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Yu C, Tang W, Ren T, Chen Q, Lu R, Gao Y. Network Meta-Analysis of All Available Regimens Based on Drug-Coated Balloon Angioplasty and Laser Atherectomy for Femoropopliteal In-Stent Restenosis. J Endovasc Ther 2024; 31:390-399. [PMID: 36189843 DOI: 10.1177/15266028221125581] [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] [Indexed: 12/24/2022]
Abstract
PURPOSE Drug-coated balloon (DCB) angioplasty and laser atherectomy (LA) have been frequently utilized to treat femoropopliteal in-stent restenosis (ISR); however, no studies have concurrently compared available regimens, including DCB, LA+DCB, and LA + plain balloon angioplasty (PB). Therefore, we conducted this network meta-analysis to determine whether there were significant differences in outcomes among these regimens. MATERIALS AND METHODS A comprehensive search was conducted in PubMed, EMBASE, and the Cochrane library to identify all randomized controlled trials comparing DCB or LA-based regimes with POBA or each other for treating femoropopliteal in-stent restenosis (ISR) from their inception until March 2021. The primary outcome measure was binary restenosis, and secondary outcome measures were target lesion revascularization (TLR) and mortality, evaluated at 6 and 12 months, respectively. Statistical analysis was performed using Aggregate Data Drug Information System (ADDIS) 1.4 software, and all data were graphically summarized using Microsoft Excel software. RESULTS The final analysis included 11 studies, of which 6 studies compared DCB with PB, 2 studies compared PB vs LA+PB, 2 studies compared DCB vs LA+DCB, and 1 study compared LA+DCB with LA+PB. DCB was better than PB in decreasing binary restenosis at 6 (odds ratio [OR]: 0.22, 95% credible interval [CrI]: 0.04-0.91) and 12 (OR: 0.26, 95% CrI: 0.12-0.50) months. DCB was associated with lower TLR than PB at 6 months (OR: 0.31, 95% CrI: 0.13-0.69). LA+DCB was also superior to PB in treating binary restenosis at 12 months (OR: 6.10, 95% CrI: 1.94-24.41) and TLR at 6 months (OR: 5.32, 95% CrI: 1.43-28.06). There was no statistical difference in mortality between PB, DCB, and LA+PB. DCB and LA+DCB were the first 2 options for reducing binary restenosis and TLR. CONCLUSION The current network meta-analysis demonstrates that both DCB and LA+DCB are superior to PB alone, and that DCB and LA+DCB may be the preferred treatment options for reducing binary restenosis and TLR. CLINICAL IMPACT The treatment for femoropopliteal in-stent restenosis (ISR) remains challenging clinical practice. One important reason is that no optimal treatment strategy was available. Drug-coated balloon angioplasty (DCB) and laser atherectomy (LA) have been extensively utilized to treat ISR; however, different combinations of these treatments further confused the clinicians' choices. This network meta-analysis systematically investigated the difference between the currently available treatments regarding therapeutic effects and safety, indicating that DCB and LA+DCB may be the optimal treatment for decreasing the risk of binary restenosis and target lesion revascularization. The results of the current network meta-analysis help to resolve the confusion of clinicians in making the decision.
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Affiliation(s)
- Chaowen Yu
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Wenbo Tang
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Tiancai Ren
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Qiwei Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Ran Lu
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Yong Gao
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
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Gujja K, Purushottam B, Kapur V, Cox‐Alomar PR, Krishnan P. Popliteal Artery Interventions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Carr J, Bowman J, Watts M, Ouriel K, Dave R. United States Investigational Device Exemption study of the Revolution™ Peripheral Atherectomy System. J Vasc Surg 2021; 75:976-986.e4. [PMID: 34624496 DOI: 10.1016/j.jvs.2021.08.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 08/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Atherectomy has become commonplace as an adjunct to interventional treatments for peripheral arterial disease, but the procedures have been complicated by risks including distal embolization and arterial perforation. This study aimed to examine the safety and effectiveness of a novel atherectomy system to treat femoropopliteal and below-knee peripheral arterial disease. METHODS The Revolution Peripheral Atherectomy System (Rex Medical LP, Conshohocken, Pa) was studied in 121 patients with 148 femoropopliteal and below-knee lesions, enrolled at 17 United States institutions. Technical success was defined when the post-atherectomy angiographic stenosis was ≤50%, as assessed by an independent core laboratory. Major adverse events were adjudicated by an independent Clinical Events Committee. RESULTS Among 148 site-identified target lesions in 121 patients, 21.4% were in the superficial femoral artery, 13.7% involved the popliteal artery, and 67.9% were in tibial arteries; 3.1% involved more than one segment. Technical success was 90.2%, with stenoses decreasing from 73% ± 19% at baseline to 42% ± 14% after atherectomy. Adjunctive treatment after atherectomy included angioplasty with uncoated balloons in 91%, drug-coated balloons in 11%, bare stent deployment in 8%, and drug-eluting stent placement in 3%. Procedural success (<30% residual stenosis) was achieved in 93.7% of target lesions. Complications during the procedure included one target vessel perforation and two distal embolizations; each of which were adjudicated by the Clinical Events Committee as unrelated to the device and were not visualized angiographically by the core laboratory. Freedom from major adverse events was 97.3% through 30 days. The Kaplan-Meier estimates of primary, assisted primary, and secondary patency were 81.6%, 87.7%, and 91.6% at 6 months, respectively. CONCLUSIONS The use of the Revolution Peripheral Atherectomy System was associated with few procedural complications and a high rate of success at the index procedure and through 6 months.
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Affiliation(s)
- Jeffrey Carr
- CardiaStream-Tyler Cardiac and Endovascular Center, Tyler.
| | | | | | | | - Raj Dave
- Geisinger Holy Spirit, Camp Hill
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Rocha-Singh KJ, Sachar R, DeRubertis BG, Nolte-Ernsting CCA, Winscott JG, Krishnan P, Scott EC, Garcia LA, Baeriswyl JL, Ansel G, Rosenfield K, Zeller T. Directional atherectomy before paclitaxel coated balloon angioplasty in complex femoropopliteal disease: The VIVA REALITY study. Catheter Cardiovasc Interv 2021; 98:549-558. [PMID: 34080792 DOI: 10.1002/ccd.29777] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/16/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Drug coated balloon (DCB) angioplasty significantly reduces reintervention rates in patients with symptomatic femoropopliteal peripheral artery disease (PAD). However, stand-alone DCB use in long, severely calcified lesions is frequently associated with vessel recoil and/or high-grade dissections necessitating provisional stent implantation. OBJECTIVES Assess the safety and effectiveness of a vessel preparation strategy with directional atherectomy (DA) prior to DCB angioplasty in patients with symptomatic severely calcified femoropopliteal PAD. METHODS REALITY (NCT02850107) prospectively enrolled subjects at 13 multinational centers with 8-36 cm femoropopliteal stenoses or occlusions with bilateral vessel wall calcification treated with DA prior to DCB angioplasty. The primary effectiveness endpoint was 12-month primary patency, and the primary safety endpoint was freedom from major adverse events through 30 days. Independent angiographic and duplex core laboratories assessed outcomes and a Clinical Events Committee adjudicated events. RESULTS A total of 102 subjects were enrolled; one lesion was treated per subject. The mean lesion length was 17.9 ± 8.1 cm, 39.0% were chronic total occlusions (mean lesion length 22.6 ± 8.6 cm); 86.2% of lesions exhibited moderate to severe bilateral calcification. Provisional stents were implanted in 8.8% (9/102) of subjects. Twelve-month primary patency rate was 76.7% (66/86) and freedom from CD-TLR rate was 92.6% (87/94). No device or procedure related deaths and one index-limb major amputation were reported. CONCLUSIONS Plaque excision with DA in patients with symptomatic severely calcified femoropopliteal arterial disease prior to DCB angioplasty is a safe and effective treatment strategy with a low provisional stent rate.
