaneous coronary intervention (PCI) of mammary artery bypass grafts through a trans-radial (TR) approach can present unique challenges, including coaxial vessel engagement of the guiding catheter, adequate visualization of the target lesion, sufficient backup support for equipment delivery, and the ability to reach very distal lesions. The GuideLiner catheter, a rapid exchange monorail mother-in-daughter system, facilitates successful interventions in such challenging anatomy. We present a case of a patient undergoing PCI of a right internal mammary artery (RIMA) graft via TR access in whom the graft could not be engaged with any guiding catheter. Using a balloon tracking technique over a guidewire, a GuideLiner was placed as an extension of the guiding catheter and facilitated TR-PCI by overcoming technical challenges associated with difficult anatomy. © 2018 Wiley Periodicals, Inc.

Aggressive plaque modification with rotational atherectomy and cutting balloon for optimal stent expansion in calcified lesions

Science.gov (United States)

Tang, Zhe; Bai, Jing; Su, Shao-Ping; Lee, Pui-Wai; Peng, Liang; Zhang, Tao; Sun, Ting; Nong, Jing-Guo; Li, Tian-De; Wang, Yu

2016-01-01

Objective To evaluate the factors affecting optimal stent expansion in calcified lesions treated by aggressive plaque modification with rotational atherectomy (RA) and a cutting balloon (CB). Methods From January 2014 to May 2015, 92 patients with moderate to severe coronary calcified lesions underwent rotational atherectomy and intravascular ultrasound imaging at Chinese PLA General Hospital (Beijing, China) were included in this study. They were divided into a rotational artherectomy combined with cutting balloon (RACB) group (46 patients treated with RA followed by CB angioplasty) and an RA group (46 patients treated with RA followed by plain balloon angioplasty). Another 40 patients with similar severity of their calcified lesions treated with plain old balloon angioplasty (POBA) were demographically matched to the other groups and defined as the POBA group. All patients received a drug-eluting stent after plaque preparation. Lumen diameter and lumen diameter stenosis (LDS) were measured by quantitative coronary angiography at baseline, after RA, after dilatation, and after stenting. Optimal stent expansion was defined as the final LDS < 10%. Results The initial and post-RA LDS values were similar among the three groups. However, after dilatation, the LDS significantly decreased in the RACB group (from 54.5% ± 8.9% to 36.1% ± 7.1%) but only moderately decreased (from 55.7% ± 7.8% to 46.9% ± 9.4%) in the RA group (time × group, P < 0.001). After stenting, there was a higher rate of optimal stent expansion in the RACB group (71.7% in the RACB group, 54.5% in the RA group, and 15% in the POBA group, P < 0.001), and the final LDS was significantly diminished in the RACB group compared to the other two groups (6.0% ± 2.3%, 10.8% ± 3.3%, 12.7% ± 2.1%, P < 0.001). Moreover, an LDS ≤ 40% after plaque preparation (OR = 2.994, 95% CI: 1.297–6.911) was associated with optimal stent expansion, which also had a positive correlation with the appearance of a

IN-VITRO EVALUATION OF BLOOD-FLOW THROUGH AUTOPERFUSION BALLOON CATHETERS

NARCIS (Netherlands)

DEMUINCK, ED; ANGELINI, P; DOUGHERTY, K; VERKERKE, BJ; RAKHORST, G; VANDIJK, RB; LIE, KI

The effective flow rates with human blood through an autoperfusion catheter cannot be monitored in vivo and have not been experimentally determined in vitro. The manufacturers (Advanced Cardiovascular Systems [ACS], Temecula, CA) have suggested that ''the flow rate'' through the Stack(TM) over the

Anchor balloons assisted deep intubation of 5F catheters for ...

African Journals Online (AJOL)

2015-07-24

Jul 24, 2015 ... However, cardiologists still encounter some difficult scenarios such as variant coronary artery origins, severely calcified and ... Medical University, 300, Guangzhou Road, Nanjing,. Jiangsu .... (l) The ST segment elevated while the 5F catheter was inserted into the proximal left anterior descending artery d.

Ileal Varices Treated with Balloon-Occluded Retrograde Transvenous Obliteration.

Science.gov (United States)

Sato, Takahiro; Yamazaki, Katsu; Toyota, Jouji; Karino, Yoshiyasu; Ohmura, Takumi; Akaike, Jun

2009-04-01

A 55-year-old man with hepatitis B virus antigen-positive liver cirrhosis was admitted to our hospital with anal bleeding. Colonoscopy revealed blood retention in the entire colon, but no bleeding lesion was found. Computed tomography images showed that vessels in the ileum were connected to the right testicular vein, and we suspected ileal varices to be the most probable cause of bleeding. We immediately performed double balloon enteroscopy, but failed to find any site of bleeding owing to the difficulty of fiberscope insertion with sever adhesion. Using a balloon catheter during retrograde transvenous venography, we found ileal varices communicating with the right testicular vein (efferent vein) with the superior mesenteric vein branch as the afferent vein of these varices. We performed balloon occluded retrograde transvenous obliteration by way of the efferent vein of the varices and have detected no further bleeding in this patient one year after treatment.

Feasibility study of an active soft catheter actuated by SMA wires

Science.gov (United States)

Konh, Bardia; Karimi, Saeed; Miller, Scott

2018-03-01

This study aims to assess the feasibility of using a combination of thin elastomer tubes and SMA wires to develop an active catheter. Cardiac catheters have been widely used in investigational and interventional procedures such as angiography, angioplasty, electro- physiology, and endocardial ablation. The commercial models manually steer inside the patient's body via internally installed pull wires. Active catheters, on the other hand, have the potential to revolutionize surgical procedures because of their computer-controlled and enhanced motion. Shape memory alloys have been used for almost a decade as a trustworthy actuator for biomedical applications. In this work, SMA wires were attached to a small pressurized elastomer tube to realize deflection. The tube was pressurized to maintain a constant stress on the SMA wires. The tip motion via actuation of SMA wires was then measured and reported. The results of this study showed that by adopting an appropriate training process for the SMA wires prior to performing the experiments and adopting an appropriate internal pressure for the elastomer tube, less external loads on SMA wires would be needed for a consistent actuation.

Fluoroscopy-guided balloon dilation in patients with Eustachian tube dysfunction

Energy Technology Data Exchange (ETDEWEB)

Kim, Kun Yung; Tsauo, Jiaywei; Song, Ho-Young [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Park, Hong Ju; Kang, Woo Seok [University of Ulsan College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, Seoul (Korea, Republic of); Park, Jung-Hoon [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); University of Ulsan College of Medicine, Department of Biomedical Engineering Research Center, Asan Medical Center, Seoul (Korea, Republic of); Wang, Zhe [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Tianjin Medical University General Hospital, Department of Radiology (China)

2018-03-15

To prospectively evaluate the technical feasibility and safety of fluoroscopy-guided balloon dilation in patients with Eustachian tube (ET) dysfunction. Patients who could not do a Valsalva manoeuvre for more than 6 months and diagnosed with chronic otitis media or ET dysfunction were prospectively enrolled. A 0.035-in. guide wire and 6-mm long balloon catheter with a diameter of 2 mm were used to dilate the cartilaginous portion of the ET under fluoroscopic guidance. The balloon was inflated by manual injection twice for 1 min each time. Clinical outcomes were assessed by the patient's ability to perform a Valsalva manoeuvre, and symptoms were assessed using the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score. Balloon dilation was attempted in a total of ten adult patients from October 2016 to March 2017. Technical success was achieved in all procedures (10/10). Ninety percent (9/10) of the balloons were fully dilated without waist deformity. There were no major complications. All patients were able to perform a Valsalva manoeuvre at the time of their last visit and/or improvement of at least one ETDQ-7 score. Fluoroscopy-guided balloon dilation seems to be technically feasible and safe in the treatment of ET dysfunction. (orig.)

Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

Energy Technology Data Exchange (ETDEWEB)

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

2011-09-15

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

Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

International Nuclear Information System (INIS)

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

2011-01-01

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

The consensus among Chinese interventional experts on the standard of interventional therapy for deep venous thrombosis of lower extremity

International Nuclear Information System (INIS)

Academic Group of Interventional Radiology, Radiology Branch of Chinese Medical Association

2011-01-01

This paper aims to introduce the indications and contraindications of catheter-directed thrombolysis, percutaneous mechanical thrombectomy, balloon angioplasty and stent implantation for deep venous thrombosis of lower extremity, and also aims to summarize and to illustrate the manipulating procedure, the points for attention, the perioperative complications and preventions in performing different kind of interventional technique. Great importance is attached to the interventional therapy for both acute and subacute deep venous thrombosis of lower extremity in order to effectively reduce the occurrence of post-thrombosis syndrome. (authors)

[Mitral valvuloplasty with double balloon catheter. Analysis of 200 cases].

Science.gov (United States)

Gomes, N L; Esteves, C A; Braga, S L; Ramos, A I; Meneghelo, Z M; Mattos, L A; Pontes Júnior, S C; Arnoni, A S; Fontes, V F; Sousa, J E

1992-04-01

To study the immediate clinical, echocardiographic and hemodynamic results of 200 patients who underwent percutaneous mitral balloon valvotomy (PMV) with double balloon technique. Two hundred patients were submitted to PVM for treatment of congestive heart failure secondary to severe mitral stenosis, between August 1987 to July 1991. Their mean age was 35.2 years, and 86.5% were female patients: 81% of them was in functional class, New York Heart Association (NYHA) III or IV; 4% was in atrial fibrilation and 4% had previous surgical commissurotomy. PMV was successfully performed in 89% of the patients. The mitral valve area, by pressure half time method, increased from 0.91 +/- 0.27 to 2.10 +/- 0.47 cm2, p atrial septum could not be performed. Mitral regurgitation (MR) immediately after PMV appeared 1+ or more grade in 50 patients, increased in 8 patients and remained unchanged in 11 patients. Ten patients needed mitral valve replacement in the first 48h after PMV, for treatment of severe MR. PMV produces excellent immediate results and can be considered an alternative to surgery for the relief of mitral stenosis.

Retrograde prostatic urethroplasty with a balloon catheter

International Nuclear Information System (INIS)

Castaneda, F.; Reddy, P.; Hulbert, J.; Letourneau, J.G.; Hunter, D.W.; Castaneda-Zuniga, W.R.; Amplatz, K.

1987-01-01

Twenty-five patients with prostatism and documented BPH who were candidates for transurethral resection of the prostate were dilated for 10 minutes with 25-mm urethroplasty balloons using a retrograde transurethral approach. The procedure was performed under local anesthesia using 2% viscous lidocaine on an outpatient basis. A mild discomfort was experienced by all patients with a moderate urgency sensation. Mild transient hematuria was present in all, which cleared in 4 to 6 hours. Dysuria usually lasted for 72 hours. Significant improvement has been seen in the relief of symptoms in patients without middle-lobe hypertrophy as documented by uroflow studies, voiding cystourethrograms, and retrograde urethrograms. In patients with middle-lobe hypertrophy, moderate improvement in uroflow studies was observed, which correlated well with symptomatic improvement. Rectal US and MR studies have shown no evidence of intraprostatic or periprostatic abnormalities. No complications have been encountered so far. The longest current follow-up is 20 months, with a mean of 10 months

Simple balloon dilation for drug-eluting in-stent restenosis: An optical coherent tomography analysis

Energy Technology Data Exchange (ETDEWEB)

Arikawa, Ryo [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Yamaguchi, Hiroshi, E-mail: hyamaguchi@tsm.bbiq.jp [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Takaoka, Junichiro; Miyamura, Akihiro; Atsuchi, Nobuhiko; Ninomiya, Toshiko; Atsuchi, Yoshihiko [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Ohishi, Mitsuru [Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima (Japan); Terashima, Mitsuyasu [Department of Cardiology, Toyohashi Heart Center, Toyohashi (Japan); Kaneda, Hideaki [Okinaka Memorial Institute for Medical Research, Tokyo (Japan)

2015-01-15

Background: Although drug-eluting stent (DES) has significantly reduced restenosis, the treatment of DES-in-stent restenosis (ISR) remains a challenge with high restenosis rate. Methods: We examined whether morphologic appearance of restenosis tissue by optical coherent tomography (OCT) had an impact on outcomes after balloon angioplasty for DES-ISR. The morphologic appearance of restenosis tissue was qualitatively assessed for tissue structures such as homogeneous, layered, and heterogeneous patterns. Results: Using OCT, 50 patients with DES-ISR were divided into 2 groups: 25 lesions with homogeneous or layered patterns (homo/layered group) and 25 lesions with heterogeneous patterns (hetero group). Acute gain was larger in the hetero group (1.33 ± 0.41 mm vs. 1.06 ± 0.32 mm in the homo/layered group, P = 0.03). On intravascular ultrasound analysis, post-procedural percent neointimal area was smaller in the hetero group (27.4 ± 9.2% vs. 34.0 ± 11.2% in the homo/layered group, P = 0.05). Angiographic follow-up was performed in 37 lesions (74%). Follow-up minimal lumen diameter was larger in the hetero group (1.75 ± 0.89 mm vs. 1.01 ± 0.81 mm in the homo/layered group, P = 0.04). Target lesion revascularization rates tended to be lower in the hetero group (20% vs. 43% in the homo/layered group, P = 0.12). Conclusions: Balloon angioplasty was more effective for DES-ISR with heterogeneous tissue appearance than DES-ISR with homogeneous/layered tissue appearance. OCT assessment of DES-ISR morphology may be a useful adjunct in determining clinical strategies. Simple balloon dilatation is a possible treatment strategy for DES-ISR lesions with a heterogeneous appearance on OCT images.

