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Robertson V, Poli F, Saratzis A, Divall P, Naylor AR. A Systematic Review of Procedural Outcomes in Patients With Proximal Common Carotid or Innominate Artery Disease With or Without Tandem Ipsilateral Internal Carotid Artery Disease. Eur J Vasc Endovasc Surg 2020; 60:817-827. [DOI: 10.1016/j.ejvs.2020.06.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/07/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
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2
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Krishnappa S, Rachaiah JM, Hegde SS, Sadananda KS, Nanjappa MC, Ramasanjeevaiah G. Percutaneous Antegrade and Retrograde Endovascular approach to Symptomatic High-Grade Subclavian Artery Stenosis: Technique and Follow-Up. Heart Views 2019; 20:87-92. [PMID: 31620253 PMCID: PMC6791090 DOI: 10.4103/heartviews.heartviews_31_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: Angioplasty and stenting of the subclavian artery have been reported with high technical and clinical success rates, low complication rates, and good midterm patency rates. Different antegrade or retrograde endovascular catheter-based approaches are used. Nowadays, endovascular therapy has taken over open surgical techniques in subclavian artery disease. The purpose of this study was to determine safety, efficacy, and midterm clinical and radiological outcome of the endovascular treatment with special focus on the different technical approaches in subclavian artery disease. Materials and Methods: Between 2014 and 2017, 11 patients (10 men, 1 woman) with symptomatic high-grade stenosis (90%–100%) of the subclavian artery were treated with endovascular treatment. Their mean age was 51.3 years (range, 32-61 years). Mean angiographic and clinical follow-up was 22.5 months (range, 5-44 months). Clinical follow-up was performed at hospital discharge and routine follow-up was performed at 1, 3, 12 months, and 6 monthly thereafter. In all 11 patients, a percutaneous approach was used successfully. In eight patients, the lesions were accessed retrogradely through a brachial artery puncture. Results: Acute success rate was 100%. There were no significant peri-procedure complications. At the latest clinical follow-up (mean of 22.5 months), all patients showed a good outcome with a restenosis rate of 18.2% including a patient with Takayasu arteritis. Conclusion: Percutaneous antegrade and retrograde stenting of high-grade subclavian artery stenosis is a viable less invasive alternative to open bypass surgery with good midterm clinical results and patency rates.
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Affiliation(s)
- Santhosh Krishnappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
| | | | - Srinidhi S Hegde
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
| | | | | | - Govardhan Ramasanjeevaiah
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
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3
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Al'Aref SJ, Swaminathan RV, Feldman DN. Endovascular therapy of axillary artery disease with drug-coated balloon angioplasty. Proc (Bayl Univ Med Cent) 2017; 30:431-434. [PMID: 28966454 DOI: 10.1080/08998280.2017.11930217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The occurrence of upper-extremity arterial disease is less common than that of the lower extremities. Nevertheless, exercise-induced symptoms, when present, can significantly affect functional capacity and limit quality of life. We report a case of exertional right upper-extremity pain and severe right axillary artery disease that was revascularized using an off-label drug-coated balloon technology with resolution of symptoms.