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Affiliation(s)
- Krishna J Rocha-Singh
- Department of Cardiology, Prairie Heart Institute at St. John's Hospital, Springfield, Illinois, USA
| | - Ravish Sachar
- Department of Cardiology, Rex Medical Center, Raleigh, North Carolina, USA
| | - Brian G DeRubertis
- Division of Vascular and Endovascular Surgery, University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Claus C A Nolte-Ernsting
- Department of Interventional Radiology, Evangelic Hospital Muelheim an der Ruhr, Muelheim an der Ruhr, Germany
| | - John G Winscott
- Department of Cardiology, University of Mississippi, Jackson, Mississippi, USA
| | - Prakash Krishnan
- Department of Cardiology, Mt. Sinai Medical Center, New York, New York, USA
| | - Eric C Scott
- Department of Vascular Surgery, The Iowa Clinic, West Des Moines, Iowa, USA
| | - Lawrence A Garcia
- Department of Cardiology, Steward St. Elizabeth Medical Center, Boston, Massachusetts, USA
| | - Jean-Luc Baeriswyl
- Division of Clinical Statistics, Clinlogix LLC, Lower Gwynedd, Pennsylvania, USA
| | - Gary Ansel
- Department of Cardiology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Kenneth Rosenfield
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas Zeller
- Department of Angiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Giannopoulos S, Strobel A, Rudofker E, Kovach C, Schneider PA, Armstrong EJ. Association of Postangioplasty Femoropopliteal Dissections With Outcomes After Drug-Coated Balloon Angioplasty in the Femoropopliteal Arteries. J Endovasc Ther 2021; 28:593-603. [PMID: 34002659 DOI: 10.1177/15266028211016441] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Balloon angioplasty for the treatment of femoropopliteal lesions is often complicated by postangioplasty dissections. While dissections are known to affect patency and reintervention after balloon angioplasty, the association between dissections and major adverse limb event (MALE) after drug-coated balloon (DCB) angioplasty remains uncertain. Thus, the postangioplasty dissection and bailout stenting patterns were investigated. MATERIALS AND METHODS This was a single-center retrospective study enrolling patients with de novo femoropopliteal lesions treated with DCB with/without stenting. Postangioplasty target vessel dissection was graded based to the coronary artery classification grades A-F, with grade C-F considered "severe." Cox regression analysis was performed to examine the association of dissection severity with outcomes during 2-year follow up, among nonstented cases. RESULTS In 85.3% of the cases (N=203/238) a postangioplasty dissection was observed. The average dissection length was 55.57 mm (SD 36.71 mm), with 1 dissection present in 91.8% (N=180/196) and 2 or more dissections present in 8.2% (N=16/196). Dissection severity was grade A (19.8%), B (20.6%), C (23.1%), D (10.9%), E (10.1%), and F (0.8%). Bailout stenting was required in 40.4% of the patients, being more prevalent among grade C and grade E cases. Among 142 nonstented cases, dissections were present in 85.2%. A total of 75 (52.8%) of these dissections were grade A and B, while 46 (32.4%) were grade C to F. Among nonstented cases, grade C (hazard ratio [HR] 5.83; 95% CI 1.25 to 27.31; p=0.025) and grade D (HR 6.32; 95% CI 1.39 to 28.86; p=0.017) vs grade A dissections were associated with a higher risk for 2-year MALE. Multivariate analysis adjusting for several lesion characteristics demonstrated a statistically significant higher risk for 2-year MALE among the severe dissection group (HR 2.94; 95% CI 1.27 to 6.79; p = 0.012). Interestingly, the risks of limb loss (HR 1.30; 95% CI 0.22 to 7.79; p=0.774) and repeat revascularization (HR 0.95; 95% CI 0.40 to 2.26; p=0.905) during follow-up were similar between the 2 groups. CONCLUSION This study indicated that nonstented moderate and severe postangioplasty dissections after DCB angioplasty were associated with higher risk for MALE. Future studies are needed to validate our results and determine other dissection characteristics (eg, total dissection length, lumen area, total number of dissections) that may affect the efficacy of DCB.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Aaron Strobel
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Eric Rudofker
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Christopher Kovach
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California at San Francisco, CA, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
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Miki K, Fujii K, Tanaka T, Yanaka K, Yoshihara N, Nishimura M, Sumiyoshi A, Horimatsu T, Imanaka T, Fukunaga M, Akahori H, Masuyama T, Ishihara M. Impact of IVUS-Derived Vessel Size on Midterm Outcomes After Stent Implantation in Femoropopliteal Lesions. J Endovasc Ther 2020; 27:77-85. [PMID: 31948376 DOI: 10.1177/1526602819896293] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To identify intravascular ultrasound (IVUS) findings that predict midterm stent patency in femoropopliteal (FP) lesions. Materials and Methods: A retrospective analysis was undertaken of 335 de novo FP lesions in 274 consecutive patients (mean age 72.4±8.2 years; 210 men) who had IVUS assessment before and after successful stent implantation. The mean lesion length was 13.2±9.8 cm. The primary outcome was primary patency at 24 months, defined as freedom from major adverse limb event (MALE) and in-stent restenosis (ISR). MALE was defined as major amputation or any target lesion revascularization (TLR). ISR was defined by a peak systolic velocity ratio >2.4 by duplex ultrasonography. Logistic regression analyses were performed to identify independent predictors of stent patency at 24 months; the results are presented as the odds ratio (OR) and 95% confidence interval (CI). Receiver operator characteristic (ROC) curve analysis was performed to determine the optimal threshold for prediction of stent patency at 24 months. Results: Over the 24-month follow-up, 18 (7%) patients died and 43 (15%) of 286 lesions were responsible for MALE (42 TLRs and 1 major amputation). Primary patency was estimated at 82.5% (95% CI 78.1% to 86.9%) at 12 months and 73.2% (95% CI 67.9% to 78.5%) at 24 months. Multivariable analysis revealed that longer lesion length (OR 0.89, 95% CI 0.82 to 0.97, p<0.01) was an independent predictor of declining patency, while cilostazol use (OR 3.45, 95% CI 1.10 to 10.78, p=0.03) and increasing distal reference external elastic membrane (EEM) area (OR 1.18, 95% CI 1.02 to 1.37, p=0.03) were associated with midterm stent patency. ROC curve analysis identified a distal reference EEM area of 29.0 mm2 as the optimal cut-point for prediction of 24-month stent patency (area under the ROC curve 0.764). Kaplan-Meier estimates of 24-month primary patency were 83.7% (95% CI 78.3% to 89.2%) in lesions with a distal EEM area >29.0 mm2 vs 53.1% (95% CI 42.9% to 63.3%) in those with a distal EEM area ≤29.0 mm2 (p<0.001). Conclusion: In FP lesions with a larger distal vessel area estimated with IVUS, stent implantation can be considered as a reasonable treatment option, with the likelihood of acceptable midterm results.
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Affiliation(s)
- Kojiro Miki
- Division of Cardiovascular Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kenichi Fujii
- Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Takamasa Tanaka
- Division of Cardiovascular Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Koji Yanaka
- Division of Cardiovascular Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Nagataka Yoshihara
- Division of Cardiovascular Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | | | | | - Tetsuo Horimatsu
- Division of Cardiovascular Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takahiro Imanaka
- Division of Cardiovascular Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | | | - Hirokuni Akahori
- Division of Cardiovascular Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tohru Masuyama
- Department of Cardiology, JCHO Hoshigaoka Medical Center, Hirakata, Japan
| | - Masaharu Ishihara
- Division of Cardiovascular Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Kokkinidis DG, Behan S, Jawaid O, Hossain P, Giannopoulos S, Singh GD, Laird JR, Valle JA, Waldo SW, Armstrong EJ. Laser atherectomy and drug‐coated balloons for the treatment of femoropopliteal in‐stent restenosis: 2‐Year outcomes. Catheter Cardiovasc Interv 2019; 95:439-446. [DOI: 10.1002/ccd.28636] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/12/2019] [Accepted: 11/22/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Damianos G. Kokkinidis
- Division of Cardiology, Rocky Mountain Regional VA Medical CenterUniversity of Colorado Denver Colorado
| | - Sean Behan
- Division of Cardiology, Rocky Mountain Regional VA Medical CenterUniversity of Colorado Denver Colorado
| | - Omar Jawaid
- Division of Cardiology, Rocky Mountain Regional VA Medical CenterUniversity of Colorado Denver Colorado
| | - Prio Hossain
- Vascular Center and Division of Cardiovascular MedicineUniversity of California Davis Sacramento California
| | - Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical CenterUniversity of Colorado Denver Colorado
| | - Gagan D. Singh
- Vascular Center and Division of Cardiovascular MedicineUniversity of California Davis Sacramento California
| | - John R. Laird
- Vascular Center and Division of Cardiovascular MedicineUniversity of California Davis Sacramento California
| | - Javier A. Valle
- Division of Cardiology, Rocky Mountain Regional VA Medical CenterUniversity of Colorado Denver Colorado
| | - Stephen W. Waldo
- Division of Cardiology, Rocky Mountain Regional VA Medical CenterUniversity of Colorado Denver Colorado
| | - Ehrin J. Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical CenterUniversity of Colorado Denver Colorado
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Varela DL, Armstrong EJ. Endovascular Management of Femoropopliteal In-Stent Restenosis: A Systematic Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:915-925. [DOI: 10.1016/j.carrev.2018.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/06/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
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Gandini R, Pratesi G, Merolla S, Scaggiante J, Chegai F. A Single-Center Experience With Phoenix Atherectomy System in Patients With Moderate to Heavily Calcified Femoropopliteal Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:676-681. [PMID: 31488361 DOI: 10.1016/j.carrev.2019.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/11/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate efficacy and safety of a new rotational atherectomy (RA), the Phoenix Atherectomy™ System, for the treatment of de novo and re-stenotic or occlusions atherosclerotic moderate-heavily lesions of the femoro-popliteal axis. MATERIAL AND METHODS From January 2015 to August 2017, 52 patients with heavily calcified femoro-popliteal lesions causing severe stenosis or occlusions were enrolled in our center to be treated using Phoenix catheters. Primary endpoints of this study were acute efficacy and safety at 30 days. Secondary endpoints were freedom from restenosis and target lesion revascularization (TLR)/target vessel revascularization (TVR) at 1-, 6- and 12- months. RESULTS The mean lesion length was 9.2 cm (range 5-23 cm). The lesions were located in superficial femoral artery (SFA) in 61.5% (Fig. 1-A), in popliteal artery in 21.1% and involved femoral-popliteal axis in 15.4%. A primary technical success was achieved in 51/52 patients, with an optimal working channel after RA alone. Using Kaplan-Meyer analysis, primary vessel patency rates at 1, 6 and 12 -months was 96.1%, 86.5% and 76.9% respectively. Assisted primary patency at 1, 6- and 12 -months was 100%, 90.3% and 86.5% respectively. CONCLUSIONS Recanalisation with the Phoenix Atherectomy System is simple and safe, with a high technical success rate.
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Affiliation(s)
- Roberto Gandini
- Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Giovanni Pratesi
- Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Merolla
- Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Jacopo Scaggiante
- Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Fabrizio Chegai
- Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
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Hajibandeh S, Hajibandeh S, Antoniou SA, Torella F, Antoniou GA. Treatment strategies for in-stent restenosis in peripheral arterial disease: a systematic review. Interact Cardiovasc Thorac Surg 2019; 28:253-261. [PMID: 30052955 DOI: 10.1093/icvts/ivy233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/15/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our purpose was to investigate the outcomes of different treatment strategies for in-stent restenosis (ISR) in patients with peripheral arterial disease of the lower limbs. METHODS We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. We searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials comparing different treatments for ISR in peripheral arterial disease. Recurrent ISR and freedom from target lesion revascularization were defined as the primary outcome measures. We performed an indirect comparison meta-analysis of different treatments. RESULTS We identified 4 randomized controlled trials that fulfilled our inclusion criteria enrolling a total of 491 patients and another 4 ongoing trials. Each of the included trials reported 1 of the 4 comparisons: drug-coated balloon angioplasty versus standard balloon angioplasty; treatment with heparin-bonded Viabahn endoprosthesis versus standard balloon angioplasty; excimer laser atherectomy plus standard balloon angioplasty versus standard balloon angioplasty alone; and peripheral cutting balloon angioplasty versus standard balloon angioplasty. The risk of recurrent ISR at 12 months was significantly higher with standard balloon angioplasty than with drug-coated balloon angioplasty (P = 0.004). There was no significant difference in the risk of recurrent ISR at 6 months between cutting balloon angioplasty and standard balloon angioplasty (P = 0.73). Freedom from target lesion revascularization at 12 months was significantly higher with drug-coated balloon angioplasty (P < 0.001) and treatment with the heparin-bonded Viabahn endoprosthesis (P < 0.001) than with standard balloon angioplasty. Freedom from target lesion revascularization at 6 months was also significantly higher with excimer laser atherectomy plus standard balloon angioplasty than with standard balloon angioplasty (P = 0.003). Tested indirect comparisons revealed large confidence intervals and no statistically significant difference between treatments. CONCLUSIONS The results from individual trials suggest that drug-coated balloon angioplasty, treatment with the heparin-bonded Viabahn endoprosthesis and adjuvant excimer laser atherectomy confer improved outcomes compared with standard balloon angioplasty. Ongoing clinical trials may elucidate uncertainties in the optimal management of ISR in this setting.
