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Endovascular treatment

Eric Klingelhoefer, Hendrik Bergert, Stephan Kersting, Stefan Ludwig, Norbert Weiss, Frank Schönleben, Robert Grützmann, Gabor Gäbel
BACKGROUND: Peripheral arterial disease (PAD) is one of the most underestimated diseases because of its high prevalence and unfavorable prognosis. Many PAD patients without suitable autologous veins or options for endovascular treatment receive prosthetic above-knee femoropopliteal bypass (PAKB). Until now predictors of prosthetic bypass failure and of increased amputation risk remain indistinct. This study aimed to identify predictive factors associated with better bypass patency and limb salvage to achieve a more favorable outcome after PAKB reconstruction...
August 2016: Journal of Vascular Surgery
Manish Mehta, Yi Zhou, Philip S K Paty, Medhi Teymouri, Kamran Jafree, Humayun Bakhtawar, Jeffrey Hnath, Paul Feustel
BACKGROUND: This study evaluated the feasibility, safety, and effectiveness of endovascular interventions for common femoral artery (CFA) occlusive disease. METHODS: Using a prospectively maintained multicenter database, we analyzed outcomes in 167 consecutive patients who underwent percutaneous CFA interventions for Rutherford class 3 to class 6 (R3-R6) disease. The standardized treatment approach included primary percutaneous transluminal angioplasty (PTA) only, atherectomy + PTA, and provisional stenting...
August 2016: Journal of Vascular Surgery
Petar Duvnjak, Mario Laguna
The use of live attenuated intravesicular Bacillus Calmette-Guerin (BCG) therapy is a generally accepted safe and effective method for the treatment of superficial transitional cell carcinoma (TCC) of the bladder. Although rare, < 5% of patient's treated with intravesicular BCG therapy may develop potentially serious complications, including localized infections to the genitourinary tract, mycotic aneurysms and osteomyelitis. We present here a case of a 63-year-old male who developed left coronary and multiple peripheral M...
August 2016: Journal of Radiology Case Reports
Jeffrey D Hooker, David A Joyner, Edward P Farley, Majid Khan
Eagle syndrome is a rare condition resulting from elongation of the temporal styloid process or calcification of its associated stylohyoid ligaments. Although usually presenting with pain or odynophagia, Eagle syndrome has been reported to cause a multitude of neurologic symptoms or vascular complications, some of which can be life-threatening. We present a case in which an endovascularly placed internal carotid artery stent in close proximity to a calcified stylohyoid ligament resulted in stent fracture with subsequent stent and vessel occlusion...
June 2016: Journal of Radiology Case Reports
Jacques Sedat, Yves Chau, Jean Gaudart, Marina Sachet, Stephanie Beuil, Michel Lonjon
BACKGROUND: Thromboembolic complications are the main problem in stent-assisted coil embolization of unruptured intracranial aneurysms. The combination of aspirin and clopidogrel is generally used to decrease these complications, but some patients do not respond to clopidogrel and have a higher risk of stent thrombosis. In cardiology, clinical trials have shown that prasugrel reduced the incidence of ischaemic events in patients with acute coronary syndrome compared with clopidogrel but, according to several authors, prasugrel would produce an increased risk of cerebral haemorrhagic complications...
October 19, 2016: Interventional Neuroradiology
Francis Cloutier, Naim Khoury, Jimmy Ghostine, Behzad Farzin, Marc Kotowski, Alain Weill, Daniel Roy, Jean Raymond
BACKGROUND AND PURPOSE: Endovascular coil embolization of cerebral aneurysms is associated with suboptimal angiographic results in up to 20-30% of patients. Coil packing density has been used as an index of the success of the initial procedure. The trial sought to study the effects of using 15-caliber coils, as compared with 10-caliber coils, on packing density. METHODS: Does Embolization with Larger coils lead to better Treatment of Aneurysms (DELTA) is an investigator-initiated multicenter prospective, randomized, controlled clinical trial...
October 19, 2016: Interventional Neuroradiology
Emily B Devine, Rafael Alfonso-Cristancho, N David Yanez, Todd C Edwards, Donald L Patrick, Cheryl A L Armstrong, Allison Devlin, Rebecca G Symons, Mark H Meissner, Ellen L T Derrick, Danielle C Lavallee, Larry G Kessler, David R Flum
Importance: Intermittent claudication (IC) is the most common presentation of infrainguinal peripheral artery disease. Both medical and revascularization interventions for IC aim to increase walking comfort and distance, but there is inconclusive evidence of the comparative benefit of revascularization given the possible risk of limb loss. Objective: To compare the effectiveness of a medical (walking program, smoking cessation counseling, and medications) vs revascularization (endovascular or surgical) intervention for IC in the community, focusing on outcomes of greatest importance to patients...
