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Bifurcation lesion

Martijn L Dijkstra, Peter C J M Goverde, Andrew Holden, Clark J Zeebregts, Michel M P J Reijnen
PURPOSE: To show feasibility of the covered endovascular repair of the aortic bifurcation (CERAB) technique in conjunction with chimney grafts in aortic side branches for complex aortoiliac occlusive disease. METHODS: Two European centers and one facility located in New Zealand participated in a retrospective observational study that enrolled 14 consecutive patients (mean age 61.2±8.9 years; 11 men) treated with CERAB in conjunction with chimney graft(s) between December 2012 and May 2015...
October 14, 2016: Journal of Endovascular Therapy
Ludovico La Grutta, Marta Marasà, Patrizia Toia, Daniele Ajello, Domenico Albano, Erica Maffei, Emanuele Grassedonio, Giuseppina Novo, Massimo Galia, Giuseppe Caruso, Salvatore Novo, Filippo Cademartiri, Massimo Midiri
OBJECTIVE: The aim of the study was to compare the atherosclerotic disease in the coronary and carotid arteries in patients who underwent non-invasive imaging for suspected stable coronary artery disease (CAD). MATERIALS AND METHODS: 107 patients (64 men, age 59 ± 12) with atypical chest pain underwent cardiac CT (CCT) and carotid ultrasound (US) on the same day. Severity (obstructive or not-obstructive disease), location, shape, and composition of atherosclerotic plaques in the two districts were evaluated...
October 13, 2016: La Radiologia Medica
Alun D Hughes, Emanuela Falaschetti, Nicholas Witt, Sumangali Wijetunge, Simon A McG Thom, Therese Tillin, Steve J Aldington, Nish Chaturvedi
BACKGROUND AND PURPOSE: Abnormalities of the retinal circulation may be associated with cerebrovascular disease. We investigated associations between retinal microvascular abnormalities and (1) strokes and subclinical cerebral infarcts and (2) cerebral white matter lesions in a UK-based triethnic population-based cohort. METHODS: A total of 1185 participants (age, 68.8±6.1 years; 77% men) underwent retinal imaging and cerebral magnetic resonance imaging. Cerebral infarcts and white matter hyperintensities were identified on magnetic resonance imaging, retinopathy was graded, and retinal vessels were measured...
October 11, 2016: Stroke; a Journal of Cerebral Circulation
Fernando Alfonso, Marcos García-Guimarães, Gonzalo Navarrete, Javier Cuesta, Teresa Bastante, Amparo Benedicto, Fernando Rivero, Bernardo Cortese
Drug-eluting balloons (DEB) may be considered as a "quiet revolution" in percutaneous coronary interventions. Early-generation DEB eluting paclitaxel proved to be very effective in animal models to reduce neointimal hyperplasia. Areas covered: Review of DEB efficacy in patients with coronary de novo lesions and in-stent restenosis (ISR). Expert opinion: Many randomized clinical trials and meta-analyses have demonstrated the value of DEB in patients with ISR. In this setting, DEB are safe and effective with clinical and angiographic results superior to plain balloon angioplasty and at least equivalent to first generation drug-eluting stents (DES)...
October 8, 2016: Expert Opinion on Drug Delivery
H M Nef, O Dörr, H Möllmann, A Elsässer
Bifurcation lesions are a therapeutic challenge in the interventional treatment of coronary artery disease. Thus, consideration of anatomical aspects and selection of the most appropriate strategy for an individual bifurcation have an impact on the interventional outcome. Accordingly, assessment of the type of bifurcation stenosis, including the relevance of the side branches, vessel diameter and the angle between the two branches are critical for the optimal choice of interventional strategy. The fractional flow reserve (FFR) is a parameter that provides a measure of the severity of coronary stenosis and despite some limitations, FFR can be applied to bifurcation lesions...
October 7, 2016: Herz
Hung-Hao Lee, Po-Chao Hsu, Wen-Hsien Lee, Chun-Yuan Chu, Ho-Ming Su, Tsung-Hsien Lin, Wen-Chol Voon, Wen-Ter Lai, Sheng-Hsiung Sheu, Cheng-An Chiu
A 66-year-old male was treated percutaneously for a bifurcation lesion of the left anterior descending coronary artery by provisional stenting using the jailed wire technique. After successfully stenting the main branch, retraction of the looped main branch guidewire was impossible. After using an intravascular ultrasound we discovered the guidewire was entangled with a stent strut. Thereafter, the proximal stent elongated after retraction. With the support of an over-the-wire microcatheter, we finally pulled out the entrapped guidewire...
