1
|
Sayfo S, Rosol ZP, Vazquez DF, Mamawala M, Bruneman BM, Weideman SG, Adelman KS, Jeong M, Ramanan B, Tsai S, Shammas NW, Monteleone PP, Nanjundappa A, Chu HB, Smith BL, Grimsley BR, Hohmann SE, Vasquez J, Metzger C, Das TS, Gable DR, Eidt JF, Banerjee S. Clinical Outcomes of Non-Stent-Based Interventions for Symptomatic Below-the-Knee Peripheral Artery Disease in the Excellence in Peripheral Artery Disease (XLPAD) Registry. Am J Cardiol 2024; 228:38-47. [PMID: 39111561 DOI: 10.1016/j.amjcard.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 08/24/2024]
Abstract
For endovascular treatment of below-the-knee (BTK) peripheral artery disease (PAD), independently adjudicated real-world outcomes comparing non-stent-based balloon angioplasty (percutaneous transluminal angioplasty) and adjunctive treatments with or without a concomitant ipsilateral femoropopliteal (FP) artery intervention are scarce. A total of 1,060 patients from the multicenter XLPAD registry who underwent non-stent-based BTK PAD intervention between 2006 and 2021 were included. The primary outcome was the 1-year incidence of major adverse limb events (MALEs), a composite of all-cause death, any amputation, or clinically driven repeat revascularization. A total of 566 patients underwent BTK and 494 BTK + FP interventions; 72% were men, with a mean age of 68.4 ± 10.9 years. Diabetes mellitus was more prevalent in the BTK-only group (76.5% vs 69%, p = 0.006). Mean Rutherford class was 4.2 ± 1.18; chronic limb-threatening ischemia was more frequent in the BTK group (55.3% vs 49%, p = 0.040). Moderate to severe calcification was more frequent in the BTK + FP group (21.2% vs 27.1%, p = 0.024), as was lesion length (110.6 ± 77.3 vs 135.4 ± 86.3 mm, p <0.001). Nearly 81% of lesions were treated with percutaneous transluminal angioplasty. Drug-coated balloon (1.6% vs 14%, p <0.001) and atherectomy (38% vs 58.5%, p <0.001) use was more frequent in the BTK + FP group. The rate of procedural success was higher in the BTK + FP group (86% vs 91%, p = 0.009), with amputation being the most common complication at 3.3% within 30 days after the procedure. The rates of 1-year MALE (21.2% vs 22.3%, p = 0.675) and mortality (4.6% vs 3.4%, p = 0.3) were similar between the BTK and BTK + FP groups. Nonstent treatment for BTK PAD with concomitant FP intervention leads to high procedural success and similar rates of 1-year MALE compared with isolated BTK intervention. Condensed Abstract: The vast majority of below-the-knee (BTK) peripheral artery disease (PAD) interventions are performed with balloon angioplasty. Presence of inflow femoropopliteal PAD in patients who undergo BTK interventions can affect the outcome of the procedure. This report explores immediate procedural success and major adverse limb events at 1 year after balloon angioplasty treatment for isolated BTK PAD and in patients who underwent an additional femoropopliteal PAD intervention.
Collapse
Affiliation(s)
- Sameh Sayfo
- Baylor Scott & White The Heart Hospital Plano, Plano, Texas
| | - Zachary P Rosol
- Baylor University Medical Center, Dallas, Texas; Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | | | | | | | | | | | - Minseob Jeong
- Baylor Scott & White Research Institute, Dallas, Texas
| | - Bala Ramanan
- University of Texas Southwestern Medical Center, Dallas, Texas; Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Shirling Tsai
- University of Texas Southwestern Medical Center, Dallas, Texas; Veterans Affairs North Texas Health Care System, Dallas, Texas
| | | | | | | | - Hung B Chu
- Baylor University Medical Center, Dallas, Texas; Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | - Bertram L Smith
- Baylor University Medical Center, Dallas, Texas; Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | - Bradley R Grimsley
- Baylor University Medical Center, Dallas, Texas; Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | - Stephen E Hohmann
- Baylor University Medical Center, Dallas, Texas; Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | - Javier Vasquez
- Baylor University Medical Center, Dallas, Texas; Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | | | - Tony S Das
- Baylor Scott & White The Heart Hospital Plano, Plano, Texas
| | - Dennis R Gable
- Baylor Scott & White The Heart Hospital Plano, Plano, Texas
| | - John F Eidt
- Baylor University Medical Center, Dallas, Texas; Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | - Subhash Banerjee
- Baylor University Medical Center, Dallas, Texas; Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas.
| |
Collapse
|
2
|
Parikh SA, Zilinyi RS. Acute limb ischaemia from stent thrombosis: bad luck or bad protoplasm? EUROINTERVENTION 2024; 20:e1122-e1123. [PMID: 39279519 PMCID: PMC11384221 DOI: 10.4244/eij-e-24-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Affiliation(s)
- Sahil A Parikh
- Columbia University Irving Medical Center, New York, NY, USA
| | | |
Collapse
|
3
|
Nakao S, Iida O, Takahara M, Suematsu N, Yamaoka T, Matsuda D, Nakama T, Fujihara M, Tobita K, Koyama E, Haraguchi T, Ogata K, Mano T. Clinical outcomes of acute limb ischaemia caused by femoropopliteal stent thrombosis. EUROINTERVENTION 2024; 20:e1163-e1172. [PMID: 39279518 PMCID: PMC11384227 DOI: 10.4244/eij-d-24-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 07/02/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND Although femoropopliteal-specific stents have durable patency, stent thrombosis (ST) may occur, which can lead to acute limb ischaemia (ALI). AIMS We aimed to investigate the clinical features and outcomes of ALI caused by femoropopliteal ST in patients with lower extremity artery disease. METHODS This multicentre retrospective study included 499 patients with ALI - of whom 108 patients had ALI caused by femoropopliteal ST (ST-ALI) and 391 patients had ALI caused by other aetiologies (de novo ALI) - who underwent treatment between September 2011 and March 2023. Clinical features and outcomes were compared between the two groups. The primary outcome measure was 12-month amputation-free survival; factors associated with amputation or death were investigated using multivariate Cox proportional hazards regression analysis. RESULTS Patients with ST-ALI were significantly more likely to exhibit conventional atherosclerotic risk factors, including diabetes mellitus (63% vs 26%) and haemodialysis (51% vs 10%) compared to patients with de novo ALI, whereas patients with de novo ALI were older (80 years vs 74 years) and more likely to have atrial fibrillation (49% vs 18%) than patients with ST-ALI. The 12-month amputation-free survival rate was significantly lower in the ST-ALI group than that in the de novo ALI group (51% vs 76%; p<0.001). Multivariate analysis revealed that ST-ALI, older age, haemodialysis, atrial fibrillation, the presence of a wound, peak C-reactive protein level, and non-ambulatory status all have an independent, positive association with death or major amputation. CONCLUSIONS The current study revealed that patients with ST-ALI had worse clinical outcomes than those with de novo ALI, highlighting the need to maximise ST prevention.
Collapse
Affiliation(s)
- Sho Nakao
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Osamu Iida
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiro Suematsu
- Department of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Daisuke Matsuda
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Eiji Koyama
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Kenji Ogata
- Department of Cardiology, Miyazaki Medical Association Hospital, Cardiovascular Center, Miyazaki, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| |
Collapse
|
4
|
Sénémaud J, Skarbek C, Hernandez B, Song R, Lefevre I, Bianchi E, Castier Y, Nicoletti A, Bureau C, Caligiuri G. Camouflaging endovascular stents with an endothelial coat using CD31 domain 1 and 2 mimetic peptides. JVS Vasc Sci 2024; 5:100213. [PMID: 39257386 PMCID: PMC11386311 DOI: 10.1016/j.jvssci.2024.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/17/2024] [Indexed: 09/12/2024] Open
Abstract
Objective Implantation of an endovascular device disrupts the homeostatic CD31:CD31 interactions among quiescent endothelial cells (ECs), platelets, and circulating leukocytes. The aim of this study was to design an endothelial-mimetic coating of nitinol and cobalt-chromium (CoCr) surfaces and stents using synthetic CD31 peptides, to promote device endothelialization and pacific integration within the arterial wall. Methods Peptides mimicking the domains 1 (D1) and 2 (D2) of CD31 were synthetized and immobilized onto experimental nitinol and CoCr surfaces using a three-step, dip-coating, mussel-inspired protocol using copper-free click chemistry. Human aortic EC phenotype and endothelialization assessment using parallel scratch tests were carried out using five synthetic CD31 peptides coated on 4.8-mm nitinol and CoCr flat disks and were compared with control disks. The CD31 peptide exhibiting the best results in vitro was then immobilized on clinical-grade 3 × 40-mm self-expanding nitinol and 2.5 × 20.0-mm balloon-expandable CoCr stents. Such devices were implanted in native arteries of White New Zealand rabbits, and compared with control uncoated bare metal stents (BMS) and drug-eluting stents 7 and 30 days after implantation using resin cross-sections and scanning electron microscopy (n = 2-3 per group at each time point). Results Membrane-distal CD31 D1 and D2 peptides exhibited a distinct capability to foster a healthy endothelial phenotype and to promote endothelialization in vitro. By day 7 after implantation, CD31 nitinol and CoCr stents were evenly covered by wholesome ECs, devoid of thromboinflammatory signs, in contrast with both BMS and drug-eluting stents. Such results were consistent until day 30. Conclusions Membrane-distal CD31 biomimetic peptides seem to camouflage the device surface effectively, preventing local reactions and promoting rapid and seamless endovascular integration.
Collapse
Affiliation(s)
- Jean Sénémaud
- Department of Vascular Surgery, Bichat University Hospital, Paris, France
- Université Paris Cité, Paris, France
- Laboratory for Vascular Translational Science, INSERM U1148, Paris, France
| | - Charles Skarbek
- Université Paris Cité, Paris, France
- Laboratory for Vascular Translational Science, INSERM U1148, Paris, France
| | - Belen Hernandez
- Laboratory for Vascular Translational Science, INSERM U1148, Paris, France
- Université Sorbonne Paris Nord, Paris, France
| | - Ran Song
- Sino Medical Sciences Technology Inc., Tianjin, China
| | | | - Elisabetta Bianchi
- Peptide Chemistry Unit, Peptides & Small Molecules R&D Department, IRBM SpA, Pomezia, Roma, Italy
| | - Yves Castier
- Department of Vascular Surgery, Bichat University Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Antonino Nicoletti
- Université Paris Cité, Paris, France
- Laboratory for Vascular Translational Science, INSERM U1148, Paris, France
| | - Christophe Bureau
- Sino Medical Sciences Technology Inc., Tianjin, China
- AlchiMedics S.A.S., Paris, France
| | - Giuseppina Caligiuri
- Université Paris Cité, Paris, France
- Laboratory for Vascular Translational Science, INSERM U1148, Paris, France
- Department of Cardiology, Bichat University Hospital, Paris, France
| |
Collapse
|
5
|
Virgen-Carrillo LR, Díaz-Sandoval L, Rossi M, Pedernera GO, Duarte ER, Pascua JA, Lugo-Gavidia LM, Lamelas P. Rationale and Design of the Latin-American Registry of Peripheral Interventions: Insights From SOLACI Peripheral. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101931. [PMID: 39132002 PMCID: PMC11307582 DOI: 10.1016/j.jscai.2024.101931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/08/2024] [Accepted: 03/06/2024] [Indexed: 08/13/2024]
Abstract
Background Chronic limb-threatening ischemia (CLTI) represents the most advanced stage of lower extremity peripheral artery disease (PAD). The aim of this manuscript is to provide an overview of the demographic and clinical characteristics of patients with lower-limb peripheral artery disease, as well as the procedural and technical aspects of peripheral endovascular interventions in Latin-America. Methods The SOLACI peripheral registry is a prospective, multi-center, observational, and hospital-based registry of patients with lower-limb PAD, who are treated with endovascular interventions across Latin American countries. Results A total of 1057 independent procedures (997 patients) were analyzed in this report. The most common clinical presentation was CLTI (61.2%): Advanced stage of the disease was common, and the symptomatic classification was predominately Rutherford V (minor tissue loss) in 37.6%. Index endovascular procedures mainly treated femoral-popliteal and infrapopliteal regions. Disease extending across multiple vascular territories was common and 27.6% of patients underwent angioplasty of multiple regions during the same procedure. There was a high prevalence of cardiovascular risk factors and concomitant comorbidities: hypertension (84.5%), dyslipidemia 67.4%), diabetes mellitus (64.7%), myocardial infarction (17%) and stroke (8.4%). Major adverse events during hospitalization included death from any cause (1.3%), cardiovascular death (0.7 %), myocardial infarction (0.4%), stroke (0.1%) and bleeding (0.8%). Conclusions Real-world data on lower limb-PAD in Latin American countries will help us identify unmet needs and generate evidence-based recommendations to facilitate the development of more effective preventive and treatment strategies according to each country's necessities and resources.