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Affiliation(s)
- Subhi J Al'Aref
- Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital, New York, New York (Al'Aref); Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina (Swaminathan); and Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York (Feldman)
| | - Rajesh V Swaminathan
- Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital, New York, New York (Al'Aref); Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina (Swaminathan); and Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York (Feldman)
| | - Dmitriy N Feldman
- Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital, New York, New York (Al'Aref); Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina (Swaminathan); and Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York (Feldman)
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4
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Zhang JL, Tong W, Lv JF, Chi LX. Endovascular treatment and morphology typing of chronic ostial occlusion of the subclavian artery. Exp Ther Med 2017; 13:2022-2028. [PMID: 28565803 DOI: 10.3892/etm.2017.4203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/13/2017] [Indexed: 12/14/2022] Open
Abstract
Chronic obstructive lesions of the subclavian artery (SCA) often result in subclavian steal syndrome, which leads to arm claudication, transient cerebral ischemia, and other serious complications. The lesions are classified as stenosis and occlusion, according to the degree of obstruction. Unlike totally occlusive lesions, including ostial occlusions, stenotic lesions have an excellent technical success rate. In the present study, ostial occlusions were classified into 4 types according to their angiographic appearance. A total of 8 patients (6 male, 2 female) with SCA occlusions were treated with percutaneous transluminal angioplasty and stenting over a 4-year period. Mean patient age was 65.6 years (range, 60-72 years). In total, 9 self-expanding and 1 balloon-expandable stent were implanted at the ostia of the SCA in 7 of the patients. One female patient did not undergo stenting. Bleeding at the access site was noted in 2 patients and was controlled by gauze pressure. The patient that did not undergo stenting was lost to follow-up with symptoms of a transient ischemic attack at 3 months. The mean follow-up time for the remaining 7 patients was 15.7 months (range, 1-36 months). No ischemic symptoms, neointimal hyperplasia, or restenosis was observed in these patients. The transfemoral artery operation approach is preferred for rat-tail and peak type occlusions, whereas the dual approach involving both femoral and radial arteries is preferred for hilly and plain type occlusions. The angiographic morphology typing used in the present study may serve as a reference to decide upon the interventional operation strategy to be used for improving the technical success rate.
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Affiliation(s)
- Jing-Liang Zhang
- Department of Aerospace Medicine, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China.,Department of Cardiology, Southwest Hospital, The Third Military Medical University, Chongqing 400038, P.R. China
| | - Wei Tong
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Jian-Feng Lv
- Department of Cardiology, Southwest Hospital, The Third Military Medical University, Chongqing 400038, P.R. China
| | - Lu-Xiang Chi
- Department of Cardiology, Southwest Hospital, The Third Military Medical University, Chongqing 400038, P.R. China
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5
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Ahmed AT, Mohammed K, Chehab M, Brinjikji W, Hassan Murad M, Cloft H, Bjarnason H. Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2015; 39:652-667. [DOI: 10.1007/s00270-015-1250-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/31/2015] [Indexed: 11/27/2022]
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6
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van de Weijer M, Vonken E, de Vries JP, Moll F, Vos J, de Borst G. Technical and Clinical Success and Long-Term Durability of Endovascular Treatment for Atherosclerotic Aortic Arch Branch Origin Obstruction: Evaluation of 144 Procedures. Eur J Vasc Endovasc Surg 2015; 50:13-20. [DOI: 10.1016/j.ejvs.2015.03.058] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/27/2015] [Indexed: 11/16/2022]
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High frequency of brachiocephalic trunk stent fractures does not impair clinical outcome. J Vasc Surg 2014; 59:781-5. [DOI: 10.1016/j.jvs.2013.09.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 09/19/2013] [Accepted: 09/19/2013] [Indexed: 11/18/2022]
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8
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Goel PK, Moorthy N. Use of subclavian steal in treating chronic total subclavian artery occlusion. Asian Cardiovasc Thorac Ann 2013; 21:599-601. [DOI: 10.1177/0218492312458913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endovascular treatment is a well-established option for subclavian artery stenosis. However, total occlusion of the proximal subclavian artery remains a challenge, posing difficulties of nonvisualization of distal vessels, access site issues, and deployment of vertebral embolism protection devices. A 65-year-old man with chronic total occlusion of the ostial left subclavian artery, underwent successful endovascular stenting in which the subclavian steal phenomenon was utilized as a roadmap to cross the occlusion.