Central venous obstruction in hemodialysis patients: the usefulness of percutaneous treatment

International Nuclear Information System (INIS)

Kim, Cheol Young; Goo, Dong Erk; Kim, Dae Ho; Hong, Hyun Suk; Lee, Hae Kyoung; Choi, Duk Lin; Yang, Sung Boo; Moon, Chul

2002-01-01

To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. In 100 patients, 107 central venous strictures (56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23,stenosis:28)) were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion was also determined. We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2-and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required

Energy efficiency and pulmonary artery flow after balloon pulmonary angioplasty for inoperable, chronic thromboembolic pulmonary hypertension: Analysis by phase-contrast MRI

Energy Technology Data Exchange (ETDEWEB)

Nagao, Michinobu, E-mail: nagao.michinobu@twmu.ac.jp [Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women’s Medical University, Tokyo (Japan); Yamasaki, Yuzo [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Abe, Kohtaro; Hosokawa, Kazuya [Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Kawanami, Satoshi [Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Kamitani, Takeshi; Yamanouchi, Torahiko [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Yabuuchi, Hidetake [Department of Medical Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Fukushima, Kenji [Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women’s Medical University, Tokyo (Japan); Honda, Hiroshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan)

2017-02-15

Purpose: The aims of this study were to propose a new quantitative method for pulmonary artery (PA) flow energetics using phase-contrast magnetic resonance imaging (PC-MRI), and to investigate how balloon pulmonary angioplasty (BPA) impacts energetics in chronic thromboembolic pulmonary hypertension (CTEPH). Materials and methods: PC-MRI at 3-Teslar and with a flow sensitive gradient echo was used to examine energetics prior to and following BPA for 24 CTEPH patients. Stroke volume (m; ml) and mean velocity (V; mm/s) for the main pulmonary artery (PA), right PA, and left PA were calculated from a time-flow curve derived from PC-MRI. Based on the Bernoulli principle, PA energy was identified as 1/2 mV{sup 2} (μj/kg), and energy loss was defined as the following equation “energy loss = main PA energy − (rt. PA energy + lt. PA energy)”. Results: Right PA energy was significantly greater post-BPA than pre-BPA (61 ± 55 vs. 32 ± 40 μj/kg). There was no difference in main PA and left PA energies. Energy loss was significantly decreased post-BPA (18 ± 97 μj/kg) than pre-BPA (79 ± 125 μj/kg). An optimal cutoff of left PA energy of 45 μj/kg pre-BPA can be used to predict patients with mPAP ≥ 30 mmHg after BPA, with an area under the curve of 0.91, 78% sensitivity, and 92% specificity. Conclusion: Analysis of PA energetics using phase-contrast MRI demonstrates that BPA improves energy loss in CTEPH. In addition, BPA responses can be predicted by PA energy status pre-treatment.

"FOLEY CATHETER CERVICAL RIPENING WITH EXTRAAMNIOTIC INFUSION OF SALINE OR CORTICOSTEROIDS: A DOUBLE-BLIND, RANDOMIZED CONTROLLED STUDY"

Directory of Open Access Journals (Sweden)

A.Sh. Zafarghandi

2004-10-01

Full Text Available Induction of labor is one of the most common procedures during pregnancy. Various methods for cervical ripening and labor induction have been described in the obstetrics literature; but the role of corticosteroids in the process of labor is not entirely understood. This study challenged the possible role of corticosteroids in induction of labor by extra-amniotic injection through an inflated intracervical Foley balloon catheter. This randomized trial was conducted on 44 women with a single pregnancy, intact membranes, and an unfavorable cervix. They were randomly assigned to receive either 20 mg of dexamethasone in saline solution (study group, n=22 or saline solution only (control group, n=22 administered extra-amniotically through an intracervical inflated Foley balloon catheter. Eighteen (81.8% patients in the study group and 20 (90.9% in the control group entered the active phase of labor and were delivered vaginally. The mean time intervals between induction of labor to the active phase and between induction of labor to delivery were significantly shorter in the study group compared with those of the control group (3.3±2.1 hours vs. 9±4.7 hours, P<0.01, 5.7±3.4 hours vs. 6.9±4.7 hours, P<0.01, respectively. There was no maternal or fetal complication in study or control group. The intracervical Foley balloon catheter with extra-amniotic corticosteroids was more efficient in reducing the induction-to-delivery interval for termination of midtrimester pregnancies than the same Foley catheter with saline solution only. Cervical ripening with extra-amniotic corticosteroids possesses the advantages of simplicity, low cost, and lack of systemic or serious side effects.

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)

Cryoplasty for the treatment of iliac artery stenosis in canine model

International Nuclear Information System (INIS)

Wu Zhengzhong; Yang Weizhu; Jiang Na; Zheng Qubin; Huang Keyao; Huang Ning; Shen Quan

2013-01-01

Objective To evaluate the treatment effect of balloon angioplasty and cryoplasty on iliac artery stenosis in canine model. Methods: Canine models of iliac artery stenosis were established with surgical ligation and transfixion. Models were randomly divided into two groups: iliac artery stenosis treated by cryoplasty (n = 8) and by balloon angioplasty (n = 8). The degree of iliac artery stenosis of two model groups was assessed by digital subtraction angiography (DSA) immediately and two weeks after the angioplasties. Then all the dogs were executed for pathological observation of the target vessels. Results: Sixteen canine models of iliac artery stenosis were established by surgical ligation and transfixion method with 100% success rate. DSA showed there was (45 ± 12)% of residual artery stenosis in the cryoplasty group immediately after surgery, while it was (39-12)% in the balloon angioplasty group, and there was no significant difference between them (t = 3.183, P > 0.05). The artery stenosis of cryoplasty group was (48 ± 17)% after two weeks and not significantly different from that after surgery immediately (t = -1.271, P > 0.05). The artery stenosis of balloon angioplasty group was (67 ± 13)% after two weeks, and it was significantly higher compared with at after surgery immediately (t = -6.666, P < 0.01). The degree of vascular stenosis in balloon angioplasty group was severer than that in cryoplasty group two weeks after angiography (P = 0.041). The pathological examination showed artery intimal hyperplasia in cryoplasty group was milder than that in balloon angioplasty group and neointimal content of collagen in cryoplasty group was less than that in balloon angioplasty group. Conclusions: The animal models of iliac artery stenosis were established successfully with surgical ligation and transfixion by damaging the intima and media of arterial wall. Compared with balloon angioplasty, the cryoplasty was able to inhibit proliferation of intimal and reduce

Endoscopic minor papilla balloon dilation for the treatment of symptomatic pancreas divisum.

Science.gov (United States)

Yamamoto, Natsuyo; Isayama, Hiroyuki; Sasahira, Naoki; Tsujino, Takeshi; Nakai, Yousuke; Miyabayashi, Koji; Mizuno, Suguru; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

2014-08-01

A subpopulation of patients with pancreas divisum experience symptomatic events such as recurrent acute pancreatitis and chronic pancreatitis. Minor papilla sphincterotomy has been reported as being an effective treatment. The aim of this study was to evaluate the safety and efficacy of endoscopic balloon dilation for the minor papilla. Between 2000 and 2012, 16 patients were retrospectively included in this study. After endoscopic balloon dilation for the minor papilla was received, a pancreatic stent or a nasal pancreatic drainage catheter was placed for 1 week. If a stricture or obstruction was evident, it was treated with balloon dilation followed by long-term stent placement (1 year). When an outflow of pancreatic juice was disturbed by a pancreatic stone, endoscopic stone extraction was performed. Balloon dilation and stent placement were achieved and were successful in all the cases (16/16; 100%). Clinical improvement was achieved in 7 (84.7%) of the 9 patients with recurrent acute pancreatitis and in 6 (85.7%) of the 7 patients with chronic pancreatitis. Early complications were observed in 1 (6.3%) patient. Pancreatitis or bleeding related to balloon dilation was not observed. Endoscopic balloon dilation for the minor papilla is feasible for the management of symptomatic pancreas divisum.

Feasibility of MR-guided angioplasty of femoral artery stenoses using real-time imaging and intraarterial contrast-enhanced MR angiography

International Nuclear Information System (INIS)

Paetzel, C.; Zorger, N.; Bachthaler, M.; Voelk, M.; Seitz, J.; Herold, T.; Feuerbach, S.; Lenhart, M.; Nitz, W.R.

2004-01-01

Purpose: To show the feasibility of magnetic resonance (MR) for guided interventional therapy of femoral and popliteal artery stenoses with commercially available materials supported by MR real-time imaging and intraarterial MR angiography. Materials and Methods: Three patients (1 female, 2 male), suffering from symptomatic arterial occlusive disease with stenoses of the femoral (n=2) or popliteal (n=1) arteries were included. Intraarterial digital subtraction angiography was performed in each patient pre- and post-interventionally as standard of reference to quantify stenoses. The degree of the stenoses reached from 71-88%. The MR images were acquired on a 1.5 T MR scanner (Magnetom Sonata; Siemens, Erlangen, Germany). For MR-angiography, a Flash 3D sequence was utilized following injection of 5 mL diluted gadodiamide (Omniscan; Amersham Buchler, Braunschweig, Germany) via the arterial access. Two maximum intensity projections (MIP) were used as road maps and localizer for the interactive positioning of a continuously running 2D-FLASH sequence with a temporal solution of 2 images per second. During the intervention, an MR compatible monitor provided the image display inside the scanner room. Safety guidelines were followed during imaging in the presence of a conductive guidewire. The lesion was crossed by a commercially available balloon catheter (Wanda, Boston Scientific; Ratingen, Germany), which was mounted on a 0.035'' guidewire (Terumo; Leuven, Belgium). The visibility was provided by radiopaque markers embedded in the balloon and was improved by injection of 1 mL gadodiamide into the balloon. After dilation, the result was checked by intraarterial MR angiography and catheter angiography. Results: The stenoses could be correctly localized by intraarterial MR angiography. There was complete correlation between intraarterial MR angiography and digital subtraction angiography. The combination of guidewire and balloon was visible and the balloon was placed

Effects of ilexonin a on IL-6 and M-CSF following ballon angioplasty in rabbit common carotid artery

International Nuclear Information System (INIS)

Zhao Lihua; Li Zhangwei; Yang Chuang; Jiang Yaqiu

2008-01-01

Objective: To observe the effects of ilexonin A(IA) on IL-6 and M-CSF following ballon angioplasty in rabbit common carotide artery to provide experimental basis for percutaneous coronary interventions. Mehtods: 30 Japanese rabbits were fed with high cholesterol food for 4 weeks. Then they were divided into three groups randomly. Each group had ten rabbits. 1) Control group: the incision was sew directly after right carotide artery of the rabbit was seeked. 2) Balloon dilation group: the proximal of the carotide artery was cuted, the ballon was delivered and distended, after it was drawn repeatly, the incision was closed. 3) IA therapy group: operation was the same to the balloon dilation group, then IA was administered in vein. All of them were fed with high cholesterol diet for 4 weeks and the blood samples were collected 1 d before the operation and 1 d, 1,2,4 weeks after the operation. The serum IL-6 and M-CSF levels were determined with radioimmunoassay. The pathological changes of injuried artery were observed. Results: 1) The IL-6 level in balloon dilation group was higher than that in IA therapy group after the operation (P<0.05), and came back later to preoperation level. 2) Though the M-CSF level in IA therapy group was increased, but it was lower than that in dilation group (P<0.05). 3) The pathological results demonstrated that the artery endothelial in control group was smooth and no foam cell in sight. In bolloon dilation group, the endangium was thickened, the vascular smooth muscle cells proliferated, there were many foam cells and the lumen was constrictive. In IA therapy group, the number of foam cells reduced, the constrictive degree of lumen was alleviated. Conclusion: IA can redece the levels of serum IL-6 and M-CSF and inhibit the proliferation of vascular smooth muscle cells following ballon angioplasty. (authors)

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

Intervention with rotational atherectomy, sharp balloon and implant of conventional Stent in ostium lesion of right coronary artery, calcified

International Nuclear Information System (INIS)

Hurtado, Edgar; Echeverria, Rene; Calderon, Luis I

2004-01-01

Atherosclerotic lesions from the right coronary artery ostium have a low incidence in the manifestation of coronary disease. The high content of smooth muscle cells in the coronary ostium is related to a low success probability of a percutaneous intervention. We present a clinical complex case of a 61 years old female with right coronary artery ostium disease to whom we performed an angioplasty with cutting balloon and rotational arterectomy with successful results

Missed signs of autonomic dysreflexia in a tetraplegic patient after incorrect placement of urethral Foley catheter: a case report.

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Vaidyanathan, Subramanian; Soni, Bakul M; Oo, Tun; Hughes, Peter L; Singh, Gurpreet

2014-01-01

Autonomic dysreflexia is poorly recognised outside of spinal cord injury centres, and may result in adverse outcomes including mortality from delayed diagnosis and treatment. We present a spinal cord injury patient, who developed autonomic dysreflexia following incorrect placement of urethral Foley catheter. Health professionals failed to recognise signs and symptoms of autonomic dysreflexia as well as its significance in this tetraplegic patient. A tetraplegic patient started sweating profusely following insertion of a Foley catheter per urethra. The catheter was draining urine; there was no bypassing, no bleeding per urethra, and no haematuria. Patient's wife, who had been looking after her tetraplegic husband for more than forty years, told the health professionals that the catheter might have been placed incorrectly but her concerns were ignored. Ultrasound scan of urinary tract revealed no urinary calculi, no hydronephrosis. The balloon of Foley catheter was not seen in urinary bladder but this finding was not recognised by radiologist and spinal cord physician. Patient continued to sweat profusely; therefore, CT of pelvis was performed, but there was a delay of ten days. CT revealed the balloon of Foley catheter in the over-stretched prostate-membranous urethra; the tip of catheter was not located within the urinary bladder but was lying distal to bladder neck. Flexible cystoscopy was performed and Foley catheter was inserted into the bladder over a guide wire. The intensity of sweating decreased; noxious stimuli arising from traumatised urethra might take a long while to settle. Inserting a catheter in a tetraplegic patient should be carried out by a senior health professional, who is familiar with spasm of bladder neck which occurs frequently in tetraplegic patients. Facilities for urgent CT scan should be available to check the position of Foley catheter in spinal cord injury patients when a patient manifests signs and symptoms of autonomic dysreflexia

Bi-layer sandwich film for antibacterial catheters.