Collapse
Affiliation(s)
- Luis R. Virgen-Carrillo
- Department of Interventional Cardiology, Virgen Cardiovascular Research, Guadalajara, Mexico
- Department of Interventional Cardiology, Universidad Autonóma de Guadalajara, Guadalajara, Mexico
| | - Larry Díaz-Sandoval
- Department of Interventional Cardiology, Ascension Borgess Hospital, Kalamazoo, Michigan
| | - Maximiliano Rossi
- Department of Interventional Cardiology, Instituto Cardiovascular Rosario, Santa Fe, Argentina
| | - Gustavo O. Pedernera
- Department of Interventional Cardiology, ICBA Instituto Cardiovascular, Buenos Aires, Argentina
| | - Ernesto R. Duarte
- Department of Interventional Cardiology, Hospital Escuela de Agudos Dr Madariaga, Posadas Misiones, Argentina
| | - Julio A. Pascua
- Department of Interventional Cardiology, Hospital Italiano La Plata, Buenos Aires, Argentina
| | - Leslie M. Lugo-Gavidia
- Dobney Hypertension Centre, Medical School, University of Western Australia, Perth, Australia
- Mexican Academic Consortium for Clinical Data Acquisition, Culican, Sinalos, Mexico
| | - Pablo Lamelas
- Instituto de Cardiologia y Cirugia Cardiovascular Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| |
Collapse
|
6
|
Shimizu H, Kobayashi T, Okazaki T, Mochizuki S, Maeda K, Sato T, Emura S, Arai Y, Kato Y, Takahashi S. Clinical impact of fluoropolymer-based drug-eluting stent thrombosis in femoropopliteal artery occlusive lesions. Vascular 2024:17085381241258553. [PMID: 38811860 DOI: 10.1177/17085381241258553] [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: 05/31/2024]
Abstract
BACKGROUND Endovascular treatment (EVT) is recommended for superficial femoral artery (SFA) lesions, and good results have been reported after implantation of drug-eluting stents (DES) for SFA. However, the major concern after implantation is acute thrombosis during the follow-up period, resulting in major amputation and major adverse limb events. In this study, we examined the incidence and outcome of acute thrombosis after DES implantation in the SFA. OBJECTIVES AND METHODS DES implantation for a femoropopliteal lesion was performed in 288 patients at multiple centers in Japan from 2019 to 2021. A total of 25 patients (8.6%) with DES acute occlusion were analyzed retrospectively. The primary endpoint was amputation-free survival (AFS) after acute occlusion. RESULTS The median patient age was 77 years, with 48% having diabetes, 40% undergoing maintenance dialysis, and 66% having chronic limb-threatening ischemia (CLTI). The mean time from initial DES implantation to acute occlusion was 153.5 ± 177.6 days, with a median of 104 days. EVT was performed in 18 patients (72%), surgical revascularization in 3 (12%), and conservative treatment in 4 (16%). Two deaths within 30 days were both due to sepsis. No major amputation or major adverse cardiovascular events occurred within 30 days. The 1-year rates of patency and freedom from target lesion revascularization after DES thrombosis were 22.9% and 48.8%, respectively. AFS at 1 year was 55.1%. CONCLUSION Acute DES occlusion is relatively frequent, and the outcome is poor. Therefore, the indication of DES implantation for a complex SFA lesion may require careful consideration. Further investigation may be needed in DES implantation for a complex SFA lesion.
Collapse
Affiliation(s)
- Haruna Shimizu
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Taira Kobayashi
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Japan
| | - Takanobu Okazaki
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Japan
| | - Shingo Mochizuki
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Kazuki Maeda
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Tomoyasu Sato
- Department of Radiology, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Shogo Emura
- Department of Cardiovascular Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima-shi, Japan
| | - Yasunori Arai
- Department of Cardiology, Fukuyama City Hospital, Fukuyama-shi, Japan
| | - Yuichi Kato
- Department of Cardiology, Fukuyama City Hospital, Fukuyama-shi, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
7
|
Terlouw LG, van Dijk LJD, van Noord D, Bakker OJ, Bijdevaate DC, Erler NS, Fioole B, Harki J, van den Heuvel DAF, Hinnen JW, Kolkman JJ, Nikkessen S, van Petersen AS, Smits HFM, Verhagen HJM, de Vries AC, de Vries JPPM, Vroegindeweij D, Geelkerken RH, Bruno MJ, Moelker A. Covered versus bare-metal stenting of the mesenteric arteries in patients with chronic mesenteric ischaemia (CoBaGI): a multicentre, patient-blinded and investigator-blinded, randomised controlled trial. Lancet Gastroenterol Hepatol 2024; 9:299-309. [PMID: 38301673 DOI: 10.1016/s2468-1253(23)00402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Mesenteric artery stenting with a bare-metal stent is the current treatment for atherosclerotic chronic mesenteric ischaemia. Long-term patency of bare-metal stents is unsatisfactory due to in-stent intimal hyperplasia. Use of covered stents might improve long-term patency. We aimed to compare the patency of covered stents and bare-metal stents in patients with chronic mesenteric ischaemia. METHODS We conducted a multicentre, patient-blinded and investigator-blinded, randomised controlled trial including patients with chronic mesenteric ischaemia undergoing mesenteric artery stenting. Six centres in the Netherlands participated in this study, including two national chronic mesenteric ischaemia expert centres. Patients aged 18 years or older were eligible for inclusion when an endovascular mesenteric artery revascularisation was scheduled and a consensus diagnosis of chronic mesenteric ischaemia was made by a multidisciplinary team of gastroenterologists, interventional radiologists, and vascular surgeons. Exclusion criteria were stenosis length of 25 mm or greater, stenosis caused by median arcuate ligament syndrome or vasculitis, contraindication for CT angiography, or previous target vessel revascularisation. Digital 1:1 block randomisation with block sizes of four or six and stratification by inclusion centre was used to allocate patients to undergo stenting with bare-metal stents or covered stents at the start of the procedure. Patients, physicians performing follow-up, investigators, and radiologists were masked to treatment allocation. Interventionalists performing the procedure were not masked. The primary study outcome was the primary patency of covered stents and bare-metal stents at 24 months of follow-up, evaluated in the modified intention-to-treat population, in which stents with missing data for the outcome were excluded. Loss of primary patency was defined as the performance of a re-intervention to preserve patency, or 75% or greater luminal surface area reduction of the target vessel. CT angiography was performed at 6 months, 12 months, and 24 months post intervention to assess patency. The study is registered with ClinicalTrials.gov (NCT02428582) and is complete. FINDINGS Between April 6, 2015, and March 11, 2019, 158 eligible patients underwent mesenteric artery stenting procedures, of whom 94 patients (with 128 stents) provided consent and were included in the study. 47 patients (62 stents) were assigned to the covered stents group (median age 69·0 years [IQR 63·0-76·5], 28 [60%] female) and 47 patients (66 stents) were assigned to the bare-metal stents group (median age 70·0 years [63·5-76·5], 33 [70%] female). At 24 months, the primary patency of covered stents (42 [81%] of 52 stents) was superior to that of bare-metal stents (26 [49%] of 53; odds ratio [OR] 4·4 [95% CI 1·8-10·5]; p<0·0001). A procedure-related adverse event occurred in 17 (36%) of 47 patients in the covered stents group versus nine (19%) of 47 in the bare-metal stent group (OR 2·4 [95% CI 0·9-6·3]; p=0·065). Most adverse events were related to the access site, including haematoma (five [11%] in the covered stents group vs six [13%] in the bare-metal stents group), pseudoaneurysm (five [11%] vs two [4%]), radial artery thrombosis (one [2%] vs none), and intravascular closure device (none vs one [2%]). Six (13%) patients in the covered stent group versus one (2%) in the bare-metal stent group had procedure-related adverse events not related to the access site, including stent luxation (three [6%] vs none), major bleeding (two (4%) vs none), mesenteric artery perforation (one [2%] vs one [2%]), mesenteric artery dissection (one [2%] vs one [2%]), and death (one [2%] vs none). INTERPRETATION The findings of this trial support the use of covered stents for mesenteric artery stenting in patients with chronic mesenteric ischaemia. FUNDING Atrium Maquet Getinge Group.
Collapse
Affiliation(s)
- Luke G Terlouw
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands.
| | - Louisa J D van Dijk
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Desirée van Noord
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - Olaf J Bakker
- Department of Vascular Surgery, St Antonius Ziekenhuis, Nieuwegein, Netherlands; Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Diederik C Bijdevaate
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, Netherlands; Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Ziekenhuis, Rotterdam, Netherlands
| | - Jihan Harki
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | | | - Jan Willem Hinnen
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, Netherlands
| | - Jeroen J Kolkman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, Netherlands; Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, Netherlands
| | - Suzan Nikkessen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | | | - Henk F M Smits
- Department of Radiology, Bernhoven Hospital, Uden, Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, Netherlands
| | - Dammis Vroegindeweij
- Department of Radiology and Nuclear Imaging, Maasstad Ziekenhuis, Rotterdam, Netherlands
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, Netherlands; Multi-modality Medical Imaging (M3I) group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| |
Collapse
|
8
|
Nakao S, Iida O, Takahara M, Okamoto S, Ishihara T, Tsujimura T, Hata Y, Toyoshima T, Higashino N, Mano T. Incidence of Acute Thrombotic Occlusion and Its Predictors After Contemporary Femoropopliteal Endovascular Therapy in Patients With Peripheral Artery Disease. J Endovasc Ther 2024; 31:263-273. [PMID: 36052430 DOI: 10.1177/15266028221120519] [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 This study investigated the incidence of acute thrombotic occlusion (ATO) and its predictors after contemporary femoropopliteal (FP) endovascular therapy (EVT) for peripheral artery disease. MATERIALS AND METHODS We retrospectively examined 763 limbs (chronic limb-threatening ischemia [CLTI]: 44%, involving popliteal lesion: 44%) in 644 patients (mean age: 75±9 years, male: 71%, hemodialysis: 34%) who successfully underwent EVT with contemporary FP devices (drug-coated stent: n=220, stent graft: n=158, drug-eluting stent: n=150, drug-coated balloon [DCB]: n=235) from June 2012 to July 2020. The outcome measure was ATO defined as acute onset of claudication and/or signs of CLTI in combination with angiographic evidence of occlusive thrombus formation within the treated segment. Cox proportional hazards regression models were used to identify baseline characteristics associated with the incidence of ATO after EVT treated with scaffold. To determine the impact of ATO occurrence and creatine phosphokinase (CPK) elevation on the subsequent composite outcome of mortality or major amputation, we developed the Cox model in which the trichotomous variable (free from ATO, ATO without CPK elevation, and ATO with CPK elevation) was a time-dependent covariate. RESULTS The 24-month incidence of ATO in the overall population was 4.3%±0.8% (DCB: 1.0%±0.7% vs scaffold: 5.8%±1.1%, p<0.01). Hemodialysis (hazard ratio [HR]: 2.63, p=0.02) and involving popliteal lesion (HR: 8.22, p<0.01) were independently associated with an increased risk of ATO in patients treated with scaffold. Both ATO without CPK elevation and ATO with CPK elevation were significantly associated with a composite outcome of mortality or major amputation comparing free from ATO, with an HR of 2.39 and 9.87, respectively (p=0.02 and p<0.01). CONCLUSION We found a substantial incidence of ATO after contemporary FP-EVT, particularly with scaffold. Hemodialysis and involving popliteal lesion were significantly associated with ATO risk in patients treated with scaffold. The occurrence of ATO, particularly with CPK elevation, was associated with an increased risk of a subsequent composite outcome of mortality or major amputation. The scaffold was safely used in patients without those risk factors of ATO, but a non-scaffolding strategy should be considered for patients with more risk factors. CLINICAL IMPACT The scaffold was safely used in patients without hemodialysis and involving popliteal lesion, but a non-scaffolding strategy should be considered for patients with those risk factors. The occurrence of ATO, particulary with CPK elevation, was of high risk of mortality or amputation.
