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Bifurcation stenting

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https://www.readbyqxmd.com/read/28324943/overcoming-spatio-temporal-limitations-using-dynamically-scaled-in-vitro-pc-mri-a-flow-field-comparison-to-true-scale-computer-simulations-of-idealized-stented-and-patient-specific-left-main-bifurcations
#1
Susann Beier, John Ormiston, Mark Webster, John Cater, Stuart Norris, Pau Medrano-Gracia, Alistair Young, Kathleen Gilbert, Brett Cowan
The majority of patients with angina or heart failure have coronary artery disease. Left main bifurcations are particularly susceptible to pathological narrowing. Flow is a major factor of atheroma development, but limitations in imaging technology such as spatio-temporal resolution, signal-to-noise ratio (SNRv), and imaging artefacts prevent in vivo investigations. Computational fluid dynamics (CFD) modelling is a common numerical approach to study flow, but it requires a cautious and rigorous application for meaningful results...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28321023/hybrid-strategy-to-treat-life-threatening-giant-coronary-artery-aneurysm-with-severe-in-stent-restenosis
#2
Wei-Chieh Lee, Hsiu-Yu Fang, Chih-Yuan Fang
Coronary artery aneurysm following drug-eluting stent implantation is rare in the literature. The presentation combined a life-threatening condition with severe in-stent restenosis. How to treat this condition is a complex problem because a surgical approach for a proximal left circumflex lesion is difficult. A hybrid method that is a combination of coronary bypass surgery and coronary stenting for left main bifurcation in-stent restenosis and proximal coronary artery aneurysm is a feasible strategy.
March 17, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28319567/treatment-of-biliary-stricture-after-live-donor-liver-transplantation-with-combined-metal-and-plastic-stent-%C3%A4-nsertion-a-feasibility-and-safety-study
#3
Erkan Parlak, Aydin Seref Koksal, Ahmet Tarik Eminler, Bilal Toka, Mustafa Ihsan Uslan
BACKGROUND: Fully covered-self expandable metal stents (Fc-SEMSs) have a challenging use in the treatment of anastomosis strictures (ASs) after live donor liver transplantation (LDLT) because they can occlude secondary branch biliary ducts when placed above the biliary bifurcation. In this study we evaluated the technical feasibility and safety of combining Fc-SEMSs with plastic stent(s) inserted to the secondary branch biliary ducts for the treatment of ASs after LDLT. METHODS: The study group included 22 patients (12 men, aged 51±11 years) with anastomotic biliary stricture after LDLT...
March 18, 2017: Transplantation
https://www.readbyqxmd.com/read/28314731/long-term-outcomes-of-provisional-stenting-compared-with-a-two-stent-strategy-for-bifurcation-lesions-a-meta-analysis-of-randomised-trials
#4
Ramez Nairooz, Marwan Saad, Islam Y Elgendy, Ahmed N Mahmoud, Fuad Habash, Partha Sardar, David Anderson, David M Shavelle, J Dawn Abbott
BACKGROUND: The optimal interventional technique for addressing coronary bifurcation lesions is debatable. Long-term clinical outcomes with provisional stenting (PS) compared with a two-stent (TS) strategy for bifurcation lesions are scarce. We aim to perform the first meta-analysis of randomised controlled trials (RCTs) to explore long-term outcomes comparing both strategies. METHODS: An electronic search was performed for online databases until August 2016 for RCTs comparing PS with TS for bifurcation lesions reporting outcomes at 1 year of follow-up or more...
March 17, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28314675/a-hybrid-strategy-with-bioresorbable-vascular-scaffolds-and-drug-eluting-stents-for-treating-complex-coronary-lesions
#5
Richard J Jabbour, Alfonso Ielasi, Akihito Tanaka, Massimo Leoncini, Bernado Cortese, Giulietta Grigis, Satoru Mitomo, Damiano Regazzoli, Gaetano Di Palma, Claudio Rapetto, Maurizio Tespili, Antonio Colombo, Azeem Latib
BACKGROUND: Due to the inherent limitations of current generation BVSs, complex coronary artery disease often contains BVS unsuitable segments. Our aim was to assess the feasibility of a hybrid approach using bioresorbable vascular scaffolds (BVSs) and drug-eluting stents (DESs) for the treatment of complex coronary artery lesions not suitable for a scaffolding only approach. METHODS: A retrospective multicenter cohort analysis was performed on patients with complex de novo or in-stent restenosis lesions treated with a hybrid BVS (Absorb BVS, Abbott Vascular, Santa Clara, CA) and DES strategy...