Science.gov (United States)

Franz, Gerhard; Schamberger, Florian; Zare, Hamideh Heidari; Bröskamp, Sara Felicitas; Jocham, Dieter

2017-01-01

Background: Approximately one quarter of all nosocomial infections can be attributed to the urinary tract. The infections are supposed to be mainly caused by implantations of urethral catheters and stents. A new catheter design is introduced with the aim to lower the high number of nosocomial urethral infections. In order to avoid limitations to use, the design is first applied to conventional commercially available balloon catheters. Results: The main feature of the design is a sandwich layer on both sides of the catheter wall, which is composed of a fragmented base layer of silver capped by a thin film of poly( p -xylylene). This top layer is mainly designed to release a controlled amount of Ag + ions, which is bactericidal, but not toxic to humans. Simultaneously, the lifetime is prolonged to at least one year. The base layer is electrolessly deposited applying Tollens' reagens, the cap layer is deposited by using chemical vapor deposition. Conclusion: The three main problems of this process, electroless deposition of a fragmented silver film on the surface of an electrically insulating organic polymer, irreproducible evaporation during heating of the precursor, and exponential decrease of the layer thickness along the capillary, have been solved trough the application of a simple electrochemical reaction and two standard principles of physics: Papin's pot and the principle of Le Chatelier.

Bi-layer sandwich film for antibacterial catheters

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Gerhard Franz

2017-09-01

Full Text Available Background: Approximately one quarter of all nosocomial infections can be attributed to the urinary tract. The infections are supposed to be mainly caused by implantations of urethral catheters and stents. A new catheter design is introduced with the aim to lower the high number of nosocomial urethral infections. In order to avoid limitations to use, the design is first applied to conventional commercially available balloon catheters.Results: The main feature of the design is a sandwich layer on both sides of the catheter wall, which is composed of a fragmented base layer of silver capped by a thin film of poly(p-xylylene. This top layer is mainly designed to release a controlled amount of Ag+ ions, which is bactericidal, but not toxic to humans. Simultaneously, the lifetime is prolonged to at least one year. The base layer is electrolessly deposited applying Tollens’ reagens, the cap layer is deposited by using chemical vapor deposition.Conclusion: The three main problems of this process, electroless deposition of a fragmented silver film on the surface of an electrically insulating organic polymer, irreproducible evaporation during heating of the precursor, and exponential decrease of the layer thickness along the capillary, have been solved trough the application of a simple electrochemical reaction and two standard principles of physics: Papin’s pot and the principle of Le Chatelier.

A novel balloon assisted two-stents telescoping technique for repositioning an embolized stent in the pulmonary conduit.

Science.gov (United States)

Kobayashi, Daisuke; Gowda, Srinath T; Forbes, Thomas J

2014-08-01

A 9-year-old male, with history of pulmonary atresia and ventricular septal defect, status post complete repair with a 16 mm pulmonary homograft in the right ventricular outflow tract (RVOT) underwent 3110 Palmaz stent placement for conduit stenosis. Following deployment the stent embolized proximally into the right ventricle (RV). We undertook the choice of repositioning the embolized stent into the conduit with a transcatheter approach. Using a second venous access, the embolized stent was carefully maneuvered into the proximal part of conduit with an inflated Tyshak balloon catheter. A second Palmaz 4010 stent was deployed in the distal conduit telescoping through the embolized stent. The Tyshak balloon catheter was kept inflated in the RV to stabilize the embolized stent in the proximal conduit until it was successfully latched up against the conduit with the deployment of the overlapping second stent. One year later, he underwent Melody valve implantation in the pre-stented conduit relieving conduit insufficiency. This novel balloon assisted two-stents telescoping technique is a feasible transcatheter option to secure an embolized stent from the RV to the RVOT. © 2014 Wiley Periodicals, Inc.

Impact of Balloon Pulmonary Angioplasty on Hemodynamics and Clinical Outcomes in Patients with Chronic Thromboembolic Pulmonary Hypertension: the Initial Korean Experience.

Science.gov (United States)

Kwon, Woochan; Yang, Jeong Hoon; Park, Taek Kyu; Chang, Sung A; Jung, Dong Seop; Cho, Young Seok; Kim, Sung Mok; Kim, Tae Jung; Park, Hye Yoon; Choi, Seung Hyuk; Kim, Duk Kyung

2018-01-22

The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). However, not all patients are eligible for PEA, and some patients experience recurrence of pulmonary hypertension even after PEA. Patients who underwent balloon pulmonary angioplasty (BPA) between December 2015 and April 2017 were enrolled from the Samsung Medical Center CTEPH registry. Enrolled patients underwent right heart catheterization, echocardiography, and 6-minute walk distance (6MWD) at baseline, 4 and 24 weeks after their first BPA session. We compared clinical and hemodynamic parameters at the baseline and last BPA session. Fifty-two BPA sessions were performed in 15 patients, six of whom had a history of PEA. BPA resulted in improvements in World Health Organization (WHO) functional class (2.9 ± 0.8 to 1.7 ± 0.6, P = 0.002), 6MWD (387.0 ± 86.4 to 453.4 ± 64.8 m, P = 0.01), tricuspid annular plane systolic excursion (14.1 ± 3.6 to 15.6 ± 4.3 mm, P = 0.03) and hemodynamics, including a decline in mean pulmonary artery pressure (41.1 ± 13.1 to 32.1 ± 9.5 mmHg, P < 0.001) and in pulmonary vascular resistance (607.4 ± 452.3 to 406.7 ± 265.4 dyne.sec.cm⁻⁵, P = 0.01) but not in cardiac index (2.94 ± 0.79 to 2.96 ± 0.93 L/min/m², P = 0.92). Six cases of complications were recorded, including two cases of reperfusion injury. BPA might be a safe and effective treatment strategy for both inoperable CTEPH patients and patients with residual pulmonary hypertension after PEA. © 2018 The Korean Academy of Medical Sciences.

Gastric Outlet Obstruction Caused by Foley Catheter: A Complication when Substituting for Commercial Gastrostomy Tubes

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Amanda B. Lewis

2018-01-01

Full Text Available The technique of using percutaneous endoscopic gastrostomy (PEG for long-term enteral feeding is well established and commonly used. While the technique is relatively safe and simple, the gastrostomy tube itself may deteriorate or malfunction, requiring a replacement tube. We present a case of a 58-year-old woman who was found to have gastric outlet obstruction from the inflated balloon of a Foley catheter being used as a replacement for her PEG tube. This case illustrates a potential complication of using a Foley catheter in place of commercially available gastrostomy tubes.

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

International Nuclear Information System (INIS)

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

2011-01-01

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

Electrophysiological and Histological Evaluation of Acute Efficacy and Safety of Balloon Occlusive Ablation at Superior Vena Cava-Right Atrial Junction

Directory of Open Access Journals (Sweden)

Kazushi Tanaka, MD

2007-01-01

Full Text Available We evaluated efficacy and safety of occlusive radiofrequency catheter ablation (o-RFA using our thermal balloon catheter (TBC at superior vena cava (SVC-right atrial (RA junction (SVCJ compared to that of RFA with a standard-tip catheter. Methods: To electrically isolate (SVCI SVC from RA in 10 pigs (group 1, the initial o-RFA at a balloon surface temperature of 53.9 ± 3.0°C for 3–5 min (13.56 MHz was achieved at the SVCJ completely obstructed with an inflated balloon. If unsuccessful, subsequent o-RFA was repeated in a ࣘ5°C increments until reaching either SVCI or sinus arrest. Before and after each o-RFA, stimulation protocol from the RA was performed. Additionally, in 5 different pigs (group 2, RFA at 55°C (ࣘ50 W for 1 min with a 4 mm-tip catheter was achieved at multiple sites along the SVCJ. Finally, the neighboring tissues of the SVCJ were histologically investigated. Results: In group 1, successful SVCI could be easily accomplished at the final temperature of 57.2 ± 2.4°C; however, in 3 pigs, a new atrial tachycardia was induced after o-RFA at <55°C and in 2 pigs sinus arrest occurred during o-RFA at 60°C. Histologically, transmural and circumferential contraction band necrosis was mainly confirmed around the SVCJ without damage to collateral tissue. In group 2, coagulation necrosis occupied almost all the ablative lesions, leading to severe degeneration of collateral tissue. Conclusion: O-RFA at the SVCJ may be more feasible and safer than RFA.

Accelerated partial breast irradiation utilizing balloon brachytherapy techniques

International Nuclear Information System (INIS)

Strauss, Jonathan B.; Dickler, Adam

2009-01-01

To overcome the barriers to BCT, methods of PBI in the setting of breast conservation have been explored. The method of PBI with the longest published follow-up is multi-catheter interstitial brachytherapy. Balloon-based brachytherapy with the MammoSite brachytherapy applicator was designed to simplify the brachytherapy procedure for PBI, enhance the reproducibility of the dosimetry, and improve patient comfort. The rates of local recurrence following PBI with the MammoSite applicator have been low, but there are few published reports and follow-up has been relatively short. The cosmetic outcomes and toxicity of MammoSite PBI are comparable to those seen after multicatheter-based PBI. Additional methods of balloon brachytherapy, including Xoft and SenoRx Contura have been developed. Finally, long-term follow-up after PBI is important for the welfare of individual patients and in order to establish the efficacy, late toxicity and cosmetic outcomes of this technique.

Expanding TAVI options: elective rotational atherectomy during trans-catheter aortic valve implantation

International Nuclear Information System (INIS)

Piccoli, Anna; Lunardi, Mattia; Ariotti, Sara; Ferrero, Valeria; Vassanelli, Corrado; Ribichini, Flavio

2015-01-01

Summary: Aortic valve stenosis (AVS) in the elderly is frequently associated to coronary artery disease (CAD). In patients with significant coronary stenosis surgical valve replacement is associated to coronary bypass grafting, but whether coronary angioplasty is needed in patients receiving trans-catheter aortic valve implantation (TAVI) is unknown. Given the frequent complexity of CAD in the elderly with calcific AVS, rotational atherectomy (RA) may be needed in some cases. No data are available about feasibility and safety of RA during TAVI. The need for myocardial revascularization in TAVI candidates is discussed, and a series of RA cases performed during TAVI is described

Expanding TAVI options: elective rotational atherectomy during trans-catheter aortic valve implantation

Energy Technology Data Exchange (ETDEWEB)

Piccoli, Anna; Lunardi, Mattia; Ariotti, Sara; Ferrero, Valeria; Vassanelli, Corrado; Ribichini, Flavio, E-mail: flavio.ribichini@univr.it

2015-01-15

Summary: Aortic valve stenosis (AVS) in the elderly is frequently associated to coronary artery disease (CAD). In patients with significant coronary stenosis surgical valve replacement is associated to coronary bypass grafting, but whether coronary angioplasty is needed in patients receiving trans-catheter aortic valve implantation (TAVI) is unknown. Given the frequent complexity of CAD in the elderly with calcific AVS, rotational atherectomy (RA) may be needed in some cases. No data are available about feasibility and safety of RA during TAVI. The need for myocardial revascularization in TAVI candidates is discussed, and a series of RA cases performed during TAVI is described.

Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions.

Science.gov (United States)

Perk, Gila; Lang, Roberto M; Garcia-Fernandez, Miguel Angel; Lodato, Joe; Sugeng, Lissa; Lopez, John; Knight, Brad P; Messika-Zeitoun, David; Shah, Sanjiv; Slater, James; Brochet, Eric; Varkey, Mathew; Hijazi, Ziyad; Marino, Nino; Ruiz, Carlos; Kronzon, Itzhak

2009-08-01

Real-time three-dimensional (RT3D) echocardiography is a recently developed technique that is being increasingly used in echocardiography laboratories. Over the past several years, improvements in transducer technologies have allowed development of a full matrix-array transducer that allows acquisition of pyramidal-shaped data sets. These data sets can be processed online and offline to allow accurate evaluation of cardiac structures, volumes, and mass. More recently, a transesophageal transducer with RT3D capabilities has been developed. This allows acquisition of high-quality RT3D images on transesophageal echocardiography (TEE). Percutaneous catheter-based procedures have gained growing acceptance in the cardiac procedural armamentarium. Advances in technology and technical skills allow increasingly complex procedures to be performed using a catheter-based approach, thus obviating the need for open-heart surgery. The authors used RT3D TEE to guide 72 catheter-based cardiac interventions. The procedures included the occlusion of atrial septal defects or patent foramen ovales (n=25), percutaneous mitral valve repair (e-valve clipping; n=3), mitral balloon valvuloplasty for mitral stenosis (n=10), left atrial appendage obliteration (n=11), left atrial or pulmonary vein ablation for atrial fibrillation (n=5), percutaneous closures of prosthetic valve dehiscence (n=10), percutaneous aortic valve replacement (n=6), and percutaneous closures of ventricular septal defects (n=2). In this review, the authors describe their experience with this technique, the added value over multiplanar two-dimensional TEE, and the pitfalls that were encountered. The main advantages found for the use RT3D TEE during catheter-based interventions were (1) the ability to visualize the entire lengths of intracardiac catheters, including the tips of all catheters and the balloons or devices they carry, along with a clear depiction of their positions in relation to other cardiac structures, and

Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: Literature review and analysis

Energy Technology Data Exchange (ETDEWEB)

Dilauro, M.D.; Dason, S. [McMaster University, Michael G. DeGroote School of Medicine (Canada); Athreya, S., E-mail: sathreya@stjoes.ca [Diagnostic Imaging, St Joseph' s Healthcare Hamilton, Ontario (Canada)

2012-06-15

Aim: To review the literature on the use of prophylactic balloon occlusion alone and in conjunction with arterial embolization of the internal iliac arteries in women with placenta accreta. Materials and methods: The PubMed, MEDLINE, CINAHL, EMBASE, and Cochrane Library databases were searched for keywords related to this technique and its use in the avoidance of caesarean hysterectomy. The relevant published articles were selected and then searched for further references. Results: The literature search found 15 case reports and five studies for a total of 20 articles. The use of balloon catheters to prevent post-partum haemorrhage in women with placenta accreta is controversial with some investigators reporting reduced blood loss and transfusion requirements while others reporting no benefit. This procedure does not appear to reduce operative time or hospital stay. Some groups have described catheter-related complications, such as maternal thromboembolic events and the need for stent placement and/or arterial bypass. Thus far, there is no reported maternal or foetal mortality related to this procedure. Conclusion: Current evidence is based upon case reports and small retrospective studies. Larger studies or randomized controlled trials are essential in order to demonstrate the safety and efficacy of bilateral iliac balloon occlusion. The creation of a data registry would also facilitate the reporting of this technique.