Collapse
Affiliation(s)
- Sho Nakao
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | | | | | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Taku Toyoshima
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Naoko Higashino
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| |
Collapse
|
9
|
Ansel GM, Brodmann M, Rocha-Singh KJ, Menk JS, Zeller T. Five-Year Safety and Effectiveness of Paclitaxel Drug-Coated Balloons Alone or With Provisional Bare Metal Stenting for Real-World Femoropopliteal Lesions: IN.PACT Global Study Subgroup Analysis. Circ Cardiovasc Interv 2024; 17:e013084. [PMID: 38348677 PMCID: PMC10871603 DOI: 10.1161/circinterventions.123.013084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 11/09/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND The treatment of complex infra-inguinal disease with drug-coated balloons (DCBs) is associated with a significant number of patients undergoing provisional stenting to treat a suboptimal result. To determine the potential long-term impact of DCB treatment with provisional bare metal stenting in complex lesions in real-world patients, a post hoc analysis was performed on data from the IN.PACT Global Study (The IN.PACT Global Clinical Study for the Treatment of Comprehensive Superficial Femoral and/or Popliteal Artery Lesions Using the IN.PACT Admiral Drug-Eluting Balloon). Five-year outcomes were compared between participants who were stented after DCB treatment versus those treated with DCB alone. METHODS The IN.PACT Global Study enrolled 1535 participants with intermittent claudication and/or ischemic rest pain caused by femoropopliteal lesions; 1397 patients were included in this subgroup analysis (353 stented and 1044 nonstented). Effectiveness was assessed as freedom from clinically driven target lesion revascularization through 60 months. The primary safety composite end point was defined as freedom from device- and procedure-related death through 30 days, and freedom from major target limb amputation and clinically driven target vessel revascularization through 60 months. RESULTS Lesions in the stented group were longer (15.37 versus 10.98 cm; P<0.001) and had more total occlusions (54.7% versus 28.6%; P<0.001) compared with the nonstented group. The 5-year Kaplan-Meier estimated freedom from clinically driven target lesion revascularization was similar between groups (66.8% stented versus 70.0% nonstented group, log-rank P=0.22). The safety composite end point was achieved in 64.5% stented versus 68.2% nonstented participants (log-rank P=0.19) as estimated by the Kaplan-Meier method. No significant difference was observed in the cumulative incidence of major adverse events (49.1% stented versus 45.0% nonstented; log-rank P=0.17), including all-cause death (19.6% stented versus 19.3% nonstented, log-rank P=0.99). CONCLUSIONS In this real-world study, revascularization of complex femoropopliteal artery lesions with DCB angioplasty alone or DCB followed by provisional bare metal stenting in certain lesions achieved comparable long-term safety and clinical effectiveness. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01609296.
Collapse
Affiliation(s)
- Gary M. Ansel
- Department of Medicine, University of Toledo, OH (G.M.A.)
- Healthcare Insights, LLC, Boston, MA (G.M.A.)
| | | | - Krishna J. Rocha-Singh
- Department of Cardiology, Prairie Heart Institute, St. John’s Hospital, Springfield, IL (K.J.R.-S.)
| | | | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg, Kardiologie und Angiologie II, Bad Krozingen, Germany (T.Z.)
| |
Collapse
|
10
|
Tobita K, Takahara M, Iida O, Soga Y, Yamaoka T, Ichihashi S, Saito S. Clinical Impact of Additional Cilostazol Treatment on Restenosis Risk following Heparin-Bonded Stent Graft Implantation: Sub-Analysis from the Viabahn Stent-Graft Placement for Femoropopliteal Diseases Requiring Endovascular Therapy (VANQUISH) Study. J Atheroscler Thromb 2023; 30:1461-1470. [PMID: 36725018 PMCID: PMC10564643 DOI: 10.5551/jat.63874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/21/2022] [Indexed: 02/03/2023] Open
Abstract
AIM The present study investigated the effects of additional cilostazol administration on the 12-month risk of restenosis after femoropopliteal heparin-bonded stent graft implantation. METHODS This study was a sub-analysis of the Viabahn stent graft placement for femoropopliteal disease reQUIring endovaScular tHerapy (VANQUISH) study, which was a prospective multicenter study investigating patients who received Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA) and dual-antiplatelet therapy with aspirin and a thienopyridine. The comparison of clinical outcomes between subgroups with and without cilostazol treatment were performed using the propensity score-matching method to minimize the intergroup differences in baseline characteristics. RESULTS Cilostazol-treated patients had a lower 12-month proportion of restenosis than cilostazol-free patients (8.2% vs 27.3%). The odds ratio of cilostazol for the 12-month restenosis was 0.27 [95% CI, 0.08 to 0.97] (p=0.045). Furthermore, the cumulative incidence rates of surgical reconstruction, target lesion revascularization and acute thrombotic occlusion (p values by the log-rank test) were 2.6% versus 1.8% (P=0.43), 5.3% versus 20.5% (P=0.067), and 0.0% versus 11.8% (P=0.0499), respectively. The rates of surgical reconstruction and target lesion revascularization (TLR) were not significantly different between both groups. CONCLUSIONS Our study revealed the clinical impact of additional cilostazol treatment on the risk of restenosis and acute thrombotic occlusion following heparin-bonded stent graft implantation, while TLR and surgical reconstruction were not significantly different.
Collapse
Affiliation(s)
- Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine and Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan
| | | | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| |
Collapse
|
11
|
Teng L, Zhang Y, Fang J, Liu X, Shi T, Qu C, Li J, Shen C. A Bayesian network meta-analysis for acute thrombosis after lower extremity artery endovascular treatment. Catheter Cardiovasc Interv 2023; 102:731-742. [PMID: 37592400 DOI: 10.1002/ccd.30803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/13/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Various endovascular treatment devices have been widely used in the lower extremity arterial disease (LEAD). Their patency efficiency for target lesions has been well studied and reported. Comparison of the risk of acute thrombosis events between the different endovascular treatment devices is unclear. AIMS To rank the risk of acute thrombosis events when bare metal stents (BMSs), covered stents (CSs), drug-eluting stents (DESs), drug-coated balloons (DCBs), and conventional percutaneous transluminal balloon angioplasty (PTA) are used to treat LEAD through Bayesian network meta-analysis. METHODS We performed a network meta-analysis of randomized controlled trials comparing the risk of 1-year postoperative acute thrombosis between BMSs, CSs, DESs, DCBs, and PTA for treating LEAD. Bayesian random models were used for pooled endovascular treatment modality comparisons. We ranked these treatment modalities via the Bayesian method according to their surface under the cumulative ranking curve (SUCRA) and estimated probabilities. RESULTS Nineteen studies (38 study arms; 2758 patients) were included. The Bayesian network ranking of treatments indicated that DCB had the lowest risk of acute thrombosis, PTA had the second-lowest risk of thrombosis, and CS, BMS, and DES had the highest risk of thrombosis. Regarding the treatment efficacy, the OR values of the loss of primary patency were significantly lower for DCB (OR = 0.44, 95% CI: 0.30-0.62), DES (OR = 0.36, 95% CI: 0.14-0.94), and CS (OR = 0.31, 95% CI: 0.18,0.56) than for PTA. When BMS was used as a reference, only the OR for CS was significantly lower (OR = 0.41, 95% CI = 0.21-0.82). Correspondingly, the Bayesian ranking of treatments from better to worse target lesion primary patency was CS, DES, DCB, BMS, and PTA. CONCLUSION With the available research evidence and according to the network analysis ranking, DES appears to have the highest risk of acute thrombosis and DCB appears to have the lowest risk.
Collapse
Affiliation(s)
- Lequn Teng
- Vascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Yongbao Zhang
- Vascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Jie Fang
- Vascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Xinnong Liu
- Vascular Surgery Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Shi
- Vascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Chengjia Qu
- Vascular Surgery Department, Beijing Jishuitan Hospital, Beijing, China
| | - Jialiang Li
- Vascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Chenyang Shen
- Vascular Surgery Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
12
|
Angel de Gregorio M, Brodmann M, Ruiz EM, Manteca JC, Salmeron RR, Munoz Ruiz-Canela JJ, Trujillo IG, Tepe G. Drug-Coated Balloon for the Treatment of Long-Segment Femoropopliteal Artery Disease: Pooled Analysis from the BIOLUX P-III SPAIN and BIOLUX P-III All-Comers Registry Long Lesion Subgroup. J Vasc Interv Radiol 2023; 34:1707-1715.e7. [PMID: 37422253 DOI: 10.1016/j.jvir.2023.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023] Open
Abstract
PURPOSE To investigate the clinical performance and safety of the Passeo-18 Lux drug-coated balloon (DCB) in complex femoropopliteal Trans-Atlantic Inter-Society Consensus (TASC) C and D lesions in an all-comers patient population. MATERIAL AND METHODS Data from BIOLUX P-III SPAIN, a prospective, national, multicenter, postmarket all-comers registry conducted from 2017 to 2019, and a matching long lesion subgroup from the BIOLUX P-III All-Comers global registry conducted from 2014 to 2018 were pooled for analysis. The primary safety end point was freedom from major adverse events (MAEs) at 6 months, and the primary performance end point was freedom from clinically driven target lesion revascularization (fCD-TLR) at 12 months, both adjudicated by an independent clinical events committee. RESULTS A total of 159 patients, of whom 32.7% had critical limb ischemia, were included in the Passeo-18 Lux long lesion cohort. The mean lesion length was 248.5 mm ± 71.6, and the majority were occluded (54.1%), calcified (87.4%), and of type TASC C (49.1%) or TASC D (50.9%). Freedom from MAEs was 90.6% (95% CI, 84.6-94.3) at 6 months and 83.9% (95% CI, 76.7-89.0) at 12 months. fCD-TLR was 84.4% (95% CI, 77.3-89.5) at 12 months. Freedom from target limb major amputation was 98.6% (95% CI, 94.6-99.7), and all-cause mortality was 5.3% (95% CI, 2.7-10.4) at 12 months. There were no device- or procedure-related deaths or amputations up to the 12-month follow-up. CONCLUSION Passeo-18 Lux DCB is safe and effective for the treatment of long femoropopliteal lesions in a real-word setting.
Collapse
Affiliation(s)
| | | | - Esau Martinez Ruiz
- Department of Angiology and Vascular Surgery, Hospital de Mataro, Barcelona, Spain
| | - Jorge Cuenca Manteca
- Department of Angiology and Vascular Surgery, Hospital Universitario San Cecilio, Granada, Spain
| | | | | | | | - Gunnar Tepe
- Department of Radiology, Klinikum Rosenheim, Rosenheim, Germany
| |
Collapse
|
13
|
Nagatomi S, Takahara M, Nakai T, Fujimura N, Yu A, Matsuda D, Yamaoka T, Bolstad F, Yamamoto H, Ichihashi S. Comparing the impact of the loss of patency between treatment with drug-coated balloon angioplasty and drug-eluting stent placement. J Vasc Surg 2023; 77:1751-1759. [PMID: 36796593 DOI: 10.1016/j.jvs.2023.01.207] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To compare the results of endovascular treatment with drug-eluting stents (DES) and drug-coated balloons (DCB) in atherosclerotic lesions in the femoropopliteal artery, as well as to assess restenotic patterns. METHODS Clinical data from 617 cases treated with DES or DCB for femoropopliteal diseases were analyzed in this multicenter, retrospective cohort study. From these, 290 DES and 145 DCB cases were extracted by propensity score matching. Outcomes investigated were 1- and 2-year primary patency, reintervention, and restenotic pattern and its impact on symptoms in each group. RESULTS The primary patency rates at 1 and 2 years in the DES group were superior to those in the DCB group (84.8% and 71.1% vs 81.3% and 66.6%, P = .043), whereas there was no significant difference in freedom from target lesion revascularization (91.6% and 82.6% vs 88.3% and 78.8%, P = .13). Compared with what was measured before the index procedures, exacerbated symptoms, rate of occlusion, and an increase in the occluded length at loss of patency were more frequent in the DES group than in the DCB group. The odds ratios were 3.53 (95% confidence interval, 1.31-9.49; P = .012), 3.61 (1.09-11.9; P = .036), and 3.82 (1.15-12.7; P = .029), respectively. On the other hand, the frequency of an increase in lesion length and requirement of target lesion revascularization were similar between the two groups. CONCLUSIONS Primary patency was significantly higher at 1 and 2 years in the DES than in the DCB group. However, DES were associated with exacerbated clinical symptoms and complicated lesion characteristics at the point of loss of patency.
Collapse
Affiliation(s)
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takahiro Nakai
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Kashihara, Japan
| | - Naoki Fujimura
- Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Ayaka Yu
- Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Daisuke Matsuda
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Francesco Bolstad
- Department of Clinical English, Nara Medical University, Kashihara, Japan
| | | | - Shigeo Ichihashi
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Kashihara, Japan
| |
Collapse
|
14
|
Kumar AP, Valakkada J, Ayappan A, Kannath S. Management of Acute Complications during Endovascular Procedures in Peripheral Arterial Disease: A Review. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1760246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AbstractEndovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arterial disease even in long segment occlusions. Complications can occur during the arterial access, catheter manipulation, balloon dilation, and/or stent placement. Given the high prevalence of comorbidities such as diabetes, hypertension, renal dysfunction, and coronary artery disease in these patients, early identification of procedural complications and initiation of treatment are of paramount importance. This review aims to provide comprehensive data on the identification and management of commonly encountered endovascular complications during endovascular interventions in peripheral arterial disease.
