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Das TS, Shammas NW, Yoho JA, Martinez-Clark P, Ramaiah V, Leon LR, Pacanowski JP, Tai Z, Ali V, Arslan B, Rundback J. Solid state, pulsed-wave 355 nm UV laser atherectomy debulking in the treatment of infrainguinal peripheral arterial disease: The Pathfinder Registry. Catheter Cardiovasc Interv 2024; 103:949-962. [PMID: 38566525 DOI: 10.1002/ccd.31023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/07/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Atherectomy is an important option for debulking atherosclerotic plaque from diseased arteries in patients with infrainguinal arterial disease. Laser atherectomy uses a high-powered laser to remove the plaque from the arteries to restore blood flow. AIMS The Pathfinder multicenter registry was initiated to evaluate the safety and efficacy of the 355 nm laser atherectomy system in a real-world setting for the treatment of de novo, re-stenotic and in-stent restenosis (ISR) lesions in infrainguinal arteries of patients with peripheral artery disease (PAD). METHODS The study was a prospective, single-arm, multicenter, open-label registry study for patients treated with the 355 nm laser system. Clinical and lesion characteristics, procedural safety and efficacy data, and baseline, 6-, and 12-month outcomes data, including Ankle Brachial Index (ABI), Rutherford class, and Walking Impairment Questionnaires (WIQ), were collected. The primary efficacy endpoint was the achievement of ≤30% final residual stenosis at the index lesion postatherectomy and adjunctive therapy evaluated by an angiographic Core Lab. The primary safety endpoint was the percentage of subjects who did not experience periprocedural major adverse events (PPMAEs) before discharge. RESULTS One hundred and two subjects with 121 lesions treated with the 355 nm laser device at 10 centers were included in the analysis. Mean age was 68.4 ± 10.21 years, 61.8% of subjects were male, 44.6% had critical limb ischemia (CLI), and 47.3% had tibial lesions. The mean residual stenosis at the end of the procedure was 24.4 ± 15.5 with 69 lesions (69.0%) achieving technical procedural success (<30% stenosis); similar rates were observed for subjects with ISR (25.5 ± 14.9), chronic total occlusion (CTO) (28.1 ± 17.0), and severe calcification (36.5 ± 21.6) lesions. Mean ABI, Rutherford, and WIQ scores were improved at both 6 and 12 months. Ninety-seven of 102 subjects (95.1%) met the primary safety endpoint of not experiencing a PPMAE before discharge. CONCLUSIONS The initial data from the Pathfinder Registry demonstrates the 355 nm laser system is safe and effective in a real-world setting for performing atherectomy in patients with infrainguinal PAD.
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Affiliation(s)
- Tony S Das
- The Heart Hospital Baylor Plano, Plano, Texas, USA
| | | | - Jason A Yoho
- The Texas Cardiac and Vascular Institute, Corpus Christi, Texas, USA
| | | | | | - Luis R Leon
- Pima Heart and Vascular, Tucson, Arizona, USA
| | | | - Zaheed Tai
- Comprehensive Cardiovascular Specialists, Winter Haven, Florida, USA
| | - Vaqar Ali
- First Coast Cardiovascular Institute, Jacksonville, Florida, USA
| | - Bulent Arslan
- Rush University Medical Center, Chicago, Illinois, USA
| | - John Rundback
- NJ Endovascular and Amputation Prevention, West Orange, New Jersey, USA
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Kareem AK, Gabir MM, Ali IR, Ismail AE, Taib I, Darlis N, Almoayed OM. A review on femoropopliteal arterial deformation during daily lives and nickel-titanium stent properties. J Med Eng Technol 2022; 46:300-317. [PMID: 35234558 DOI: 10.1080/03091902.2022.2041749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The increasing number of studies on the behaviour of stent placement in recent decades provides a clear understanding of peripheral artery disease (PAD). The severe mechanical loads (axial tension and compression, bending, radial compression and torsion) deformation of the femoropopliteal artery (FPA) is responsible for the highest failure rate of permanent nickel-titanium (Nitinol) stents. Therefore, the purpose of this article is to review research papers that examined the deformation of the natural load environment of FPA, the properties of Nitinol and mechanical considerations. In conclusion, a better understanding of mechanical behaviour for FPA Nitinol stents contributes to increased mechanical performance and fatigue-life.