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Affiliation(s)
- Shahab Hajibandeh
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Shahin Hajibandeh
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Stavros A Antoniou
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Francesco Torella
- Liverpool Vascular and Endovascular Service, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
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Sauguet A, Philippart R, Honton B. Directional atherectomy with antirestenotic therapy for the treatment of no-stenting zones. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:198-204. [PMID: 30650962 DOI: 10.23736/s0021-9509.19.10866-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endovascular treatment for peripheral artery occlusive disease carries unresolved problem of restenosis. Treatment modalities in areas of high mechanical stress like popliteal artery and common femoral artery remains challenging. New-generation devices improved the results of stent therapy in this anatomical territory, but could impact on future surgical options if they are needed. Vessel preparation prior to drug (paclitaxel)-coated balloons (DCB) angioplasty leads to better paclitaxel penetration into the arterial wall and improved drug uptake. The "leave nothing behind" strategies, DCB angioplasty and combined directional atherectomy (DA) and antirestenotic therapy (DAART), can theoretically overcome the problems caused by the mobility of the knee joint. However, calcified and longer lesions remain a challenging subset that is less responsive to DCBs, resulting in higher provisional stent rates. For the treatment of long and calcified femoropopliteal lesions, vessel preparation with DA before DCB angioplasty seems to be safe in mid-term follow-up and might have benefits in more challenging lesion subsets that are at higher risk for acute and chronic technical treatment failure of percutaneous transluminal angioplasty, including DCB angioplasty, such as severely calcified lesions. Treatment with DA+DCB resulted in both increased technical success and fewer flow-limiting dissections compared with treatment with DCB alone. In concept of "leave nothing behind" therapies for isolated popliteal artery lesions, DAART was associated with a higher primary patency rate than DCB angioplasty alone.
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Affiliation(s)
- Antoine Sauguet
- Interventional Cardiovascular Group, Pasteur Toulouse Clinic, Pasteur GCVI Clinic, Toulouse, France -
| | - Raphaël Philippart
- Interventional Cardiovascular Group, Pasteur Toulouse Clinic, Pasteur GCVI Clinic, Toulouse, France
| | - Benjamin Honton
- Interventional Cardiovascular Group, Pasteur Toulouse Clinic, Pasteur GCVI Clinic, Toulouse, France
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Wong G, Lahsaei S, Aoun J, Garcia LA. Management of common femoral artery occlusive disease: A review of endovascular treatment strategies and outcomes. Catheter Cardiovasc Interv 2018; 93:514-521. [DOI: 10.1002/ccd.27983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Gordon Wong
- Department of Internal MedicineUniversity of California Davis California
| | - Saba Lahsaei
- Department of Cardiovascular Medicine, St. Elizabeth's Medical CenterTufts University School of Medicine Boston Massachusetts
| | - Joe Aoun
- Department of Cardiovascular Medicine, St. Elizabeth's Medical CenterTufts University School of Medicine Boston Massachusetts
| | - Lawrence A. Garcia
- Department of Cardiovascular Medicine, St. Elizabeth's Medical CenterTufts University School of Medicine Boston Massachusetts
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13
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Qato K, Conway AM, Mondry L, Giangola G, Carroccio A. Management of isolated femoropopliteal in-stent restenosis. J Vasc Surg 2018; 68:807-810. [PMID: 30144908 DOI: 10.1016/j.jvs.2018.01.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/04/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The optimal catheter-directed therapy for femoropopliteal in-stent restenosis (ISR) remains controversial with limited durability. The natural history of untreated ISR is not well characterized. We evaluated the midterm outcomes of patients with asymptomatic isolated femoropopliteal ISR who were observed under a surveillance program. METHODS Patients treated with isolated femoropopliteal stents from January 2009 to December 2013 were retrospectively investigated for the development of ISR. ISR was classified on the basis of duplex ultrasound criteria, with >50% defined as peak systolic velocity (PSV) twice that of the normal vessel and >75% as PSV >400 cm/s or four times the normal PSV. Asymptomatic patients with ISR of >50% were tracked for progression to high-grade (>75%) stenosis, occlusion, need for reintervention, and amputation. RESULTS Asymptomatic ISR of >50% was identified in 62 (15.3%) of 402 patients with isolated femoropopliteal stents. The mean time for development of ISR was 22.1 (±20.1) months. The mean age was 72 (±9.7) years, and 34 (55.7%) patients were female. Thirty-one (50%) patients were diabetic, 18 (29.1%) were smokers, and 8 (12.9%) had chronic kidney disease. Indications for treatment were claudication in 49 (79.0%), tissue loss in 9 (14.5%), and rest pain in 4 (6.4%) patients. TransAtlantic Inter-Society Consensus (TASC) A lesions were treated in 13 (21%) patients, TASC B lesions in 24 (38.7%), and TASC C lesions in 25 (40.3%). Three-vessel runoff was identified in 25 (40.3%) patients, two-vessel runoff in 18 (29.0%), and one-vessel runoff in 19 (30.6%). Under surveillance, ISR of >50% progressed to >75% or occlusion in 20 (32.3%) patients. The mean time to progression was 17.4 months, and the mean overall follow-up was 33.1 months. Reintervention was required in 22 (35.0%) patients, with an average of 1.95 (range, 1-4) interventions per patient. Reintervention was undertaken in 19 (86%) patients for claudication and in 3 (18%) patients for critical limb ischemia. One patient required an amputation despite previous reintervention for progression. Progression to >75% stenosis was predictive of need for reintervention (P = .004). CONCLUSIONS Under a surveillance program, asymptomatic patients with femoropopliteal ISR of >50% may be observed with a low risk of limb loss. Given the slow rate of progression and the poor durability of reintervention, surveillance with delayed intervention may be warranted.
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Affiliation(s)
- Khalil Qato
- Division of Vascular Surgery, Lenox Hill Hospital, Northwell Health, New York, NY.
| | - Allan M Conway
- Division of Vascular Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Laurie Mondry
- Division of Vascular Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Gary Giangola
- Division of Vascular Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Alfio Carroccio
- Division of Vascular Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
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14
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Patel SV, Sonani R, Patel P, Patel M, Bhatt P, Badheka A. Effect of hospital volume on outcomes of percutaneous peripheral atherectomy - An observational analysis from National Inpatient Sample. Vascular 2018; 26:615-625. [PMID: 29973108 DOI: 10.1177/1708538118786596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the published literature has reported an inverse association between hospital volume and outcomes of coronary interventions, sparse data are available for percutaneous peripheral atherectomy (PPA). The aim of our study was to examine the effect of hospital volume on outcomes of PPA. METHODS Using the Nationwide Inpatient Sample (NIS) database of the year 2012, PPA with ICD-9 code of 17.56 was identified. The primary outcomes were mortality and amputation rates; secondary outcomes were peri-procedural complications, cost, and length of hospitalization and discharge disposition of the patient. Multivariate models were generated for predictors of the outcomes. RESULTS We identified a total of 21,015 patients with mean age of 69.53 years, with 56% males. Higher hospital volume centers were associated with a significantly lower mortality (OR 0.42, 95% CI 0.30-0.57, p < 0.0001), amputation rates (5.34% vs. 9.32%, p < 0.0001), combined endpoint of mortality and complications (OR 0.53, 95% CI 0.49-0.58, p < 0.0001), shorter length of hospital stay (LOS) (4.86 vs. 6.79 days, p < 0.0001) and lower hospitalization cost ($23,062 vs. $30,794, p < 0.0001). Subgroup analysis for acute and chronic limb ischemia showed similar results. CONCLUSION Hospital procedure volume is an independent predictor of mortality, amputation rates, complications, LOS, and costs in patients undergoing PPA with an inverse relationship.
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Affiliation(s)
- Samir V Patel
- 1 Sparks Regional Medical Center, University of Arkansas Medical Sciences west, Fort Smith, AR, USA
| | | | - Palak Patel
- 3 Massachusetts College of Pharmacy and Health Sciences, Manchester, NH, USA
| | | | - Parth Bhatt
- 5 Texas Tech Health Sciences Center, Amarillo, TX, USA
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15
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Krishnan P, Tarricone A, K-Raman P, Majeed F, Kapur V, Gujja K, Wiley J, Vasquez M, Lascano RA, Quiles KG, Distin T, Fontenelle R, Atallah-Lajam F, Kini A, Sharma S. Intravascular ultrasound guided directional atherectomy versus directional atherectomy guided by angiography for the treatment of femoropopliteal in-stent restenosis. Ther Adv Cardiovasc Dis 2018; 12:17-22. [PMID: 29265002 DOI: 10.1177/1753944717745509] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to compare 1-year outcomes for patients with femoropopliteal in-stent restenosis using directional atherectomy guided by intravascular ultrasound (IVUS) versus directional atherectomy guided by angiography. METHODS AND RESULTS This was a retrospective analysis for patients with femoropopliteal in-stent restenosis treated with IVUS-guided directional atherectomy versus directional atherectomy guided by angiography from a single center between March 2012 and February 2016. Clinically driven target lesion revascularization was the primary endpoint and was evaluated through medical chart review as well as phone call follow up. CONCLUSIONS Directional atherectomy guided by IVUS reduces clinically driven target lesion revascularization for patients with femoropopliteal in-stent restenosis.