Collapse
Affiliation(s)
- Ajay Pawan Kumar
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anoop Ayappan
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Santhosh Kannath
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| |
Collapse
|
15
|
Comparison Between Clinical Outcomes of Low- and High-Dose Paclitaxel Drug-Coated Balloon in Endovascular Therapy for Femoropopliteal Lesion. Cardiovasc Intervent Radiol 2022; 46:590-597. [PMID: 36316495 DOI: 10.1007/s00270-022-03289-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE There is a little datum about the impact of paclitaxel dosage in patients undergoing drug-coated balloons (DCB) in endovascular therapy (EVT) for femoropopliteal lesions. In the current study, the authors sought to compare the clinical outcomes of low-dose (LD) and high-dose (HD) paclitaxel DCBs for patients undergoing EVT for femoropopliteal lesions in a real-world setting. MATERIALS AND METHODS The study population was derived from a multicenter registry named "Evaluation of clinical outcome after endovascular therapy for femoropopliteal artery disease in Kanagawa" (LANDMARK registry). This registry consists of patients from 5 hospitals in Kanagawa, Japan. Overall, 1,378 patients with 1,777 lesions received treatment between July 2017 and June 2020. Among these, DCB angioplasty was performed in 477 patients (516 lesions). Propensity score matching analysis was performed to compare the clinical outcomes of LD-DCB (Lutonix; Becton Dickinson and Company, Franklin Lakes, New Jersey) and HD-DCB (IN.PACT Admiral; Medtronic Vascular, Santa Clara, CA, USA). RESULTS A total of 160 matched pairs of lesions were analyzed. Primary patency and freedom from target lesion revascularization at 2 years were similar between the two groups (LD-DCB vs. HD-DCB: 72% vs. 70%, p = 0.53; and 75% vs. 73%, p = 0.59, respectively). CONCLUSION No significant differences were found in the clinical outcomes between LD-DCB and HD-DCB angioplasty for femoropopliteal lesions. LEVEL OF EVIDENCE Level 3.
Collapse
|
16
|
Liu P, Zheng LH, He XQ, Yang Y, Zhang LK, Zhang L, Zhang F. Mid-Term Outcomes of Endovascular Therapy for TASC II D Femoropopliteal Lesions with Critical Limb Ischaemia: A Retrospective Analysis. Ann Vasc Surg 2022; 88:182-190. [PMID: 36007776 DOI: 10.1016/j.avsg.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/17/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study evaluated the mid-term results of endovascular therapy (EVT) for Trans-Atlantic Inter-Society (TASC) II D femoropopliteal lesions in patients with critical limb ischaemia (CLI). METHODS Fifty-seven limbs of 54 patients with CLI due to TASC II D femoropopliteal lesions who underwent EVT at the First Hospital of Hebei Medical University were retrospectively analysed in single-centre, observational study. The patient characteristics, endovascular procedural details, freedom from target lesion revascularisation (TLR), patency rates, ulcer healing rate, and limb salvage rate were accessed. RESULTS The patients' mean age was 68.2 ± 8.2 years. All patients were treated by EVT. The final technical success rate was 98.2% (56/57). There were 23 cases of pain at rest, 18 cases of ulcer, and 15 cases of gangrene. The median length of the treated segment was 286 ± 42 mm (56/56) and the mean number of stents placed per patient was 2.0 ± 0.8 (49/56). The postoperative ankle-brachial index (ABI) was significantly higher than that of the preoperative ABI (P < 0.05). The perioperative complication rate was 10.7% (6/56). The re-stenosis or occlusion rate was 44.6% (25/56). The estimated rates of freedom from TLR at 1 year, 2 years, and 3 years were 86.8%, 67.0%, and 62.5%, respectively. Univariate analysis showed that predictors of freedom from TLR were the number of runoff vessels, length of the lesion, and complexity of the lesion, while predictors for re-stenosis or occlusion were the length and the complexity of the lesion. The ulcer healing rate was 93.8%. The limb salvage rates were 76.4%, 74.4%, and 70.9% at 1, 2, and 3 years after treatment, respectively. CONCLUSIONS The mid-term outcomes of EVT for TASC II D femoropopliteal lesions in patients with CLI indicated that this treatment approach is safe and effective, and is clinically applicable.
Collapse
Affiliation(s)
- Peng Liu
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Li-Hua Zheng
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Xin-Qi He
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Yan Yang
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Li-Ke Zhang
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Lei Zhang
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China
| | - Feng Zhang
- Department of Vascular and Endovascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, PR China.
| |
Collapse
|
17
|
Ichihashi S, Takahara M, Yamaoka T, Hara M, Kobayashi T, Tamai H, Nagatomi S, Igari K, Endo M, Uchiyama H, Bolstad F, Iwakoshi S, Fujimura N, Ohki T, Kichikawa K. Drug eluting versus covered stent for femoropopliteal artery lesions: Results of the ULTIMATE study. Eur J Vasc Endovasc Surg 2022; 64:359-366. [DOI: 10.1016/j.ejvs.2022.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 05/06/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
|
18
|
Hayakawa N, Kodera S, Takanashi K, Kanagami T, Ichihara S, Arakawa M, Hirano S, Inoguchi Y, Shakya S, Kanda J. Optimal intraluminal drug-coated balloon versus drug-eluting stent in patients with chronic total occlusion of the superficial femoral artery: A retrospective analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:87-96. [DOI: 10.1016/j.carrev.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
|
19
|
Iida O, Takahara M, Soga Y, Yamaoka T, Fujihara M, Kawasaki D, Ichihashi S, Kozuki A, Nanto S, Sakata Y, Mano T. 1-Year Outcomes of Fluoropolymer-Based Drug-Eluting Stent in Femoropopliteal Practice: Predictors of Restenosis and Aneurysmal Degeneration. JACC Cardiovasc Interv 2022; 15:630-638. [PMID: 35331454 DOI: 10.1016/j.jcin.2022.01.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to investigate the 1-year risk of restenosis and aneurysmal degeneration and explore the associated factors after femoropopliteal implantation of fluoropolymer-based drug-eluting stents (FP-DESs) for symptomatic atherosclerotic peripheral artery disease in real-world practice. BACKGROUND Although clinical trials have demonstrated that FP-DES implantation has favorable 1-year outcomes, its performance in real-world practice has not been well elucidated. METHODS This multicenter, prospective, observational study evaluated 1,204 limbs (chronic limb-threatening ischemia: 34.8%, mean lesion length: 18.6 ± 9.9 cm, chronic total occlusion: 53.2%, bilateral wall calcification: 41.9%) of 1,097 patients with peripheral artery disease (age: 75 ± 9 years, men: 69.4%, diabetes mellitus: 60.8%, chronic kidney disease: 66.2%) undergoing Eluvia (Boston Scientific) drug-eluting stent implantation for femoropopliteal lesions. The primary outcome measure was 1-year restenosis, whereas the secondary outcome measures were 1-year occlusive restenosis, stent thrombosis, target lesion revascularization, and aneurysmal degeneration. RESULTS The 1-year occurrence rates of restenosis (12.9%), occlusive restenosis (9.2%), stent thrombosis (3.3%), target lesion revascularization (6.2%), and aneurysmal degeneration (16.8%) were found. Multivariate analysis demonstrated that dialysis, chronic limb-threatening ischemia, history of revascularization, a smaller reference vessel diameter, chronic total occlusion, and spot stenting were significantly associated with an increased risk of 1-year restenosis, whereas intravascular ultrasound use and subintimal wire passage were significantly associated with an increased risk of 1-year aneurysmal degeneration. CONCLUSIONS This study documented the 1-year clinical outcomes after femoropopliteal endovascular therapy with FP-DES implantation in real-world practice. The 1-year restenosis rate would be clinically acceptable, whereas the occurrence of occlusive restenosis and aneurysmal degeneration should be noted.
Collapse
Affiliation(s)
- Osamu Iida
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan.
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Daizo Kawasaki
- Department of Cardiology, Morinomiya Hospital, Osaka, Japan
| | - Shigeo Ichihashi
- Division of Radiology, Nara Medical University, Kashihara, Japan
| | - Amane Kozuki
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Shinsuke Nanto
- Department of Cardiology, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | | |
Collapse
|
20
|
Giannopoulos S, Strobel A, Rudofker E, Kovach C, Kokkosis AA, Armstrong EJ. Outcomes of Stented vs Nonstented Femoropopliteal Lesions Treated With Drug-Coated Balloon Angioplasty. J Endovasc Ther 2022; 30:194-203. [PMID: 35179065 DOI: 10.1177/15266028221079770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Drug-coated balloon (DCB) angioplasty has been increasingly used for the treatment of lower limb peripheral artery disease (PAD). However, bail-out stenting may be necessary in cases of suboptimal angioplasty. This study investigated the outcomes of femoropopliteal disease treated with DCB with/without bail-out stenting. MATERIALS AND METHODS This was a single-center retrospective study enrolling 166 consecutive patients (DCB+stent: n=81 vs DCB: n=85) with 253 femoropopliteal lesions (DCB+stent: n=99 vs DCB: n=154) treated with DCB with/without stenting. Bail-out stenting was performed at the operator discretion for postangioplasty dissections or otherwise suboptimal angiographic result (>30% residual stenosis). Cox regression analysis was performed to examine the outcomes of DCB with/without stenting during 2-year follow-up. RESULTS The baseline clinical characteristics were similar between the 2 groups. About half of the patients presented with critical limb ischemia, with most of the lesions located at the superficial femoral artery. The overall mean lesion length was 147±67 mm. The most frequent bail-out stent types were bare metal stents (BMS) (53.5%) followed by drug-eluting stents (DES) (41.4%). Lesions requiring bail-out stenting were on average longer (177±67 mm vs 127±59 mm; p<0.01) and on average had higher prevalence of flow-limiting postangioplasty dissections. The overall procedural success rate was 94% without any differences between the 2 groups. Both the stented and nonstented treatment modalities were effective and safe, demonstrating similar rates of 2-year freedom from major adverse limb event (stented: 71.3% vs nonstented: 64.4%) and 2-year freedom from target lesion revascularization (stented: 77.1% vs nonstented: 72.3%) during following up. The use of DES as bail-out therapy was associated with a lower risk of 2-year death compared with the use of BMS (DES: 97.2% vs BMS: 75.8%; p=0.01). CONCLUSION Drug-coated balloon with bail-out stenting is a viable treatment option for cases of suboptimal DCB results, promising similar efficacy with DCB-alone procedures. However, as the patency of stents at the femoropopliteal segment may be a challenge due to the biomechanical stress of the artery, the efficacy of DCB+bail-out stenting should be further evaluated. In addition, future studies are needed to determine which grades of post-DCB dissections should be treated and optimize current bail-out strategies.
Collapse
Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Aaron Strobel
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Eric Rudofker
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Christopher Kovach
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Angela A Kokkosis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado Denver, Denver, CO, USA.,Adventist Health St. Helena, St. Helena, CA, USA
| |
Collapse
|
21
|
He Z, Wang H, Lin F, Ding W, Chen K, Zhang Z. The safety and efficacy of different endovascular treatments for in-stent restenosis of the femoropopliteal artery: A network meta-analysis. Vasc Med 2022; 27:239-250. [PMID: 35164613 DOI: 10.1177/1358863x211070327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: Femoropopliteal artery in-stent restenosis (ISR) remains a challenging treatment. We performed a network meta-analysis (NWM) for femoropopliteal artery ISR to explore the safety and efficacy of endovascular therapeutic strategies. Methods: The MEDLINE, Embase, Web of Science, and Cochrane databases were used as data sources. The network meta-analysis (NWM) approach used random-effects models based on the frequentist framework. We compared technical success rate, primary patency, target lesion revascularization (TLR), and major amputation at the 12-month follow-up for femoropopliteal artery ISR. Results: In total, 14 eligible studies (10 prospective and four retrospective; 1348 patients; and eight treatment modalities - standard balloon angioplasty (SBA), drug-coated balloon (DCB), peripheral cutting balloon angioplasty (PCBA), Viabahn endoprosthesis (VBE), directional atherectomy (DA), excimer laser atherectomy (ELA), and combinations - were included. The primary patency rates (at 6 months) were significantly higher for DCB and ELA+DCB than for SBA and ELA+SBA. ELA+DCB had higher primary patency rates (at 12 months) than ELA+SBA and SBA. The technical success rates were significantly lower for DCB and SBA than for VBE. The major amputation rates were significantly lower for ELA+DCB than for DCB. Based on the surface values under the cumulative ranking curve (SUCRA), ELA+DCB was considered the best treatment in terms of primary patency at 6 months (SUCRA = 91.1), primary patency at 12 months (SUCRA = 82.3), and TLR (SUCRA = 83.4). Conclusion: ELA+DCB showed positive encouraging results in primary patency (6, 12 months), TLR, and major amputation in femoropopliteal ISR. The efficacy and safety of ELA+DCB are worthy of further investigation. (PROSPERO Registration No.: CRD42021246674).