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Affiliation(s)
- Ali K Kareem
- Department of Biomedical Engineering, Al-Mustaqbal University College, Hillah, Iraq.,Faculty of Mechanical and Manufacturing Engineering, Universiti Tun Hussein Onn Malaysia (UTHM), Batu Pahat, Malaysia
| | - Mustafa M Gabir
- Air Conditioning and Refrigeration Techniques Engineering Department, Al-Mustaqbal University College, Hillah, Iraq
| | - Inas R Ali
- Business Administration Department, Al-Mustaqbal University College, Hillah, Iraq.,Faculty of Applied Sciences and Technology, Universiti Tun Hussein Onn Malaysia, Muar, Malaysia
| | - Al E Ismail
- Faculty of Mechanical and Manufacturing Engineering, Universiti Tun Hussein Onn Malaysia (UTHM), Batu Pahat, Malaysia
| | - Ishkrizat Taib
- Faculty of Mechanical and Manufacturing Engineering, Universiti Tun Hussein Onn Malaysia (UTHM), Batu Pahat, Malaysia
| | - Nofrizalidris Darlis
- Faculty of Mechanical and Manufacturing Engineering, Universiti Tun Hussein Onn Malaysia (UTHM), Batu Pahat, Malaysia
| | - Omar M Almoayed
- Faculty of Mechanical and Manufacturing Engineering, Universiti Tun Hussein Onn Malaysia (UTHM), Batu Pahat, Malaysia
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Effect of Nitinol on Metabolic and Coagulation Activity of Endothelial Cells Culture. Bull Exp Biol Med 2021; 171:480-482. [PMID: 34542754 DOI: 10.1007/s10517-021-05255-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Indexed: 10/20/2022]
Abstract
We studied the effect of nitinol, the most prevalent material for endovascular stents, on metabolic and coagulation activity of a primary culture of human umbilical vein endothelial cells (HUVEC). Metabolic activity was evaluated using MTS-test and by the level of stable NO metabolites in the conditioned medium, coagulation activity was assessed by activity of von Willebrand factor (vWF) and levels of plasminogen activator inhibitor-1 (PAI-1) and soluble endothelial protein C receptors (sEPCR). Exposure to nitinol reduced metabolic activity of the cell culture by 11.1% in comparison with the control (p<0.001). Although absolute activity of vWF and absolute level of sEPCR were elevated, incubation with nitinol did not lead to a statistically significant elevation of these parameters in comparison with the control, which can indicate the absence of substantial hypercoagulation effects of nitinol.
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Karimi Galougahi K, Soukas PA, Kolski B, Tayal R, Parikh SA, Armstrong EJ, Petrossian G, Kaki A, Rosenfield K, Gray WA, Ali ZA. Acoustic shock waves to modify calcific plaques - Intravascular lithotripsy in the peripheral circulation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:135-144. [PMID: 34187754 DOI: 10.1016/j.carrev.2021.06.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/01/2021] [Accepted: 06/22/2021] [Indexed: 12/23/2022]
Abstract
Intravascular lithotripsy (IVL) is a new technique for treatment of severely calcified lesions that uses acoustic shockwaves in a balloon-based system to induce fracture in calcific plaque, facilitating luminal gain and vessel expansion. In this review, we provide a concise summary of the available data and clinical experience of IVL in various peripheral vascular beds, including facilitating vascular access for large-bore devices. We discuss the physics and mode of action of IVL in modifying calcified plaques, include several illustrative examples of utility of IVL in peripheral interventions, and discuss the future directions for adoption of the technique in peripheral interventions.
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Affiliation(s)
- Keyvan Karimi Galougahi
- Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Heart Research Institute, Sydney, Australia
| | - Peter A Soukas
- The Miriam Hospital/Brown Medical School, Providence, RI, United States of America
| | - Brian Kolski
- Department of Cardiology, St Joseph Hospital, Orange, CA, United States of America
| | - Rajiv Tayal
- University of Medicine and Dentistry of New Jersey, Newark, NJ, United States of America
| | - Sahil A Parikh
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, United States of America
| | - Ehrin J Armstrong
- University of Colorado School of Medicine, Aurora, CO, United States of America
| | - George Petrossian
- DeMatteis Cardiovascular Institute, St Francis Hospital, Roslyn, NY, United States of America
| | - Amir Kaki
- Ascension Health, Detroit, MI, United States of America
| | | | - William A Gray
- Main Line Health/Lankenau Heart Institute, Wynnewood, PA, United States of America
| | - Ziad A Ali
- DeMatteis Cardiovascular Institute, St Francis Hospital, Roslyn, NY, United States of America; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States of America.