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Affiliation(s)
- Prakash Krishnan
- Mount Sinai Medical Center, 1 Gustave l Levy Place, Box 1080, New York, 10026, NY, USA
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16
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Jetstream Atherectomy System treatment of femoropopliteal arteries: Results of the post-market JET Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:506-511. [DOI: 10.1016/j.carrev.2017.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/22/2017] [Indexed: 11/24/2022]
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17
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Brodmann M, Keirse K, Scheinert D, Spak L, Jaff MR, Schmahl R, Li P, Zeller T. Drug-Coated Balloon Treatment for Femoropopliteal Artery Disease: The IN.PACT Global Study De Novo In-Stent Restenosis Imaging Cohort. JACC Cardiovasc Interv 2018; 10:2113-2123. [PMID: 29050631 DOI: 10.1016/j.jcin.2017.06.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/20/2017] [Accepted: 06/13/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to evaluate the safety and effectiveness of a paclitaxel-coated drug-coated balloon (DCB) for the treatment of patients with de novo in-stent restenosis (ISR). BACKGROUND Treatment of patients with ISR remains a challenge. Current strategies are plagued by high rates of recurrent restenosis and need for reintervention. The best intervention for ISR remains to be elucidated. METHODS The IN.PACT Global study is an independently adjudicated multicenter, prospective, single-arm study that enrolled 1,535 subjects with symptomatic atherosclerotic disease of the superficial femoral and/or popliteal arteries, including de novo ISR lesions. Patients enrolled in the pre-specified ISR imaging cohort were evaluated for vessel patency and reintervention within the 12-month follow-up period. RESULTS A total of 131 subjects with 149 ISR lesions were included for analysis. The mean age of the cohort was 67.8 years. Mean lesion length was 17.17 ± 10.47 cm, including 34.0% total occlusions and 59.1% calcified lesions. The 12-month Kaplan-Meier estimate of primary patency was 88.7%. The rate of clinically driven target lesion revascularization (CD TLR) at 12 months was 7.3%. The primary safety outcome, a composite of freedom from device- and procedure-related mortality through 30 days and freedom from major target limb amputation and CD TLR within 12 months, was 92.7%. There were no major target limb amputations, no deaths, and a low (0.8%) thrombosis rate. CONCLUSIONS Results from the ISR imaging cohort demonstrate high patency and a low rate of CD TLR at 12 months. These data confirm the safety and effectiveness of the IN.PACT Admiral DCB (Medtronic, Dublin, Ireland) in complex femoropopliteal lesions, including this challenging subset.
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Affiliation(s)
- Marianne Brodmann
- Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria.
| | - Koen Keirse
- Department of Vascular Surgery, Regional Hospital Heilig Hart Tienen, Tienen, Belgium
| | - Dierk Scheinert
- Division of Interventional Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Lubomir Spak
- Clinic of Angiology, Eastern Slovak Institute for Cardiovascular Diseases, Kosice, Slovak Republic
| | - Michael R Jaff
- President, Newton-Wellesley Hospital, Newton, Massachusetts; Professor of Medicine, Harvard Medical School Boston, Massachusetts
| | - Randy Schmahl
- Medtronic, Bakken Research Center BV, Maastricht, the Netherlands
| | - Pei Li
- Medtronic, Minneapolis, Minnesota
| | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
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18
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Loffroy R, Chevallier O, Falvo N, Gehin S, Midulla M, Galland C. Combined HawkOne directional atherectomy and paclitaxel-coated balloon angioplasty for isolated calcified popliteal artery lesion: a no-stent approach to lower extremity endovascular revascularization. Quant Imaging Med Surg 2018; 8:364-367. [PMID: 29774189 DOI: 10.21037/qims.2018.03.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Romaric Loffroy
- Department of Vascular Medicine and Interventional Radiology, Center of Mini-Invasive Image-Guided Therapies, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular Medicine and Interventional Radiology, Center of Mini-Invasive Image-Guided Therapies, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular Medicine and Interventional Radiology, Center of Mini-Invasive Image-Guided Therapies, François-Mitterrand University Hospital, Dijon, France
| | - Sophie Gehin
- Department of Vascular Medicine and Interventional Radiology, Center of Mini-Invasive Image-Guided Therapies, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- Department of Vascular Medicine and Interventional Radiology, Center of Mini-Invasive Image-Guided Therapies, François-Mitterrand University Hospital, Dijon, France
| | - Christophe Galland
- Department of Vascular Medicine and Interventional Radiology, Center of Mini-Invasive Image-Guided Therapies, François-Mitterrand University Hospital, Dijon, France
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19
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Tatò F, Heilmeier B. [Peripheral arterial disease]. MMW Fortschr Med 2018; 160:54-62. [PMID: 29417496 DOI: 10.1007/s15006-018-0002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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AbuRahma AF. When Are Endovascular and Open Bypass Treatments Preferred for Femoropopliteal Occlusive Disease? Ann Vasc Dis 2018; 11:25-40. [PMID: 29682105 PMCID: PMC5882358 DOI: 10.3400/avd.ra.18-00001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Several meta-analyses and multicenter trials have shown that chronic limb ischemia did not occur for up to 5 years in 50%–70% of patients who underwent saphenous vein grafts, with limb salvage and perioperative mortality rates of >80% and 3%, respectively. However, open surgical bypass can have limitations, including postoperative morbidity/wound complications of 10%–20% and prolonged length of hospital stay and outpatient care. Several studies have analyzed clinical outcomes for patients with critical limb ischemia treated with endovascular therapies, but they have been mainly retrospective with significant heterogeneity or were single center. Only few randomized trials have compared surgical vs. endovascular therapy. These included the Bypass vs. Angioplasty in Severe Ischemia of the Leg (BASIL) trial, with no differences found in amputation-free or overall survival rates at 1 year; however, late outcomes favored the surgical group. The Bypass or Angioplasty in Severe Intermittent Claudication (BASIC) trial concluded that the 1-year patency rates were 82% and 43% for bypass and angioplasty, respectively. The BEST Endovascular vs. Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial is currently enrolling patients. This review analyzed studies comparing open vs. endovascular therapy in patients with femoropopliteal disease. (This is a review article based on the invited lecture of the 45th Annual Meeting of Japanese Society for Vascular Surgery.)
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Affiliation(s)
- Ali F AbuRahma
- Department of Surgery, West Virginia University, Charleston, West Virginia, USA
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21
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Kobayashi N, Hirano K, Yamawaki M, Araki M, Sakai T, Sakamoto Y, Mori S, Tsutsumi M, Honda Y, Ito Y. Simple classification and clinical outcomes of angiographic dissection after balloon angioplasty for femoropopliteal disease. J Vasc Surg 2017; 67:1151-1158. [PMID: 29242063 DOI: 10.1016/j.jvs.2017.08.092] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Angiographic dissection is considered to be associated with restenosis. However, little is known about the impact of the severity of angiographic dissection on future restenosis. METHODS A total of 319 consecutive de novo femoropopliteal lesions were treated by balloon angioplasty alone. All of these lesions were divided into three groups: group A, no angiographic dissection; group B, mild dissection, the width of the dissection was less than one-third of the lumen; and group C, severe dissection, the width of the dissection was more than one-third of the lumen. Kaplan-Meier analysis estimated the primary patency rate at 3 years between the groups. RESULTS The primary patency rates at 3 years were 66.0% in group A, 63.8% in group B, and 32.5% in group C (log-rank, P < .001). Cox proportional hazards analysis revealed that a lesion length >100 mm (hazard ratio, 1.734; 95% confidence interval, 1.099-2.735; P = .018) and severe angiographic dissection (hazard ratio, 1.956; 95% confidence interval, 1.276-2.997; P = .002) were predictors of primary patency loss at 3 years. When the lesions were divided into two groups according to the lesion length >100 mm or not, angiographic dissection had a larger impact on restenosis in a long lesion >100 mm (≤100 mm: 65.5% in group A, 75.6% in group B, and 48.0% in group C [log-rank, P = .015]; >100 mm: 68.8% in group A, 42.5% in group B, and 24.2% in group C [log-rank, P = .017]). CONCLUSIONS Severe angiographic dissection was associated with future restenosis after balloon angioplasty for femoropopliteal lesions, but mild angiographic dissection was not. Angiographic dissection had more impact on future restenosis particularly in treated long lesions. Stents might not be necessary in short lesions with mild dissection.
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Affiliation(s)
- Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Tsuyoshi Sakai
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yasunari Sakamoto
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Masakazu Tsutsumi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yohsuke Honda
- 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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22
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Kovalenko YA, Zharikov YO. [Portal cholangiocarcinoma: epidemiology, staging principles and aspects of tumor biology]. Khirurgiia (Mosk) 2017:85-91. [PMID: 29186104 DOI: 10.17116/hirurgia20171185-91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Yu O Zharikov
- A.V. Vishnevsky Institute of Surgery, Moscow, Russia
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23
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Rastan A, McKinsey JF, Garcia LA, Rocha-Singh KJ, Jaff MR, Harlin S, Kamat S, Janzer S, Zeller T. One-Year Outcomes Following Directional Atherectomy of Popliteal Artery Lesions: Subgroup Analysis of the Prospective, Multicenter DEFINITIVE LE Trial. J Endovasc Ther 2017; 25:100-108. [PMID: 29117818 PMCID: PMC5774616 DOI: 10.1177/1526602817740133] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose: To report the effectiveness of directional atherectomy for the treatment of popliteal artery occlusive disease. Methods: This subset of the prospective, multicenter, single-arm DEFINITIVE LE trial included 158 patients (mean age 72.0±10.9 years; 82 men) who underwent directional atherectomy in 162 popliteal artery lesions between 2009 and 2011. Forty-eight (30.4%) patients were suffering from critical limb ischemia (CLI). The mean lesion length was 5.8±3.9 cm; 38 (23.5%) arteries were occluded. The primary outcome measure for patients with intermittent claudication (IC) was duplex ultrasound–defined primary patency at 1 year; the outcome for subjects with CLI was freedom from major amputation of the target limb at 1 year. Outcomes and adverse events were independently assessed. Results: Procedure success (≤30% residual stenosis) was achieved in 84.4% of treated lesions; adjunctive stenting was required in 6 (3.7%) of the 162 lesions. The 1-year primary patency rate was 75.0% (IC patients 78.2% and CLI patients 67.5%, p=0.118). The freedom from major amputation in both cohorts was 100%. In both IC and CLI patients, significant improvements were demonstrated at 1 year in the Rutherford category, walking distance, and quality of life in comparison to baseline. Conclusion: This study indicates that directional atherectomy in popliteal arteries leads to favorable technical and clinical results at 1 year for claudicant as well as CLI patients.