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Affiliation(s)
- Pravin K Goel
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Nagaraja Moorthy
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Park S, Kwak JH, Baek HJ, Park JW, Kim JS, Suh DC. The Use of Protection Device in Landmark-wire Technique of Symptomatic Subclavian Artery Occlusion with Combined Approach via Trans-femoral vs. Trans-brachial Arteries: Technical note. Neurointervention 2011; 6:89-94. [PMID: 22125755 PMCID: PMC3214817 DOI: 10.5469/neuroint.2011.6.2.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 06/29/2011] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Since we reported about a landmark technique to reopen an occluded subclavian artery, we have faced difficulty in using protection devices in the vertebral artery to protect against thromboembolism from the reversed steal phenomenon after angioplasty and stenting. Therefore, we are presenting an optimal solution in using a protection device while recanalizing the occluded subclavian artery. MATERIALS AND METHODS Among 21 cases of stenting for subclavian artery steno-occlusion, we applied the landmark technique at the opposite end of an occluded segment in 4 patients and used a protection device in two patients. Because the embolic protection device was placed in the vertebral artery via the brachial artery, optimal angioplasty and stenting via the brachial route were limited. Therefore, angioplasty via the trans-brachial approach was needed to be followed by stenting through a trans-femoral approach. We estimated the safe and optimal steps for placement and retrieval of the protection devices in addition to stenting. RESULTS The procedure was safely performed when a stent was introduced via the femoral artery and a protection device was used via the brachial artery. However, in cases when a guidewire wasn't passed via the transfemoral route, simultaneous use of two systems via the brachial route could cause friction of devices or trapping of protection devices in a stent. When a protection device was trapped in a deployed stent, we retrieved the protection device with a 4F angiocatheter by selectively rotating the catheter tip. To avoid such procedural difficulty, we recommend using a transbrachial angioplasty followed by trans-femoral stenting while placing the protection device in the vertebral artery via the trans-brachial route. CONCLUSION If a guidewire is not passed through using a trans-femoral approach while performing the landmark technique, changing the stenting route from brachial to the femoral artery can be useful after securing the lumen in the occluded subclavian artery after angioplasty via the brachial artery.
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Affiliation(s)
- Soonchan Park
- Department of Diagnostic Radiology, Ajou University School of Medicine, Yeongtong-gu, Suwon, Korea
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Paukovits TM, Nemes B, Hüttl K, Bérczi V. [Percutaneous, endovascular treatment of innominate artery lesions is a safe and effective procedure]. Orv Hetil 2011; 152:1745-50. [PMID: 21983401 DOI: 10.1556/oh.2011.29221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Percutaneous endovascular treatment (transluminar balloon angioplasty with or without stent implantation) of innominate artery lesions has become the treatment of choice prior to surgery in the past decades. Authors present the diagnostics, treatment and follow-up of two patients as examples from their largest series in the literature. A 74-year-old male patient with a history of hyperlipidemia, hypertension, nicotine abuse and lower limb claudication was admitted because of acute upper limb claudication and dizziness. Physical examination revealed blood pressure difference of 30 mmHg between his arms, and poststenotic flow pattern in the common carotid artery with retrograde flow in the vertebral artery on carotid duplex scan. Diagnostic angiography showed 80% stenosis of the innominate artery, which was treated with percutaneous transluminar balloon angioplasty with stent implantation. Follow-up examination at 5 months showed no significant restenosis or neurological complication. The second patient was a 59-year-old smoker female patient with hypertension and type 2 diabetes mellitus, who was evaluated for her upper limb claudication. Initial finding was the absence of radial pulse in the right side. Color duplex scan revealed proximal subocclusion, which was confirmed by angiography. In one stage, balloon angioplasty was made, with immediate pain relief. After 15 months the patient was symptom-free. These two cases demonstrate an excellent outcome of endovascular treatment of innominate artery lesions, as authors already reported in two retrospective studies. Balloon angioplasty with, or without stent deployment appears to be a safe procedure with excellent primary success rate. Review of international studies also indicates that endovascular therapy of the innominate artery is safe and effective.