March 8, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28314672/fenestration-of-a-papyrus-pk-covered-stent-to-recover-the-occluded-left-main-bifurcation-after-sealing-a-left-main-perforation-during-a-cto-procedure
#6
Gerald S Werner, Waqar H Ahmed
Covered stents are indicated for coronary perforations, but they may seal off major side branches in that process. We report the successful sealing of an ostial left main perforation, induced by a guide catheter in the course of a retrograde approach to treat a chronic total occlusion (CTO) of the right coronary artery (RCA) in a 76year old woman with prior CABG. The implanted Papyrus covered stent, however, overlapped the left main bifurcation and occluded the non-grafted circumflex artery (CX) resulting in acute ischemia...
March 6, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28304199/jailed-double-microcatheter-technique-following-horizontal-stenting-for-coil-embolization-of-intracranial-wide-necked-bifurcation-aneurysms-a-technical-report-of-two-cases
#7
Takahiro Kitahara, Taketo Hatano, Makoto Hayase, Etsuko Hattori, Akinori Miyakoshi, Takehiko Nakamura
The horizontal stenting technique facilitates endovascular treatment of wide-necked bifurcation intracranial aneurysms. Previous literature shows, however, that subsequent coil embolization at initial treatment results in incomplete obliteration in many cases. The authors present two consecutive cases of wide-necked large bifurcation aneurysms to describe an additional coil embolization technique following horizontal stenting. The patients were a 53-year-old female with an unruptured internal carotid artery terminus aneurysm and a 57-year-old female with a recurrent basilar artery tip aneurysm...
April 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28304190/the-second-generation-eclips-endovascular-clip-system-initial-experience
#8
Albert H Chiu, Joost De Vries, Cian J O'Kelly, Howard Riina, Ian McDougall, Jonathan Tippett, Martina Wan, Airton Leonardo de Oliveira Manoel, Thomas R Marotta
OBJECTIVE Treatment of wide-necked intracranial aneurysms is associated with higher recanalization and complication rates; however, the most commonly used methods are not specifically designed to work in bifurcation lesions. To address these issues, the authors describe the evolution in the design and use of the eCLIPs (Endovascular Clip System) device, a novel hybrid stent-like assist device with flow diverter properties that was first described in 2008. METHODS A registry was established covering 13 international centers at which patients were treated with the second-generation eCLIPs device...
March 17, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28304189/physiological-remodeling-of-bifurcation-aneurysms-preclinical-results-of-the-eclips-device
#9
Thomas R Marotta, Howard A Riina, Ian McDougall, Donald R Ricci, Monika Killer-Oberpfalzer
OBJECTIVE Intracranial bifurcation aneurysms are complex lesions for which current therapy, including simple coiling, balloon- or stent-assisted coiling, coil retention, or intrasaccular devices, is inadequate. Thromboembolic complications due to a large burden of intraluminal metal, impedance of access to side branches, and a high recurrence rate, due largely to the unmitigated high-pressure flow into the aneurysm (water hammer effect), are among the limitations imposed by current therapy. The authors describe herein a novel device, eCLIPs, and its use in a preclinical laboratory study that suggests the device's design and functional features may overcome many of these limitations...
March 17, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28299676/bioresorbable-scaffolds-for-coronary-stenosis-when-and-how-based-upon-current-studies
#10
REVIEW
Alexandre Abizaid, J Ribamar Costa
PURPOSE OF REVIEW: First-generation bioresorbable scaffolds (BRS), largely represented by the poly-l-lactic acid (PLLA) ABSORB (Abbott Vascular, Temecula, Illinois, US), have demonstrated, in low to moderate lesion complexity, similar efficacy to current generation metallic drug-eluting stents. However, a trend toward more device thrombosis has been observed, especially when the scaffolds are used in off-label situations. In this review, we address the most relevant drawbacks of these devices and, based on the available scientific data, we visit the scenarios where there is more uncertainty about their indication, trying to identify the lesions/patients to whom this technology should be voided at its current stage of development...