Collapse
Affiliation(s)
- Zhipeng He
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Haoran Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Feng Lin
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Wenjie Ding
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Ke Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Zhigong Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| |
Collapse
|
22
|
Patel K, Liu Y, Etaee F, Patel C, Monteleone P, Patel M, Amer Alaiti M, Metzger C, Banerjee A, Minniefield N, Tejani I, Brilakis ES, Shishehbor MH, Banerjee S. Differences Between Patients With Intermittent Claudication and Critical Limb Ischemia Undergoing Endovascular Intervention: Insights From the Excellence in Peripheral Artery Disease Registry. Circ Cardiovasc Interv 2021; 14:e010635. [PMID: 34706553 DOI: 10.1161/circinterventions.121.010635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are limited data on differences in angiographic distribution of peripheral artery disease and endovascular revascularization strategies in patients presenting with intermittent claudication (IC) and critical limb ischemia (CLI). We aimed to compare anatomic features, treatment strategies, and clinical outcomes between patients with IC and CLI undergoing endovascular revascularization. METHODS We examined 3326 patients enrolled in the Excellence in Peripheral Artery Disease registry from 2006 to 2019 who were referred for endovascular intervention for IC (n=1983) or CLI (n=1343). The primary outcome was 1-year major adverse limb events, which included death, repeat target limb revascularization, or target limb amputation. RESULTS Patients with CLI were older and more likely to have diabetes and chronic kidney disease and less likely to receive optimal medical therapy compared with IC. Patients with IC had higher femoropopliteal artery interventions (IC 87% versus CLI 65%; P<0.001), while below the knee interventions were more frequent in CLI (CLI 47% versus IC 12%; P<0.001). Patients with CLI were more likely to have multilevel peripheral artery disease (CLI 32% versus IC 15%, P<0.001). Patients with IC were predominantly revascularized with stents (IC 48% versus CLI 37%; P<0.001) while balloon angioplasty was more frequent in CLI (CLI 37% versus IC 25%; P<0.001). All-cause mortality was higher in patients with CLI (CLI 4% versus IC 2%; P=0.014). Major adverse limb event rates for patients with IC and CLI were 16% and 26%, respectively (P<0.001) and remained higher in CLI after multivariable adjustment of baseline risk factors. CONCLUSIONS Patients with IC and CLI have significant anatomic, lesion, and treatment differences with significantly higher mortality and adverse limb outcomes in CLI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01904851. Graphic Abstract: A graphic abstract is available for this article.
Collapse
Affiliation(s)
- Kunal Patel
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.).,Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.)
| | - Yulun Liu
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.)
| | - Farshid Etaee
- Texas Tech University Health Sciences Center, Amarillo School of Medicine (F.E.)
| | - Chirag Patel
- Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.).,Methodist Health System Dallas, TX (C.P.)
| | | | - Mitul Patel
- University of California San Diego Sulpizio Cardiovascular Center, La Jolla (M.P.)
| | - Mohamad Amer Alaiti
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.).,Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.)
| | | | | | - Nicole Minniefield
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.).,Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.)
| | - Ishita Tejani
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.).,Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.)
| | | | - Mehdi H Shishehbor
- Case Western Reserve University and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (M.H.S.)
| | - Subhash Banerjee
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.).,Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.)
| |
Collapse
|
23
|
Tan M, Takahara M, Soga Y, Mori S, Tsuchiya T, Mazaki T, Shintani Y, Noguchi M, Taniguchi M, Kobayashi Y, Nakazato J, Urasawa K. Three-Year Clinical Outcomes Following Implantation of LifeStent Self-Expanding Nitinol Stents in Patients With Femoropopliteal Artery Lesions. Angiology 2021; 73:244-251. [PMID: 34493086 DOI: 10.1177/00033197211042685] [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] [Indexed: 01/22/2023]
Abstract
The aim of this study was to evaluate midterm clinical outcomes after implantation of LifeStent self-expanding nitinol stents for the treatment of femoropopliteal lesions. This retrospective, multicenter, non-randomized study examined 260 femoropopliteal lesions in 250 consecutive patients with peripheral artery disease implanted with LifeStents from April 2016 to April 2017. The prevalence of chronic total occlusion (CTO), lesion length ≥25 cm, and distal reference vessel diameter (RVD) <5 mm was 58%, 35%, and 50%, respectively. The 3-year restenosis rate in the overall population was estimated to be 72.9% and a major adverse limb event was observed in 36.9%. Multivariate analysis revealed that chronic limb-threatening ischemia (CLTI) (odds ratio [OR]: 8.04; 95% confidence interval [CI]: 1.86-34.7), CTO (OR: 4.87; 95% CI: 1.43-16.6), lesion length ≥25 cm (OR: 5.95; 95% CI: 1.11-32.0), and distal RVD <5 mm (OR: 4.43; 95% CI: 1.34-14.6) were independent risk factors for 3-year restenosis. The present study demonstrated the midterm clinical outcomes and risk factors for restenosis after implantation of the LifeStent in femoropopliteal artery lesions. CLTI, CTO, lesion length ≥25 cm, and distal RVD <5 mm predicted decreased patency after a 3-year follow-up.
Collapse
Affiliation(s)
- Michinao Tan
- Cardiovascular Center, Tokeidai Memorial Hospital, Sapporo, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan
| | - Taketsugu Tsuchiya
- Department of Transcatheter Cardiovascular Therapeutics, Kanazawa Medical University Hospital, Kahoku-gun, Japan
| | - Toru Mazaki
- Department of Cardiology, Kobe Central Hospital, Kobe, Japan
| | - Yoshiaki Shintani
- Department of Cardiology, Ageo Central General Hospital, Ageo, Saitama, Japan
| | - Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Uyarasu, Japan
| | | | - Yohei Kobayashi
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Jun Nakazato
- Division of Cardiovascular Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Kazushi Urasawa
- Cardiovascular Center, Tokeidai Memorial Hospital, Sapporo, Japan
| |
Collapse
|
24
|
Hayakawa N, Kodera S, Arakawa M, Hirano S, Shakya S, Kanda J. Clinical outcome of drug-coated balloon versus scaffold device in patients with superficial femoral artery chronic total occlusion. Heart Vessels 2021; 37:282-290. [PMID: 34279711 DOI: 10.1007/s00380-021-01912-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
The demand for endovascular therapy is increasing in an aging society, but the problem of restenosis in the chronic phase has not been resolved in femoropopliteal occlusive disease. Few studies have compared drug-coated balloon (DCB) and scaffold devices in chronic total occlusion (CTO) of the superficial femoral artery (SFA). This study aimed to compare DCBs with scaffold in patients with CTO of the SFA. This was a single-center, retrospective study. From June 2018 to December 2019, we compared 31 patients and 33 limbs treated with DCBs and 44 patients and 45 limbs treated with a stent or stent-graft (scaffold) for SFA CTO. The primary endpoint was 12-month primary patency. The secondary endpoints were 12-month freedom from clinically driven target lesion revascularization (CD-TLR) and 12-month freedom from re-occlusion. The DCBs were performed using an intravascular ultrasound (IVUS)-guided approach or a non-loop wire technique. Baseline characteristics were similar between the groups. An intraluminal approach was performed to use all DCBs. The bailout stent rate was 0% in the DCB group. Kaplan-Meier analysis showed that rates of 12-month primary patency tended to be higher in the DCB than in the scaffold group (92.7 vs. 76.6%, p = 0.073) and that freedom from CD-TLR also did not differ significantly between the two groups (96.8 vs. 86.3%, p = 0.17). Kaplan-Meier analysis also showed that the 12-month freedom from re-occlusion rate was significantly less in the Scaffold than in the DCB group (96.8 vs. 79.3%, p = 0.045). Therefore, we concluded that in treatment for CTO of the SFA, a DCB with intraluminal angioplasty without bailout stenting was less re-occlusion compared with scaffold.
Collapse
Affiliation(s)
- Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, , Chiba, 289-2511, Japan.
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan
| | - Masataka Arakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, , Chiba, 289-2511, Japan
| | - Satoshi Hirano
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, , Chiba, 289-2511, Japan
| | - Sandeep Shakya
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, , Chiba, 289-2511, Japan
| | - Junji Kanda
- Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, , Chiba, 289-2511, Japan
| |
Collapse
|
25
|
Abstract
Effective revascularization of the patient with peripheral artery disease is about more than the procedure. The approach to the patient with symptom-limiting intermittent claudication or limb-threatening ischemia begins with understanding the population at risk and variation in clinical presentation. The urgency of revascularization varies significantly by presentation; from patients with intermittent claudication who should undergo structured exercise rehabilitation before revascularization (if needed) to those with acute limb ischemia, a medical emergency, who require revascularization within hours. Recent years have seen the rapid development of new tools including wires, catheters, drug-eluting technology, specialized balloons, and biomimetic stents. Open surgical bypass remains an important option for those with advanced disease. The strategy and techniques employed vary by clinical presentation, lesion location, and lesion severity. There is limited level 1 evidence to guide practice, but factors that determine technical success and anatomic durability are largely understood and incorporated into decision-making. Following revascularization, medical therapy to reduce adverse limb outcomes and a surveillance plan should be put in place. There are many hurdles to overcome to improve the efficacy of lower extremity revascularization, such as restenosis, calcification, microvascular disease, silent embolization, and tools for perfusion assessment. This review highlights the current state of revascularization in peripheral artery disease with an eye toward technologies at the cusp, which may significantly impact current practice.
Collapse
Affiliation(s)
- Joshua A Beckman
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN (J.A.B.)
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California, San Francisco (P.A.S., M.S.C.)
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco (P.A.S., M.S.C.)
| |
Collapse
|
26
|
Frequency, predictors, and effect of the slow-flow phenomenon after drug-coated balloon angioplasty for femoropopliteal lesions. Heart Vessels 2021; 36:1818-1824. [PMID: 34050788 DOI: 10.1007/s00380-021-01871-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/14/2021] [Indexed: 12/24/2022]
Abstract
Drug-coated balloon (DCB) angioplasty for femoropopliteal (FP) lesions has been available in Japan since 2018. In daily practice, we encountered cases of the slow-flow phenomenon after DCB angioplasty. However, no data regarding the slow-flow phenomenon after DCB angioplasty for FP lesions are available. This study aimed to investigate the frequency, predictors, and effect of the slow-flow phenomenon following DCB angioplasty for FP lesions. This single-center, retrospective, observational study analyzed 88 FP lesions treated by DCB angioplasty between April 2018 and July 2019. Patients were divided into the slow-flow group (n = 7) and non-slow-flow group (n = 81) and were analyzed. The primary endpoint was primary patency at 6 months. The slow-flow phenomenon was observed in seven cases (8.0%). The slow-flow group had higher incidence rates of critical limb ischemia (CLI) (71% vs. 25%, p < 0.01), chronic total occlusion (CTO) lesions (86% vs. 26%, p < 0.01), and poor tibial vessel runoff (86% vs. 33%, p < 0.01) and had a longer DCB length (237 ± 56 mm vs. 159 ± 97 mm, p = 0.03) than the non-slow-flow group. The primary patency rate at 6 months was 71% in the slow-flow group and 91% in the non-slow-flow group (p = 0.09). The rate of freedom from target lesion revascularization at 6 months was 71% in the slow-flow group and 97% in the non-slow-flow group (p < 0.01). The amputation-free survival rate at 6 months was 71% and 95% (p = 0.02), whereas the survival rate at 6 months was 71% and 95% (p = 0.02). The incidence rate of the slow-flow phenomenon after DCB angioplasty for FP lesions was 8.0%. CLI, a CTO lesion, poor tibial vessel runoff, and total DCB length were associated with the slow-flow phenomenon. Our results indicate that the slow-flow phenomenon is associated with poor short-term clinical outcomes.
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
van Hattum ES, Hazenberg C. Stent Graft Thrombosis in Femoropopliteal Arterial Lesions. JACC Cardiovasc Interv 2021; 14:1148-1150. [PMID: 34016413 DOI: 10.1016/j.jcin.2021.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/19/2022]
|
29
|
Clinical Impact of Stent Graft Thrombosis in Femoropopliteal Arterial Lesions. JACC Cardiovasc Interv 2021; 14:1137-1147. [PMID: 34016412 DOI: 10.1016/j.jcin.2021.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study sought to elucidate the clinical impact and prognosis of stent graft (SG) thrombosis. BACKGROUND The VIABAHN SG offers a favorable outcome in long peripheral artery occlusive disease (PAOD) lesions in the femoropopliteal artery. One concern after SG deployment is the incidence of stent thrombosis and consequent acute limb ischemia (ALI). METHODS In this retrospective multicenter study, we collected the clinical data of PAOD patients treated with VIABAHN SG who subsequently experienced SG thrombosis. The clinical symptoms of SG thrombosis, patency after reintervention, and predictors of loss of patency after reintervention were examined. RESULTS VIABAHN SGs were used for 1,215 patients; SG thrombosis occurred in 159 (13%) patients at a median of 6.4 months (interquartile range: 2.8 to 13.5 months) after SG implantation; 21 (13%) patients presented with ALI. A total of 131 (82%) patients underwent reintervention for SG thrombosis, whereas 2 (1%) underwent primary major amputation and the remaining 26 (16%) were treated conservatively. The patency rate 1 year after reintervention, freedom from major adverse limb events, and limb salvage after reintervention were 54.9%, 73.6%, and 92.5%, respectively. Critical limb-threatening ischemia at SG implantation and ALI presentation at SG thrombosis were positively associated with an increased risk of rethrombosis, whereas distal stent diameter was negatively associated with the risk of rethrombosis. CONCLUSIONS SG thrombosis is associated with a considerable risk of ALI, but the risk of primary major amputation was not high. Clinical outcomes after reinterventions for thrombosed SGs were suboptimal.