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Affiliation(s)
- Aljoscha Rastan
- 1 Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - James F McKinsey
- 2 Division of Vascular Surgery, Mount Sinai Health Care System, New York, NY, USA
| | - Lawrence A Garcia
- 3 Sections of Interventional Cardiology and Vascular Medicine, Steward St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Michael R Jaff
- 5 VasCore, Massachusetts General Hospital, Boston, MA, USA
| | - Stuart Harlin
- 6 Santa Rosa Medical Center, Vascular and Interventional Radiology, Pensacola, FL, USA
| | - Suraj Kamat
- 7 Alice Heart and Vascular Center, Alice, TX, USA
| | - Sean Janzer
- 8 Einstein Heart and Vascular Institute, Philadelphia, PA, USA
| | - Thomas Zeller
- 1 Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Abstract
PURPOSE OF THE REVIEW Percutaneous transluminal angioplasty is an established form of therapy for femoropopliteal artery disease. Currently, percutaneous transluminal angioplasty (PTA) is carried out using standard balloon with or without deployment of a stent but is associated with a high rate of restenosis and stent-related complications. Treatment options for restenosis, especially in-stent restenosis, are limited. Drug-coated balloons promise to reduce the rates of restenosis by effective delivery of antiproliferative agent (paclitaxel) directly to vessel wall without the need for a permanent implant. In this review, we look at the technology and rationale behind drug-coated balloons and examine the evidence available so far. RECENT FINDINGS Recently, several studies tested the effectiveness of paclitaxel-coated balloon angioplasty compared to that of standard PTA in both de novo lesions and in-stent restenosis of femoropopliteal artery. Paclitaxel-coated balloon use resulted in reduced rates of restenosis and favourable clinical outcomes in both these lesion groups. However, in complex lesions, there is still lack of data to support the use of these balloons. Paclitaxel-coated balloon is a safe and effective therapeutic option in patients with both de novo lesions and in-stent restenosis involving femoropopliteal artery. In light of the new evidence, it is time to consider incorporation of this effective therapeutic option into clinical practice. However, further research is needed for the use of paclitaxel-coated balloons in complex femoropopliteal lesions like calcified lesions especially as adjuncts to cutting balloons and debulking strategies.
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25
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Katsanos K, Spiliopoulos S, Reppas L, Karnabatidis D. Debulking Atherectomy in the Peripheral Arteries: Is There a Role and What is the Evidence? Cardiovasc Intervent Radiol 2017; 40:964-977. [PMID: 28451812 PMCID: PMC5486795 DOI: 10.1007/s00270-017-1649-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/04/2017] [Indexed: 02/05/2023]
Abstract
Traditional percutaneous balloon angioplasty and stent placement is based on mechanical plaque disruption and displacement within the arterial wall. On the contrary, transcatheter atherectomy achieves atherosclerotic plaque clearance by means of directional plaque excision or rotational plaque removal or laser plaque ablation. Debulking atherectomy may allow for a more uniform angioplasty result at lower pressures with consequently less vessel barotrauma and improved luminal gain, thereby decreasing the risk of plaque recoil and dissection that may require permanent metal stenting. It has been also argued that atherectomy may disrupt the calcium barrier and optimize drug transfer and delivery in case of drug-coated balloon applications. The authors discuss the various types of atherectomy devices available in clinical practice to date and critically appraise their mode of action as well as relevant published data in each case. Overall, amassed randomized and observational evidence indicates that percutaneous atherectomy of the femoropopliteal and infrapopliteal arteries may achieve high technical success rates and seems to lessen the frequency of bailout stenting, however, at the expense of increased risk of peri-procedural distal embolization. Long-term clinical outcomes reported to date do not support the superiority of percutaneous atherectomy over traditional balloon angioplasty and stent placement in terms of vessel patency or limb salvage. The combination of debulking atherectomy and drug-coated balloons has shown promise in early studies, especially in the treatment of more complex lesions. Unanswered questions and future perspectives of this continuously evolving endovascular technology as part of a broader treatment algorithm are discussed.
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Affiliation(s)
- Konstantinos Katsanos
- Department of Interventional Radiology, School of Medicine, Patras University Hospital, Panepistimiou St., 26504, Rion, Greece.
- Guy's and St.Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Stavros Spiliopoulos
- Interventional Radiology Unit, 2nd Department of Radiology, ATTIKO Athens University Hospital, 1st Rimini St., Chaidari, 12461, Athens, Greece
| | - Lazaros Reppas
- Interventional Radiology Unit, 2nd Department of Radiology, ATTIKO Athens University Hospital, 1st Rimini St., Chaidari, 12461, Athens, Greece
| | - Dimitris Karnabatidis
- Department of Interventional Radiology, School of Medicine, Patras University Hospital, Panepistimiou St., 26504, Rion, Greece
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Ho KJ, Owens CD. Diagnosis, classification, and treatment of femoropopliteal artery in-stent restenosis. J Vasc Surg 2017; 65:545-557. [PMID: 28126181 DOI: 10.1016/j.jvs.2016.09.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/13/2016] [Indexed: 01/19/2023]
Abstract
In-stent restenosis is a pervasive challenge to the durability of stenting for the treatment of lower extremity ischemia. There is considerable controversy about the criteria for diagnosis, indications for treatment, and preferred algorithm for addressing in-stent restenosis. This evidence summary seeks to review existing information on strategies for the treatment of this difficult problem.
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Affiliation(s)
- Karen J Ho
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Christopher D Owens
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, Calif
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27
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Ott I, Cassese S, Groha P, Steppich B, Hadamitzky M, Ibrahim T, Kufner S, Dewitz K, Hiendlmayer R, Laugwitz KL, Schunkert H, Kastrati A, Fusaro M. Randomized Comparison of Paclitaxel-Eluting Balloon and Stenting Versus Plain Balloon Plus Stenting Versus Directional Atherectomy for Femoral Artery Disease (ISAR-STATH). Circulation 2017; 135:2218-2226. [PMID: 28424222 DOI: 10.1161/circulationaha.116.025329] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 03/17/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Atherosclerosis in the superficial femoral artery is common in patients suffering from peripheral artery disease. Paclitaxel-eluting balloon (PEB) angioplasty, stenting, and directional atherectomy (DA) have provided new options for the treatment of superficial femoral artery disease; however, the comparative efficacy of these interventional strategies remains uncertain. METHODS One hundred and fifty-five patients with symptomatic peripheral artery disease due to de novo superficial femoral artery stenotic or occlusive lesions were randomized to treatment with plain balloon angioplasty (BA) followed by PEB angioplasty and stenting (n=48), BA and stenting (n=52), or DA with distal protection and bailout stenting (n=55). The primary end point of the study was percentage diameter stenosis after 6 months measured by angiography. Other end points included target lesion revascularization, thrombosis, ipsilateral amputation, binary restenosis, and all-cause mortality at 6 and 24 months. RESULTS Baseline and lesion characteristics were comparable in all groups with a mean lesion length of 65.9±46.8 mm and 56% total occlusions. At 6 months angiography, the percent diameter stenosis was significantly lower in patients treated by PEB angioplasty and stenting (34±31%) as compared with BA angioplasty and stenting (56±29%, P=0.009) or DA (55±29%, P=0.007). Similarly, binary restenosis was significantly lower after treatment with PEB and stenting as compared with BA and stenting or DA. Clinical follow-up at 24 months revealed a lower risk for target lesion revascularization after PEB angioplasty and stenting as compared with BA and stenting or DA. We found no difference in terms of target lesion thrombosis and mortality among groups, and no patient underwent amputation. CONCLUSIONS Treatment of de novo superficial femoral artery lesions with PEB angioplasty and stenting is superior to BA angioplasty and stenting or DA in terms of angiographic diameter stenosis at 6 months and target lesion revascularization at 24 months. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00986752.
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Affiliation(s)
- Ilka Ott
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.).
| | - Salvatore Cassese
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Philipp Groha
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Birgit Steppich
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Martin Hadamitzky
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Tareq Ibrahim
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Sebastian Kufner
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Karl Dewitz
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Regina Hiendlmayer
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Karl-Ludwig Laugwitz
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Heribert Schunkert
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Adnan Kastrati
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Massimiliano Fusaro
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
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Peterson S, Hasenbank M, Silvestro C, Raina S. IN.PACT™ Admiral™ drug-coated balloon: Durable, consistent and safe treatment for femoropopliteal peripheral artery disease. Adv Drug Deliv Rev 2017; 112:69-77. [PMID: 27771367 DOI: 10.1016/j.addr.2016.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
Endovascular management of peripheral artery disease was until recently limited to percutaneous balloon angioplasty, atherectomy, stent grafts, and bare-metal stents. These therapies have been valuable, but plagued by high restenosis and revascularization rates. Important progress has been made with the introduction of combination devices, including drug-eluting stents and drug-coated balloons (DCB), designed to combat restenosis by locally delivering anti-proliferative drugs. In particular, promising clinical performance has been seen with the Medtronic IN.PACT™ Admiral™ DCB, with durable, consistent and safe results. Rigorous, randomized controlled trials have directly compared this and other drug-delivering devices to their non-drug-coated counterparts with data available through two years. Additionally, trials are ongoing to assess use of drug-coated technologies in combination with traditional therapies in hope of synergistic effects. This review gathers data from currently published clinical trials with the IN.PACT Admiral DCB for the treatment of femoropopliteal peripheral artery disease and explores the possible impact on continuing clinical practice.