March 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28292511/thoracic-stomach-right-main-bronchus-fistula-treated-with-dual-y-shaped-covered-airway-stents
#11
Z-M Li, H-B Lu, K-W Ren, X-W Han, G Wu, D-C Jiao
AIM: To determine the efficacy of dual Y-shaped covered airway stents to treat thoracic stomach-right main bronchus fistulae. MATERIAL AND METHODS: Fifteen patients who developed thoracic stomach-right main bronchus fistula after oesophageal cancer resection and postoperative irradiation were retrospectively analysed. All fistulae were close to the right upper lobe bronchus. Two Y-shaped covered airway stents were designed for each patient. Under radiographic guidance, one stent was placed from the right main bronchus into the bifurcation of upper lobe and intermediate bronchus, the other was placed from the trachea into both main bronchi...
March 11, 2017: Clinical Radiology
https://www.readbyqxmd.com/read/28285931/flow-and-wall-shear-stress-characterization-after-endovascular-aneurysm-repair-and-endovascular-aneurysm-sealing-in-an-infrarenal-aneurysm-model
#12
Johannes T Boersen, Erik Groot Jebbink, Michel Versluis, Cornelis H Slump, David N Ku, Jean-Paul P M de Vries, Michel M P J Reijnen
BACKGROUND: Endovascular aneurysm repair (EVAR) with a modular endograft has become the preferred treatment for abdominal aortic aneurysms. A novel concept is endovascular aneurysm sealing (EVAS), consisting of dual endoframes surrounded by polymer-filled endobags. This dual-lumen configuration is different from a bifurcation with a tapered trajectory of the flow lumen into the two limbs and may induce unfavorable flow conditions. These include low and oscillatory wall shear stress (WSS), linked to atherosclerosis, and high shear rates that may result in thrombosis...
March 9, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28279720/stent-assisted-coil-embolization-of-a-symptomatic-renal-artery-aneurysm-at-a-bifurcation-point
#13
Naiem Nassiri, Lauren A Huntress
PURPOSE: Symptomatic renal artery aneurysms at bifurcation points present challenging clinical scenarios rarely amenable to endovascular repair due to concerns regarding parenchymal loss following intervention. Herein, we add to the scant body of literature describing successful endovascular repair of a saccular, symptomatic renal artery aneurysm situated at a bifurcation point. METHODS: A 52 year-old woman with a 2.5 cm extra-parenchymal, saccular, symptomatic left renal artery aneurysm underwent self-expanding stent-assisted detachable platinum microcoil embolization...
March 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28274589/contemporary-use-of-drug-coated-balloons-in-coronary-artery-disease-where-are-we-now
#14
REVIEW
Fabien Picard, Serge Doucet, Anita W Asgar
The drug-coated balloon (DCB) has emerged as an additional tool in the arsenal of interventional cardiology devices; it delivers antiproliferative drugs to local arterial tissue by single prolonged coated balloon angioplasty inflation, and prevents restenosis, leaving no implant behind. This strategy theoretically decreases the risk of late inflammatory response to device components, without preventing positive remodelling. DCBs, when used carefully and with a good technique, may have a role in the treatment of lesion subsets, such as in-stent restenosis, small vessel disease or side branch bifurcations, in which the implantation of a drug-eluting stent is not desirable or is technically challenging...
March 5, 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28269012/cfd-analysis-of-strut-influence-on-blood-flow-in-stent-implanted-left-main-coronary-artery-bifurcation
#15
Yuya Yamada, Takahiro Tsukahara, Masahiro Motosuke, Yusuke Fujino
We numerically studied blood flows in a simulated branching pipe of coronary artery bifurcation, which is affected by stent implantation. We found that stent struts provide effects as guide vanes and blockages on the flow into circumflex branch. The former effect increases the flow rate and shear stress on the arteriosclerosis-prone site. The blockage effect may overwhelm the guide effect depending on a strut position against the inflow.
