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Mori S, Hirano K, Takahara M, Shirai S, Makino K, Honda Y, Tsutsumi M, Kobayashi N, Yamawaki M, Ito Y. Accuracy of quantitative vessel analysis in endovascular treatment for femoropopliteal lesions. Quant Imaging Med Surg 2022; 12:568-575. [PMID: 34993102 DOI: 10.21037/qims-20-1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Our aim was to evaluate the accuracy of quantitative vessel analysis (QVA) in measuring the reference vessel diameter (RVD) of femoropopliteal lesions. METHODS Between October 2014 and September 2015, 30 consecutive femoropopliteal lesions in 25 patients who underwent endovascular therapy (EVT) under intravascular ultrasound (IVUS) guidance were analyzed. RVDs measured using QVAsheath (calibrated using a 6-Fr sheath in the common femoral artery) and QVAruler (calibrated using a ruler on the angiography table) were compared to those obtained using IVUS as the reference values. RESULTS The mean QVAsheath-measured RVD was significantly larger than the mean IVUS-measured RVD (5.34±1.29 vs. 5.07±1.20 mm, P=0.001). In contrast, mean QVAruler-measured RVD was 4.60±1.04 mm, which was significantly smaller than both the mean IVUS- and mean QVAsheath-measured RVD (both P<0.001). Bland-Altman analysis revealed that the 95% limits of agreement versus IVUS ranged from -0.94 to 1.49 mm for QVAsheath and -1.69 to 0.76 mm for QVAruler, respectively. Agreement with tolerance of ±1.00 mm accounted for 88% of QVAsheath and 83% of QVAruler (P=0.60). The difference between QVA- and IVUS-measured RVDs was inversely correlated with the distance from the table (P=0.029 for QVAsheath and P=0.003 for QVAruler). CONCLUSIONS The accuracy of both QVAsheath and QVAruler in measuring RVD were similarly suboptimal. Over- and under-estimation of RVD is not rare in QVA.
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Affiliation(s)
- Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Keisuke Hirano
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shigemitsu Shirai
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Kenji Makino
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yohsuke Honda
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Masakazu Tsutsumi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
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Kurata N, Iida O, Shiraki T, Fujita M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Sunaga A, Tsujimura T, Takahara M, Mano T. Impact of Stent-to-Vessel Diameter Ratio on Restenosis in the Superficial Femoral Artery After Endovascular Therapy. Circ J 2018; 82:1412-1417. [DOI: 10.1253/circj.cj-17-0726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Tatsuya Shiraki
- Cardiovascular Center, Kansai Rosai Hospital
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine
| | | | | | | | | | | | | | | | | | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine
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Kamioka N, Soga Y, Kuramitsu S, Iida O, Hirano K, Suzuki K, Kawasaki D, Yamaoka T, Suematsu N, Shintani Y, Miyashita Y, Takahashi H, Tsuchiya T, Shinozaki N, Okazaki S, Ando K. Clinical outcomes of balloon angioplasty alone versus nitinol stent implantation in patients with small femoropopliteal artery disease: Observations from the Retrospective Multicenter Analysis for Femoropopliteal Stenting (REAL-FP). Catheter Cardiovasc Interv 2017; 90:790-797. [PMID: 28722294 DOI: 10.1002/ccd.27192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/17/2017] [Accepted: 06/08/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We sought to assess whether balloon angioplasty (BA) alone for small femoropopliteal disease improved the outcome following endovascular therapy as compared with stent implantation. BACKGROUND The optimal strategy of endovascular therapy for small vessel arteries in femoropopliteal disease remains unclear. METHODS We performed a multicenter retrospective analysis of 337 consecutive patients (371 limbs) with femoropopliteal arteries 4.0 mm or less in diameter and 150 mm or less in length. RESULTS Cumulative 3-year incidence of primary patency was significantly higher in the BA group than in the stent group (53.8% vs. 34.2%, P = 0.002). While assisted-primary patency and freedom from any major adverse limb events were also significantly higher in the BA group than in the stent group (70.9% vs. 44.2%, P < 0.001 and 60.6% vs. 36.4%, P = 0.001, respectively), secondary patency did not significantly differ between the two groups (86.9% vs. 86.9%, P = 0.67). Predictors of restenosis were diabetes mellitus (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.14-2.31; P = 0.01), no administration of cilostazol (HR, 1.50; 95% CI, 1.07-2.13; P = 0.02), stent implantation (HR, 1.68; 95% CI, 1.15-2.41; P = 0.01), and lesion length >75.0 mm(HR, 2.09; 95% CI, 1.50-2.92; P < 0.001). CONCLUSIONS Lesions in small (<4.0 mm diameter) FP vessels demonstrated better primary patency at 3 years when successfully treated with balloon angioplasty alone as opposed to routine or bailout stenting. This difference was especially pronounced for lesions 75 to 150 mm in length.