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Armstrong EJ, Waldo SW. Prevention of Distal Embolization During Peripheral Vascular Interventions: Filtering the Evidence. JACC Cardiovasc Interv 2017; 10:411-412. [PMID: 28231910 DOI: 10.1016/j.jcin.2017.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/08/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Ehrin J Armstrong
- VA Eastern Colorado Healthcare System, Denver, Colorado; University of Colorado, Denver, Colorado.
| | - Stephen W Waldo
- VA Eastern Colorado Healthcare System, Denver, Colorado; University of Colorado, Denver, Colorado
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Cioppa A, Stabile E, Tesorio T. Commentary: Endovascular Treatment of Popliteal Lesions Requires Advanced Physician Skills. J Endovasc Ther 2017; 24:189-190. [PMID: 28093946 DOI: 10.1177/1526602816688651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Angelo Cioppa
- 1 Division of Invasive Cardiology, Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Eugenio Stabile
- 2 Division of Cardiology, Department of Advanced Biomedical Sciences, University of Napoli "Federico II," Naples, Italy
| | - Tullio Tesorio
- 1 Division of Invasive Cardiology, Clinica Montevergine, Mercogliano, Avellino, Italy
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31
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Park YS, Heo SH, Hyun DH, Do YS, Park HS, Park KB, Kim YW, Park YJ, Lee CH, Kim DI. Usefulness of intraopertive ultrasonography during directional atherectomy using SilverHawk/TurboHawk system. Ann Surg Treat Res 2017; 92:42-46. [PMID: 28090505 PMCID: PMC5234428 DOI: 10.4174/astr.2017.92.1.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/31/2016] [Accepted: 09/19/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Directional atherectomy (DA) was introduced for the management of infrainguinal arterial stenosis or occlusive lesions. The procedure success rate in the DEFINITIVE LE study was determined using radiologic imaging. The aim of our study was to determine the usefulness of intraoperative ultrasonography (USG) during DA for evaluating the early results of this procedure. METHODS Patients who underwent DA from January to December 2014 were reviewed retrospectively. Twenty lesions from 14 patients with femoral artery stenosis (>70% stenosis) with short segment occlusive lesions (<2 cm in length) were treated. Among 20 lesions, 3 were treated with the TurboHawk system with a protective device due to lesion calcification. The percentage of stenosis during and after DA was determined with USG. RESULTS Median follow-up was 5.1 months, and the procedural success rate (<30% stenosis at the end of the procedure) was 100% on angiography, but only 30% on intraoperative USG. On USG, median residual stenosis was 40% (range, 28%-42%) at the end of DA, 40% (range, 30%-55%) at 1 month, 55% (range, 35%-85%) at 6 months, and 64% (range, 60%-100%) at 1 year. There was one dissection, but no cases of perforation, pseudoaneurysm, or thrombosis. Primary patency, which was defined as a peak systolic velocity ratio ≤3.5 with no reintervention at 6 months, was found in 18 lesions (90%), and 11 of 14 patients (78.6%) were free of ischemic symptoms such as claudication at 6 months. CONCLUSION Our results demonstrated that DA with intraoperative USG is an effective treatment option for short segment occlusive lesions of the femoral artery.
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Affiliation(s)
- Yoong-Seok Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong-Suk Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang-Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul-Hyung Lee
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Femoropopliteal In-stent Restenosis Repair: Midterm Outcomes After Paclitaxel Eluting Balloon Use (PLAISIR Trial). Eur J Vasc Endovasc Surg 2017; 53:106-113. [DOI: 10.1016/j.ejvs.2016.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 10/09/2016] [Indexed: 11/22/2022]
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Gujja K, Punukollu G, Kapur V, Krishnan P. Popliteal Artery Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Karthik Gujja
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | | | - Vishal Kapur
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Prakash Krishnan
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
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Kim W, Gandhi RT, Peña CS, Herrera RE, Schernthaner MB, Acuña JM, Becerra VN, Katzen BT. The Influence of Statin Therapy on Restenosis in Patients Who Underwent Nitinol Stent Implantation for de Novo Femoropopliteal Artery Disease: Two-Year Follow-up at a Single Center. J Vasc Interv Radiol 2016; 27:1494-501. [DOI: 10.1016/j.jvir.2016.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022] Open
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Freitas B, Steiner S, Bausback Y, Branzan D, Ülrich M, Bräunlich S, Schmidt A, Scheinert D. Rotarex Mechanical Debulking in Acute and Subacute Arterial Lesions. Angiology 2016; 68:233-241. [DOI: 10.1177/0003319716646682] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Data regarding the effectiveness and safety of percutaneous mechanical thrombectomy (PMT) in contemporary routine care are scarce. Materials and Methods: Consecutive patients undergoing PMT of native lower limb acutely/subacutely occluded arteries were included. Results: In all, 525 consecutive patients were available for analysis with a mean age of 66.7 ± 10.7 years. Almost two-third (n = 324; 61.7%) were men with acutely (n = 211; 40.2%) or subacutely (n = 314; 59.8%) occluded lesions presenting mostly in Rutherford-Becker category (RBC): 3 (30.3%) and 4 (47.6%). Mean lesion length was 159 mm (range 22-279 mm), with moderate and severe calcification in 119 (23.3%) lesions. PMT was performed solely in 161(27.2%), PMT + balloon angioplasty in 232 (39.1%), provisional stenting in 169 (28.4%), and thrombolysis in 77 (13.9%) interventions. Procedural technical success rate was 97.7%, with improvement in RBC persisting in 74.1% of patients after 12 ± 2.4 months mean time follow-up. Overall 30 days major adverse events (MAEs) was 6.9% with a mortality rate of 1.1%. No death was directly related to the device. After 12 months, a promising overall target lesion revascularization (TLR; 10.1%), non-TLR (6.6%), and major amputation rates (2.3%) were found. One-year mortality was 8%. Conclusion: Treatment with PMT resulted in clinic and hemodynamic improvement in the majority of patients, thereby reducing the need for thrombolysis in a significant proportion of patients. Prospective studies in this issue are recommended.
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Affiliation(s)
- Bruno Freitas
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
- Universidade Federal do Vale do Sao Francisco, Petrolina, Brazil
| | - Sabine Steiner
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
| | - Yvonne Bausback
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
| | - Daniela Branzan
- Department of Vascular Surgery, University Hospital, University of Leipzig, Leipzig, Germany
| | - Matthias Ülrich
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
| | - Sven Bräunlich
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
| | - Andrej Schmidt
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
| | - Dierk Scheinert
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
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Significant variation in P2Y12 inhibitor use after peripheral vascular intervention in Medicare beneficiaries. Am Heart J 2016; 179:10-8. [PMID: 27595675 DOI: 10.1016/j.ahj.2016.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 06/08/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED There is no consensus regarding whether to use antithrombotic medications in patients with peripheral artery disease after lower-extremity peripheral vascular intervention. OBJECTIVES The main hypothesis is that significant variation exists regarding use of antithrombotic medications after lower-extremity peripheral vascular intervention. We sought to examine the patterns of postprocedural antithrombotic medication use and associated factors in Medicare patients. METHODS We measured rates of P2Y12 inhibitor use after peripheral vascular intervention in a 100% national sample of Medicare beneficiaries with Part D prescription drug coverage. We used logistic regression modeling to examine associations between patient and clinical factors and P2Y12 inhibitor use. RESULTS Between 2010 and 2012, a total of 85,830 patients underwent peripheral vascular intervention and had prescription drug claims. Overall, 18.3% of patients were treated with an oral anticoagulant, 19.1% received no P2Y12 inhibitor, 30.8% received a P2Y12 inhibitor before and after the procedure, 6.2% received a P2Y12 inhibitor for up to 30 days after the procedure, and 25.6% received a P2Y12 inhibitor for more than 30 days after the procedure. After adjustment, factors associated with P2Y12 inhibitor use included male sex; black race; history of renal disease, dementia, or heart failure; physician specialty; and clinical setting of the procedure. We observed a strong interaction effect between clinical setting and physician specialty (P < .001). CONCLUSIONS One-fifth of patients who underwent lower-extremity peripheral vascular intervention did not fill a prescription for a P2Y12 inhibitor. Patients whose operators were surgeons or radiologists had lower odds of P2Y12 inhibitor use. More research to determine the optimal use and duration of antithrombotic medications after the procedure is warranted.
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Tsuchiya T, Takamura T, Soga Y, Iida O, Hirano K, Suzuki K, Yamaoka T, Miyashita Y, Kitayama M, Kajinami K. Clinical impact and risk stratification of balloon angioplasty for femoropopliteal disease in nitinol stenting era: Retrospective multicenter study using propensity score matching analysis. SAGE Open Med 2016; 4:2050312116660116. [PMID: 27504184 PMCID: PMC4962519 DOI: 10.1177/2050312116660116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 06/16/2016] [Indexed: 11/16/2022] Open
Abstract
Objective: Nitinol stenting could bring the better outcome in endovascular therapy for femoropopliteal disease. However, it might be expected that recent marked advances in both device technology and operator technique had led to improved efficacy of balloon angioplasty even in this segment. The aims of this study were to evaluate the clinical impact of balloon angioplasty for femoropopliteal disease and make risk stratification clear by propensity score matching analysis. Methods: Based on the multicenter retrospective data, 2758 patients (balloon angioplasty: 729 patients and nitinol stenting: 2029 patients), those who underwent endovascular therapy for femoropopliteal disease, were analyzed. Results: The propensity score matching procedure extracted a total of 572 cases per group, and the primary patency rate of balloon angioplasty and nitinol stenting groups after matching was significantly the same (77.2% vs 82.7% at 1 year; 62.2% vs 64.3% at 3 years; 47.8% vs 54.3% at 5 years). In multivariate Cox hazard regression analysis, significant predictors for primary patency were diabetes mellitus, regular dialysis, cilostazol use, chronic total occlusion, and intra-vascular ultra-sonography use. The strategy of balloon angioplasty was not evaluated as a significant predictor for the primary patency. After risk stratification using five items (diabetes mellitus, regular dialysis, no use of intra-vascular ultra-sonography, chronic total occlusion, and no use of cilostazol: the DDICC score), the estimated primary patency rates of each group (low, DDICC score 0–2; moderate, DDICC score 3; high risk, DDICC score 4–5) were 88.6%, 78.3%, and 63.5% at 1 year; 75.2%, 60.7%, and 39.8% at 3 years; and 66.0%, 47.1%, and 26.3% at 5 years (p < 0.0001). The primary patency rate of balloon angioplasty and nitinol stenting groups was significantly the same in each risk stratification. Conclusion: This study suggests that balloon angioplasty does not have inferiority to nitinol stenting but does have favorable efficacy in femoropopliteal segment by careful risk stratification with the recent advance of technique.