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Affiliation(s)
- Tamás Mirkó Paukovits
- Semmelweis Egyetem, Általános Orvostudományi Kar Cardiovascularis Centrum Budapest Gál József u. 9. 1122.
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11
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Mordasini P, Gralla J, Do DD, Schmidli J, Keserü B, Arnold M, Fischer U, Schroth G, Brekenfeld C. Percutaneous and open retrograde endovascular stenting of symptomatic high-grade innominate artery stenosis: technique and follow-up. AJNR Am J Neuroradiol 2011; 32:1726-31. [PMID: 21852376 DOI: 10.3174/ajnr.a2598] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Angioplasty and stenting of the IA have been reported with high technical and clinical success rates, low complication rates and good mid-term patency rates. Different antegrade or retrograde endovascular catheter-based approaches and combinations with surgical exposure of the CCA are used. The purpose of this study was to determine safety, efficacy and mid-term clinical and radiological outcome of the stent-assisted treatment of atherosclerotic stenotic disease of the IA with special focus on the different technical approaches. MATERIALS AND METHODS Between 1996 and 2008, 18 patients (12 men, 6 women) with symptomatic high-grade stenosis (>80%) of the IA were treated with endovascular stent placement. Their mean age was 60.4 years (range, 48-78 years). Mean angiographic and clinical follow-up was 2.7 years (range, 0.3-9.1 years). Clinical follow-up was performed by using the mRS at hospital discharge, routine follow-up controls, and a questionnaire. In 11 patients, a percutaneous approach was used. In 7 patients, the lesions were accessed retrogradely through a cervical cut-down with common carotid arteriotomy. In 2 patients, a simultaneous ipsilateral carotid endarterectomy was performed. RESULTS In all patients, primary stent placement was performed. There were 2 procedure-related transient complications (11.1%) due to cerebral embolism without permanent morbidity or mortality. During the follow-up, all patients showed improvement of the preprocedural symptoms. At the latest clinical follow-up (mean, 2.7 years), all patients showed an excellent or good outcome (mRS, 0 or 1). In 2 patients (11.1%), a secondary stent placement was needed due to a significant symptomatic in-stent stenosis. CONCLUSIONS Percutaneous and open retrograde stenting of high-grade stenosis of the IA is a viable less invasive alternatives to open bypass surgery with good midterm clinical results and patency rates.
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Affiliation(s)
- P Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
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12
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Abstract
Endovascular treatment of supra-aortic atherosclerotic arterial stenoses and occlusions using percutaneous transluminal angioplasty (PTA) and stent placement is an accepted first-choice procedure. Technical success, primary success, and midterm patency after PTA and stent placement for the treatment of stenosed or obstructed brachiocephalic arteries are promising and complication rates are low. Permanent miniaturization and device improvement makes treatment of atherosclerotic obstructive disease by endovascular means in brachial and cephalic arteries a safe procedure showing promising midterm patency rates.
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Affiliation(s)
- S Müller-Hülsbeck
- Department of Radiology, University Hospitals Schleswig-Holstein-Campus Kiel, Kiel, Germany
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13
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Percutaneous transluminal angioplasty for atherosclerotic stenosis of the subclavian or innominate artery: angiographic and clinical outcomes in 36 patients. Neurosurg Rev 2011; 35:121-5; discussion 125-6. [DOI: 10.1007/s10143-011-0328-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 04/03/2011] [Indexed: 10/18/2022]
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Aiello F, Morrissey NJ. Open and Endovascular Management of Subclavian and Innominate Arterial Pathology. Semin Vasc Surg 2011; 24:31-5. [DOI: 10.1053/j.semvascsurg.2011.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Percutaneous Endovascular Treatment of Innominate Artery Lesions: A Single-centre Experience on 77 Lesions. Eur J Vasc Endovasc Surg 2010; 40:35-43. [DOI: 10.1016/j.ejvs.2010.03.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 03/12/2010] [Indexed: 11/22/2022]
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Liu S, Hee Jung J, Kwon HJ, Kim SM, Suh DC. Landmark-wire technique of symptomatic subclavian artery occlusion. Interv Neuroradiol 2010; 15:401-5. [PMID: 20465876 DOI: 10.1177/159101990901500404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 09/05/2009] [Indexed: 11/15/2022] Open
Abstract
SUMMARY The landmark at the opposite end of an occluded segment can be used for probing the occluded subclavian artery to be recanalized. Using this technique in three patients with symptomatic subclavian artery occlusion, we found the landmark-wire technique to be safe and effective for reopening completely occluded subclavian arteries. We also introduced a technique in which a protective device can be safely used throughout the stenting procedure.
