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Mochidome T, Takahara M, Miura T, Soga Y, Fujihara M, Kawasaki D, Hirano K, Choi D, Iida O. Vascular Pathology and Impact of Stent Eccentricity for Stent Restenosis in Femoropopliteal Endovascular Therapy. J Vasc Interv Radiol 2022; 33:1089-1096. [PMID: 35671987 DOI: 10.1016/j.jvir.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/18/2022] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To explore the clinical features associated with stent eccentricity and reveal the impact of stent eccentricity on 1-year restenosis risk after femoropopliteal stent implantation for symptomatic atherosclerotic peripheral artery disease (PAD). MATERIALS AND METHODS The effect of stent asymmetry expansion immediately after treatment on long-term patency has not been fully investigated. We used the clinical database of a multicenter prospective study registering 2,018 limbs of 1,766 patients in whom intravascular ultrasound (IVUS)-supported femoropopliteal endovascular therapy (EVT) for symptomatic atherosclerotic PAD was planned from November 2015 to June 2017. We included 1,233 limbs of 1,088 patients implanted with either a bare nitinol stent, drug-eluting stent (DES), or stent graft, and administered two or more antithrombotic drugs. Stent eccentricity was evaluated using IVUS calculated as ((maximum diameter)/(minimum diameter) - 1) at the cross-section segment with the lowest lumen area after stent implantation. RESULTS Chronic total occlusion and bilateral arterial calcification (peripheral artery calcification scoring system grades 3 and 4) were positively associated with stent eccentricity, whereas renal failure on dialysis, DES, and stent graft use were negatively associated with stent eccentricity (all p<0.05). Stent eccentricity was associated with an increased risk of 1-year restenosis (odds ratio (OR) 1.18, 95% confidence interval (CI) 1.01-1.37; p=0.034). However, after adjustment for the lesion severity and implanted stent types, the association was no longer significant (OR 1.07, 95% CI 0.91-1.24; p=0.43). CONCLUSION Stent eccentricity was not significantly associated with 1-year restenosis risk after femoropopliteal EVT.
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Affiliation(s)
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Miura
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Morinomiya Hospital, Osaka, Japan
| | - Daizo Kawasaki
- Department of Cardiology, Morinomiya Hospital, Osaka, Japan
| | - Keisuke Hirano
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | - Donghoon Choi
- Department of Cardiology, Yonsei University Severance Hospital, Seoul, South Korea
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
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Loffroy R, Falvo N, Galland C, Fréchier L, Ledan F, Midulla M, Chevallier O. Intravascular Ultrasound in the Endovascular Treatment of Patients With Peripheral Arterial Disease: Current Role and Future Perspectives. Front Cardiovasc Med 2020; 7:551861. [PMID: 33344512 PMCID: PMC7738328 DOI: 10.3389/fcvm.2020.551861] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Over the last decade, intravascular ultrasound (IVUS) has emerged as a useful adjunctive tool to angiography in an increasing number of catheter-based procedures for peripheral arterial disease (PAD). IVUS catheters offer accurate cross-sectional imaging of arterial vessels with high dimensional accuracy and provide accurate information about lesion morphology. IVUS enables assessment of the plaque morphology, vessel diameter, and the presence of arterial dissections. Furthermore, IVUS is able to properly guide the best choice of appropriate percutaneous transluminal angioplasty (PTA) technique, guide the delivery of different devices, and assess the immediate result of any endovascular intervention. In the present review, the role of IVUS for PAD will be discussed, specifically the applications of IVUS technology during interventional procedures including PTA, stent sizing, crossing total occlusion, assessing residual narrowing and stent apposition and expansion, and atherectomy. Future perspectives of IVUS-guided treatments and cost-effectiveness of the systematic use of IVUS during endovascular interventions will be also discussed.
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Affiliation(s)
- Romaric Loffroy
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Christophe Galland
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Léo Fréchier
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Frédérik Ledan
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
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Hayakawa N, Kodera S, Ohki N, Sakkya S, Kanda J. Efficacy of three-dimensional road mapping by fusion of computed tomography angiography and fluoroscopy in endovascular treatment of aorto-iliac chronic total occlusion. Heart Vessels 2020; 36:359-365. [PMID: 32885284 DOI: 10.1007/s00380-020-01694-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
The efficacy of multimodality image fusion road-mapping technique for endovascular therapy has been reported recently. Our aim was to evaluate the efficacy of endovascular therapy (EVT) with three-dimensional (3D) road mapping by fusing computed tomography (CT) and angiographical volumetric data for aorto-iliac chronic total occlusion (CTO). We retrospectively analyzed 36 patients with aorto-iliac CTO from June 2017 to November 2019 and classified them into two groups: EVT using a CT fused 3D roadmap (CTf3D-RM; 3D group, n = 14) and standard EVT (standard group, n = 22). Primary endpoint was wiring time and secondary endpoints were procedural success rate, number of guidewires, procedure time, radiation dose, contrast medium dose, and complications. Wiring time was significantly shorter in the 3D group than the standard group (3D, 15.6 ± 10.23 min vs. standard, 44.6 ± 35.3 min; p = 0.0052). Both groups had high procedural success rates (3D, 100% vs. standard, 100%) and low complication rates (3D, 0.0% vs. standard, 9.1%; p = 0.51). There were significantly fewer guidewires in the 3D group than the standard group (3D, 2.78 ± 1.31 vs. standard, 4.36 ± 2.01; p = 0.0138). The 3D group trended towards shorter procedural time (3D, 78.8 ± 32.5 min vs. standard, 107.5 ± 52.5 min; p = 0.076), lower radiation dose (3D, 28.6 ± 18.9 Gycm2 vs. standard, 48.9 ± 49.2 Gycm2; p = 0.15), and lower contrast medium dose (3D, 102.2 ± 30.6 vs. standard, 127.5 ± 51.3; p = 0.11) than the standard group. Therefore, we concluded that EVT with CTf3D-RM is effective for aorto-iliac CTO. This method may improve the quality of aorto-iliac CTO interventions.