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

International Nuclear Information System (INIS)

Chen Shiwei; Qiao Delin

2004-01-01

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

Balloon dacryocystoplasty: Incomplete versus complete obstruction of the nasolacrimal system

International Nuclear Information System (INIS)

Lee, Jeong Min; Lee, Sang Hoon; Han, Young Min; Chung, Gyung Ho; Kim, Chong Soo; Choi, Ki Chul; Song, Ho Young

1993-01-01

Balloon dilatation of nasolacrimal drainage apparatus was attempted for the treatment of stenoses or obstructures of the nasolacrimal system in 49 eyes of 41 consecutive patients with complete obstructions and 16 eyes of 14 patients with incomplete obstructions. These two groups were compared with regards to the effectiveness of balloon dacryocystoplasty. All patients suffered from severe epiphora had already undergone multiple probings. A 0.018 inch hair or ball guide wire was introduced through the superior punctum into the inferior meatus of the nasal cavity and pulled out through the nasal aperture using a hemostat under nasal endoscopy. A deflated angiography balloon catheter was then introduced in a retrograde direction and dilated under fluoroscopic control. No major complications occurred in any of the patients. At 7 days after balloon dilatation, 25 of 49 eyes with complete obstruction demonstrated improvement in epiphora (initial success rate: 51.0%) and among them 17 eyes showed complete resolution of symptoms. Reocclusion occurred in 12 of the 25 eyes with initial improvement at the 2 months follow up. For the 16 eyes with incomplete obstruction, and improvement of epiphora was attained in 11 eyes (initial success rate 68.8%): 5 of these eyes showed complete resolution of epiphora, and 3 was failed to maintain initial improvement at the 2 month follow up. Although this study demonstrate that results of balloon dacryocystoplasty are not encouraging because of the high failure and recurrence rate, balloon dacryocystoplasty is a simple and safe nonsurgical technique that can be used to treat for obstructions of the nasolacrimal system. In addition, balloon dacryocystoplasty shows better results in incomplete obstruction than in complete obstruction than complete obstruction of the nasolacrimal system

Evaluation of the fetal dose during prophylactic placement of internal iliac artery balloon occlusion catheters in placenta accreta

Energy Technology Data Exchange (ETDEWEB)

Kim, Dong Sik [Dept. of Radiology, Gachon University Gil hospital, Incheon (Korea, Republic of); Ahn, Sung Min [Dept. of Radiological Science, Gachon University, Incheon (Korea, Republic of)

2016-09-15

Placenta accrete patients whose mother mortality rates are rather high due to massive bleeding during childbirth need to have Prophylactic placement of Internal Iliac Artery Balloon Occlusion Catheters procedure to reduce amount of blood loss and inoperative transfusion. Nevertheless, studies for mothers inevitably exposed to dose during PIIABOCs procedure have not been published many yet. Therefore, this study is to investigate exact information on radiation dose exposed to fetus during PIIABOCs procedure. Average effective dose of fetus per organ is 2.38∼8.83 mGy, measured highest at beam center and followed by eyeball, stomach and bladder. The result showed that the longer fluoroscopy time is used, the closer beam center is and the thicker abdominal thickness is, the more effective dose on fetus is increasing. When using the collimator and protection shown to decrease the effective dose and when using higher the patient table shown to decrease the effective dose. It has been reported that the threshold of deterministic effect is about 100mGy. Deterministic effect was regarded as a factor that would influence on fetus exposed by medical radiation than stochastic effect. Consequently, it concluded that dose exposed on fetus in PIIABOCs procedure was approximately 10% of threshold of deterministic effect with effective dose of 0.49∼18.27 mGy.

Inadvertent positioning of suprapubic catheter in urethra: a serious complication during change of suprapubic cystostomy in a spina bifida patient - a case report.

Science.gov (United States)

Vaidyanathan, Subramanian; Hughes, Peter L; Soni, Bakul M; Oo, Tun; Singh, Gurpreet

2009-12-22

Spinal cord injury patients are at risk for developing unusual complications such as autonomic dysreflexia while changing suprapubic cystostomy. We report a male patient with spina bifida in whom the Foley catheter was placed in the urethra during change of suprapubic cystostomy with serious consequences. A male patient, born in 1972 with spina bifida and paraplaegia, underwent suprapubic cystostomy in 2003 because of increasing problems with urethral catheter. The patient would come to spinal unit for change of suprapubic catheter every four to six weeks. Two days after a routine catheter change in November 2009, this patient woke up in the morning and noticed that the suprapubic catheter had come out. He went straight to Accident and Emergency. The suprapubic catheter was changed by a health professional and this patient was sent home. But the suprapubic catheter did not drain urine. This patient developed increasing degree of pain and swelling in suprapubic region. He did not pass any urine per urethra. He felt sick and came to spinal unit five hours later. About twenty ml of contrast was injected through suprapubic catheter and X-rays were taken. The suprapubic catheter was patent; the catheter was not blocked. The Foley catheter could be seen going around in a circular manner through the urinary bladder into the urethra. The contrast did not opacify urinary bladder; but proximal urethra was seen. The tip of Foley catheter was lying in proximal urethra. The balloon of Foley catheter had been inflated in urethra. When the balloon of Foley catheter was deflated, this patient developed massive bleeding per urethra. A sterile 22 French Foley catheter was inserted through suprapubic track. The catheter drained bloody urine. He was admitted to spinal unit and received intravenous fluids and meropenem. Haematuria subsided after 48 hours. The patient was discharged home a week later in a stable condition. This case shows that serious complications can occur during

Maximizing Lumen Gain With Directional Atherectomy.

Science.gov (United States)

Stanley, Gregory A; Winscott, John G

2016-08-01

To describe the use of a low-pressure balloon inflation (LPBI) technique to delineate intraluminal plaque and guide directional atherectomy in order to maximize lumen gain and achieve procedure success. The technique is illustrated in a 77-year-old man with claudication who underwent superficial femoral artery revascularization using a HawkOne directional atherectomy catheter. A standard angioplasty balloon was inflated to 1 to 2 atm during live fluoroscopy to create a 3-dimensional "lumenogram" of the target lesion. Directional atherectomy was performed only where plaque impinged on the balloon at a specific fluoroscopic orientation. The results of the LPBI technique were corroborated with multimodality diagnostic imaging, including digital subtraction angiography, intravascular ultrasound, and intra-arterial pressure measurements. With the LPBI technique, directional atherectomy can routinely achieve <10% residual stenosis, as illustrated in this case, thereby broadly supporting a no-stent approach to lower extremity endovascular revascularization. © The Author(s) 2016.

Usefulness of Interventional Treatment for Dysfunctional Hemodialysis Shunts of the Upper Arm by Means of the Retrograde Transradial Approach

International Nuclear Information System (INIS)

Shin, Hwa Seon; Shin, Tae Beom; Na, Jae Beom; Jung, Seong Hoon; Kim, Hyun Jung; Lee, Jung Eun; Song, Yun Gyu; Jung, Gyoo Sik

2010-01-01

This study was designed to evaluate the technical feasibility and clinical outcome of endovascular intervention using the retrograde transradial approach to treat dysfunctional hemodialysis shunts of the upper arms. During the last 3 years, sixteen procedures were performed by the transradial approach in 13 patients with dysfunctional hemodialysis shunts of the upper arms. The radial artery was accessed with the use of 20-gauge needle and a 6-Fr sheath. Angiography was performed using a 5-Fr catheter placed in the brachial artery, and then the interventional procedure was performed. The technical and clinical success rates, complications and patency rates were evaluated. Fistulography and percutaneous transluminal angioplasty via the transradial approach were performed in 16 cases of the 13 patients. Fistulography demonstrated stenosis in 7 cases and occlusions in 9 cases. Lesion multiplicity was identified in 9 out of 16 cases. Balloon angioplasty was performed in all cases and a stent was placed to overcome restenosis or to treat venous rupture in two cases. The technical success rate of balloon angioplasty was 87.5% (14/16) and the technical success rate with including stent insertion was 100% (16/16). The clinical success rate was 93.8%. There was one procedural-related complication. The primary patency rates at 6 and 12 months were 84.6% and 74%, respectively. The transradial approach seems to be technically feasible and effective for the management of insufficient hemodialysis shunts of the upper arms

Interventional treatment of transplanted renal artery stenosis

International Nuclear Information System (INIS)

Zhou Haihong; Chen Weiguo; Lu Wei; Chen Yong; Yan Xinmin; Zhou Jianyong; Li Yanhao

2002-01-01

Purpose: To evaluate the clinical application of percutaneous transluminal renal artery angioplasty (PTRA) in the treatment of transplanted renal artery stenosis. Methods: Nine patients with transplanted renal artery stenosis were treated by PTRA with balloon catheter through the f amoral artery. Metal stent was placed in 3 patients out of 9. Results: Technical success was obtained in all procedures. In 7 patients normal blood pressure was restored and serum creatinine remarkably decreased. But anti-hypertension drugs were still needed in rest 2 patients. Conclusion: PTRA and stent implantation are useful and valuable method in the treatment of transplanted renal artery stenosis

Percutaneous angioplasty of carotid artery stenoses

Energy Technology Data Exchange (ETDEWEB)

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

1986-03-01

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

Transluminal laser angioplasty

Science.gov (United States)

Otto, Wlodzimierz

1996-03-01

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

Incremental balloon deflation following complete resuscitative endovascular balloon occlusion of the aorta results in steep inflection of flow and rapid reperfusion in a large animal model of hemorrhagic shock.

Science.gov (United States)

Davidson, Anders J; Russo, Rachel M; Ferencz, Sarah-Ashley E; Cannon, Jeremy W; Rasmussen, Todd E; Neff, Lucas P; Johnson, M Austin; Williams, Timothy K

2017-07-01

To avoid potential cardiovascular collapse after resuscitative endovascular balloon occlusion of the aorta (REBOA), current guidelines recommend methodically deflating the balloon for 5 minutes to gradually reperfuse distal tissue beds. However, anecdotal evidence suggests that this approach may still result in unpredictable aortic flow rates and hemodynamic instability. We sought to characterize aortic flow dynamics following REBOA as the balloon is deflated in accordance with current practice guidelines. Eight Yorkshire-cross swine were splenectomized, instrumented, and subjected to rapid 25% total blood volume hemorrhage. After 30 minutes of shock, animals received 60 minutes of Zone 1 REBOA with a low-profile REBOA catheter. During subsequent resuscitation with shed blood, the aortic occlusion balloon was gradually deflated in stepwise fashion at the rate of 0.5 mL every 30 seconds until completely deflated. Aortic flow rate and proximal mean arterial pressure (MAP) were measured continuously over the period of balloon deflation. Graded balloon deflation resulted in variable initial return of aortic flow (median, 78 seconds; interquartile range [IQR], 68-105 seconds). A rapid increase in aortic flow during a single-balloon deflation step was observed in all animals (median, 819 mL/min; IQR, 664-1241 mL/min) and corresponded with an immediate decrease in proximal MAP (median, 30 mm Hg; IQR, 14.5-37 mm Hg). Total balloon volume and time to return of flow demonstrated no correlation (r = 0.016). This study is the first to characterize aortic flow during balloon deflation following REBOA. A steep inflection point occurs during balloon deflation that results in an abrupt increase in aortic flow and a concomitant decrease in MAP. Furthermore, the onset of distal aortic flow was inconsistent across study animals and did not correlate with initial balloon volume or relative deflation volume. Future studies to define the factors that affect aortic flow during balloon

[Efficacy of angioplasty of native coarctations of the aorta of the big infant and of the adult with systematic endoprosthesis implantation].

Science.gov (United States)

Fraisse, A; Amabile, N; Errera, J; Aubert, F; Chetaille, P; Kreitmann, B; Metras, D; Durieux, O; Bonnet, J L; Djiane, P

2004-05-01

The angioplasty of native coarcatations of the aorta remains a controversial treatment due to recurrences and the potential risk of aneurysm or of descending aorta dissection during catheterization. The interest of a systematic implantation of an endoprothesis is poorly documented. We report our experience in a small series of 3 patients aged from 7, 28 to 52 years at the moment of the angioplasty of their native aortic coarctation. In all the three cases it corresponded to a "membranous" type, localized a the level of the isthmus without hypoplasia of the aortic arch. All presented a refractory hypertension. One patient presented an intermittent claudication related to a low perfusion of lower limbs. The angioplasty was performed with BIB balloon, associated at the same time with the implantation of a Palmaz P308 stent in two cases and Genesis PG2910P in the last patient. The efficacy was immediate in all the 3 cases with stopping antihypertensive drugs at the very day of the procedure. The immediate results were complicated by a bilateral hematoma of the scarpa in a context of excessive anticoagulation in one patient requiring blood tranfusion. After a follow-up of one, 12 and 21 months, all the 3 patients are asymptomatic without any significant residual hypertension. The control scan of the infant confirmed the absence of re-coarctation. In conclusion, the angioplasty followed by systematic implantation of an endoprosthesis is a safe and effective technique for treating simple forms of native coarctations of the aortic isthmus. It can be proposed as a first line treatment for big infants and adults affected by localized types.

Percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease using a transluminal endatherectomy catheter (TEC): Initial results and angiographic follow-up

International Nuclear Information System (INIS)

Rilinger, Norbert; Goerich, Johannes; Scharrer-Pamler, Reinhard; Vogel, Jochen; Tomczak, Reinhard; Merkle, Elmar; Sokiranski, Roman; Brambs, Hans-Juergen

1997-01-01

Purpose. To evaluate the clinical results of percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease. Methods. Rotational atherectomy was performed in 39 patients aged 39-87 years (mean 66.6 years). A total of 71 lesions (43 stenoses and 28 occlusions) were treated in 40 limbs. Additional balloon angioplasty was required in 54% of lesions. Fifteen patients (37.5%) presented in Fontaine stage II, 10 patients (25%) in Fontaine stage III and 15 patients (37.5%) in Fontaine stage IV. Rotational atherectomy at 750 rpm was carried out over a 0.014-inch guidewire with continuous aspiration into a vacuum, bottle. Follow-up angiography and color flow Doppler examinations were performed in 22 patients (23 limbs) after a mean period of 6 months (range 2-14 months). Results. There was one primary technical failure. In 36 of 40 lesions there was a good angiographic result with residual stenoses in less than 30%. In 70 lesions treated by rotational atherectomy, however, 54% showed residual stenoses of 30%-50% and these cases required additional balloon angioplasty. The mean ankle-brachial index improved significantly (p<0.001), from 0.49 before the procedure to 1.01 after the procedure. A single distal embolus, related to primary recanalization, occurred and there were two large inguinal hematomas. Cumulative clinical patency after 6 months was 83.8% and cumulative angiographic patency after 6 months was 79.1%. Conclusion. Percutaneous rotational atherectomy is a promising approach for the treatment of chronic peripheral vascular disease. Further prospective, randomized studies are necessary to compare percutaneous transluminal angioplasty with this new technical approach

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

Energy Technology Data Exchange (ETDEWEB)

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

1985-01-01

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

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

International Nuclear Information System (INIS)

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

1985-01-01

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

Retrograde transurethral balloon dilation of the prostate

International Nuclear Information System (INIS)

Castaneda, F.; Reddy, P.; Wasserman, N.F.; Lund, G.; Hulbert, J.; Hunter, D.; Castaneda-Zuniga, W.R.; Amplatz, K.