October 19, 2016: JAMA Surgery
Yafei Qi, Xiaoyuan Ma, Gang Li, Xiangxing Ma, Qing Wang, Dexin Yu
AIMS: Conventional computed tomography (CT) approaches provides limited visualization of the entire endoluminal changes of aortic dissection (AD), which is essential for its treatment. As an important supplement, three-dimensional CT virtual intravascular endoscopy (VIE) can show relevant details. This study aims to determine the value of VIE in displaying the entry tear and intimal flap of AD. METHODS AND RESULTS: Among 127 consecutive symptomatic patients with suspected AD who underwent CT angiography (CTA), 84 subjects were confirmed to have AD and were included in the study...
2016: PloS One
Zhao Chenhui, Wei Yi
BACKGROUND: Despite great advances in treatment of Aneurysmal subarachnoid hemorrhage (aSAH), yet, a consensus as to the most optimal timing of surgery has not been reached. MATERIALS AND METHODS: PubMed and the Cochrane Library were searched for English-language studies published up to May 2015. Before conducting the meta-analysis, the studies were evaluated for publication bias and heterogeneity. Fixed and random effect models were used to estimate relative risks (RR) and the corresponding 95% confidence intervals (CIs)...
December 7, 2015: Turkish Neurosurgery
Shigemitsu Shirai, Keisuke Hirano, Norihiro Kobayashi
It is difficult to treat a thrombotic embolism in the common femoral artery or popliteal artery (POP A), i.e., the non-stenting zone. We report a new technique for the treatment of thrombotic embolism in the non-stenting zone using a self-expandable nitinol stent. Case 1 had an external iliac artery (EIA) occlusion that occurred over several months. A self-expandable nitinol stent was placed in the right EIA lesion via a retrograde approach using a distal 9-Fr balloon protection guide catheter in the right femoral artery...
October 19, 2016: Catheterization and Cardiovascular Interventions
Wolfgang G Kunz, M G Myriam Hunink, Wieland H Sommer, Sebastian E Beyer, Felix G Meinel, Franziska Dorn, Stefan Wirth, Maximilian F Reiser, Birgit Ertl-Wagner, Kolja M Thierfelder
BACKGROUND AND PURPOSE: Endovascular therapy in addition to standard care (EVT+SC) has been demonstrated to be more effective than SC in acute ischemic large vessel occlusion stroke. Our aim was to determine the cost-effectiveness of EVT+SC depending on patients' initial National Institutes of Health Stroke Scale (NIHSS) score, time from symptom onset, Alberta Stroke Program Early CT Score (ASPECTS), and occlusion location. METHODS: A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with both strategies applied in a US setting...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
Stefan Knippen, Florian Putz, Sabine Semrau, Ulrike Lambrecht, Arzu Knippen, Michael Buchfelder, Sven Schlaffer, Tobias Struffert, Rainer Fietkau
BACKGROUND: Intracranial arteriovenous malformations (AVMs) may show a harmful development. AVMs are treated by surgery, embolization, or radiation therapy. OBJECTIVE: This study investigated obliteration rates and side effects in patients with AVMs treated by radiation therapy. METHODS: A total of 40 cases treated between 2005 and 2013 were analyzed. Single-dose stereotactic radiosurgery (SRS) was received by 13 patients and 27 received hypofractionated stereotactic radiation therapy (HSRT)...
October 18, 2016: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
Keith W Muir, Gary A Ford, Claudia-Martina Messow, Ian Ford, Alicia Murray, Andrew Clifton, Martin M Brown, Jeremy Madigan, Rob Lenthall, Fergus Robertson, Anand Dixit, Geoffrey C Cloud, Joanna Wardlaw, Janet Freeman, Philip White
OBJECTIVE: The Pragmatic Ischaemic Thrombectomy Evaluation (PISTE) trial was a multicentre, randomised, controlled clinical trial comparing intravenous thrombolysis (IVT) alone with IVT and adjunctive intra-arterial mechanical thrombectomy (MT) in patients who had acute ischaemic stroke with large artery occlusive anterior circulation stroke confirmed on CT angiography (CTA). DESIGN: Eligible patients had IVT started within 4.5 hours of stroke symptom onset. Those randomised to additional MT underwent thrombectomy using any Conformité Européene (CE)-marked device, with target interval times for IVT start to arterial puncture of <90 min...