September 2016: Acta Cardiol Sin
Amritaj Patra, Qianqian Zhang, F Peter Guengerich, Martin Egli
O6-Methyl-2(prime)-deoxyguanosine (O6-MeG) is a ubiquitous DNA lesion, formed not only by xenobiotic carcinogens but also by the endogenous methylating agent S-adenosylmethionine. It can introduce mutations during DNA replication, with different DNA polymerases displaying different ratios of correct or incorrect incoporation opposite this nucleoside. Of the "translesion" Y-family human DNA polymerases (hpols), hpol η is most efficient in incorporating equal numbers of correct and incorrect C and T bases. However, the mechanistic basis for this specific yet indescriminate activity is not known...
September 30, 2016: Journal of Biological Chemistry
Takayuki Yabe, Mikihoto Toda, Rine Nakanishi, Daiga Saito, Ippei Watanabe, Ryo Okubo, Hideo Amano, Takanori Ikeda
BACKGROUND: The treatment strategy for in-stent restenosis (ISR) with bifurcation lesions has not been well explored. We examined the clinical outcomes between final kissing balloon technique (FKBT) after stent implantation and single-stent implantation without FKBT for bifurcation ISR lesions. METHODS: We identified 115 consecutive ISR with bifurcation lesions among 108 patients who underwent drug-eluting stent implantation. The patients were divided into the FKBT group (34 patients, 35 lesions) and the non-FKBT group (74 patients, 80 lesions)...
September 27, 2016: Journal of Cardiology
David C Lange, Morton J Kern
Fractional flow reserve (FFR) is a well-validated tool for determining the functional significance of a coronary artery stenosis, facilitating clinical decisions regarding the need for revascularization. FFR-guided revascularization improves clinical and economic outcomes. However, its application remains challenging in certain complex anatomic subsets, including left main coronary artery stenosis, bifurcation disease, and saphenous vein graft disease. This article reviews recent data supporting the use of FFR in these complex anatomic subsets...
2016: Reviews in Cardiovascular Medicine
Manuel Pan, Soledad Ojeda, Elena Villanueva, Jorge Chavarria, Miguel Romero, Javier Suarez de Lezo, Francisco Mazuelos, Jose Segura, Francisco Carrasco, Francisco Hidalgo, Jose Lopez Aguilera, Sara Rodriguez, Miguel Puente, Jose Suarez de Lezo
OBJECTIVES: The study sought to compare the safety (resistance to damage) and efficacy (ability to cross the side branch) of polymer-coated and non-polymer-coated guidewires in the jailed wire technique used during the percutaneous treatment of bifurcation lesions. BACKGROUND: The jailed wire technique is a useful strategy in the treatment of bifurcation lesions by provisional stenting. However, these wires can be damaged or even be broken during their removal...
September 26, 2016: JACC. Cardiovascular Interventions
Fadi J Sawaya, Thierry Lefèvre, Bernard Chevalier, Phillipe Garot, Thomas Hovasse, Marie-Claude Morice, Tanveer Rab, Yves Louvard
Coronary bifurcations are frequent and account for approximately 20% of all percutaneous coronary interventions. Nonetheless, they remain one of the most challenging lesion subsets in interventional cardiology in terms of a lower procedural success rate and increased rates of long-term adverse cardiac events. Provisional side branch stenting should be the default approach in the majority of cases and we propose easily applicable and reproducible stepwise techniques associated with low risk of failure and complications...
September 26, 2016: JACC. Cardiovascular Interventions
Rafael Cavalcante, Yohei Sotomi, Yaping Zeng, Cheol Whan Lee, Jung-Min Ahn, Carlos Collet, Erhan Tenekecioglu, Pannipa Suwannasom, Yoshinobu Onuma, Seung-Jung Park, Patrick W Serruys
OBJECTIVE: In patients with multivessel disease and proximal left anterior descending artery (LAD) involvement, the best revascularisation strategy is still unclear. We assess outcomes after coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents in a pooled analysis of individual patient-level data of the SYNTAX and BEST randomised trials. DESIGN: Proximal LAD involvement was defined by any lesion ≥ 50% diameter stenosis in the arterial segment starting from the left-main bifurcation up to (and including) the origin of the first major septal branch...
September 20, 2016: Heart: Official Journal of the British Cardiac Society
Angkoon Anuwong, Matteo Lavazza, Hoon Yub Kim, Che-Wei Wu, Stefano Rausei, Vincenzo Pappalardo, Cesare Carlo Ferrari, Davide Inversini, Andrea Leotta, Antonio Biondi, Feng-Yu Chiang, Gianlorenzo Dionigi
The objective is to compare the consequences of routine visualization (RV) and the application of intermitted (I-IONM), standardized (S-IONM), and continuous monitoring (C-IONM) of recurrent laryngeal nerve (RLN) management. RV includes that 698 RLNs managed solely with visual identification. In a second period 777, RLNs were handled by the I-IONM. The third period 768 RLNs monitoring was performed according to the standards. C-IONM via VN stimulation included 626 RLNs. The following issues were analyzed and compared per each period study: RLN identification rate, branching detection, assessment of NRLN, intraoperative recognizable nerve damage, stage thyroidectomy rate, transient or definitive lesions, bilateral nerve palsy, and recovery time...