Collapse
|
30
|
Atrial Fibrillation is Associated with Femoropopliteal Totally Occlusive In-Stent Restenosis: A Single-Center, Retrospective, Observational Study. J Interv Cardiol 2021; 2021:8852466. [PMID: 33623483 PMCID: PMC7875648 DOI: 10.1155/2021/8852466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The proportion of patients with comorbid atrial fibrillation (AF) and peripheral artery disease (PAD) has increased in this era. This study aimed to assess the relationship between AF and totally occlusive in-stent restenosis (ISR) in femoropopliteal (FP) lesions. Methods In this study, 363 patients (461 stents) who underwent endovascular therapy with de novo stent implantation in our hospital between April 2007 and December 2016 were retrospectively evaluated. The patients were divided into two groups according to the AF status (AF group, 61 patients; sinus group, 302 patients). The primary endpoint was the incidence of totally occlusive ISR within 3 years. The secondary endpoint was the incidence of acute limb ischemia (ALI) due to FP stent occlusion. Results Baseline characteristics were similar, except for higher age and a lower prevalence of dyslipidemia in the AF group. The incidence of a totally occlusive ISR was higher in the AF group than in the sinus group (29.5% vs. 14.6%, p=0.004). A multiple Cox regression model suggested that presence of AF (hazard ratio, 2.10) and CTO lesion (hazard ratio, 1.97) which were the independent predictors of a totally occlusive ISR within 3 years. The incidence of ALI was significantly higher in the AF group than in the sinus group (3.9% vs. 0%, p=0.0001). In the AF group, the introduction of an anticoagulant did not prevent the occurrence of totally occlusive ISR (p=0.71) for ALI (p=0.79). Conclusions AF is independently associated with totally occlusive ISR of FP stents; however, anticoagulant use does not prevent stent occlusion.
Collapse
|
31
|
Tsujimura T, Takahara M, Iida O, Soga Y, Katsuki T, Fujihara M, Kawasaki D, Kozuki A, Mano T. Clinical outcomes of polymer-free, paclitaxel-coated stents vs stent grafts in peripheral arterial disease patients with femoropopliteal artery lesions. J Vasc Surg 2021; 73:1998-2008.e1. [PMID: 33347998 DOI: 10.1016/j.jvs.2020.12.061] [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: 08/10/2020] [Accepted: 12/05/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Zilver PTX polymer-free, paclitaxel-coated stents and Viabahn stent grafts are effective for the treatment of femoropopliteal lesions. The aim of this study was to compare clinical outcomes between the two devices in patients with symptomatic peripheral arterial disease in real-world settings. METHODS This multicenter, retrospective study concerned a clinical database of 445 patients with symptomatic peripheral arterial disease (Rutherford categories 1-6) who underwent either Zilver PTX or Viabahn implantation for a femoropopliteal lesion of 10 cm or longer with reference vessel diameters of 4.0 to 7.5 mm between 2012 and 2018 at five hospitals in Japan. Outcome measures were primary patency, freedom from stent thrombosis, freedom from any target lesion reintervention, limb salvage, and overall survival. After propensity score matching, these clinical outcomes were compared between patients treated with the Zilver PTX and those treated with the Viabahn. Also assessed were the interaction effects of baseline characteristics on the association of the Zilver PTX and Viabahn with restenosis and stent thrombosis. RESULTS In total, 271 patients were treated with the Zilver PTX, and 174 patients were treated with the Viabahn. Propensity score matching extracted 133 patient pairs with no major intergroup differences in baseline characteristics. The Zilver PTX group had a lower rate of 3-year primary patency (59.5%; [95% confidence interval (CI), 53.0%-66.2%] vs 69.6% [95% CI, 59.3%-79.4%]; P = .005), but a higher rate of 3-year freedom from stent thrombosis (93.6% [95% CI, 90.0%-96.3%] vs 82.4% [95% CI, 74.5%-89.0%], P = .038). There was no significant difference in overall survival, limb salvage, or freedom from reintervention (all P > .05). An interaction analysis showed that the restenosis risk of the Zilver PTX was significantly higher vs the Viabahn in patients with no or one below-the-knee runoff vessel and in those with intravascular ultrasound use than in patients with two or three below-the-knee runoff vessels and in those without intravascular ultrasound use, respectively (P for interaction = .046 and .010, respectively), whereas the stent thrombosis risk of the Zilver PTX was significantly smaller vs the Viabahn in patients not on dialysis than in those on dialysis (P for interaction = .034). CONCLUSIONS Compared with Viabahn stent grafts, Zilver PTX stents have a lower rate of primary patency but a higher rate of freedom from stent thrombosis.
Collapse
Affiliation(s)
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine and Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Tomonori Katsuki
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Daizo Kawasaki
- Department of Cardiology, Morinomiya Hospital, Osaka, Japan
| | - Amane Kozuki
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| |
Collapse
|
32
|
Tomoi Y, Soga Y, Okazaki J, Iida O, Shiraki T, Hiramori S, Ando K. Drug-coated stent implantation vs. bypass surgery for in-stent occlusion after femoropopliteal stenting. Heart Vessels 2021; 36:646-653. [PMID: 33392645 DOI: 10.1007/s00380-020-01740-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022]
Abstract
The optimal revascularization for in-stent occlusion (ISO) lesions after femoropopliteal (FP) bare-nitinol stenting has not been established. We, therefore, investigated the comparison between drug-coated stent (DCS) implantation and bypass surgery (BSX) for ISO lesions after FP bare-nitinol stenting. This study was a dual-center, observational study from January 2004 to December 2015. A total of 172 ISO lesions were observed, and after excluding 120 ISO lesions, 52 ISO lesions (50 patients; mean age, 71.0 ± 9.2 years; male, 59.6%) after FP bare-nitinol stenting were enrolled. The included patients with clinical symptoms underwent either DCS implantation (n = 28) or BSX (n = 22). The primary endpoint was recurrent in-stent restenosis (ReISR); secondary endpoints were recurrent target lesion revascularization (ReTLR), recurrent occlusion (reocclusion) and major adverse limb events (MALE), and perioperative complications (POCs), respectively. ReISR or reocclusion was defined as ISR or occlusion after TLR. Stent restenosis was defined as a peak systolic velocity ratio (PSVR) > 2.4 on a duplex scan or ≥ 50% stenosis on angiography. Graft restenosis was defined as a PSV > 300 cm/s and velocity ratio 3.5 or uniformly low PSV < 45 cm/s throughout the entire graft based on graft surveillance. The mean follow-up period was 36.6 ± 25.5 months. At 2 years, the rates of freedom from ReISR, ReTLR, and MALE were not significantly different between the DCS implantation and BSX groups (68.9% vs. 73.7%, p = 0.81; 84.7% vs. 73.7%, p = 0.45; 84.7% vs. 78.6%, p = 0.60, respectively). However, the freedom from reocclusion rate was significantly lower in the DCS implantation group (81.6% vs. 100%, p = 0.04). The occurrence of POCs was not significantly different between the DCS implantation and BSX groups (7.1% vs 4.2%, p = 1.0). Although BSX was the gold-standard therapy for ISO lesions after FP bare-nitinol stenting, DCS implantation might be a good option because the rates of freedom from ReISR, ReTLR, and MALE were similar.
Collapse
Affiliation(s)
- Yusuke Tomoi
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, 802-0001, Japan.
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, 802-0001, Japan
| | - Jin Okazaki
- Department of Vascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Osamu Iida
- Department of Cardiology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tatsuya Shiraki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Seiichi Hiramori
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, 802-0001, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, 802-0001, Japan
| |
Collapse
|
33
|
Tsujimura T, Ishihara T, Iida O, Hata Y, Kurata N, Asai M, Masuda M, Okamoto S, Nanto K, Kanda T, Matsuda Y, Mano T. Angioscopic Assessments at 3 Months After Fluoropolymer-Based Paclitaxel-Eluting Stent Implantation for Femoropopliteal Endovascular Intervention. Circ J 2020; 84:1999-2005. [DOI: 10.1253/circj.cj-20-0551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center
| | | | - Naoya Kurata
- Department of Clinical Engineering, Kansai Rosai Hospital
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Sugimoto M, Komori K, Yokoi H, Ohki T, Kichikawa K, Nakamura M, Nanto S, O'Leary EE, Lottes AE, Saunders AT, Dake MD. Long-Term Effectiveness of a Drug-Eluting Stent for Femoropopliteal In-Stent Restenosis: Subanalysis of the Zilver PTX Japan Post-Market Surveillance Study. J Endovasc Ther 2020; 28:229-235. [PMID: 33084502 DOI: 10.1177/1526602820966708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To present a subgroup analysis of patients from a large real-world study evaluating the safety and effectiveness of the Zilver PTX drug-eluting stent (DES) for treating femoropopliteal in-stent restenosis (ISR). MATERIALS AND METHODS This study examined patients enrolled in the Zilver PTX Japan Post-Market Surveillance Study (ClinicalTrials.gov identifier NCT02254837), a prospective, multicenter registry of 904 symptomatic patients with 1082 femoropopliteal lesions treated with the DES at 95 institutions in Japan. Five-year outcomes, including mortality, stent radiography, freedom from target lesion revascularization (TLR), and clinical benefit, were evaluated for 177 patients (mean age 74.2±8.3 years; 118 men) with 204 ISR lesions treated with the Zilver DES. Over half of the patients (108, 61.0%) were diabetic. Mean lesion length was 17.8±10.4 cm, and a third (72, 35.3%) were total occlusions. Outcome measures were all-cause mortality, thrombosis, freedom from TLR, and clinical benefit, defined as freedom from persistent or deteriorating ischemic symptoms. RESULTS No device-related or procedure-related deaths or paclitaxel-related adverse events were reported. All-cause mortality was 25.1% at 5 years. Stent fracture was observed in 5 stents through 5 years. The 5-year rate of freedom from clinically-driven TLR was 73.4%, and the rate of clinical benefit was 63.6%. Improvement in Rutherford category and ankle-brachial index was sustained through 5 years. CONCLUSION The safety and effectiveness of the Zilver PTX stent for the treatment of femoropopliteal ISR lesions demonstrated that this device provides a favorable treatment option in this difficult-to-treat subgroup.
Collapse
Affiliation(s)
- Masayuki Sugimoto
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiovascular Medicine, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Takao Ohki
- Department of Surgery, Jikei University Hospital, Tokyo, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan
| | - Shinsuke Nanto
- Department of Cardiology, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | | | | | | | - Michael D Dake
- The University of Arizona Health Sciences, Tucson, AZ, USA
| |
Collapse
|
35
|
Iida O, Takahara M, Soga Y, Yamaoka T, Nanto S, Kuratani T, Sakata Y, Mano T. One-Year Outcomes of Heparin-Bonded Stent-Graft Therapy for Real-World Femoropopliteal Lesions and the Association of Patency With the Prothrombotic State Based on the Prospective, Observational, Multicenter Viabahn Stent-Graft Placement for Femoropopliteal Diseases Requiring Endovascular Therapy (VANQUISH) Study. J Endovasc Ther 2020; 28:123-131. [DOI: 10.1177/1526602820960445] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To evaluate the real-world primary patency of heparin-bonded stent-graft therapy for femoropopliteal (FP) occlusive disease and identify any clinical factors, including the prothrombotic state, associated with the loss of patency. Materials and Methods: This multicenter study prospectively enrolled 424 limbs of 371 patients (mean age 75±8 years; 247 men) scheduled for Viabahn stent-graft placement in the FP segment. A full-coverage strategy using only a Viabahn stent-graft was preferred, but “spot stenting” with the Viabahn was also allowed. The prothrombotic state was assessed by measuring platelet reactivity. Vascular morphology was evaluated using intravascular ultrasound (IVUS). Primary patency was estimated using the Kaplan-Meier method in the subgroup of patients having full lesion stent-graft coverage (n=343 limbs, 81.1%). The secondary outcomes were major amputation, surgical reconstruction, target lesion revascularization (TLR), and thrombotic occlusion. Regression analyses were used to explore associations of baseline and clinical variables with loss of patency; the results are given as the odds ratio (OR) and 95% confidence interval (CI). Results: The 1-year primary patency estimate was 80.3% (95% CI 75.5% to 85.1%) in the full-coverage group. There were 7 surgical reconstructions, 46 TLRs, 21 acute thrombotic occlusions, and 1 major amputation during the 1-year follow-up in the full-coverage group. Only angiography- and IVUS-determined vessel diameters were significantly associated with loss of patency, with crude ORs of 0.64 (95% CI 0.45 to 0.89, p=0.009) and 0.67 (95% CI 0.51 to 0.90, p=0.009), respectively, per 1-mm increase, whereas other variables, including the prothrombotic state (p=0.74), were not. Multivariable analysis demonstrated that only IVUS-determined vessel diameter was independently associated with loss of patency (adjusted OR per 1-mm increase 0.72, 95% CI 0.52 to 1.00, p=0.049). Conclusion: FP stent-graft placement achieved acceptable patency at 1 year in a real-world setting. A smaller vessel size was significantly associated with loss of patency, whereas the prothrombotic state was not.