1986-01-01

A series of patients with documented benign prostatic hypertrophy evaluated by urodynamic studies, voiding cystourethrography, retrograde urethrography, and MR imaging underwent dilation performed using a retrograde transurethral approach with 25-mm balloon dilators inflated at a pressure of 3-4 atm for 10 minutes. Immediately after the procedure, retrograde and voiding cystourethrography as well as MR imaging were performed. A Foley catheter was left in place for 24 hours. Complete relief of symptoms has occurred in all of the patients during the follow-up period. No significant complications other than transient hematuria resulted from the procedure. Results of the comparison studies and of MR imaging are discussed

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

A study on usefulness of balloon cholangiography in operating ERCP

International Nuclear Information System (INIS)

Son, Soon Yong

1997-01-01

Purpose of this paper is to extend help for clinical application in balloon cholangiography on patients who have undergone endoscopic sphincterotomy, impacted stones of intrahepatic duct, and missed bile duct because of other diseases in operating endoscopic retrograde cholangio pancreatography. This study was done for the patients who had clinical signs of biliary diseases from January to December in 1996. We studied 45 patients who had endoscopic sphincterotomy, re-examination after interventional treatment of the endoscopic retrograde cholangio pancreatography, and uncertain diagnosis due to common bile duct and intrahepatic duct those are not filled with contrast media. Balloon cholangiography was performed in case of uncertain diagnosis while operating endoscopic retrograde cholangio pancreatography. First of all, we insert balloon catheter into the working channel of treatment jejunofiberscope and remove treatment jejunofiberscope after ballooning, and lastly take biliary tract X-ray after injection and changing position of patient. The results of this study were as follows. (1) In classification of diseases, stones of gall bladder, those of common bile duct, and those of intrahepatic duct were 30 cases, fistula was 1 case. (2) In total cases of 45, only diagnosis were 25 cases, interventional treatment were 20 cases. (3) In case of interventional treatment, endoscopic sphincterotomy and endoscopic nasobiliary drainage, and stone removal were about the same, 7, 7, 6 respectively. Balloon cholangiography will be useful to prevent patients from having repeated and unnecessary studies for the cases above explained. It is considered that this study will be useful for clinical application in terms of reducing medical expenses, pain while examination, and consultation hours

Monte Carlo Simulations Validation Study: Vascular Brachytherapy Beta Sources

International Nuclear Information System (INIS)

Orion, I.; Koren, K.

2004-01-01

During the last decade many versions of angioplasty irradiation treatments have been proposed. The purpose of this unique brachytherapy is to administer a sufficient radiation dose into the vein walls in order to prevent restonosis, a clinical sequel to balloon angioplasty. The most suitable sources for this vascular brachytherapy are the β - emitters such as Re-188, P-32, and Sr-90/Y-90, with a maximum energy range of up to 2.1 MeV [1,2,3]. The radioactive catheters configurations offered for these treatments can be a simple wire [4], a fluid filled balloon or a coated stent. Each source is differently positioned inside the blood vessel, and the emitted electrons ranges therefore vary. Many types of sources and configurations were studied either experimentally or with the use of the Monte Carlo calculation technique, while most of the Monte Carlo simulations were carried out using EGS4 [5] or MCNP [6]. In this study we compared the beta-source absorbed-dose versus radial-distance of two treatment configurations using MCNP and EGS4 simulations. This comparison was aimed to discover the differences between the MCNP and the EGS4 simulation code systems in intermediate energies electron transport

Coronary and peripheral stenting in aorto-ostial protruding stents: The balloon assisted access to protruding stent technique.

Science.gov (United States)

Helmy, Tarek A; Sanchez, Carlos E; Bailey, Steven R

2016-03-01

Treatment of aorto-ostial in-stent restenosis lesions represents a challenge for interventional cardiologists. Excessive protrusion of the stent into the aorta may lead to multiple technical problems, such as difficult catheter reengagement of the vessel ostium or inability to re-wire through the stent lumen in repeat interventions. We describe a balloon assisted access to protruding stent technique in cases where conventional coaxial engagement of an aorto-ostial protruding stent with the guide catheter or passage of the guide wire through the true lumen is not feasible. This technique is applicable both in coronary and peripheral arteries. © 2015 Wiley Periodicals, Inc.

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

Combined use of a two-channel endoscope and a flexible tip catheter for difficult biliary cannulation

Directory of Open Access Journals (Sweden)

Masaki Kuwatani

2018-04-01

Full Text Available A 69-year-old woman with jaundice was referred to our hospital. After a final diagnosis of pancreatic cancer with liver metastasis, we performed transpapillary biliary drainage with a covered self-expandable metal stent (SEMS. Three months later, we also placed an uncovered duodenal stent for duodenal stricture in a side-to-end fashion. Another month later, for biliary SEMS obstruction, we attempted a transpapillary approach. A duodenoscope was advanced and a guidewire was passed through the mesh of the duodenal stent into the bile duct with a flexible tip catheter, but the catheter was not. Thus, we exchanged the duodenoscope for a forward-viewing two-channel endoscope and used the left working channel with a flexible tip catheter. By adjusting the axis, we finally succeeded biliary cannulation and accomplished balloon cleaning for recanalization of the SEMS. This is the first case with successful biliary cannulation by combined use of a two-channel endoscope and a flexible tip catheter.

Balloon Dilatation of Pediatric Subglottic Laryngeal Stenosis during the Artificial Apneic Pause: Experience in 5 Children

Directory of Open Access Journals (Sweden)

J. Lisý

2014-01-01

Full Text Available Introduction. Balloon dilatation is a method of choice for treatment of laryngeal stenosis in children. The aim of procedure in apneic pause is to avoid new insertion of tracheostomy cannula. Patients and Methods. The authors performed balloon dilatation of subglottic laryngeal strictures (SGS in 5 children (3 girls and 2 boys without tracheotomy. Two of them with traumatic and inflammatory SGS had a tracheal cannula removed in the past. The other 3 children with postintubation SGS had never had a tracheostomy before. The need for tracheostomy due to worsening stridor was imminent for all of them. Results. The total of seven laryngeal dilatations by balloon esophagoplasty catheter in apneic pause was performed in the 5 children. The procedure averted the need for tracheostomy placement in 4 of them (80%. Failure of dilatation in girl with traumatic stenosis and concomitant severe obstructive lung disease led to repeated tracheostomy. Conclusion. Balloon dilatation of laryngeal stricture could be done in the absence of tracheostomy in apneic pause. Dilatation averted threatening tracheostomy in all except one case. Early complication after the procedure seems to be a negative prognostic factor for the outcome of balloon dilatation.

Aortic valvuloplasty of calcific aortic stenosis with monofoil and trefoil balloon catheters: practical considerations

NARCIS (Netherlands)

S. Plante (Sylvain); M.J.B.M. van den Brand (Marcel); L.C.P. van Veen; C. di Mario (Carlo); C.E. Essed; K.J. Beatt (Kevin); P.W.J.C. Serruys (Patrick)

1990-01-01

textabstractIn order to evaluate the relation between balloon design (monofoil, trefoil) and valvular configuration, experimental aortic valvuloplasty was performed in four post-mortem hearts with calcific aortic stenosis of various morphology. The degree of obstruction of the aortic orifice was

The use of balloon-expandable metallic stents in the treatment of pediatric tracheomalacia and bronchomalacia.

Science.gov (United States)

Furman, R H; Backer, C L; Dunham, M E; Donaldson, J; Mavroudis, C; Holinger, L D

1999-02-01

To evaluate the use of balloon-expandable metallic stents in the treatment of children with tracheomalacia and bronchomalacia in whom conventional therapy has failed. Retrospective case series. Tertiary pediatric otolaryngology and cardiothoracic surgery referral center. Six patients were identified as having undergone bronchoscopic placement of metallic balloon-expandable stents between 1994 and 1997. The age at stent placement, prior surgical interventions, and indications for and sites of stent placement were noted. Also, the complications related to stent placement and the current airway status of the patients were reviewed. Twelve balloon-expandable metallic angioplasty stents (Palmaz; Johnson & Johnson Interventional Systems Co, Warren, NJ) were placed bronchoscopically in 6 patients. Six stents were placed in the lower trachea, and 6 were placed in the main bronchi. The stents were balloon expanded under fluoroscopic guidance. Discontinuation of mechanical ventilation. The age at stent placement ranged from 1.5 to 38 months (mean age at placement, 10 months). The indications for stent placement were (1) tracheomalacia or bronchomalacia, (2) pericardial patch or slide tracheoplasty failure, and (3) bronchomalacia caused by tetralogy of Fallot and large pulmonary arteries. The primary complication of stent placement was postoperative granulation tissue formation. One patient required the removal of 2 tracheal stents because of granulation tissue formation. There were 2 deaths in the series, 1 possibly related to stent placement. Four of the 6 patients were weaned from mechanical ventilation, and 3 experienced prolonged relief of airway obstruction. Metallic balloon-expandable stents are effective in relieving lower tracheomalacia and bronchomalacia in select patients. Only patients in whom conventional therapy has failed should be considered for stent placement.

Atherectomy offers no benefits over balloon angioplasty in tibial interventions for critical limb ischemia.

Science.gov (United States)

Todd, Kevin E; Ahanchi, Sadaf S; Maurer, Christian A; Kim, Jung H; Chipman, Candice R; Panneton, Jean M

2013-10-01

Endovascular adjuncts, like atherectomy, were developed to improve outcomes of endovascular arterial interventions. The true impact of atherectomy on endovascular outcomes remains to be determined, and little data exist on the influence of atherectomy on tibial interventions. Our study compares early and late outcomes of tibial intervention with angioplasty vs atherectomy-assisted interventions. We completed a retrospective review of all tibial interventions between 2008 and 2010. Outcomes were analyzed using single and multivariate analysis, Cox regression, and Kaplan-Meier curves. Primary outcomes were primary, primary assisted, and secondary patency rates, as well as limb salvage and survival rates. Over a 2-year period, 480 tibial interventions were completed for 421 patients. Eighty-seven percent (n = 418) of interventions were performed for critical limb ischemia (CLI) and 13% (n = 62) for claudication. The CLI cohort of 418 interventions was analyzed. These patients had a mean age of 71 years with a mean follow-up time of 16 ± 15 months (range, 0-59 months). Of the 418 interventions, 339 underwent percutaneous transluminal angioplasty (PTA): 333 PTA alone, six PTA + stent. The remaining 79 interventions received atherectomy: 33 laser, 13 directional, and 33 orbital either alone or in conjunction with PTA (11 atherectomy only, 68 atherectomy + PTA). The groups did not differ significantly in terms of demographics, risk factors, or technical success. The atherectomy group had more TASC B lesions (54% vs 38%; P = .013), while the PTA-alone group had more TASC D lesions (25% vs 13%; P = .004). TASC A and C lesions did not differ significantly between the groups. No significant differences existed with respect to the early (30-day) outcomes of loss of patency (11% vs 13%; P = .699), complications (8% vs 13%; P = .292), or major amputation (17% vs 13%; P = .344) in the PTA-alone group vs the atherectomy-assisted group. Kaplan-Meier analysis revealed no difference

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

Energy Technology Data Exchange (ETDEWEB)

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

2009-05-15

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

Experimental study of the mechanism in esophageal restenosis after balloon dilation of benign stricture

International Nuclear Information System (INIS)

Cheng Yingsheng; Yang Renjie; Shang Kezhong; Zhang Huizhen; Li Minghua; Zhuang Qixin; Jiang Zhiming; Ding Zaixian

2002-01-01

Objective: Experimental study of the mechanism in esophageal restenosis after balloon dilation of benign stricture. Methods: Esophageal stenosis model of the rats was created by 5 ml of 50% NaOH solution burn with double balloon method, and esophageal restenosis (RS) model was developed by esophageal stenosis with dilation of PTCA balloon catheter. Quantitative and quantitative analysis of esophageal stenosis and RS formation in the rats were observed and recorded by analytic measurements imaging and immuno-histologic chemistry respectively. Results: Esophageal benign stricture and RS model of 49 rats were developed. Cross section area and perimeter of esophageal mucosa layer, muscular layer and the whole layer had increased in experimental group. Comparing to control group, it had remarkable significance in statistics (P < 0.05). PCNA was expressed in 5th day after dilation, and persisted to 1st month. FN was expressed in the 1st day after dilation, still positive on 21st days, partly strong on 30th day. Conclusions: The continued over secretion at all stage of PCNA and FN plays an important role in the RS after balloon dilation of esophageal benign stenosis

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

Science.gov (United States)

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

2010-12-01

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

Erosion of the Silicone Peritoneal Dialysis Catheter with the Use of Gentamicin Cream at the Exit Site.