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Affiliation(s)
- S Liu
- Asan Medical Center, University of Ulsan, College of Medicine; Seoul, Korea - The First Affiliated Hospital of Nanjing Medical University, Nanjing, China -
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17
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[Cerebrovascular diseases]. Internist (Berl) 2009; 50:945-51. [PMID: 19562263 DOI: 10.1007/s00108-009-2367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the majority of the cases cerebrovascular disease is caused by atherosclerosis. Duplexsonography is the diagnostic tool of first choice. Management of cardiovascular risk factors is of paramount importance in secondary prevention of atherosclerotic vascular complications. Patients with a symptomatic internal carotid artery stenosis >70% have a clear indication for revascularization. Asymptomatic patients with >60% stenosis benefit from revascularisation if the perioperative risk for death or stroke is below 3%. The optimal revascularization strategy highly depends on the expertise of the local surgeon or endovascular specialist. In younger patients with cerebrovascular disease rare causes such as dissection, large vessel arteritis, fibromuscular dysplasia or vasospasms have to be considered.
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Von Sarnowski B, Khaw AV, Kessler C, Schminke U. Evaluation of a Microconvex Array Transducer for the Ultrasonographic Examination of the Intrathoracic Segments of the Supraaortic Arteries. J Neuroimaging 2009; 20:246-50. [DOI: 10.1111/j.1552-6569.2009.00360.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hedayati N, Kougias P, El Sayed HF, Zhou W, Huynh TT, Lin PH. Dual guidewire placement to enhance arch vessel origin identification: a simple technique to facilitate ostial aortic arch vessel stenting. J Vasc Surg 2007; 46:1274-6. [PMID: 18155005 DOI: 10.1016/j.jvs.2007.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Accepted: 07/19/2007] [Indexed: 10/22/2022]
Abstract
Orificial occlusive lesion involving the aortic arch vessels is commonly treated with balloon-expandable stent placement. Stenting of such a lesion typically involves an initial aortogram to precisely identify the vessel origin, followed by deployment of a balloon-expandable stent to cover the ostial lesion. We report a simple technique of an antegrade femoral guidewire placement along the outer curvature of the aortic arch to facilitate the identification of the origin of aortic arch vessels. This enhanced ostial visualization enables a precise positioning and deployment of a balloon-expandable stent in aortic arch vessels. This dual guidewire technique facilitates the visual identification of arch vessel origin and reduces potential contrast requirement, which provides procedural benefit in patients with renal insufficiency or contrast allergy.