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Affiliation(s)
- Taketsugu Tsuchiya
- Division of Trans-Catheter Cardiovascular Therapeutics, Kanazawa Medical University Hospital, Kahoku, Japan
| | - Takaaki Takamura
- Division of Cardiology, Kanazawa Medical University Hospital, Kahoku, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Keisuke Hirano
- Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan
| | - Kenji Suzuki
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Yusuke Miyashita
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Michihiko Kitayama
- Division of Trans-Catheter Cardiovascular Therapeutics, Kanazawa Medical University Hospital, Kahoku, Japan
| | - Koji Kajinami
- Division of Cardiology, Kanazawa Medical University Hospital, Kahoku, Japan
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Abstract
Considerable advances have been made over the last decade in percutaneous technology for the treatment of atherosclerotic diseases in the femoro-popliteal arteries. While treatment strategies are well defined in the iliac segment, where angioplasty and stenting perform well in appropriately selected lesions, the search for a durable transcatheter therapy for femoro-popliteal lesions continues. Whereas balloon angioplasty (PTA) is the accepted therapy for short lesions, long diffuse lesions are still recommended for surgical treatment. However, attractive new technologies ranging from transcatheter plaque excision to laser ablation, rotational atherectomy, cryoplasty, brachytherapy, and placement of drug-eluting stents to simple angioplasty with drug-coated balloons may have the potential to replace femoro-popliteal bypass surgery as a treatment of choice for complex lesions. This article reviews the status of percutaneous endovascular techniques for the treatment of femoro-popliteal artery occlusive disease.
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Affiliation(s)
- Thomas Zeller
- Albert-Ludwigs-University Freiburg, Freiburg, Germany.
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Zeller T, Sixt S, Schwarzwälder U, Schwarz T, Frank U, Bürgelin K, Pochert V, Müller C, Noory E, Krankenberg H, Hauswald K, Neumann FJ, Rastan A. Two-Year Results after Directional Atherectomy of Infrapopliteal Arteries with the SilverHawk Device. J Endovasc Ther 2016; 14:232-40. [PMID: 17484535 DOI: 10.1177/152660280701400216] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To report the 12- and 24-month results after directional atherectomy (DA) of below-the-knee (BTK) arterial lesions with the SilverHawk device. Methods: Forty-nine BTK lesions in 36 patients (58% men; mean age 70611 years) with peripheral occlusive disease of the lower limbs were treated with DA; 19 (53%) of the limbs were classified with Rutherford-Becker 4 or 5 ischemia. Target lesions were in the popliteal artery (n=6, 12%), tibioperoneal trunk (n=25, 51%), peroneal artery (n=10, 20%), anterior tibial artery (n=5, 10%), and posterior tibial artery (n=3, 6%). Nine (18%) lesions were located in a stent. Twelve lesions extended to 2 artery segments. The average degree of diameter stenosis was 89%±10% (range 70%–100%); there were 11 (22%) occlusions. The mean lesion length was 48±28 mm. Results: Sixteen (33%) lesions were treated after predilation; 33 (67%) lesions were treated with primary DA. All but 1 (2%) lesion could be treated with DA. In 19 (39%) lesions, additional balloon angioplasty was performed, and 2 (4%) lesions required stent implantation as a result of dissection. The mean stenosis diameter after DA was 12%±18% (range 0%–100%). After additional therapy, the mean stenosis diameter was 8%±9% (range 0%–100%). A residual stenosis ≤30% was achieved in 48 (98%) lesions. The mean ankle-brachial index significantly increased from 0.48±0.26 to 0.81±0.32 (p<0.05) before discharge and remained improved during follow-up. Primary and secondary patency rates were 67% and 91% after 1 year and 60% and 80% after 24 months. The 12-and 24-month cumulative event-free survival rates (primary patency) by Kaplan-Meier analysis were 58%±8% and 46%±9%; at the same time intervals, the cumulative survival rates (secondary patency) were 88%±6% and 73%±9%, respectively. Conclusion: BTK lesions can be treated successfully and safely with DA. Midterm clinical results are encouraging.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Heart Center Bad Krozingen, Germany.
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40
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Abstract
Peripheral atherectomy is a class of procedures that is rapidly increasing in volume. Multiple classes of devices exist, and newer variants are added to the market annually. The devices see wide application for de novo lesions, in-stent restenosis, and adjunctive therapy for drug-coated balloons. The body of evidence supporting atherectomy is less robust than for many other peripheral therapies. The frequency and severity of complications from atherectomy can be significant compared with angioplasty and stenting, and familiarity with preventative and bailout techniques is essential for the interventionalist.
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Affiliation(s)
- Derek Mittleider
- Vascular & Interventional Physicians, Spectrum Medical Group, Portland, ME.
| | - Erich Russell
- Department of Radiology, Maine Medical Center, Portland, ME
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41
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Murata N, Takahara M, Soga Y, Nakano M, Yamauchi Y, Zen K, Kawasaki D, Yokoi H, Tosaka A, Tanaka N, Iida O. Drug-Eluting Stent vs Percutaneous Transluminal Angioplasty for Treatment of Femoropopliteal In-Stent Restenosis: Results From a Retrospective 1-Year Multicenter Study. J Endovasc Ther 2016; 23:642-7. [PMID: 27099284 DOI: 10.1177/1526602816642195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare drug-eluting stent (DES) implantation with percutaneous transluminal angioplasty (PTA) in the treatment of femoropopliteal in-stent restenosis (ISR). METHODS A comparison was performed of data from 112 ZEPHYR registry patients (mean age 74±9 years; 60 men) with 119 femoropopliteal ISR lesions treated with a drug-eluting stent (Zilver PTX) with historical data from 116 patients (mean age 72±8 years; 83 men) with 133 lesions treated with PTA. The patients were stratified for analysis by lesions with (101/252, 40%) and without (n=151) in-stent occlusion. The primary outcome measure was the 1-year incidence of recurrent restenosis; the secondary outcome was major adverse limb events (MALE). Multivariate logistic regression analysis was performed to look for any independent association of DES implantation with 1-year recurrent restenosis in the respective subgroups; results are presented as the odds ratio (OR) and 95% confidence interval (CI). RESULTS In the subgroup without in-stent occlusion, there was no significant difference between DES and PTA in the 1-year incidence of recurrent restenosis (40.5% vs 45.7%, p=0.583, respectively) or MALE (27.8% vs 20.7%, p=0.322, respectively). However, in the subgroup with in-stent occlusion, DES implantation was associated with significantly lower incidences of recurrent restenosis (44.1% vs 90.3% for PTA, p<0.001) and MALE (25.5% vs 53.6% for PTA, p<0.001). Multivariate analysis confirmed that DES implantation had a significant independent negative association with the risk of recurrent restenosis in the subgroup with occlusion (OR 0.2, 95% CI 0.1 to 0.6, p=0.006). CONCLUSION DES implantation may be more effective than PTA in the management of femoropopliteal ISR with occlusion, but equally effective to PTA in nonocclusive ISR lesions. These results require confirmation in prospective randomized studies.
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Affiliation(s)
- Naotaka Murata
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Masatsugu Nakano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan
| | | | - Kan Zen
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Daizo Kawasaki
- Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital, Osaka, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Atsushi Tosaka
- Department of Cardiology, Kawakita General Hospital, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
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McKinsey JF, Zeller T, Rocha-Singh KJ, Jaff MR, Garcia LA. Lower extremity revascularization using directional atherectomy: 12-month prospective results of the DEFINITIVE LE study. JACC Cardiovasc Interv 2016; 7:923-33. [PMID: 25147039 DOI: 10.1016/j.jcin.2014.05.006] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/02/2014] [Accepted: 05/08/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and effectiveness of directional atherectomy (DA) for endovascular treatment of peripheral arterial disease (PAD) in infrainguinal arteries in patients with claudication or critical limb ischemia. BACKGROUND To date, no prospective, multicenter, independently-adjudicated study has evaluated the effectiveness and durability of DA in the treatment of PAD. Previous DA studies have not been prospectively powered to evaluate any differences in outcomes in patients with and without diabetes. METHODS DEFINITIVE LE (Determination of EFfectiveness of the SilverHawk(®) PerIpheral Plaque ExcisioN System (SIlverHawk Device) for the Treatment of Infrainguinal VEssels / Lower Extremities) prospectively enrolled subjects at 47 multinational centers with an infrainguinal lesion length up to 20 cm. Primary endpoints were defined as primary patency at 12 months for claudicants and freedom from major unplanned amputation for critical limb ischemia (CLI) subjects. A pre-specified statistical hypothesis evaluated noninferiority of primary patency in diabetic versus nondiabetic claudicants. Independent angiographic and sonographic core laboratories assessed outcomes, and events were adjudicated by a clinical events committee. RESULTS A total of 800 subjects were enrolled. The 12-month primary patency was 78% (95% confidence interval: 74.0% to 80.6%) in claudicants, with a 77% rate in the diabetic subgroup versus 78% in the nondiabetic subgroup (noninferior, p < 0.001). The rate of freedom from major unplanned amputation of the target limb at 12 months in CLI subjects was 95% (95% confidence interval: 90.7% to 97.4%). Periprocedural adverse events included embolization (3.8%), perforation (5.3%), and abrupt closure (2.0%). The bail-out stent rate was 3.2%. CONCLUSIONS The DEFINITIVE LE study demonstrated that DA is a safe and effective treatment modality at 12 months for a diverse patient population with either claudication or CLI. Furthermore, DA was shown to be noninferior for treating PAD in patients with diabetes compared with those without diabetes. (Study of SilverHawk/TurboHawk in Lower Extremity Vessels [DEFINITIVE LE]; NCT00883246).