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Zheng Q, Dong P, Li Z, Lv Y, An M, Gu L. Braided composite stent for peripheral vascular applications. NANOTECHNOLOGY REVIEWS 2020; 9:1137-1146. [PMID: 35936942 PMCID: PMC9354498 DOI: 10.1515/ntrev-2020-0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Braided composite stent (BCS), woven with nitinol wires and polyethylene terephthalate (PET) strips, provides a hybrid design of stent. The mechanical performance of this novel stent has not been fully investigated yet. In this work, the influence of five main design factors (number of nitinol wires, braiding angle, diameter of nitinol wire, thickness and stiffness of the PET strip) on the surface coverage, radial strength, and flexibility of the BCS were systematically studied using computational models. The orthogonal experimental design was adopted to quantitatively analyze the sensitivity of multiple factors using the minimal number of study cases. Results have shown that the nitinol wire diameter and the braiding angle are two most important factors determining the mechanical performance of the BCS. A larger nitinol wire diameter led to a larger radial strength and less flexibility of the BCS. A larger braiding angle could provide a larger radial strength and better flexibility. In addition, the impact of the braiding angle decreased when the stent underwent a large deformation. At the same time, the impact of the PET strips increased due to the interaction with nitinol wires. Moreover, the number of PET strips played an important role in the surface coverage. This study could help understand the mechanical performance of BCS stent and provides guidance on the optimal design of the stent targeting less complications.
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Affiliation(s)
- Qingli Zheng
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Pengfei Dong
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL, 32901, United States of America
| | - Zhiqiang Li
- Institute of Applied Mechanics, College of Mechanical and Vehicle Engineering Taiyuan University of Technology, Taiyuan, 030024, China
| | - Ying Lv
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
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Rundback J, Chandra P, Brodmann M, Weinstock B, Sedillo G, Cawich I, Micari A, Lee A, Metzger C, Palena LM, Shammas NW. Novel laser‐based catheter for peripheral atherectomy: 6‐month results from the Eximo Medical B‐Laser™ IDE study. Catheter Cardiovasc Interv 2019; 94:1010-1017. [DOI: 10.1002/ccd.28435] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/16/2019] [Accepted: 07/27/2019] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | | | - Gino Sedillo
- Cardiovascular Solutions Institute Bradenton Florida
| | - Ian Cawich
- Arkansas Heart Hospital Little Rock Arkansas
| | - Antonio Micari
- Maria Cecilia Hospital Cotignola Italy
- Gavazzeni Humanitas Hospital Bergamo Italy
| | - Arthur Lee
- North Florida Regional Medical Center Gainesville Florida
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Maleckis K, Anttila E, Aylward P, Poulson W, Desyatova A, MacTaggart J, Kamenskiy A. Nitinol Stents in the Femoropopliteal Artery: A Mechanical Perspective on Material, Design, and Performance. Ann Biomed Eng 2018; 46:684-704. [PMID: 29470746 DOI: 10.1007/s10439-018-1990-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/31/2018] [Indexed: 12/12/2022]
Abstract
Endovascular stenting has matured into a commonly used treatment for peripheral arterial disease (PAD) due to its minimally invasive nature and associated reductions in short-term morbidity and mortality. The mechanical properties of the superelastic Nitinol alloy have played a major role in the explosion of peripheral artery stenting, with modern stents demonstrating reasonable resilience and durability. Yet in the superficial femoral and popliteal arteries, even the newest generation Nitinol stents continue to demonstrate clinical outcomes that leave significant room for improvement. Restenosis and progression of native arterial disease often lead to recurrence of symptoms and reinterventions that increase morbidity and health care expenditures. One of the main factors thought to be associated with stent failure in the femoropopliteal artery (FPA) is the unique and highly dynamic mechanical environment of the lower limb. Clinical and experimental data demonstrate that the FPA undergoes significant deformations with limb flexion. It is hypothesized that the inability of many existing stent designs to conform to these deformations likely plays a role in reconstruction failure, as repetitive movements of the leg and thigh combine with mechanical mismatch between the artery and the stent and result in mechanical damage to both the artery and the stent. In this review we will identify challenges and provide a mechanical perspective of FPA stenting, and then discuss current research directions with promise to provide a better understanding of Nitinol, specific features of stent design, and improved characterization of the biomechanical environment of the FPA to facilitate development of better stents for patients with PAD.