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28258843/mid-to-long-term-outcome-of-patients-treated-with-everolimus-eluting-bioresorbable-vascular-scaffolds-data-of-the-bvs-registry-g%C3%A3-ttingen-predominantly-from-acs-patients
#16
Kristian Hellenkamp, Alexander Becker, Yannick D Gabriel, Gerd Hasenfuß, Mark Hünlich, Claudius Jacobshagen, Wolfgang Schillinger, Marco R Schroeter
BACKGROUND: Bioresorbable vascular scaffolds (BVS) are widely used in routine clinical practice. While previous studies reported acceptable short- to midterm outcome after BVS implantation, data on longer-term outcome are rare. METHODS: Patients treated with at least one Absorb®-BVS were consecutively enrolled. Follow-up data were assessed after 834.0 [769.0-1026.0] days. The primary device-oriented composite endpoint (DOCE) was defined as cardiovascular death, myocardial infarction (MI) and/or target lesion revascularization (TLR)...
May 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28254257/snuggle-t-and-protrusion-s-tap-technique-for-coronary-bifurcation-stenting-a-step-by-step-angiographic-and-illustration-demonstration
#17
Ziad Dahdouh, Bahaa M Fadel, Vincent Roule, Antoine Sarkis, Gilles Grollier
T and small protrusion (TAP) is a stenting technique that is utilized for the management of coronary bifurcation lesions when using a two-stent strategy. This technique is also useful whenever stenting of a main vessel (MV) jeopardizes a side branch (SB) or when a sub-optimal result is encountered in a daughter vessel after starting with one-stent approach. The conversion from one-stent strategy to TAP could be achieved smoothly and often leads to good results. Technically, optimal positioning of the SB stent to achieve the required protrusion into the lumen of the MV remains a challenge...
February 8, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28250690/aortoiliac-reconstruction-in-the-setting-of-in-stent-restenosis
#18
H S Natraj Setty, T R Raghu, B C Srinivas, C M Nagesh, Babu Reddy, Jayashree Kharge, B K Geetha, B N Krishnamurthy, Shivanand Patil, C N Manjunath
Complex iliac artery obstructions, particularly bilateral stenosis or total iliac artery occlusions, are usually treated with aortofemoral or aortobifemoral graft surgery. However, surgical treatment is associated with 3% mortality rate and significant morbidity such as intestinal ischemia, spinal cord injury, and ureteral damage. Percutaneous interventions of aortic bifurcation offer a promising alternative to surgery with potentially lower morbidity and mortality risk. We report a case of peripheral artery disease who had underwent right transfemoral iliac angioplasty with femoropopliteal bypass presented again with bilateral lower limb ischemia, who was successfully treated with stent implantation with the kissing balloon technique...
January 2017: Journal of Natural Science, Biology, and Medicine
https://www.readbyqxmd.com/read/28238918/zenith-bifurcated-iliac-side-branch-device-mid-term-results-and-assessment-of-risk-factors-for-intraoperative-thrombosis
#19
Charline Delay, Sébastien Deglise, Anne Lejay, Yannick Georg, Mathieu Roussin, Mickaël Schaeffer, François Saucy, Fabien Thaveau, Jean-Marc Corpataux, Nabil Chakfe
INTRODUCTION: The aim of this study was to evaluate the short- and mid-term results of the Zenith bifurcated iliac side branch device (ZBIS) in the treatment of common iliac artery (CIA) aneurysms, and to assess risk factors for intraoperative internal iliac artery (IIA) thrombosis. MATERIALS AND METHODS: All patients who underwent endovascular treatment of either an isolated CIA aneurysm or an aorto-iliac aneurysm using the ZBIS device in the departments of vascular surgery of Strasbourg (France) and Lausanne (Switzerland) between January 2010 and December 2014 were retrospectively collected...
February 23, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28228303/impact-of-very-high-pressure-stent-deployment-on-angiographic-and-long-term-clinical-outcomes-in-true-coronary-bifurcation-lesions-treated-by-the-mini-crush-stent-technique-a-single-center-experience
#20
Antoine Gerbay, Jeremy Terreaux, Alexis Cerisier, Marco Vola, Karl Isaaz
BACKGROUND: Percutaneous coronary intervention (PCI) for bifurcation lesions (BL) using 2 stents technique is known to be associated with high rates of procedural failure especially on the side branch (SB) mainly due to stent incomplete apposition. Stent deployment at very high pressure (SDHP) may lead to better stent expansion and apposition. However, SDHP may also be at the origin of deeper wall injury resulting into major cardiac adverse events. No data are available on evaluation of SDHP in BL treated by a mini-crush stent technique...
January 2017: Indian Heart Journal
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