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Affiliation(s)
- James F McKinsey
- Division of Vascular Surgery, New York Presbyterian Hospital, University Hospital of Columbia and Cornell, New York, New York.
| | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Michael R Jaff
- Institute for Heart, Vascular, and Stroke Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Lawrence A Garcia
- Sections of Interventional Cardiology and Vascular Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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43
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Panaich SS, Arora S, Patel N, Patel NJ, Patel SV, Savani C, Singh V, Jhamnani S, Sonani R, Lahewala S, Thakkar B, Patel A, Dave A, Shah H, Bhatt P, Jaiswal R, Ghatak A, Gupta V, Deshmukh A, Kondur A, Schreiber T, Grines C, Badheka AO. In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization. Am J Cardiol 2016; 117:676-684. [PMID: 26732418 DOI: 10.1016/j.amjcard.2015.11.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p <0.001). Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications.
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44
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Burket MW. Drug-Eluting Stents Are the Default Strategy for Superficial Femoral Artery Intervention NowResponse to Burket. Circulation 2016; 133:320-9; discussion 329. [DOI: 10.1161/circulationaha.115.018034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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45
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Cioppa A, Stabile E, Tesorio T. Commentary: Never Forget Your Old Toys When You Get New Ones. J Endovasc Ther 2015; 22:853-4. [DOI: 10.1177/1526602815612171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Angelo Cioppa
- Division of Invasive, Clinic Montevergine, Mercogliano, Avellino, Italy
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Tullio Tesorio
- Division of Invasive, Clinic Montevergine, Mercogliano, Avellino, Italy
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46
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Grotti S, Liistro F, Angioli P, Ducci K, Falsini G, Porto I, Ricci L, Ventoruzzo G, Turini F, Bellandi G, Bolognese L. Paclitaxel-Eluting Balloon vs Standard Angioplasty to Reduce Restenosis in Diabetic Patients With In-Stent Restenosis of the Superficial Femoral and Proximal Popliteal Arteries: Three-Year Results of the DEBATE-ISR Study. J Endovasc Ther 2015; 23:52-7. [PMID: 26511896 DOI: 10.1177/1526602815614555] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the 3-year safety and effectiveness outcomes from the prospective all-comers DEBATE-ISR study (ClinicalTrials.gov identifier NCT01558531) of symptomatic diabetic patients with femoropopliteal in-stent restenosis (ISR) undergoing treatment with paclitaxel-eluting balloons compared with historical diabetic controls. METHODS From January 2010 to December 2011, 44 consecutive diabetic patients (mean age 74±11 years; 32 men) were treated with drug-eluting balloons (DEBs) and enrolled in the study. The control group comprised 42 consecutive diabetic patients (age 76±7 years; 23 men) treated with conventional balloon angioplasty (BA) from 2008 to 2009. RESULTS No significant differences in terms of clinical, angiographic, or procedural characteristics were observed between the study groups. Critical limb ischemia was present in the majority of patients. Tosaka class III ISR was observed in more than half of the patients. Mean lesion length was 132±86 and 137±82 mm in the DEB and BA groups, respectively (p=0.7). At 3-year follow-up, the rate of target lesion revascularization (TLR) was 40% in the DEB group vs 43% in the BA group (p=0.8); Kaplan-Meier analysis showed no significant differences in terms of freedom from TLR. The presence of a Tosaka class III occlusion was associated with a worse outcome in both study groups (odds ratio 3.96, 95% confidence interval 1.55 to 10.1, p=0.004). CONCLUSION Using DEBs for femoropopliteal ISR yielded similar results to BA in terms of TLR at 3-year follow-up. The treatment of more complex ISR lesions was associated with an increased rate of TLR, irrespective of the technology used.
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Affiliation(s)
- Simone Grotti
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | | | - Paolo Angioli
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | - Kenneth Ducci
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | | | - Italo Porto
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Lucia Ricci
- Diabetes Unit, San Donato Hospital, Arezzo, Italy
| | | | - Filippo Turini
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | - Guido Bellandi
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy
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Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, Reekers J, Norgren L. An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries: A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II): The TASC Steering Comittee(.). Ann Vasc Dis 2015; 8:343-57. [PMID: 26730266 DOI: 10.3400/avd.tasc.15-01000] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) guidelines were last updated in 2007 (TASC II) and represented the collaboration of international vascular specialties involved in the management of patients with peripheral arterial disease (PAD). Since the publication of TASC II, there have been innovations in endovascular revascularization strategies for patients with PAD. The intent of this publication is to provide a complete anatomic lower limb TASC lesion classification, including the infrapopliteal segment, and an updated literature review of new endovascular techniques and practice patterns employed by vascular specialists today.
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Affiliation(s)
| | - Christopher J White
- The Ochsner Clinical School-University of Queensland, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - William R Hiatt
- Division of Cardiology, University of Colorado School of Medicine, and CPC Clinical Research, Aurora, CO, USA
| | - Gerry R Fowkes
- Centre for Population Health Sciences, The University of Edinburgh, UK
| | | | | | - Jim Reekers
- Academic Medical Center, University Hospital, Amsterdam, The Netherlands
| | - Lars Norgren
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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48
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[Update peripheral arterial occlusive disease]. Herz 2015; 40:1013-22; quiz 1023-4. [PMID: 26432712 DOI: 10.1007/s00059-015-4357-5] [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: 10/23/2022]
Abstract
Due to demographic changes, peripheral arterial occlusive disease (PAD) has become one of the most prevalent diseases in western industrial nations. In recent years the trend towards initial endovascular treatment approaches has further continued. Because of the high primary success and low complication rates, intervention-based revascularization strategies are the method of choice in the majority of cases. The treatment strategy should always be assessed in a multidisciplinary setting and if possible, within a designated vascular center. One of the main limitations of interventions is the occurrence of restenosis, in particular in infrapopliteal arterial lesions. A major progress arose from drug-eluting balloons, which dramatically reduced restenosis rates particular for femoropopliteal lesions. A potential alternative strategy could be the use of a combination therapy, such as plaque removal followed by insertion of drug-eluting balloons; however, economic issues have to be kept in mind for such approaches.
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49
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Stavroulakis K, Bisdas T, Torsello G, Stachmann A, Schwindt A. Combined Directional Atherectomy and Drug-Eluting Balloon Angioplasty for Isolated Popliteal Artery Lesions in Patients With Peripheral Artery Disease. J Endovasc Ther 2015; 22:847-52. [DOI: 10.1177/1526602815608194] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate the midterm results of combined directional atherectomy (DA) and drug-eluting balloon (DEB) angioplasty for atherosclerotic lesions of the popliteal artery. Methods: In a single-arm, prospective study, 21 patients (mean age 63±16 years; 16 men) with isolated popliteal artery lesions were enrolled and underwent treatment with combined DA and DEB angioplasty under filter protection between October 2009 and February 2014. The majority (18, 86%) presented with lifestyle-limiting intermittent claudication and 3 with critical limb ischemia. Fifteen (71%) target sites were de novo lesions; 4 were occlusions. The main outcome was primary patency; secondary outcomes were technical success, secondary patency, and early and midterm morbidity and mortality. Results: The TurboHawk atherectomy device was used in 15 (71%) patients and the SilverHawk peripheral plaque excision system in the remaining 6 patients. The In.Pact Admiral/Pacific DEB was used in the majority of cases (15, 71%). The technical success rate was 90% (n=19). One flow-limiting dissection was treated with bailout stenting. Complications included a perforation of the popliteal artery and 2 puncture site hematomas; there was no distal embolic event. The mean follow-up was 18±12 months. Two restenoses were retreated successfully. Kaplan-Meier estimates of primary patency at 12 and 18 months were 95% and 90%, respectively; the secondary patency was 100%. One (5%) patient died in follow-up. None of the patients had an amputation. Conclusion: In this prospective single-arm study, the combined therapy of DA and DEB angioplasty for popliteal artery lesions showed promising midterm performance. The combination of DA and DEB may, in highly selected patients, overcome the challenges presented by the mobility of the knee joint.
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Affiliation(s)
- Konstantinos Stavroulakis
- Department of Vascular and Endovascular Surgery, University of Münster, Germany
- Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany
| | - Theodosios Bisdas
- Department of Vascular and Endovascular Surgery, University of Münster, Germany
- Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany
| | - Giovanni Torsello
- Department of Vascular and Endovascular Surgery, University of Münster, Germany
- Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany
| | - Arne Stachmann
- Department of Vascular and Endovascular Surgery, University of Münster, Germany
- Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany
| | - Arne Schwindt
- Department of Vascular and Endovascular Surgery, University of Münster, Germany
- Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany
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50
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Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, Reekers J, Norgren L. An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries: A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Vasc Med 2015; 20:465-78. [DOI: 10.1177/1358863x15597877] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) guidelines were last updated in 2007 (TASC II) and represented the collaboration of international vascular specialties involved in the management of patients with peripheral arterial disease (PAD). Since the publication of TASC II, there have been innovations in endovascular revascularization strategies for patients with PAD. The intent of this publication is to provide a complete anatomic lower limb TASC lesion classification, including the infrapopliteal segment, and an updated literature review of new endovascular techniques and practice patterns employed by vascular specialists today.
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Affiliation(s)
| | | | - Christopher J. White
- The Ochsner Clinical School–University of Queensland, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - William R. Hiatt
- Division of Cardiology, University of Colorado School of Medicine, and CPC Clinical Research, Aurora, CO, USA
| | - Gerry R. Fowkes
- Centre for Population Health Sciences, The University of Edinburgh, UK
| | | | | | - Jim Reekers
- Academic Medical Center, University Hospital, Amsterdam, The Netherlands
| | - Lars Norgren
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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