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Affiliation(s)
- Kaspars Maleckis
- Department of Surgery, 987690 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-7690, USA
| | - Eric Anttila
- Department of Surgery, 987690 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-7690, USA
| | - Paul Aylward
- Department of Surgery, 987690 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-7690, USA
| | - William Poulson
- Department of Surgery, 987690 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-7690, USA
| | - Anastasia Desyatova
- Department of Surgery, 987690 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-7690, USA
| | - Jason MacTaggart
- Department of Surgery, 987690 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-7690, USA.
| | - Alexey Kamenskiy
- Department of Surgery, 987690 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-7690, USA.
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Maleckis K, Deegan P, Poulson W, Sievers C, Desyatova A, MacTaggart J, Kamenskiy A. Comparison of femoropopliteal artery stents under axial and radial compression, axial tension, bending, and torsion deformations. J Mech Behav Biomed Mater 2017; 75:160-168. [PMID: 28734257 DOI: 10.1016/j.jmbbm.2017.07.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/05/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
High failure rates of Peripheral Arterial Disease (PAD) stenting appear to be associated with the inability of certain stent designs to accommodate severe biomechanical environment of the femoropopliteal artery (FPA) that bends, twists, and axially compresses during limb flexion. Twelve Nitinol stents (Absolute Pro, Supera, Lifestent, Innova, Zilver, Smart Control, Smart Flex, EverFlex, Viabahn, Tigris, Misago, and Complete SE) were quasi-statically tested under bench-top axial and radial compression, axial tension, bending, and torsional deformations. Stents were compared in terms of force-strain behavior, stiffness, and geometrical shape under each deformation mode. Tigris was the least stiff stent under axial compression (6.6N/m axial stiffness) and bending (0.1N/m) deformations, while Smart Control was the stiffest (575.3N/m and 105.4N/m, respectively). Under radial compression Complete SE was the stiffest (892.8N/m), while Smart Control had the lowest radial stiffness (211.0N/m). Viabahn and Supera had the lowest and highest torsional stiffness (2.2μNm/° and 959.2μNm/°), respectively. None of the 12 PAD stents demonstrated superior characteristics under all deformation modes and many experienced global buckling and diameter pinching. Though it is yet to be determined which of these deformation modes might have greater clinical impact, results of the current analysis may help guide development of new stents with improved mechanical characteristics.
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Affiliation(s)
- Kaspars Maleckis
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Paul Deegan
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - William Poulson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Cole Sievers
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Anastasia Desyatova
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States.
| | - Alexey Kamenskiy
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States.
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Brahmbhatt A, Misra S. Techniques in Vascular and Interventional Radiology Drug Delivery Technologies in the Superficial Femoral Artery. Tech Vasc Interv Radiol 2016; 19:145-52. [PMID: 27423996 DOI: 10.1053/j.tvir.2016.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Peripheral arterial disease (PAD) affects over 8 million people in the United States alone. Although great strides have been made in reducing the burden of cardiovascular disease the prevalence of PAD is expected to rise with the age of global population. PAD characterized by narrowing of arterial blood can be asymptomatic or cause limb threatening claudication. It has been classically treated with bypass, but these techniques have been supplanted by endovascular therapy. Plain old balloon angioplasty has been successful in helping revascularize lesions, but its effect has not been durable because of restenosis. This prompted the creation of several technologies aimed at reducing restenosis. These advances slowly improved outcomes and the durability of endovascular management. Among the main tools used in current endovascular practice are drug-delivery devices aimed at inhibiting the inflammatory and proliferative pathways that lead to restenosis. This article examines the current drug-delivery technologies used in the superficial femoral artery.
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Affiliation(s)
- Akshaar Brahmbhatt
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology Mayo Clinic, Rochester, MN; Department of Radiology, Mayo Clinic, Rochester, MN; Rutgers-New Jersey Medical School, Newark, NJ
| | - Sanjay Misra
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology Mayo Clinic, Rochester, MN; Department of Radiology, Mayo Clinic, Rochester, MN.
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