Collapse
Affiliation(s)
- Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine and Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Shinsuke Nanto
- Department of Cardiology, Nishinomiya Municipal Central Hospital, Nishinomiya City, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| |
Collapse
|
36
|
Yasunaga M, Yanagawa K, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Tanaka A, Okamoto N, Matsunaga-Lee Y, Yano M, Yamato M, Egami Y, Shutta R, Nishino M, Tanouchi J. Serial angioscopic evaluation of self-expanding stent graft implantation in superficial femoral artery. J Cardiol Cases 2020; 22:59-63. [PMID: 32774521 DOI: 10.1016/j.jccase.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/19/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022] Open
Abstract
We evaluated Viabahn stent-graft (W.L. Gore & Associates, Flagstaff, AZ, USA) implanted in the superficial femoral artery at 6 months and one year after implantation because the patient felt claudication due to repeated restenosis of bare nitinol stent which was implanted just proximal to the site of Viabahn stent-graft. At 6 months, angioscopy showed severe thrombosis in the stent-graft while the stent-graft was entirely patent. However, at one year, angioscopic evaluation revealed no thrombosis in the stent-graft. She received the same dual antiplatelet therapy. <Learning objective: We report a case with Viabahn stent-graft in whom an angioscopy revealed severe thrombosis at 6 months but no thrombosis at one year during the same dual antiplatelet therapy (DAPT). It might be necessary to continue DAPT after Viabahn stent-graft implantation at least over one year to prevent thrombosis.>.
Collapse
Affiliation(s)
- Motoki Yasunaga
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Kyosuke Yanagawa
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yutaka Matsuhiro
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Akihiro Tanaka
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | | | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masaki Yamato
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Ryu Shutta
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| |
Collapse
|
37
|
Chavez MA, Heidari B, Thacker S, Samuel LL, Ogbonna M. Acute Promyelocytic Leukemia Presenting as Bilateral Acute Limb Ischemia and ST Elevation Myocardial Infarction: A Case Report. Cureus 2020; 12:e8495. [PMID: 32656013 PMCID: PMC7343312 DOI: 10.7759/cureus.8495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Acute myelogenous leukemia (AML) is one of the most common hematologic malignancies. Among them, acute promyelocytic leukemia (APL) is well known for its coagulopathies. Bleeding secondary to disseminated intravascular coagulation, is a common initial presentation and carries a high risk for mortality if left untreated. Thrombotic complications are uncommon and can be related to treatment with chemotherapeutic agents. Large artery thrombosis is very rare, and standardized management remains elusive given the classic revascularization techniques carry a significant risk of re-thrombosis, as well as high risk for mortality given the multiple surgical and percutaneous interventions that are attempted. A multidisciplinary approach is necessary in these cases to carefully weigh the risk and benefits as the classical approach to revascularization and acute arterial thrombosis could potentially cause harm.
Collapse
Affiliation(s)
| | - Behnam Heidari
- Internal Medicine, Houston Methodist Hospital, Houston, USA
| | - Sameer Thacker
- Internal Medicine, Houston Methodist Hospital, Houston, USA
| | - Leena L Samuel
- Internal Medicine, Houston Methodist Hospital, Houston, USA
| | | |
Collapse
|
38
|
Okuno S, Iida O, Inoue K, Asai M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Tsujimura T, Matsuda Y, Hata Y, Mano T. Very late intrastent thrombotic occlusion caused by neoatherosclerosis after bare-metal stent implantation in the superficial femoral artery: Insight from histopathological findings. J Cardiol Cases 2020; 21:172-175. [PMID: 32373240 PMCID: PMC7195560 DOI: 10.1016/j.jccase.2019.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/26/2019] [Accepted: 12/18/2019] [Indexed: 01/22/2023] Open
Abstract
A 58-year-old male with gangrene in his left 1st digit due to critical limb ischemia had undergone endovascular therapy for chronic total occlusion of the left superficial femoral artery using bare-metal stents (BMSs). Angiography revealed in-stent occlusion of the BMS site when he was referred to our hospital with a recurrent ulcer at 7 years after stent implantation. As catheter-directed thrombolysis with urokinase was not effective, surgical thrombectomy was performed. His ankle-brachial index improved, and the ulcer was completely healed after thrombectomy. Pathological evaluation of the retrieved thrombi showed that it consisted of a massive erythrocyte, abundant fibrin precipitation, and fragments of atherosclerotic plaques, such as foamy macrophages and ghost images thought to be cholesterol crystals. These findings suggested that the neoatherosclerotic changes in the neointima gradually occurred in the stented segment, and neointimal disruption potentially caused the intrastent thrombotic occlusion. .
Collapse
Affiliation(s)
- Shota Okuno
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Katsumi Inoue
- Kokura Memorial Hospital, Fukuoka, Kitakyushu, Japan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | | | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | | | | | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| |
Collapse
|
39
|
Affiliation(s)
- Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine
| | | |
Collapse
|
40
|
Loffroy R, Edriss N, Goyault G, Chabanier A, Pernes JM, Sauguet A, Touil M, Woerly B, Pongas D, Chevallier O, Falvo N, Galland C, Midulla M, Garnier N, Guenfoudi MP, Boulin M, Aho-Gléglé S, Bost S. Percutaneous mechanical atherothrombectomy using the Rotarex ®S device in peripheral artery in-stent restenosis or occlusion: a French retrospective multicenter study on 128 patients. Quant Imaging Med Surg 2020; 10:283-293. [PMID: 31956549 DOI: 10.21037/qims.2019.11.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background To ascertain the safety and mid-term outcomes of Rotarex®S rotational atherectomy plus thrombectomy device (Straub Medical AG, Wangs, Switzerland) with or without adjunctive treatment (e.g., percutaneous transluminal angioplasty, PTA/drug-coated balloon, DCB/stenting) in patients with in-stent restenosis (ISR) or occlusion in the iliac and/or infrainguinal arteries. Methods French multicenter retrospective study of all patients treated by in-stent percutaneous mechanical debulking (PMD) of the lower limbs with Rotarex®S device between January 2013 and November 2018. Results The cohort consisted of 128 patients (88 men and 40 women), aged 39-94 years (mean, 66.7±12 years). All patients presented with cardio-vascular risk factors. Overall, 51.5% of patients had critical limb ischemia. The study demonstrated a technical success of 96.9% in the population with PMD and adjunctive PTA (95/128, 74.2%) or adjunctive DCB (16/128, 12.5%) or both (13/128, 10.2%). At 12-months follow-up, the primary clinical success/patency rate was 92.3% and the secondary clinical success/patency rate was 91.4%. Rate of limb salvage was 93.7%. Overall 32 (25%) reinterventions were reported with mean time from Rotarex®S treatment to reintervention of 7.1±8.2 months. Target lesion revascularization (TLR) was 19.5% (25/128). Seven (5.5%) patients developed distal embolism that responded to endovascular treatment. At mean follow-up, major adverse events (MAE) observed were death (18/128, 14.1%), myocardial infarction (MI) (9/128, 7.0%), stroke (2/128, 1.6%) and renal failure (3/128, 2.3%). Conclusions Recanalization with Rotarex®S rotational atherectomy plus thrombectomy device is a practical choice for arterial ISR/occlusions of the iliac and/or infrainguinal arteries, regardless of the age of the thrombus, with satisfying TLR. Only adjunctive PTA is often necessary to further improve the recanalization.
Collapse
Affiliation(s)
- Romaric Loffroy
- Department of Vascular and Interventional Radiology, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Nizam Edriss
- Department of Vascular Surgery, Centre Hospitalier Artois-Ternois, Arras, France
| | - Gilles Goyault
- Department of Vascular and Interventional Radiology, Clinique de l'Orangerie, Strasbourg, France
| | - Alain Chabanier
- Department of Interventional Cardiology, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - Jean-Marc Pernes
- Department of Interventional Radiology and Cardiology, Hôpital Privé d'Antony, Paris, France
| | - Antoine Sauguet
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Mehdi Touil
- Department of Vascular Surgery, Centre Hospitalier Artois-Ternois, Arras, France
| | - Bernard Woerly
- Department of Vascular and Interventional Radiology, Clinique de l'Orangerie, Strasbourg, France
| | - Dionyssios Pongas
- Department of Interventional Radiology and Cardiology, Hôpital Privé d'Antony, Paris, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Christophe Galland
- Department of Vascular and Interventional Radiology, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Nathalie Garnier
- Department of Pharmacy, Statistics and Clinical Research, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Marie-Pierre Guenfoudi
- Department of Pharmacy, Statistics and Clinical Research, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Mathieu Boulin
- Department of Pharmacy, Statistics and Clinical Research, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Serge Aho-Gléglé
- Department of Epidemiology, Statistics and Clinical Research, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Stéphanie Bost
- Department of Pharmacy, Statistics and Clinical Research, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| |
Collapse
|
41
|
Bradaric C, Koppara T, Müller A, Haller B, Ott I, Cassese S, Fusaro M, Kastrati A, Laugwitz KL, Ibrahim T. Incidence and predictors of stent thrombosis after endovascular revascularisation of the superficial femoral artery. EUROINTERVENTION 2019; 15:e1107-e1114. [DOI: 10.4244/eij-d-19-00187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
42
|
Layer-by-layer biofabrication of coronary covered stents with clickable elastin-like recombinamers. Eur Polym J 2019. [DOI: 10.1016/j.eurpolymj.2019.109334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
43
|
Schneider PA, Laird JR, Tepe G, Brodmann M, Zeller T, Scheinert D, Metzger C, Micari A, Sachar R, Jaff MR, Wang H, Hasenbank MS, Krishnan P. Treatment Effect of Drug-Coated Balloons Is Durable to 3 Years in the Femoropopliteal Arteries: Long-Term Results of the IN.PACT SFA Randomized Trial. Circ Cardiovasc Interv 2019; 11:e005891. [PMID: 29326153 PMCID: PMC5771683 DOI: 10.1161/circinterventions.117.005891] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/29/2017] [Indexed: 01/23/2023]
Abstract
Supplemental Digital Content is available in the text. Background— Randomized controlled trials have reported favorable 1-year outcomes with drug-coated balloons (DCBs) for the treatment of symptomatic peripheral arterial disease when compared with standard percutaneous transluminal angioplasty (PTA). Evidence remains limited on the durability of the treatment effect with DCBs in the longer term. Methods and Results— IN.PACT SFA is a single-blind, randomized trial (Randomized Trial of IN.PACT Admiral Paclitaxel-Coated Percutaneous Transluminal Angioplasty [PTA] Balloon Catheter vs Standard PTA for the Treatment of Atherosclerotic Lesions in the Superficial Femoral Artery [SFA] and/or Proximal Popliteal Artery [PPA]) that enrolled 331 patients with symptomatic (Rutherford 2–4) femoropopliteal lesions up to 18 cm in length. Patients were randomized 2:1 to receive treatment with DCB or PTA. The 36-month assessments included primary patency, freedom from clinically driven target lesion revascularization, major adverse events, and functional outcomes. At 36 months, primary patency remained significantly higher among patients treated with DCB compared with PTA (69.5% versus 45.1%; log rank P<0.001). The rates of clinically driven target lesion revascularization were 15.2% and 31.1% (P=0.002) for the DCB and PTA groups, respectively. Functional outcomes were similarly improved between treatment groups even though subjects in the DCB group required significantly fewer reinterventions versus those in the PTA group (P<0.001 for target lesion revascularization, P=0.001 for target vessel revascularization). There were no device- or procedure-related deaths as adjudicated by an independent Clinical Events Committee. Conclusions— Three-year results demonstrate a durable and superior treatment effect among patients treated with DCB versus standard PTA, with significantly higher primary patency and lower clinically driven target lesion revascularization, resulting in similar functional improvements with reduced need for repeat interventions. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01175850 for IN.PACT SFA phase I in the European Union and NCT01566461 for IN.PACT SFA phase II in the United States.