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Affiliation(s)
- Nasim Hedayati
- Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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van Hattum ES, de Vries JPPM, Lalezari F, van den Berg JC, Moll FL. Angioplasty with or without Stent Placement in the Brachiocephalic Artery: Feasible and Durable? A Retrospective Cohort Study. J Vasc Interv Radiol 2007; 18:1088-93. [PMID: 17804769 DOI: 10.1016/j.jvir.2007.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the results of percutaneous transluminal angioplasty (PTA) and stent placement in isolated brachiocephalic trunk lesions. MATERIALS AND METHODS PTA, with or without stent placement, was used to treat 30 patients with isolated clinically significant stenoses (n = 25) or occlusions (n = 5) of the brachiocephalic artery. Initial clinical success was defined as a relief or substantial reduction of the preprocedural symptoms, and initial technical success was defined as a mean translesion pressure gradient of less than 5 mm Hg or a residual stenosis of less than 20%. Clinical evaluation and duplex Doppler ultrasonography of the lesion site were performed at follow-up. Clinical restenosis was defined as recurrent clinical symptoms and a lumen reduction of more than 50%, determining the primary clinical patency. Technical restenosis was defined as more than 50% lumen reduction with or without renewed clinical symptoms, determining the primary technical patency. RESULTS The initial technical success rate was 83% (occlusions, 60%; stenoses, 88%), and the clinical success rate was 81%. Two patients had major complications, and four experienced minor complications. At a median follow-up of 24 months (4 weeks to 92 months), the primary clinical patency rate was 79% (95% confidence interval [CI]: 57%, 104%), with 83% (95% CI: 60%, 105%) for arteries with stents and 67% (95% CI: 13%, 120%) for those without stents (P = .11). The primary technical patency rate was 50% (95% CI: 24%, 76%). CONCLUSION PTA with or without stent placement in a stenotic or occlusive brachiocephalic artery is a procedure of tolerable safety with a high initial success rate; however, only moderately rewarding results were obtained after 2 years. Selective stent placement probably improves long-term success. Primary PTA with selective stent placement in an atherosclerotic obstructive brachiocephalic artery should be considered the preferred treatment option.
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Affiliation(s)
- Eline S van Hattum
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands.
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Mahmud E, Cavendish JJ, Salami A. Current Treatment of Peripheral Arterial Disease. J Am Coll Cardiol 2007; 50:473-90. [PMID: 17678729 DOI: 10.1016/j.jacc.2007.03.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 03/12/2007] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
Despite advances in medical therapies to help prevent the development of atherosclerosis and improve the management of patients with established peripheral arterial disease (PAD), the prevalence of PAD and associated morbidity remains high. Over the past decade, percutaneous revascularization therapies for the treatment of patients with PAD have evolved tremendously, and a great number of patients can now be offered treatment options that are less invasive than traditional surgical options. With the surgical approach, there is significant symptomatic improvement, but the associated morbidity and mortality preclude its routine use. Although newer percutaneous treatment options are associated with lower procedural complications, the technical advances have outpaced the evaluation of these treatments in adequately designed clinical studies, and therapeutic options are available that may not have been rigorously investigated. Therefore, for physicians treating patients with PAD, an understanding of the various therapies available, along with the inherent benefits and limitations of each treatment option is imperative as a greater number of patients with PAD are being encountered.
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Affiliation(s)
- Ehtisham Mahmud
- Division of Cardiovascular Medicine, University of California, San Diego School of Medicine, San Diego, California 92103-8784, USA.
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22
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de Souza JM, Espinosa G, Santos Machado M, Soares PJ. Bilateral occlusion associated to steal phenomenon of internal carotid and left subclavian arteries: treatment by angioplasty and stenting. ACTA ACUST UNITED AC 2007; 67:298-302; discussion 302. [PMID: 17320643 DOI: 10.1016/j.surneu.2006.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Accepted: 04/21/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Treatment of subclavian artery occlusion is still a matter of controversy due to the short- and long-term complications and patency issues. We report an unusual case of combined occlusion of the proximal segment of the left subclavian artery and subclavian steal phenomenon associated with bilateral occlusion of the internal carotid arteries. CASE DESCRIPTION A 55-year-old male patient with previous history of myocardial infarction and hypertension presented with amblyopia and recurrent dizziness, mainly at work. Doppler fluxometry and digital subtraction angiography depicted proximal left subclavian artery occlusion and subclavian steal. Internal carotid arteries were occluded at the common carotid artery bifurcation. Percutaneous transluminal angioplasty and stenting (PTAS) were successfully performed by the left radial artery approach without complications. The patient had no recurrence of the symptoms, and the angiographic follow-up at 1 year showed good patency of the subclavian artery and normal flow through the left vertebral artery. CONCLUSION The planned approach for the case (PTAS) was performed without complications and evidence of restenosis in the angiography study at the completion of the first year of the treatment. The described strategy is safe and should be considered the first-choice procedure in the treatment of the subclavian occlusion.