September 20, 2016: Updates in Surgery
Marc-Alexander Ohlow, Ahmed Farah, Stefan Richter, Mohamad El-Garhy, Hubertus von Korn, Bernward Lauer
BACKGROUND: In a number of coronary bifurcation lesions, both the main vessel and the side branch (SB) need stent coverage. OBJECTIVES: To analyze the procedural performance and the impact on radiation times (RT) and contrast medium consumption (CMC) of the Axxess™ stent system (Biosensors, Switzerland) treating de novo bifurcation lesions (DBL). METHODS: One hundred and ten consecutive prospectively enrolled cases (Axxess Group) and 110 age, sex, and lesion location matched controls undergoing mandatory (Group A, n = 56) or provisional (Group B, n = 54) SB intervention were analyzed...
September 21, 2016: Catheterization and Cardiovascular Interventions
Daniel Markel, Ives Levesque, Joe Larkin, Pierre Léger, Issam El Naqa
At present, there exists few openly available methods for evaluation of simultaneous segmentation and registration algorithms. These methods allow for a combination of both techniques to track the tumor in complex settings such as adaptive radiotherapy. We have produced a quality assurance platform for evaluating this specific subset of algorithms using a preserved porcine lung in such that it is multi-modality compatible: positron emission tomography (PET), computer tomography (CT) and magnetic resonance imaging (MRI)...
October 7, 2016: Physics in Medicine and Biology
Alessandro Stefano, Salvatore Vitabile, Giorgio Russo, Massimo Ippolito, Maria Gabriella Sabini, Daniele Sardina, Orazio Gambino, Roberto Pirrone, Edoardo Ardizzone, Maria Carla Gilardi
An algorithm for delineating complex head and neck cancers in positron emission tomography (PET) images is presented in this article. An enhanced random walk (RW) algorithm with automatic seed detection is proposed and used to make the segmentation process feasible in the event of inhomogeneous lesions with bifurcations. In addition, an adaptive probability threshold and a k-means based clustering technique have been integrated in the proposed enhanced RW algorithm. The new threshold is capable of following the intensity changes between adjacent slices along the whole cancer volume, leading to an operator-independent algorithm...
September 16, 2016: Medical & Biological Engineering & Computing
Kazuhiro Osawa, Toru Miyoshi, Takashi Miki, Yuji Koide, Yusuke Kawai, Kentaro Ejiri, Masatoki Yoshida, Shuhei Sato, Susumu Kanazawa, Hiroshi Ito
High diagnostic performance of noninvasive fractional flow reserve computed from CT (FFR-CT) was recently reported in prospective multicenter trials. The aims of this study were to evaluate the diagnostic accuracy of FFR-CT in clinical practice and to examine the lesion characteristics showing a mismatch between FFR-CT and invasive FFR. A total of 20 patients (29 vessels) with suspected coronary artery disease were included. All patients underwent invasive coronary angiography and invasive FFR according to coronary artery CT angiography (CCTA) findings...
September 13, 2016: Heart and Vessels
Monika Herten, Giovanni B Torsello, Eva Schönefeld, Stefan Stahlhoff
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...
2016: Vascular Health and Risk Management
Giulia Ottaviani, L Maximilian Buja
Sudden cardiac death (SCD) is defined as the unexpected death without an obvious noncardiac cause that occurs within 1 h of witnessed symptom onset (established SCD) or within 24 h of unwitnessed symptom onset (probable SCD). In the United States, its incidence is 69/100,000 per year. Dysfunctions of the cardiac conduction and autonomic nervous systems are known to contribute to SCD pathogenesis, even if most clinicians and cardiovascular pathologists lack experience with detailed examination of the cardiac conduction system and fail to recognize lesions that are crucial to explain the SCD itself...
August 28, 2016: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Tomoya Kamide, Motohiro Nomura, Akira Tamase, Kentaro Mori, Shunsuke Seki, Yoshihisa Kitamura, Mitsutoshi Nakada
BACKGROUND: The internal carotid artery (ICA) usually runs posterolaterally to the external carotid artery (ECA), but occasionally we encounter the twisted carotid bifurcation, a variant in which the ICA courses medially to the ECA during carotid endarterectomy (CEA). Prediction of this anomaly in the preoperative evaluation is mandatory, although descriptions in the literature are limited. We reviewed the clinical features of patients who underwent CEA and analyzed preoperative cerebral angiography, especially the anteroposterior (AP) view to determine whether it could be a predictive modality...
September 10, 2016: Acta Neurochirurgica
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