October 18, 2016: Journal of Neurology, Neurosurgery, and Psychiatry
Stanislav Pekarskiy, Andrei Baev, Viktor Mordovin, Galina Semke, Tatiana Ripp, Alla Falkovskaya, Ekaterina Sitkova, Valeria Lichikaki, Irina Zubanova, Maria Kuzmichkina, Sergei Popov
OBJECTIVE: A failure of endovascular renal denervation (RDN) as a series of point treatments equally distributed within main trunk of renal artery (Symplicity and other methods) was easily predictable. It may only be effective if all renal nerves closely follow the course of renal artery (RA) from aorta to the kidney. However, surgical studies demonstrated that proximally most renal nerves go at a distance from RA and join mainly its distal part. To evaluate whether denervation treatment in distal part of RA is more effective than conventional RDN...
September 2016: Journal of Hypertension
Adenauer Marinho de Oliveira Góes Junior, Salim Abdon Haber Jeha
Endovascular treatment of a giant extracranial internal carotid aneurysm by a stent graft implantation was unsuccessful due to a high flow leak directly through the stent graft's coating. The problem was solved deploying a second stent graft inside the previously implanted one resulting in complete exclusion of the aneurysmal sac and patent carotid lumen preservation. The review of the literature did not provide a case using this endovascular strategy. Follow-up for more than 12 months, using CT angiography, showed confirmed aneurysmal exclusion and carotid patency and no clinical complications have been detected...
2016: Case Reports in Surgery
Mohammad Jafarian, Nima Dehghani, Shahin Shams, Mohammad Esmaeelinejad, Farzad Aghdashi
Arteriovenous malformations are uncommon congenital disorders in vascular development. They frequently involve craniofacial structures and result in a morphogenic abnormality with ominous arteriovenous shunting. We present a huge AVM of the upper lip in an 18-year-old patient who was successfully treated by the combination method of presurgical endovascular embolization and complete resection of the lesion. Subsequent surgical defect in upper lip, which involved more than two-third of the lip length, was reconstructed via Webster's modification of cheek advancement flap...
September 2016: Journal of Maxillofacial and Oral Surgery
J J Jiang, H K Qing, X M Zhang, X M Zhang, W Li, C Y Shen, Q L Li, Y Jiao
OBJECTIVE: To compare total percutaneous access using preclose technique with femoral artery cut-down in endovascular aneurysm repair (EVAR) and assess the safety and feasibility of preclose technique. METHODS: In the study, 81 cases undergoing EVAR from Dec. 2011 to Nov. 2014 in Peking University People's Hospital were retrospectively reviewed. Preoperative CT angiography (CTA) showed presence of infrarenal abdominal aortic aneurysm or descending aortic aneurysm in all the cases...
October 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Gregory M Weiner, Rafey Feroze, David M Panczykowski, Amin Aghaebrahim, William Ares, Nitin Agarwal, John Enis, Xiao Zhu, Andrew F Ducruet
INTRODUCTION: Tandem occlusion resulting in acute ischemic stroke (AIS) is associated with high morbidity and mortality and a poor response to thrombolytic therapy. The use of endovascular strategies for tandem stroke cases results in an improved outcome for this subgroup of patients. We present two cases with a pattern of tandem occlusion consisting of proximal obstruction at the origin of the common carotid artery (CCA) with concomitant intracranial occlusion treated by endovascular techniques...
October 14, 2016: World Neurosurgery
Yu Xiao, Jian Zhou, Xiaolong Wei, Yudong Sun, Lei Zhang, Jiaxuan Feng, Rui Feng, Zhiqing Zhao, Zaiping Jing
BACKGROUND: Takayasu's arteritis (TA) is a nonspecific chronic inflammation of the aorta and its branches. This study compared the outcomes of surgical treatments including bypass surgery, cutting balloon angioplasty and conventional balloon angioplasty to TA patients exhibiting supra-aortic arterial (SAA). METHODS: This retrospective study was conducted on 42 TA patients, obtained from hospital database, who underwent surgical therapy due to SAA lesions from January 2010 to March 2015...
September 2016: Journal of Thoracic Disease
Nadine Lilla, Jasmin Hartmann, Stefan Koehler, Ralf-Ingo Ernestus, Thomas Westermaier
A lack of nitric oxide (NO) may be a possible factor in the pathogenesis of an acute decrease of cerebral blood flow (CBF) after subarachnoid hemorrhage (SAH). This study was conducted to investigate whether early therapy with an NO-donor can improve CBF and offer neuroprotection after experimental SAH in rats. Male Sprague-Dawley rats were subjected to SAH by the endovascular filament model and treated with 1.5μg/kg/min of intravenous sodium nitroprusside (SNP) or vehicle (n=10) starting 15min after induction of SAH until 180min thereafter...
September 20, 2016: Journal of the Neurological Sciences
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