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Kobayashi N, Miyachi S, Hattori K, Tanasawa T, Okada T, Endo O, Yamamoto N. Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note. Neuroradiology 2006; 48:847-51. [PMID: 16900378 DOI: 10.1007/s00234-006-0126-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 06/19/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. METHODS A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. RESULTS Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. CONCLUSION In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed.
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Affiliation(s)
- Nozomu Kobayashi
- Department of Neurosurgery, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Aichi, Japan.
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Nagata SI, Kazekawa K, Matsubara S, Sugata S. Percutaneous reconstruction of the innominate bifurcation using the retrograde ‘kissing stents’ technique. Neuroradiology 2006; 48:537-40. [PMID: 16642322 DOI: 10.1007/s00234-006-0090-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Accepted: 02/01/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Obstructions of the supraaortic vessels are an important cause of morbidity associated with a variety of symptoms. Percutaneous transluminal angioplasty has evolved as an effective and safe treatment modality for occlusive lesions of the supraaortic vessels. However, the endovascular management of an innominate bifurcation has not previously been reported. METHODS A 53-year-old female with a history of systematic hypertension, diabetes mellitus and hypercholesterolemia presented with left hemiparesis and dysarthria. Angiography of the innominate artery showed a stenosis of the innominate bifurcation. RESULTS The lesion was successfully treated using the retrograde kissing stent technique via a brachial approach and an exposed direct carotid approach. CONCLUSION The retrograde kissing stent technique for the treatment of a stenosis of the innominate bifurcation was found to be a safe and effective alternative to conventional surgery.
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Affiliation(s)
- Shun-ichi Nagata
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, 377-1 Zokumyoin, Chikushino, Fukuoka, 818-8502, Japan
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Meyers PM, Schumacher HC, Higashida RT, Leary MC, Caplan LR. Use of Stents to Treat Extracranial Cerebrovascular Disease. Annu Rev Med 2006; 57:437-54. [PMID: 16409159 DOI: 10.1146/annurev.med.57.121304.131320] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Stent-assisted carotid angioplasty (CAS) is increasingly utilized for hemodynamically significant stenoses of the extracranial carotid artery. Carotid endarterectomy (CEA) is still considered the gold standard in the management of symptomatic hemodynamically significant carotid stenoses. However, endovascular device technology is rapidly evolving and the recent introduction of embolic filtration devices (EFD) proved to reduce periprocedural stroke rates in CAS considerably. Several randomized multicenter trials are currently recruiting patients to compare CAS with EFD to carotid endarterectomy in different cohorts, such as patients at high surgical risk for CEA and those with asymptomatic stenosis. The review presents current developments in CAS.
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Affiliation(s)
- Philip M Meyers
- Department of Radiology and Neurological Surgery, Columbia University, and Neuroendovascular Service, Neurological Institute of New York and New York Presbyterian Hospitals, New York, New York 10032, USA.
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Dumurgier J, Desgranges P, Chapoy E, Becquemin JP, Hosseini H. [Occlusion of the innominate artery in association with a primary antiphospholipid syndrome: treatment by angioplasty stenting]. Rev Neurol (Paris) 2004; 160:1089-92. [PMID: 15602354 DOI: 10.1016/s0035-3787(04)71149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Antiphospholipid syndrome may be associated with stroke. CASE REPORT We report a case of a symptomatic occlusion of the innominate artery in a 37-year-old patient, who developed primary anti-phospholipid syndrome. This association, to our knowledge, has not been reported in the literature. Occlusion of the innominate artery was treated by angioplasty-stenting. Effective oral anticoagulation was given to prevent a new thrombotic event. CONCLUSION Systematic search for antiphospholipid antibodies is needed as part of the etiology work-up in young stroke victims.