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Affiliation(s)
- Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326, Asahi, Chiba, 289-2511, Japan.
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan
| | - Noriyoshi Ohki
- Department of Radiology, Asahi General Hospital, Asahi, Chiba, Japan
| | - Sandeep Sakkya
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326, Asahi, Chiba, 289-2511, Japan
| | - Junji Kanda
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326, Asahi, Chiba, 289-2511, Japan
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Piazza M, Squizzato F, Dall’Antonia A, Lepidi S, Menegolo M, Grego F, Antonello M. Editor's Choice – Outcomes of Self Expanding PTFE Covered Stent Versus Bare Metal Stent for Chronic Iliac Artery Occlusion in Matched Cohorts Using Propensity Score Modelling. Eur J Vasc Endovasc Surg 2017; 54:177-185. [DOI: 10.1016/j.ejvs.2017.03.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/21/2017] [Indexed: 12/13/2022]
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Vuruskan E, Saracoglu E. Procedural and Early Outcomes of Two Re-entry Devices for Subintimal Recanalization of Aortoiliac and Femoropopliteal Chronic Total Occlusions. Korean Circ J 2016; 47:89-96. [PMID: 28154596 PMCID: PMC5287192 DOI: 10.4070/kcj.2016.0310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/15/2016] [Accepted: 10/18/2016] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Subintimal angioplasty is a common treatment choice for chronic total occlusions (CTO) in the iliac and femoropopliteal arteries. This article describes the technical aspects and early outcomes of two different re-entry devices and comparison with manual re-entry technique. Subjects and Methods A retrospective review of 61 patients (re-entry group) treated with Outback or Pioneer Plus catheters was carried out. A matched cohort of patients (n=62) who underwent lower extremity interventions without the use of re-entry devices (manual re-entry group) were also analyzed (overall 123 patients were analyzed). Procedural success, procedural durations, patency estimates, ankle-brachial indices, and complications were analyzed. Results Sixty-one patients underwent Outback or Pioneer Plus guided subintimal recanalization. After the procedure, ankle-brachial indices significantly increased in all patients during follow-up. Primary patency for the entire cohort was 83% in the first month. When the re-entry device group was compared with manual re-entry group, no difference was found with respect to success, complication, and patencies between the two groups during follow-up. However, procedure duration and the amount of contrast agent used was significantly decreased in re-entry groups (p<0.001). Also, re-entry time was significantly decreased in Pioneer plus group according to Outback group (p<0.001) Conclusion Recanalization of CTO using re-entry devices for aortoiliac or femoropopliteal arteries is safe and effective. These devices shorten the procedure time, the re-entry time, reduce radiation risk, and reduce the amount of contrast agent employed.
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Affiliation(s)
- Ertan Vuruskan
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | - Erhan Saracoglu
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
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Endovascular Treatment of Chronic Total Occlusions of the Iliac Arteries: Early and Midterm Results. Ann Vasc Surg 2015; 29:1508-15. [DOI: 10.1016/j.avsg.2015.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 05/30/2015] [Accepted: 07/03/2015] [Indexed: 11/23/2022]
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Bekken JA, Jongsma H, de Vries JPP, Fioole B. Self-expanding stents and aortoiliac occlusive disease: a review of the literature. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:99-105. [PMID: 24833925 PMCID: PMC4014367 DOI: 10.2147/mder.s60594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The treatment of symptomatic aortoiliac occlusive disease has shifted from open to endovascular repair. Both short- and long-term outcomes after percutaneous angioplasty and stenting rival those after open repair and justify an endovascular-first approach. In this article, we review the current endovascular treatment strategies in patients with aortoiliac occlusive disease, indications for primary and selective stenting in the iliac artery, and physical properties and future perspectives of self-expanding stents.
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Affiliation(s)
- Joost A Bekken
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Hidde Jongsma
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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