Science.gov (United States)

Gardezi, Ali I; Schlageter, Karen W; Foster, Dawn M; Astor, Brad C; Chan, Micah R; Waheed, Sana

Infection remains the leading complication of peritoneal dialysis (PD). Topical mupirocin and gentamicin are frequently used to prevent infections. Mupirocin ointment has been reported to cause damage to both polyurethane and silicone PD catheters. Gentamicin cream has not been associated with physical damage to catheters.A 64-year-old woman on PD developed relapsing peritonitis with Staphylococcus epidermidis. Because of a drainage problem and white discoloration at the exit site, which is known as " frosting," she underwent catheter exchange. The catheter was found to be fractured within the area of frosting. Four more patients with frosting of the catheter were identified. On further questioning, it was recognized that they were applying excessive amounts of gentamicin cream directly on the catheter surface rather than at the exit site. All patients in the program were educated about the correct method of topical antibiotic application. After the change in practice, no further cases of catheter frosting were identified.Polyurethane catheters can undergo oxidation, mineralization, and environmental stress cracking, leading to physical damage such frosting, ballooning, and fracture. Polyethylene glycol, a component of the mupirocin ointment base, is thought to cause plasticization of polyurethane, reducing its tensile strength. Similar damage has been observed in silicone catheters. Previous reports have not found gentamicin cream to cause that type of damage. We observed that excessive amounts of cream applied directly to the catheter surface can damage it. Damage did not recur once patients had been educated about the proper method of application.

Radianttrademark Liquid Radioisotope Intravascular Radiation Therapy System

International Nuclear Information System (INIS)

Eigler, N.; Whiting, J.; Chernomorsky, A.; Jackson, J.; Knapp, F.F. Jr.; Litvack, F.

1998-01-01

RADIANTtrademark is manufactured by United States Surgical Corporation, Vascular Therapies Division, (formerly Progressive Angioplasty Systems). The system comprises a liquid β-radiation source, a shielded isolation/transfer device (ISAT), modified over-the-wire or rapid exchange delivery balloons, and accessory kits. The liquid β-source is Rhenium-188 in the form of sodium perrhenate (NaReO 4 ), Rhenium-188 is primarily a β-emitter with a physical half-life of 17.0 hours. The maximum energy of the β-particles is 2.1 MeV. The source is produced daily in the nuclear pharmacy hot lab by eluting a Tungsten-188/Rhenium-188 generator manufactured by Oak Ridge National Laboratory (ORNL). Using anion exchange columns and Millipore filters the effluent is concentrated to approximately 100 mCi/ml, calibrated, and loaded into the (ISAT) which is subsequently transported to the cardiac catheterization laboratory. The delivery catheters are modified Championtrademark over-the-wire, and TNTtrademark rapid exchange stent delivery balloons. These balloons have thickened polyethylene walls to augment puncture resistance; dual radio-opaque markers and specially configured connectors

Radiant{trademark} Liquid Radioisotope Intravascular Radiation Therapy System

Energy Technology Data Exchange (ETDEWEB)

Eigler, N.; Whiting, J.; Chernomorsky, A.; Jackson, J.; Knapp, F.F., Jr.; Litvack, F.

1998-01-16

RADIANT{trademark} is manufactured by United States Surgical Corporation, Vascular Therapies Division, (formerly Progressive Angioplasty Systems). The system comprises a liquid {beta}-radiation source, a shielded isolation/transfer device (ISAT), modified over-the-wire or rapid exchange delivery balloons, and accessory kits. The liquid {beta}-source is Rhenium-188 in the form of sodium perrhenate (NaReO{sub 4}), Rhenium-188 is primarily a {beta}-emitter with a physical half-life of 17.0 hours. The maximum energy of the {beta}-particles is 2.1 MeV. The source is produced daily in the nuclear pharmacy hot lab by eluting a Tungsten-188/Rhenium-188 generator manufactured by Oak Ridge National Laboratory (ORNL). Using anion exchange columns and Millipore filters the effluent is concentrated to approximately 100 mCi/ml, calibrated, and loaded into the (ISAT) which is subsequently transported to the cardiac catheterization laboratory. The delivery catheters are modified Champion{trademark} over-the-wire, and TNT{trademark} rapid exchange stent delivery balloons. These balloons have thickened polyethylene walls to augment puncture resistance; dual radio-opaque markers and specially configured connectors.

Long-term results from the Contura multilumen balloon breast brachytherapy catheter phase 4 registry trial.

Science.gov (United States)

Cuttino, Laurie W; Arthur, Douglas W; Vicini, Frank; Todor, Dorin; Julian, Thomas; Mukhopadhyay, Nitai

2014-12-01

To describe the long-term outcomes from a completed, multi-institutional phase 4 registry trial using the Contura multilumen balloon (CMLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) in patients with early-stage breast cancer. Three hundred forty-two evaluable patients were enrolled by 23 institutions between January 2008 and February 2011. All patients received 34 Gy in 10 fractions, delivered twice daily. Rigorous target coverage and normal tissue dose constraints were observed. The median follow-up time was 36 months (range, 1-54 months). For the entire patient cohort of 342 patients, 10 patients experienced an ipsilateral breast tumor recurrence (IBTR). Eight of these IBTR were classified as true recurrences/marginal miss (TRMM), and 2 were elsewhere failures (EF). Local recurrence-free survival was 97.8% at 3 years. For the entire cohort, 88% of patients had good to excellent overall cosmesis. The overall incidence of infection was 8.5%. Symptomatic seroma was reported in only 4.4% of patients. A separate analysis was performed to determine whether improved outcomes would be observed for patients treated at high-volume centers with extensive brachytherapy experience. Three IBTR were observed in this cohort, only 1 of which was classified as a TRMM. Local recurrence-free survival at high-volume centers was 98.1% at 3 years. Overall cosmetic outcome and toxicity were superior in patients treated at high-volume centers. In these patients, 95% had good to excellent overall cosmesis. Infection was observed in only 2.9% of patients, and symptomatic seroma was reported in only 1.9%. Use of the CMLB for APBI delivery is associated with acceptable long-term local control and toxicity. Local recurrence-free survival was 97.8% at 3 years. Significant (grade 3) toxicity was uncommon, and no grade 4 toxicity was observed. Treatment at high-volume centers was associated with decreased late toxicity. Copyright © 2014 Elsevier Inc

Long-Term Results From the Contura Multilumen Balloon Breast Brachytherapy Catheter Phase 4 Registry Trial

Energy Technology Data Exchange (ETDEWEB)

Cuttino, Laurie W., E-mail: lcuttino@mcvh-vcu.edu [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia (United States); Arthur, Douglas W. [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia (United States); Vicini, Frank [Michigan Healthcare Professionals/21st Century Onoclogy, Farmington Hills, Michigan (United States); Todor, Dorin [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia (United States); Julian, Thomas [Allegheny Hospital, Temple School of Medicine, Pittsburgh, Pennsylvania (United States); Mukhopadhyay, Nitai [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia (United States)

2014-12-01

Purpose: To describe the long-term outcomes from a completed, multi-institutional phase 4 registry trial using the Contura multilumen balloon (CMLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) in patients with early-stage breast cancer. Methods and Materials: Three hundred forty-two evaluable patients were enrolled by 23 institutions between January 2008 and February 2011. All patients received 34 Gy in 10 fractions, delivered twice daily. Rigorous target coverage and normal tissue dose constraints were observed. Results: The median follow-up time was 36 months (range, 1-54 months). For the entire patient cohort of 342 patients, 10 patients experienced an ipsilateral breast tumor recurrence (IBTR). Eight of these IBTR were classified as true recurrences/marginal miss (TRMM), and 2 were elsewhere failures (EF). Local recurrence-free survival was 97.8% at 3 years. For the entire cohort, 88% of patients had good to excellent overall cosmesis. The overall incidence of infection was 8.5%. Symptomatic seroma was reported in only 4.4% of patients. A separate analysis was performed to determine whether improved outcomes would be observed for patients treated at high-volume centers with extensive brachytherapy experience. Three IBTR were observed in this cohort, only 1 of which was classified as a TRMM. Local recurrence-free survival at high-volume centers was 98.1% at 3 years. Overall cosmetic outcome and toxicity were superior in patients treated at high-volume centers. In these patients, 95% had good to excellent overall cosmesis. Infection was observed in only 2.9% of patients, and symptomatic seroma was reported in only 1.9%. Conclusion: Use of the CMLB for APBI delivery is associated with acceptable long-term local control and toxicity. Local recurrence-free survival was 97.8% at 3 years. Significant (grade 3) toxicity was uncommon, and no grade 4 toxicity was observed. Treatment at high-volume centers was associated

Cerebral angioplasty practice at major medical centers in the United States

International Nuclear Information System (INIS)

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

2000-01-01

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

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

International Nuclear Information System (INIS)

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

1984-01-01

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

Perioperative Internal Iliac Artery Balloon Occlusion, In the Setting of Placenta Accreta and Its Variants: The Role of the Interventional Radiologist.

Science.gov (United States)

Petrov, David A; Karlberg, Benjamin; Singh, Kamalpreet; Hartman, Matthew; Mittal, Pardeep K

2017-11-10

Placenta accreta and its variants (increta and percreta) are conditions of abnormal placentation that are encountered with increasing frequency. The spectrum of placenta accreta (including placenta increta and percreta) involves an abnormal attachment of the placental chorionic villi to the uterine myometrium. This abnormal attachment leads to increased adherence of the placenta to the uterus and abnormal placental-uterine separation at the time of delivery. Placental invasion into, or through the myometrium is associated with increased postpartum morbidity and mortality as a result of uterine hemorrhage during and following cesarean section. A multidisciplinary clinical approach to the treatment of patients with placenta accreta is recommended by the American College of Obstetricians and Gynecologists. As potential members of an interdisciplinary team, interventional radiologists can perform prophylactic internal iliac arterial balloon occlusion as an adjunctive therapy for reducing potentially life-threatening postpartum hemorrhage. The procedure involves placement of a balloon catheter into the internal iliac or common iliac arteries bilaterally prior to cesarean section. Following delivery, and prior to placental separation, the catheter balloons are inflated with a pre-determined volume of saline leading to transient occlusion of the internal iliac arteries and reduced uterine blood flow. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of a balloon-expandable metallic stent for treatment of nasopharyngeal stenosis in dogs and cats: six cases (2005-2007).

Science.gov (United States)

Berent, Allyson C; Weisse, Chick; Todd, Kimberly; Rondeau, Mark P; Reiter, Alexander M

2008-11-01

To determine outcome associated with use of a balloon-expandable metallic stent for treatment of nasopharyngeal stenosis in dogs and cats. Retrospective case series. 3 dogs and 3 cats. All 6 animals had severe inspiratory stertor at initial examination. Two animals had no orifice present at the stenosis. Nasopharyngeal stenosis was diagnosed and stent size determined by use of computed tomography. A percutaneous transluminal angioplasty balloon premounted with a balloon-expandable metallic stent was placed over a guidewire, advanced through the stenotic lesion under fluoroscopic and rhinoscopic guidance, and dilated to restore patency. All animals had immediate resolution of clinical signs after stent placement. The procedure took a median of 38 minutes (range, 22 to 70 minutes). One animal with a stenosis located far caudally needed the tip of the stent resected because of hairball entrapment and exaggerated swallowing. Both animals without an orifice in the stenosis had tissue in-growth requiring a covered stent. All animals were reexamined 6 to 12 weeks after treatment via rhinoscopy, radiography, computed tomography, or a combination of techniques. All animals lacked signs of discomfort; 5 of 6 were breathing normally 12 to 28 months after the procedure. Transnasal balloon-expandable metallic stent placement may represent a rapid, safe, noninvasive, and effective treatment in animals with nasopharyngeal stenosis. If the stenosis is extremely caudal in the nasopharynx, serial balloon dilatation might be considered prior to stent placement. A covered stent should be considered initially if the stenosis is completely closed.

SU-E-T-297: Dosimetric Assessment of An Air-Filled Balloon Applicator in HDR Vaginal Cuff Brachytherapy Using the Monte Carlo Method

International Nuclear Information System (INIS)

Jiang, H; Lee, Y; Pokhrel, D; Badkul, R

2015-01-01

Purpose: As an alternative to cylindrical applicators, air inflated balloon applicators have been introduced into HDR vaginal cuff brachytherapy treatment to achieve sufficient dose to vagina mucosa as well as to spare rectum and bladder. In general, TG43 formulae based treatment planning systems do not take into account tissue inhomogeneity, and air in the balloon applicator can cause higher delivered dose to mucosa than treatment plan reported. We investigated dosimetric effect of air in balloon applicator using the Monte Carlo method. Methods: The thirteen-catheter Capri applicator with a Nucletron Ir-192 seed was modeled for various balloon diameters (2cm to 3.5cm) using the MCNP Monte Carlo code. Ir-192 seed was placed in both central and peripheral catheters to replicate real patient situations. Existence of charged particle equilibrium (CPE) with air balloon was evaluated by comparing kerma and dose at various distances (1mm to 70mm) from surface of air-filled applicator. Also mucosa dose by an air-filled applicator was compared with by a water-filled applicator to evaluate dosimetry accuracy of planning system without tissue inhomogeneity correction. Results: Beyond 1mm from air/tissue interface, the difference between kerma and dose was within 2%. CPE (or transient CPE) condition was deemed existent, and in this region no electron transport was necessary in Monte Carlo simulations. At 1mm or less, the deviation of dose from kerma became more apparent. Increase of dose to mucosa depended on diameter of air balloon. The increment of dose to mucosa was 2.5% and 4.3% on average for 2cm and 3.5cm applicators, respectively. Conclusion: After introduction of air balloon applicator, CPE fails only at the proximity of air/tissue interface. Although dose to mucosa is increased, there is no significant dosimetric difference (<5%) between air and water filled applicators. Tissue inhomogeneity correction is not necessary for air-filled applicators

SU-E-T-297: Dosimetric Assessment of An Air-Filled Balloon Applicator in HDR Vaginal Cuff Brachytherapy Using the Monte Carlo Method

Energy Technology Data Exchange (ETDEWEB)

Jiang, H; Lee, Y; Pokhrel, D; Badkul, R [University of Kansas Hospital, Kansas City, KS (United States)

2015-06-15

Purpose: As an alternative to cylindrical applicators, air inflated balloon applicators have been introduced into HDR vaginal cuff brachytherapy treatment to achieve sufficient dose to vagina mucosa as well as to spare rectum and bladder. In general, TG43 formulae based treatment planning systems do not take into account tissue inhomogeneity, and air in the balloon applicator can cause higher delivered dose to mucosa than treatment plan reported. We investigated dosimetric effect of air in balloon applicator using the Monte Carlo method. Methods: The thirteen-catheter Capri applicator with a Nucletron Ir-192 seed was modeled for various balloon diameters (2cm to 3.5cm) using the MCNP Monte Carlo code. Ir-192 seed was placed in both central and peripheral catheters to replicate real patient situations. Existence of charged particle equilibrium (CPE) with air balloon was evaluated by comparing kerma and dose at various distances (1mm to 70mm) from surface of air-filled applicator. Also mucosa dose by an air-filled applicator was compared with by a water-filled applicator to evaluate dosimetry accuracy of planning system without tissue inhomogeneity correction. Results: Beyond 1mm from air/tissue interface, the difference between kerma and dose was within 2%. CPE (or transient CPE) condition was deemed existent, and in this region no electron transport was necessary in Monte Carlo simulations. At 1mm or less, the deviation of dose from kerma became more apparent. Increase of dose to mucosa depended on diameter of air balloon. The increment of dose to mucosa was 2.5% and 4.3% on average for 2cm and 3.5cm applicators, respectively. Conclusion: After introduction of air balloon applicator, CPE fails only at the proximity of air/tissue interface. Although dose to mucosa is increased, there is no significant dosimetric difference (<5%) between air and water filled applicators. Tissue inhomogeneity correction is not necessary for air-filled applicators.