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Affiliation(s)
- J Dumurgier
- Service de Neurologie, CHU Henri Mondor, Crétil
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Khaw AV, Schumacher HC, Meyers PM, Gupta R, Higashida RT. Extracranial revascularization therapy: Angioplasty and stenting. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2004; 6:179-192. [PMID: 15096309 DOI: 10.1007/s11936-996-0012-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Beginning with simple balloon angioplasty, minimally invasive revascularization techniques have progressed to the use of metallic stents for improved immediate and long-term results. Stent-supported angioplasty now offers a therapeutic option for those individuals ineligible for surgical revascularization of stenotic atherosclerotic lesions and who have failed maximal medical therapy. However, the clinical equivalence, or possibly even superiority, of angioplasty of the extracranial carotid and vertebral arteries in atheromatous occlusive disease over surgical revascularization has yet to be determined in ongoing randomized controlled trials. Additionally, endovascular techniques offer treatment for a variety of nonatherosclerotic disease affecting the extracranial arteries, such as inflammatory, radiation-induced, and postsurgical strictures; acute intimal dissection; traumatic and spontaneous arteriovenous fistulas; and aneurysms or pseudoaneurysms. For certain disease entities at high risk for surgical complications, endovascular procedures have gained preference as the therapeutic modality of choice, yet lacking controlled trials providing evidence for noninferiority against surgical approach. Continued innovation and refinement of endovascular technology and techniques will further improve technical success, reduce procedure-related morbidity, and broaden the endovascular therapeutic spectrum for extracranial and intracranial cerebrovascular disease.
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Affiliation(s)
- Alexander V. Khaw
- Neuroendovascular Service, Departments of Radiology and Neurological Surgery, Columbia and Cornell University Medical Centers, Neurological Institute
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Lee PY, Chen WH, Ng W, Lau CP. Percutaneous recanalization of chronic subclavian artery occlusion using optical coherence reflectometry-guided radiofrequency ablation guidewire. Catheter Cardiovasc Interv 2003; 60:558-61. [PMID: 14624441 DOI: 10.1002/ccd.10695] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Subclavian artery lesion that is associated with low complication rate could be treated by percutaneous intervention effectively. However, the success of endovascular therapy for occlusive lesion may be limited by failure to cross with a guidewire. We describe the use of a system using optical coherence reflectometry for navigation and radiofrequency ablation to enable wire passage through subclavian artery occlusion that could not be crossed by conventional guidewires.
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Affiliation(s)
- Pui-Yin Lee
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Hong Kong, China
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D'Ayala M, Toursarkissian B, Ferral H, Lewis WMC, Jones WT, Wholey MH. Endovascular treatment of innominate artery stenosis in a bovine aortic arch--a case report. Vasc Endovascular Surg 2003; 37:279-82. [PMID: 12894370 DOI: 10.1177/153857440303700407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent reports have established the feasibility and safety of percutaneous transluminal angioplasty and stent placement in the treatment of innominate artery occlusive disease. Although the long-term durability of these endovascular approaches has not been clearly established, they are particularly attractive in patients who are not considered good candidates for surgical reconstruction. The authors present a case involving a morbidly obese Hispanic woman who had undergone previous coronary artery bypass and complained of right visual symptoms, dizziness, and right upper extremity claudication. Because of her unusual bovine anatomy and the desire to avoid reoperating in her chest, a unique approach with a left subclavian-to-carotid bypass and innominate artery angioplasty and stenting was used.
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Affiliation(s)
- Marcus D'Ayala
- Divisions of Vascular Surgery and Interventional Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
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