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Affiliation(s)
- Norihiko Kamioka
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Osamu Iida
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan
| | - Kenji Suzuki
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Daizo Kawasaki
- Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan
| | - Terutoshi Yamaoka
- Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Nobuhiro Suematsu
- Department of Cardiology, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | | | - Yusuke Miyashita
- Department of Advanced PAD Therapeutics, Shinshu University, Matsumoto, Japan
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Taketsugu Tsuchiya
- Division of Trans-Catheter Cardiovascular Therapeutics, Kanazawa Medical University Hospital, Ishikawa, Japan
| | | | - Shinya Okazaki
- Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Hiramori S, Soga Y, Iida O, Suzuki K, Hirano K, Kawasaki D, Shintani Y, Ando K. Relationship between clinical outcomes and vessel size in endovascular therapy for femoropopliteal lesions. J Vasc Surg 2017; 65:1690-1697. [DOI: 10.1016/j.jvs.2016.12.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022]
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Shirai S, Hirano K, Kobayashi N. New endovascular technique for thrombus in the non-stenting zone-the Grab a Clot and Hold ON "(GACHON) technique": Case report. Catheter Cardiovasc Interv 2016; 89:1087-1092. [PMID: 27759183 DOI: 10.1002/ccd.26779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/05/2016] [Accepted: 08/15/2016] [Indexed: 11/10/2022]
Abstract
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. A thrombotic embolism occurred at the balloon protection site. It was too big to be removed using an aspiration catheter; therefore, we attempted removal with a self-expandable stent. Using a crossover approach, we delivered a nitinol self-expandable stent to the distal site of the thrombus, opened the tip of the stent, and pulled it up to the proximal site. Finally, we "grabbed a clot," moved it to the stenting zone, and "held on" the vessel wall without occurrence of a distal embolism. We named this the "GACHON technique." Case 2 underwent endovascular therapy for an acute thrombotic embolism in POP A after thoracic endovascular aortic repair for dissection. This thrombus was too big to aspirate, and we successfully treated it using the "GACHON technique." The "GACHON technique" may be considered as a choice of treatment for a thrombotic embolism in the non-stenting zone. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Shigemitsu Shirai
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Kanagawa, 230-8765, Japan
| | - Keisuke Hirano
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Kanagawa, 230-8765, Japan
| | - Norihiro Kobayashi
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Kanagawa, 230-8765, Japan
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Mori S, Hirano K, Nakano M, Muramatsu T, Tsukahara R, Ito Y, Ishimori H. Intravascular Ultrasound Measurements After Drug-Eluting Stent Placement in Femoropopliteal Lesions. J Endovasc Ther 2015; 22:341-9. [DOI: 10.1177/1526602815580308] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To investigate the relationship between postprocedure intravascular ultrasound (IVUS) findings and restenosis after placement of drug-eluting stents (DES) for femoropopliteal lesions. Methods: Between July 2012 and May 2013, DES were placed in 64 patients with 88 de novo femoropopliteal lesions. In 40 patients (mean age 74.2±9.4 years; 27 men), DES were placed in 50 lesions under IVUS guidance, and restenosis was monitored for 1 year. All patients were symptomatic (Rutherford 2–6), and 17 patients (43%) suffered from critical limb ischemia. IVUS findings after stenting were compared for patients with vs without restenosis, which was defined as a peak systolic velocity ratio >2.4 on duplex ultrasonography or >50% diameter stenosis on angiography. Results: Ten patients (14 lesions) developed restenosis, while 30 patients (36 lesions) did not. There were no significant differences in the frequency of diabetes or dialysis between the 2 groups. Female patients were predominant in the restenosis group (p<0.003). There were no significant differences of the percentage of TransAtlantic Inter-Society Consensus C/D lesions or stent edge dissection. Multivariate analysis indicated that cilostazol use [odds ratio (OR) 0.13; p=0.046], distal lumen cross-sectional area (CSA) (OR 0.86; p=0.035), and axial symmetry index (OR 0.60; p=0.045) were independent predictors of restenosis. Using receiver operator characteristic analysis, the best cutoff values of the distal lumen CSA and axial symmetry index for predicting restenosis were 17.1 cm2 and 0.6, respectively. Conclusion: IVUS guidance of DES placement in femoropopliteal lesions can offer useful predictors of restenosis at 1 year. The utility of distal lumen CSA and the axial symmetry index in the prediction of restenosis after femoropopliteal DES placement should be confirmed in a larger cohort.
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Affiliation(s)
- Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Masatsugu Nakano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Toshiya Muramatsu
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Reiko Tsukahara
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
| | - Hiroshi Ishimori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan
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Araki M, Hirano K, Nakano M, Ito Y, Ishimori H, Yamawaki M, Sasaki S, Takimura H, Sakamoto Y, Takama T, Tsukahara R, Muramatsu T. Two-year outcome of the self-expandable stent for chronic total occlusion of the iliac artery. Cardiovasc Interv Ther 2013; 29:40-6. [PMID: 24068528 DOI: 10.1007/s12928-013-0210-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/11/2013] [Indexed: 11/30/2022]
Abstract
To evaluate the 2-year results obtained with self-expandable stent for chronic total occlusion (CTO) of the iliac artery, a retrospective study was performed of patients who underwent endovascular therapy (EVT) for chronic iliac artery CTO who presented from April 2007 to September 2012. 82 patients with 86 occluded iliac arteries underwent successful recanalization and stenting with a self-expandable stent. The primary equivalence end point was a composite of restenosis, mortality, target vessel revascularization, and limb salvage rates. Patients were followed up with the presence of a palpable femoral artery pulse, resolution of symptoms, and noninvasive vascular laboratory testing reviewed at 1, 3, and 6 months after EVT and then were evaluated at 6-month intervals. In patients who gave consent, repeat angiography was done in sixty-one of 86 lesions (70.1 %) for follow-up. The mean follow-up was at 27.6 ± 17.8 months (range 3-60 months). All stents were placed in the true lumen under intravascular ultrasound (IVUS) guidance. There were no cases of peripheral embolization or iliac artery rupture after the procedure. The ankle-brachial index increased significantly from 0.55 ± 0.19 to 0.88 ± 0.17 (P < 0.001). The primary patency rate was 96.5 % at 2 years. The MLD immediately after the procedure was 5.10 ± 0.26 mm and increased significantly to 5.40 ± 0.28 mm at the period of follow-up angiography. The 2-year outcome of endovascular therapy with self-expandable stents for CTO of the iliac artery had an acceptable result.
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Affiliation(s)
- Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi Tsurumiku, Yokohama City, Kanagawa, 260-0012, Japan,
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