Evaluation of the Distribution of Paclitaxel After Application of a Paclitaxel-Coated Balloon in the Rabbit Urethra.

Science.gov (United States)

Barbalias, Dimitrios; Lappas, Georgios; Ravazoula, Panagiotia; Liourdi, Despoina; Kyriazis, Iason; Liatsikos, Evangelos; Kallidonis, Panagiotis

2018-03-02

Urethral strictures are a common urologic problem that could require complex reconstructive procedures. Urethral dilatation represents a frequent practiced intervention associated with high recurrence rates. Drug-coated percutaneous angioplasty balloons (DCBs) with cytostatic drugs have been effectively used for the prevention of vascular restenosis after balloon dilatation. To reduce restenosis rates of urethral dilatation, these balloons could be used in the urethra. Nevertheless, the urothelium is different than the endothelium and these drugs may not be distributed to the outer layers of the urethra. Thus, an experiment was performed to evaluate the distribution of paclitaxel (PTX) in the rabbit urethra after the inflation of a PTX-coated balloon (PCB). Eleven rabbits underwent dilatation of the posterior urethra with common endoscopic balloons after urethrography. Nine of these rabbits were additionally treated with PCB. The urethras of the two control animals were removed along with three more dilated with PCB urethras immediately after the dilatation. The remaining of the urethras were removed after 24 (n = 3) and 48 hours (n = 3). The posterior segments of the urethras were evaluated with hematoxylin and eosin staining as well as with immunohistochemistry with polyclonal anti-PTX antibody. The two control specimens showed denudation of the urothelium after balloon dilatations and no PTX was observed. All specimens from dilated PCB urethras showed distribution of PTX to all layers of the urethra. The specimens that were immediately removed exhibited denudation of the urothelium without any inflammation. The specimens removed at 24 and 48 hours showed mild acute inflammation. PTX was distributed to the urothelial, submucosal, and smooth muscle layers of the normal rabbit urethra immediately after dilatation with a DCB. PTX and mild inflammation were present at the site 24 and 48 hours after the dilatation.

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

Science.gov (United States)

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

2013-01-01

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

Percutaneous transluminal angioplasty of infrarenal arteries in intermittent claudication

DEFF Research Database (Denmark)

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

1988-01-01

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

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

Science.gov (United States)

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

2013-01-01

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

[Obstruction of the nasal passage caused by a balloon catheter in a calf].

Science.gov (United States)

Rijkenhuizen, A B

1993-01-01

Decompression of the rumen as a supporting symptomatic therapy of recurrent bloat in calves and juvenile cattle is used regularly. The gas should be released for several days. This is facilitated by the use of a balloon stomach tube, which can be left in situ for up to five days. However, the use of this tube is not always without risks, which will be discussed on base of a patient.

Stenting for curved lesions using a novel curved balloon: Preliminary experimental study.

Science.gov (United States)

Tomita, Hideshi; Higaki, Takashi; Kobayashi, Toshiki; Fujii, Takanari; Fujimoto, Kazuto

2015-08-01

Stenting may be a compelling approach to dilating curved lesions in congenital heart diseases. However, balloon-expandable stents, which are commonly used for congenital heart diseases, are usually deployed in a straight orientation. In this study, we evaluated the effect of stenting with a novel curved balloon considered to provide better conformability to the curved-angled lesion. In vitro experiments: A Palmaz Genesis(®) stent (Johnson & Johnson, Cordis Co, Bridgewater, NJ, USA) mounted on the Goku(®) curve (Tokai Medical Co. Nagoya, Japan) was dilated in vitro to observe directly the behavior of the stent and balloon assembly during expansion. Animal experiment: A short Express(®) Vascular SD (Boston Scientific Co, Marlborough, MA, USA) stent and a long Express(®) Vascular LD stent (Boston Scientific) mounted on the curved balloon were deployed in the curved vessel of a pig to observe the effect of stenting in vivo. In vitro experiments: Although the stent was dilated in a curved fashion, stent and balloon assembly also rotated conjointly during expansion of its curved portion. In the primary stenting of the short stent, the stent was dilated with rotation of the curved portion. The excised stent conformed to the curved vessel. As the long stent could not be negotiated across the mid-portion with the balloon in expansion when it started curving, the mid-portion of the stent failed to expand fully. Furthermore, the balloon, which became entangled with the stent strut, could not be retrieved even after complete deflation. This novel curved balloon catheter might be used for implantation of the short stent in a curved lesion; however, it should not be used for primary stenting of the long stent. Post-dilation to conform the stent to the angled vessel would be safer than primary stenting irrespective of stent length. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Mechanical Thrombectomy of Iliac Vein Thrombosis in a Pig Model Using the Rotarex and Aspirex Catheters

Energy Technology Data Exchange (ETDEWEB)

Minko, P., E-mail: peterminko@yahoo.com; Bücker, A. [University Hospital Homburg/Saar, Department of Diagnostic and Interventional Radiology (Germany); Laschke, M.; Menger, M. [University Hospital Homburg/Saar, Institute of Clinical and Experimental Surgery (Germany); Bohle, R. [University Hospital Homburg/Saar, Department of Pathology (Germany); Katoh, M. [University Hospital Homburg/Saar, Department of Diagnostic and Interventional Radiology (Germany)

2013-06-08

PurposeTo investigate the efficacy and safety of mechanical thrombectomy for iliac vein thrombosis using Rotarex and Aspirex catheters in a pig model.Materials and MethodsIliac vein thrombosis was induced in six pigs by means of an occlusion-balloon catheter and thrombin injection. The presence of thrombi was verified by digital subtraction angiography (DSA) and computed tomography (CT). Thrombectomy was performed using 6F and 8F Rotarex and 6F, 8F, and 10F Aspirex catheters (Straub Medical AG, Wangs, Switzerland). After intervention, DSA and CT were repeated to evaluate the efficacy of mechanical thrombectomy and to exclude local complications. In addition, pulmonary CT was performed to rule out pulmonary embolism. Finally, all pigs were killed, and iliac veins were dissected to perform macroscopic and histological examination.ResultsThrombus induction was successfully achieved in all animals as verified by DSA and CT. Subsequent thrombectomy lead to incomplete recanalization of the iliac veins with residual thrombi in all cases. However, the use of the 6F and 8F Rotarex catheters caused vessel perforation and retroperitoneal hemorrhage in all cases. Application of the Aspirex device caused one small transmural perforation in a vessel treated with a 10F Aspirex catheter, and this was only seen microscopically. Pulmonary embolism was detected in one animal treated with the Rotarex catheters, whereas no pulmonary emboli were seen in animals treated with the Aspirex catheters.ConclusionThe Aspirex catheter allowed subtotal and safe recanalization of iliac vein thrombosis. In contrast, the use of the Rotarex catheter caused macroscopically obvious vessel perforations in all cases.

Temporary balloon occlusion as therapy for uncontrollable arterial hemorrhage in multiply injured patients; Temporaere Ballonokklusion als Therapie unkontrollierbarer arterieller Blutungen bei Polytraumapatienten

Energy Technology Data Exchange (ETDEWEB)

Rieger, J.; Linsenmaier, U.; Rock, C.; Pfeifer, K.J. [Abt. fuer Radiologie, Klinikum Innenstadt, Ludwig-Maximilian-Univ., Muenchen (Germany); Euler, E. [Chirurgische Klinik und Poliklinik, Klinikum Innenstadt, Ludwig-Maximilian-Univ., Muenchen (Germany)

1999-01-01

Purpose: Presentation of temporary balloon occlusion as an interventional radiological method for managing hemorrhage in multiply injured patients with uncontrollable loss of blood. Method: Temporary, non-selective arterial occlusion by introduction of a balloon catheter contralaterally to the source of bleeding has been performed since 1992 on 7 patients with multiple injuries, hemorrhagic shock requiring reanimation, and angiographic demonstration of an arterial hemorrhage in the supply region of the internal iliac artery with complex pelvic fracture. In each case a PTA balloon catheter was introduced transfemorally, non-selectively positioned proximal to the bleeding source, and left in place for 24-48 h under manometric control. Control angiographies were performed prior to catheter removal. Results: The bleeding was stopped immediately in all 7 patients. The hemodynamic stability made transport and thus further surgical management and/or a short-term treatment in the intensive-care station possible. Control angiographies confirmed that the bleeding had stopped in all patients. Conclusions: We recommend temporary balloon occlusion as a rapid and effective method for the management of bleeding in otherwise uncontrollable traumatic hemorrhages in the supply region of the internal iliac artery. (orig.) [Deutsch] Ziel: Vorstellung der temporaeren Ballonokklusion als interventionell-radiologischer Methode zur Blutungskontrolle bei Polytraumapatienten mit unkontrollierbarem Blutverlust. Methode: Temporaerer, nicht-selektiver arterieller Gefaessverschluss mit kontralateral der Blutungsquellen eingefuehrten PTA-Ballonkathetern bei seit 1992 insgesamt 7 Patienten mit Polytrauma, reanimationspflichtigem haemorrhagischem Schock und angiographischem Nachweis einer arteriellen Blutung im Versorgungsgebiet der A. iliaca interna im Rahmen einer komplexen Beckenfraktur. Transfemoral wurde jeweils ein PTA-Ballonkatheter eingefuehrt, nicht selektiv proximal der Blutungsquelle

Treatment Effect of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension Quantified by Automatic Comparative Imaging in Computed Tomography Pulmonary Angiography.

Science.gov (United States)

Zhai, Zhiwei; Ota, Hideki; Staring, Marius; Stolk, Jan; Sugimura, Koichiro; Takase, Kei; Stoel, Berend C

2018-05-01

Balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) can have variable outcomes. To gain more insight into this variation, we designed a method for visualizing and quantifying changes in pulmonary perfusion by automatically comparing computed tomography (CT) pulmonary angiography before and after BPA treatment. We validated these quantifications of perfusion changes against hemodynamic changes measured with right-sided heart catheterization. We studied 14 consecutive CTEPH patients (12 women; age, 70.5 ± 24), who underwent CT pulmonary angiography and right-sided heart catheterization, before and after BPA. Posttreatment images were registered to pretreatment CT scans (using the Elastix toolbox) to obtain corresponding locations. Pulmonary vascular trees and their centerlines were detected using a graph cuts method and a distance transform method, respectively. Areas distal from vessels were defined as pulmonary parenchyma. Subsequently, the density changes within the vascular centerlines and parenchymal areas were calculated and corrected for inspiration level differences. For visualization, the densitometric changes were displayed in color-coded overlays. For quantification, the median and interquartile range of the density changes in the vascular and parenchymal areas (ΔVD and ΔPD) were calculated. The recorded changes in hemodynamic parameters, including changes in systolic, diastolic, and mean pulmonary artery pressure (ΔsPAP, ΔdPAP, and ΔmPAP, respectively) and vascular resistance (ΔPVR), were used as reference assessments of the treatment effect. Spearman correlation coefficients were employed to investigate the correlations between changes in perfusion and hemodynamic changes. Comparative imaging maps showed distinct patterns in perfusion changes among patients. Within pulmonary vessels, the interquartile range of ΔVD correlated significantly with ΔsPAP (R = -0.58, P = 0.03), �

Symptomatic portal vein occlusion: treated by interventional radiological techniques

International Nuclear Information System (INIS)

Wang Maoqiang; Gu Xiaofang; Guan Jun; Wang Zhongpu; Liu Fengyong; Wang Zhiqiang

2004-01-01

Objective: To evaluate the efficacy and safety of the interventional radiological techniques for management of symptomatic portal vein (PV) occlusion. Methods: Nine patients with PV trunk occlusion were treated using interventional procedures. Four patients presented with abdominal pain, distention, and malabsorption; five presented with portal hypertension and repeated bleeding from esophagogastric varices. The etiologic factors were identified in all 9 patients, including post-transplantation of the liver in 2, hepatocellular carcinoma (HCC) associated with PV tumor thrombus in 3, post abdominal operative state in 1, and PV thrombosis in 3 cases. The portal access was established via a percutaneous transhepatic route in 4, and via a transjugular intrahepatic portosystemic shunt ( TIPS) approach in 5 patients. The interventional procedures included stent placement in 4, balloon angioplasty in 6, and catheter directed pharmacologic and mechanical thrombolysis in 7 patients. Results: The technical success was achieved in all cases. No complications related to the procedure occurred. Portal flow was reestablished in all patients after the procedures. Clinical improvement was seen in 3 patients with symptomatic PV thrombosis, characterized by progressive reduction of abdominal pain, distention, and diarrhea. Follow-up time ranged from 4 to 36 months. One patient with HCC died of multiple organs metastases at 11 months after the treatment . One patient died of intraabdominal sepsis and multiple organs failure 12 days after the procedure even though the antegrade flow was re-established in the main trunk of the PV. Patency of the PV trunk was confirmed by follow-up color Doppler ultrasound scan in the rest 7 patients, without recurrence of variceal bleeding or PV thrombus. Conclusions: Interventional minimally invasive procedures, including balloon angioplasty, stent placement, catheter directed local pharmacologic and mechanical thrombolysis, are safe and effective in

Tunneled dialysis catheter exchange with fibrin sheath disruption is not associated with increased rate of bacteremia.