Collapse
Affiliation(s)
- Peter A Schneider
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.).
| | - John R Laird
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Gunnar Tepe
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Marianne Brodmann
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Thomas Zeller
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Dierk Scheinert
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Christopher Metzger
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Antonio Micari
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Ravish Sachar
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Michael R Jaff
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Hong Wang
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Melissa S Hasenbank
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | - Prakash Krishnan
- From the Hawaii Permanente Medical Group, Kaiser Foundation Hospital, Honolulu, HI (P.A.S.); Adventist Heart and Vascular Institute, St Helena Hospital, CA (J.R.L.); Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany (G.T.); Department of Internal Medicine, Division of Angiology, Medical University, Graz, Austria (M.B.); Angiology Division, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany (T.Z.); Department of Angiology, University Hospital Leipzig, Germany (D.S.); Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.M.); North Carolina Heart and Vascular, UNC-REX Health Care, Raleigh, NC (R.S.); Newton-Wellesley Hospital, MA (M.R.J.); Medtronic, Santa Rosa, CA (H.W., M.S.H.); and Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (P.K.)
| | | |
Collapse
|
44
|
Treatment of Common Femoral Artery Pseudoaneurysm: A Novel Approach Utilizing a VASCADE Percutaneous Closure Device. Case Rep Surg 2019; 2019:1397981. [PMID: 31263620 PMCID: PMC6556803 DOI: 10.1155/2019/1397981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 11/17/2022] Open
Abstract
Iatrogenic common femoral artery pseudoaneurysm is a well-known complication to vascular access. Many options, both surgical and nonsurgical, have been implemented as means to treat pseudoaneurysms such as thrombin injection, image-guided compression, and percutaneous closure devices. This case report demonstrates a novel technique using a VASCADE closure device to successfully treat an iatrogenic common femoral pseudoaneurysm.
Collapse
|
45
|
Bio-Based Covered Stents: The Potential of Biologically Derived Membranes. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:135-151. [DOI: 10.1089/ten.teb.2018.0207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
46
|
Milnerowicz A, Milnerowicz A, Kuliczkowski W, Protasiewicz M. Rotational Atherectomy Plus Drug-Coated Balloon Angioplasty for the Treatment of Total In-Stent Occlusions in Iliac and Infrainguinal Arteries. J Endovasc Ther 2019; 26:316-321. [PMID: 30907258 DOI: 10.1177/1526602819836749] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To analyze the long-term outcomes of a hybrid treatment method combining rotational atherectomy with drug-coated balloon (DCB) angioplasty in patients with total in-stent occlusion in the iliac and/or infrainguinal arteries. MATERIALS AND METHODS Between April 2014 and June 2017, 74 consecutive patients (mean age 66.7±9.7 years; 49 men) with total occlusion of a previously implanted stent underwent endovascular recanalization using the Rotarex system and DCB angioplasty. Half (37, 50%) of the patients had critical limb ischemia (CLI), and 30 (41%) of the procedures were performed in emergency. Mean lesion length was 22±15 cm. RESULTS Overall procedure success was achieved in 73 (98.6%) patients. Six (8.1%) CLI patients developed distal embolism that responded to thrombolysis. Three (4.1%) dissections did not require treatment, while 1 (1.4%) perforation necessitated stent-graft implantation. In all, 33 (44.6%) patients had an additional stent implanted, mainly due to a suboptimal outcome (n=28) or complications (n=5 including the stent-graft). The restenosis rate assessed by duplex ultrasound at 12 months was 20.5% (15/73); 4 (5.5%) patients underwent target lesion revascularization. Recurrent restenosis was more frequent in patients with Rutherford category 5 ischemia (p=0.005), in emergency procedures (p=0.021), after extensive procedures involving 3 independent vessel segments (p=0.016), and if a complication arose during the procedure (p<0.001). In multivariate analysis, only occurrence of a procedural complication was an independent predictor of recurrent restenosis at 1 year (OR 63.3, 95% CI 5.7 to 701.5). CONCLUSION These findings imply that rotational atherectomy and DCB angioplasty may provide satisfactory outcomes in the treatment of total in-stent occlusion, with a satisfactory recurrent restenosis rate at 12 months.
Collapse
Affiliation(s)
- Artur Milnerowicz
- 1 Department of Vascular, General and Transplantation Surgery, Medical University of Wrocław, Poland
| | - Aleksandra Milnerowicz
- 1 Department of Vascular, General and Transplantation Surgery, Medical University of Wrocław, Poland
| | - Wiktor Kuliczkowski
- 2 Department and Clinic of Cardiology, Medical University of Wrocław, Poland
| | - Marcin Protasiewicz
- 2 Department and Clinic of Cardiology, Medical University of Wrocław, Poland
| |
Collapse
|
47
|
Banerjee S, Jeon-Slaughter H, Armstrong EJ, Bajzer C, Abu-Fadel M, Khalili H, Prasad A, Bou Dargham B, Kamath P, Addo T, Luna M, Gigliotti O, Foteh M, Cawich I, Kinlay S, Ali M, Ramanan B, Niazi K, Tsai S, Shammas NW, Brilakis ES. Clinical Outcomes and Cost Comparisons of Stent and Non-Stent Interventions in Infrainguinal Peripheral Artery Disease: Insights From the Excellence in Peripheral Artery Disease (XLPAD) Registry. THE JOURNAL OF INVASIVE CARDIOLOGY 2019; 31:1-9. [PMID: 30611122 PMCID: PMC6428413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The contemporary limb outcomes and costs of stent-based vs non-stent based strategies in endovascular revascularization of femoropopliteal (FP) peripheral artery disease (PAD) are not well understood. METHODS AND RESULTS We present data from the ongoing United States multicenter Excellence in Peripheral Artery Disease Registry between 2006-2016 to compare stent vs non-stent treatment outcomes and associated costs in FP interventions. A total of 2910 FP interventions were performed in 2162 patients (mean age, 66 years), comprising 1339 stent based (superficial femoral artery, 93%) in 1007 patients and 1571 non-stent interventions (superficial femoral artery, 85%) in 1155 patients. A growing trend for non-stent based interventions and a declining trend in repeat revascularization rate at 1 year were observed across years of registry enrollment. Stent implantation was the prevailing strategy in treating longer FP lesions (mean length, 152 mm vs 105 mm; P<.001) and chronic total occlusions (65% vs 40%; P<.001), while stent implantation was employed less frequently when treating in-stent restenotic lesions (14% vs 20%; P<.001). Stent and non-stent interventions had similar 1-year limb outcomes in all-cause death, target-limb revascularization, target-vessel revascularization, and major or minor amputation. The average procedure costs for the stent group were significantly higher than the non-stent group ($6215 vs $4790; P<.001). CONCLUSION There is a growing trend for non-stent FP artery interventions, with a significant decline in 1-year target-limb revascularization rates over time. One-year limb outcomes in stent-based compared to non-stent interventions are similar; however, at a significantly higher procedural cost.
Collapse
Affiliation(s)
- Subhash Banerjee
- Dallas VA Medical Center, 4500 S. Lancaster Road (111a), Dallas, TX 75216 USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Khalili H, Jeon-Slaughter H, Armstrong EJ, Baskar A, Tejani I, Shammas NW, Prasad A, Abu-Fadel M, Brilakis ES, Banerjee S. Atherectomy in below-the-knee endovascular interventions: One-year outcomes from the XLPAD registry. Catheter Cardiovasc Interv 2018; 93:488-493. [PMID: 30499198 DOI: 10.1002/ccd.27897] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/31/2018] [Accepted: 08/29/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Use of atherectomy for the treatment of peripheral arterial disease (PAD) is increasing as an adjunctive treatment to either conventional or drug-coated balloon angioplasty. There is limited data on atherectomy outcomes in below-the-knee (BTK) endovascular interventions. METHODS Data from the multicenter Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851) were analyzed to examine predictors of atherectomy use and its associated 1-year patency rate. We analyzed 518 BTK procedures performed between January 2005 and December 2016. RESULTS Overall a total of 518 BTK procedures were treated in 430 patients, and 43% of interventions used atherectomy. African American patients were less likely (13% vs 25%; |standard residual| = 3.41) to be treated with atherectomy. Use of atherectomy was lower in chronic total occlusive (CTO) lesions (48% vs 58%; P = 0.02). There were no significant associations of baseline comorbidities, critical limb ischemia (CLI), ankle-brachial index, number of BTK vessel run-off, or vessel location with atherectomy use. Compared with patients without atherectomy, use of atherectomy was associated with lower incidence of repeat target limb intervention at 1 year after adjusting for age, CLI, in-stent restenosis, heavy calcification, presence of diffuse disease, and CTO lesion traits (Hazard Ratio 0.41, 95% confidence interval 0.23-0.72; P < 0.01). CONCLUSIONS Compared with no atherectomy, use of atherectomy in BTK interventions is associated with lower rates of 1-year repeat target limb revascularization. These findings require confirmation in prospective, randomized clinical studies.
Collapse
Affiliation(s)
- Houman Khalili
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Veterans Affairs North Texas Health Care System
| | - Haekyung Jeon-Slaughter
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Veterans Affairs North Texas Health Care System
| | | | | | - Ishita Tejani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Veterans Affairs North Texas Health Care System
| | | | - Anand Prasad
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mazen Abu-Fadel
- Oklahoma University Health Science Center, Oklahoma City, Oklahoma
| | - Emmanouil S Brilakis
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Veterans Affairs North Texas Health Care System.,Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Subhash Banerjee
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Veterans Affairs North Texas Health Care System
| |
Collapse
|
49
|
Kichikawa K, Ichihashi S, Yokoi H, Ohki T, Nakamura M, Komori K, Nanto S, O'Leary EE, Lottes AE, Snyder SA, Dake MD. Zilver PTX Post-market Surveillance Study of Paclitaxel-Eluting Stents for Treating Femoropopliteal Artery Disease in Japan: 2-Year Results. Cardiovasc Intervent Radiol 2018; 42:358-364. [PMID: 30411151 PMCID: PMC6373439 DOI: 10.1007/s00270-018-2110-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022]
Abstract
Purpose A prospective, multicenter post-market surveillance study in Japan evaluated the 2-year safety and effectiveness of the DES in real-world patients with complex femoropopliteal artery lesions. Methods There were no exclusion criteria, and consecutive symptomatic patients with femoropopliteal lesions treated with the DES were enrolled in the study. Clinically driven target lesion revascularization (TLR) was defined as reintervention performed for > 50% diameter stenosis after recurrent clinical symptoms of peripheral arterial disease. Clinical benefit was defined as freedom from persistent or deteriorating ischemic symptoms. Patency was evaluated by duplex ultrasound where physicians considered this standard of care. Results In this study, 905 patients were enrolled at 95 institutions in Japan. There were numerous comorbidities including a high incidence of diabetes (58.8%) and chronic kidney disease (43.6%). Additionally, 21.4% of patients were classified with critical limb ischemia. Lesions were complex, with an average length of 14.6 ± 9.6 cm (range 0.5–40 cm), 41.5% total occlusions, and 18.7% in-stent restenosis. In total, 1861 DES were placed in 1080 lesions. Two-year follow-up was obtained for > 90% of eligible patients. Freedom from TLR was 83.7%, and clinical benefit was 80.0% through 2 years. The 2-year primary patency rate was 70.3%. Rutherford classification significantly improved (p < 0.01), with approximately 80% of patients classified as Rutherford class 0 or 1 at 2 years. Conclusion Despite more challenging lesion characteristics, 2-year results from the current study are similar to outcomes from the previous Zilver PTX studies, confirming the efficacy of the Zilver PTX DES in a complicated femoropopliteal lesion (Zilver PTX Post-Market Study in Japan; NCT02254837). Level of Evidence Post-market surveillance study, Level III.
Collapse
Affiliation(s)
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan.
| | - Hiroyoshi Yokoi
- Department of Cardiovascular Medicine, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Takao Ohki
- Department of Surgery, Jikei University Hospital, Tokyo, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Kimihiro Komori
- Division of Vascular Surgery, Division of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinsuke Nanto
- Nishinomiya Hospital Affairs, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | | | | | | | - Michael D Dake
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA
| |
Collapse
|
50
|
Feldman DN, Armstrong EJ, Aronow HD, Gigliotti OS, Jaff MR, Klein AJ, Parikh SA, Prasad A, Rosenfield K, Shishehbor MH, Swaminathan RV, White CJ. SCAI consensus guidelines for device selection in femoral-popliteal arterial interventions. Catheter Cardiovasc Interv 2018; 92:124-140. [DOI: 10.1002/ccd.27635] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Herbert D. Aronow
- The Warren Alpert Medical School of Brown University; Providence Rhode Island
| | | | | | | | | | | | | | | | | | | |
Collapse
|