Science.gov (United States)

Valliant, Amanda M; Chaudhry, Muhammad K; Yevzlin, Alexander S; Astor, Brad; Chan, Micah R

2015-01-01

Tunneled dialysis catheters are the most common form of vascular access among incident dialysis patients in the United States. Fibrin sheath formation is a frequent cause of late catheter dysfunction requiring an exchange procedure with balloon disruption of the fibrin sheath. It is unknown whether fibrin sheath disruption is associated with increased incidence of bacteremia or catheter failure. We reviewed all tunneled dialysis catheter exchange procedures at the University of Wisconsin between January 2008 and December 2011. The primary outcome was incidence of bacteremia, defined as positive blood cultures within 2 weeks of the procedure. Catheter failure, requiring intervention or replacement, was examined as a secondary outcome. Baseline characteristics examined included diabetic status, gender, race and age. A total of 163 procedures were reviewed; 67 (41.1%) had fibrin sheath disruption and 96 did not. Bacteremia occurred in 4.5% (3/67) of those with and 3.1% (3/97) of those without fibrin sheath disruption (p=0.65). Fibrin sheath disruption was not significantly associated with the risk of catheter failure (adjusted hazard ratio [aHR]=1.34; 95% confidence interval [CI]: 0.87-2.10; p=0.18). Diabetes was associated with greater risk of catheter failure (aHR=1.88; 95% CI: 1.19-2.95; p=0.006), whereas higher age was associated with a lower risk of catheter failure (aHR per 10 years=0.83; 95% CI: 0.72-0.96; p=0.01). This study demonstrates that there is no significant increase in bacteremia and subsequent catheter dysfunction rates after fibrin sheath disruption compared to simple over the wire exchange. These results are encouraging given the large numbers of patients utilizing tunneled catheters for initial hemodialysis access and the known rates of fibrin sheath formation leading to catheter failure.

Percutaneous transluminal angioplasty of the carotid artery

International Nuclear Information System (INIS)

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

1984-01-01

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

Initial clinical experience with a new percutaneous peripheral atherectomy device for the treatment of femoro-popliteal stenoses

International Nuclear Information System (INIS)

Zeller, T.; Frank, U.; Buergelin, K.; Schwarzwaelder, U.; Neumann, F.J.; Reimers, B.

2004-01-01

Background: Evaluation of the efficacy and safety of a new 7F-atherectomy device (30-day endpoint) for the treatment of short and mid-length arterial lesions with a reference diameter of 2.5-7 mm. Material and Methods: Fifty-eight femoto-popliteal stenoses in 46 patients (67% male, mean age 66± 9 years) with chronic peripheral occlusive disease of the lower limbs [Rutherford stage 2: n = 13 (28%); stage 3: n = 29 (63%); stage 4: 2 (4%), stage 5: n = 2 (4%]), were treated with directional atherectomy. Target lesion characteristics: Common femoral artery: n = 1 (2%), superficial femoral artery: n = 47 (81%); popliteal artery, n = 10 (17%); instent n = 3 (5%). Thirty (65%) of the interventions were performed using an antegrade approach, 16 (35%) interventions in cross-over technique. Mean degree of stenosis was 83 ± 11 mm, mean length of lesion was 37 ± 37 mm. Results: 6.5 ± 2 (4-10) passes of the lesion were performed with the catheter. Three lesions were treated after predilatation, 55 (95%) interventions as primary atherectomy. In 31/58 lesions (53%) additional balloon angioplasty was performed, in 1 lesion (2%) additional stent placement was needed. The mean degree of stenosis after atherectomy was reduced to 29 ± 20% (0-60%) after additional balloon angioplasty, it was 11 ± 10% (0-30%). A residual stenosis of [de

Percutaneous transhepatic balloon dilation of biliary-enteric anastomotic strictures after surgical repair of iatrogenic bile duct injuries.

Directory of Open Access Journals (Sweden)

Andrew Y Lee

Full Text Available PURPOSE: To evaluate the efficacy of percutaneous balloon dilation of biliary-enteric anastomotic strictures resulting from surgical repair of laparoscopic cholecystectomy-related bile duct injuries. MATERIAL AND METHODS: A total of 61 patients were referred to our institution from 1995 to 2010 for treatment of obstruction at the biliary-enteric anastomosis following surgical repair of laparoscopic cholecystectomy-related bile duct injuries. Of these 61 patients, 27 underwent surgical revision upon stricture diagnosis, and 34 patients were managed using balloon dilation. Of these 34 patients, 2 were lost to follow up, leaving 32 patients for analysis. The primary study objective was to determine the clinical success rate of balloon dilation of biliary-enteric anastomotic strictures. Secondary study objectives included determining anastomosis patency, rates of stricture recurrence following treatment, and morbidity. RESULTS: Balloon dilation of biliary-enteric anastomotic strictures was clinically successful in 21 of 32 patients (66%. Anastomotic stricture recurred in one of 21 patients (5% after an average of 13.1 years of follow-up. Patients who were unsuccessfully managed with balloon dilation required significantly more invasive procedures (6.8 v. 3.4; p = 0.02 and were left with an indwelling biliary catheter for a significantly longer period of time (8.8 v. 2.0 months; p = 0.02 than patients whose strictures could be resolved by balloon dilation. No significant differences in the number of balloon dilations performed (p = 0.17 or in the maximum balloon diameter used (p = 0.99 were demonstrated for patients with successful or unsuccessful balloon dilation outcomes. CONCLUSION: Percutaneous balloon dilation of anastomotic biliary strictures following surgical repair of laparoscopic cholecystectomy-related injuries may result in lasting patency of the biliary-enteric anastomosis.

Malfunctioning and infected tunneled infusion catheters: over-the-wire catheter exchange versus catheter removal and replacement.

Science.gov (United States)

Guttmann, David M; Trerotola, Scott O; Clark, Timothy W; Dagli, Mandeep; Shlansky-Goldberg, Richard D; Itkin, Maxim; Soulen, Michael C; Mondschein, Jeffrey I; Stavropoulos, S William

2011-05-01

To compare the safety and effectiveness of over-the-wire catheter exchange (catheter-exchange) with catheter removal and replacement (removal-replacement) at a new site for infected or malfunctioning tunneled infusion catheters. Using a quality assurance database, 61 patients with tunneled infusion catheters placed during the period July 2001 to June 2009 were included in this study. Patients receiving hemodialysis catheters were excluded. Catheter-exchange was performed in 25 patients, and same-day removal-replacement was performed in 36 patients. Data collected included demographic information, indication for initial catheter placement and replacement, dwell time for the new catheter, and ultimate fate of the new device. Statistical comparisons between the two cohorts were analyzed using the Kaplan-Meier technique and Fisher exact test. Catheters exchanged over the wire remained functional without infection for a median of 102 days (range, 2-570 days), whereas catheters removed and replaced were functional for a median 238 days (range, 1-292 days, P = .12). After catheter replacement, there were 11 instances of subsequent infection in the catheter-exchange group and 7 instances in the removal-replacement cohort, accounting for infection rates of 4.4 and 2.3 per 1,000 catheter days (P = .049). Patients in the catheter-exchange group had 3.2 greater odds of infection compared with patients in the removal-replacement group. Five malfunction events occurred in each group, accounting for 2.0 and 1.7 malfunctions per 1,000 catheter days in the catheter-exchange and removal-replacement groups (P = .73). Catheter-exchange of tunneled infusion catheters results in a higher infection rate compared with removal-replacement at a new site. The rate of catheter malfunction is not significantly different between the two groups. Catheter-exchange is an alternative for patients with tunneled infusion catheters who have limited venous access, but this technique should not be

Catheter Angiography

Medline Plus

Full Text Available ... News Physician Resources Professions Site Index A-Z Catheter Angiography Catheter angiography uses a catheter, x-ray ... are the limitations of Catheter Angiography? What is Catheter Angiography? Angiography is a minimally invasive medical test ...

Imaging after vascular gene therapy

International Nuclear Information System (INIS)

Manninen, Hannu I.; Yang, Xiaoming

2005-01-01

Targets for cardiovascular gene therapy currently include limiting restenosis after balloon angioplasty and stent placement, inhibiting vein bypass graft intimal hyperplasia/stenosis, therapeutic angiogenesis for cardiac and lower-limb ischemia, and prevention of thrombus formation. While catheter angiography is still standard method to follow-up vascular gene transfer, other modern imaging techniques, especially intravascular ultrasound (IVUS), magnetic resonance (MR), and positron emission tomography (PET) imaging provide complementary information about the therapeutic effect of vascular gene transfer in humans. Although molecular imaging of therapeutic gene expression in the vasculatures is still in its technical development phase, it has already offered basic medical science an extremely useful in vivo evaluation tool for non- or minimally invasive imaging of vascular gene therapy

Transluminal angioplasty of a stenotic surgical splenorenal shunt

International Nuclear Information System (INIS)

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

1988-01-01

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

Successful Use of Orbital Atherectomy as an Adjunct in Treating Extensively Calcified Mesenteric Artery Lesions.

Science.gov (United States)

Richard, Michele; Krol, Emilia; Dietzek, Alan

2016-10-01

To describe the use of orbital technique of atherectomy as an adjunct to successful angioplasty and stent placement of the superior mesenteric artery (SMA). The technique is demonstrated in a 68-year-old man with critical SMA stenosis. The SMA was cannulated with 0.014-in wire, but the lesion was highly stenotic and densely calcified and prevented the passage of even the smallest 1.5-mm balloon. Orbital atherectomy was thus performed with a 1.25-mm CSI crown. Balloon angioplasty was then possible with a 4 mm × 2 cm balloon followed by placement of a 7 mm × 22 mm balloon-mounted stent. The use of atherectomy as an adjunct to angioplasty and stenting in extensive, calcified SMA lesions supports the value of this technique to avoid a much larger and morbid open procedure. Published by Elsevier Inc.

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

Directory of Open Access Journals (Sweden)

Gaurav K Gupta

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

Urinary catheters

Science.gov (United States)

Catheter - urine; Foley catheter; Indwelling catheter; Suprapubic catheters ... stones Blood infections ( septicemia ) Blood in the urine (hematuria) Kidney damage (usually only with long-term, indwelling ...

Paclitaxel-Coated Balloons for the Treatment of Dysfunctional Dialysis Access. Results from a Single-Center, Retrospective Analysis

Energy Technology Data Exchange (ETDEWEB)

Kitrou, Panagiotis M., E-mail: panoskitrou@gmail.com; Spiliopoulos, Stavros; Papadimatos, Panagiotis; Christeas, Nicolaos; Petsas, Theodoros; Katsanos, Konstantinos; Karnabatidis, Dimitris [Patras University Hospital, Interventional Radiology Department (Greece)

2017-01-15

PurposeTo investigate the safety and effectiveness of lutonix paclitaxel-coated balloon (PCB) for the treatment of dysfunctional dialysis access.Materials and MethodsThis was a single-center, single-arm, retrospective analysis of 39 patients (23 male, 59 %) undergoing 61 interventions using 69 PCBs in a 20-month period. There was a balance between arteriovenous fistulae (AVF) and grafts (AVG) (20 AVFs, 19AVGs), and the majority of lesions were restenotic (25/39, 64.1 %). Mean balloon diameter used was 6.6 mm and length 73.4 mm. Primary outcome measure was target lesion primary patency (TLPP) at 6 months, while secondary outcome measures included factors affecting TLPP and major complications. As there were lesions treated more than once with PCB, authors also compared patency results after first and second PCB angioplasty.ResultsTLPP was 72.2 % at 6 months with a median patency of 260 days according to the Kaplan–Meier survival analysis. No major complications occurred. TLPP between AVFs and AVGs (311 vs. 237 days, respectively; p = 0.29) and de novo and restenotic lesions was similar (270.5 vs. 267.5 days, respectively; p = 0.50). In 14 cases, in which lesions were treated with two PCB angioplasties, a statistically significant difference in TLPP after the second treatment was noted (first intervention 179.5 days vs. second intervention 273.5 days; p = 0.032).ConclusionIn this retrospective analysis, Lutonix PCB proved to be safe and effective in treating restenosis in dysfunctional dialysis access with results comparable to the literature available. Larger studies are needed to prove abovementioned results.

Radiation dermatitis due to catheter ablation used in the treatment of arrhythmia. A report of two cases

International Nuclear Information System (INIS)

Nagano, Tohru; Kosaka, Hiroshi; Shimoura, Shinichi; Tsuru, Kenta; Yamagami, Nao; Ikeda, Tetsuya; Nishigori, Chikako; Yoshida, Akihiro

2004-01-01

We report 2 cases of radiation dermatitis caused by catheter ablation for treatment of atrial fibrillation resisitant to conventional therapies. Case 1, 50-year-old male underwent pulmonary veins ablation for treatment of atrial fibrillation. Cumulative fluoroscopic imaging time of 370 min was required. Case 2, 74-year-old female also underwent pulmonary veins ablation for treatment of atrial fibrillation. Cumulative fluoroscopic imaging time of 550 min was required. Since dose rate used for imaging is 20∼80 mGy/min, accumulated skin doses were estimated as 7.4∼29.6 Gy and 5.6∼22.4 Gy, respectively. Two weeks after their last ablation, brown, painful macule and plaque appeared on the outer side of their right upper arms. To our knowledge, the risk of overexposure to X-ray in cases of PTCA (percutaneous transluminal coronary angioplasty) for ischemic heart diseases has been well known, but little is known about the risk of catheter ablation. The location of radiation dermatitis caused by catheter ablation (CA) is rather different from that of PTCA. It is critical for cardiologists and dermatologists to observe and find the symptoms of acute radiation dermatitis in order to avoid repeated overexposure to X-ray. (author)

Laserassisteret ballonangioplastik af okklusioner i det femoropopliteale segment

DEFF Research Database (Denmark)

Eiberg, J P; Rasmussen, John Bøje Grønvall; Schroeder, T V

1995-01-01

of collateral vessels. In this series, laser angioplasty carried a high risk of perforation. The initial and long-term results were no better than could be expected of percutaneous transluminal angioplasty, suggesting that laser-assisted balloon angioplasty has no place in the vascular surgical armamentarium....

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

Brachytherapy using holmium-166 liquid balloon system for in-stent restenosis: 6 months clinical and angiographic follow-up

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