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Tang X, Ma H, Zhou G, Shu X, Li Y, Guo M. Efficacy of Supera Stent in the Treatment of Complex Femoropopliteal Artery Lesions: A Short-Term Result Analysis of Real-World Evidence. Ann Vasc Surg 2024:S0890-5096(24)00438-2. [PMID: 39032594 DOI: 10.1016/j.avsg.2024.06.022] [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: 01/20/2024] [Revised: 05/06/2024] [Accepted: 06/09/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE When dealing with complex femoropopliteal lesions, there is a growing preference for the utilization of drug-coated balloons (DCB) or stents. However, in real-world scenarios, a greater number of elderly patients with longer lesion lengths are encountered. The purpose of our study was to compare the efficacy and safety of different interventional strategies, including the utilization of Supera stent and DCB, in a real-world setting. METHODS This was a retrospective study that collected treatment and follow-up data of patients with complex femoropopliteal artery lesions treated between January 2019 and March 2022. All patients were categorized into three groups: "non-Supera stent group,""Supera stent group," and "Supera stent + DCB group." The primary effectiveness outcome was primary patency at 12 months, defined as duplex ultrasound peak systolic velocity ratio<2.5 at the 12-month visit. Other outcomes included improvements in Rutherford categories and safety. RESULTS A total of 162 patients were enrolled in this study. Compared to non-Supera group (47.6%) in the primary patency rate at 12 months, Supera group (58.7%) or Supera + DCB group (60.0%) showed no significant difference. There were no significant differences in all-cause death, major amputation of the target limb, and target lesion revascularization (TLR) between the groups. Supera group showed a significant improvement in Rutherford category without TLR at 12 months compared to non-Supera group (73.3% vs. 54.8%, P=0.041). In 12-month follow-up, over 65% of patients maintained a Rutherford category of 3 or below, particularly in Supera group where 74.7% of patients had mild symptoms. CONCLUSION The Supera stent has demonstrated its efficacy and safety in treating complex peripheral artery disease. However, combining Supera stent with DCB did not provide a significant advantage. Further research is necessary to validate these findings in a larger patient population.
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Affiliation(s)
- Xingyi Tang
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Huibo Ma
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Guanzhi Zhou
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Xiaolong Shu
- The First Affiliated Hospital of Naval Medical University, Shanghai, Shanghai, 200000
| | - Yongxin Li
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, 266000, China.
| | - Mingjin Guo
- Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, 266000, China.
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Ergun O, Eraslan O, Hekimoglu A, Birgi E, Ceylan AH, Conkbayir I. Evaluation of the self-expanding effect of carotid stents in the early postoperative period. Vascular 2024; 32:589-595. [PMID: 36794658 DOI: 10.1177/17085381231158494] [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: 02/17/2023]
Abstract
PURPOSE To evaluate the expansion effect of self-expandable stents during the first week after carotid artery stenting (CAS) procedure and to examine the variation of the effect according to the carotid plaque type. METHODS Seventy stenotic carotid arteries of 69 patients were stented by using self-expanding Wallstents with diameters of 7 and 9 mm, after detection of stenosis and plaque type by Doppler ultrasonography. Post-stent aggressive ballooning was avoided and residual stenosis rates were measured with digital subtraction angiography. After the stenting procedure, the caudal, narrowest, and cranial diameters of stents were measured with ultrasonography at 30 min, first day and first week. Stent diameter increase and change according to plaque type were evaluated. Two-way repeated measure ANOVA test was used for statistical analysis. RESULTS A significant increase was observed in the mean stent diameter in the three stent regions (caudal, narrow, and cranial) from the 30th minute to the first and seventh days (p < 0.001). The most prominent stent expansion occurred in the cranial and narrow segments within the first day. In the narrow stent region; Stent diameter increase between 30th minute-first day, 30th minute-first week, and first day-first week were all significant (p < 0.001). At 30 min, first day, and first week, no significant difference was detected between plaque type and stent expansion in caudal, narrow, and cranial regions (p = 0.286). CONCLUSION We think that keeping the lumen patency limited to 30% residual stenosis after CAS procedure by applying minimal post-stenting balloon dilatation and leaving the remaining lumen expansion to the self-expanding feature of the Wallstent might be a sensible approach in order to avoid embolic events and excessive carotid sinus reactions (CSR).
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Affiliation(s)
- Onur Ergun
- Lokman Hekim University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Onder Eraslan
- Lokman Hekim University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Azad Hekimoglu
- University of Health Sciences, Diskapi Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Erdem Birgi
- University of Health Sciences, Diskapi Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Arda H Ceylan
- University of Health Sciences, Diskapi Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Isık Conkbayir
- University of Health Sciences, Diskapi Training and Research Hospital, Department of Radiology, Ankara, Turkey
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Tan Q, Chen Z, Wu H, Wang H, Chen J, Lai K, Zhang F, Kang T, Zheng J. A Systematic Review and Meta-Analysis of Efficacy and Safety of Cilostazol Prescription in Patients With Femoropopliteal Peripheral Artery Disease After Endovascular Therapy. J Endovasc Ther 2024:15266028241241248. [PMID: 38590247 DOI: 10.1177/15266028241241248] [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: 04/10/2024]
Abstract
PURPOSE The purpose of this study is to assess the efficacy and safety of cilostazol prescription in patients with femoropopliteal peripheral artery disease (PAD) after endovascular therapy (EVT). MATERIALS AND METHODS We conducted a systematic review and meta-analysis of all studies reporting the outcomes of cilostazol after femoropopliteal EVT of PAD up to September 2022. Clinical outcomes of interest included primary patency, in-stent restenosis (ISR), vessel re-occlusion, freedom from target lesion revascularization (TLR), repeat revascularization, all-cause mortality, amputation, major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs), and bleeding complication. RESULTS A total of 4 randomized controlled trials (RCTs) and 8 observational studies containing a total of 4898 patients met the inclusion criteria and were included in this systematic review and meta-analysis. We found that the use of cilostazol was associated with higher primary patency after femoropopliteal artery EVT (odds ratio [OR]=1.67, 95% confidence interval [CI]=1.50-1.87, p<0.001, I2=33.2%), a lower risk of ISR (OR=0.43, 95% CI=0.29-0.63, p<0.001, I2=37.6%), repeat revascularization (OR=0.43, 95% CI=0.24-0.76, p<0.005, I2=27.4%), and vessel re-occlusion (OR=0.59, 95% CI=0.38-0.93, p<0.05, I2=0%). There was an increase in freedom from TLR rate (OR=2.19, 95% CI=1.58-3.05, p<0.001, I2=0%), as well as a reduction in the occurrence of MALEs (OR=0.50, 95% CI=0.29-0.85, p<0.05, I2=0%). However, there was no significant difference in amputation, MACEs, all-cause mortality, and major bleeding complications. Subgroup analysis showed that cilostazol treatment in patients with femoropopliteal drug-eluting stents (DES) implantation remained associated with higher primary patency and a lower risk of ISR. CONCLUSIONS After EVT of femoropopliteal artery lesions, additional oral cilostazol enhances primary patency, reduces the occurrences of ISR and vessel re-occlusion, diminishes the risks associated with MALEs, lowers the need for repeat revascularization, and increases freedom from TLR rates. However, it does not impact amputation, MACEs, all-cause mortality, or major bleeding complications. These findings suggest cilostazol as a potentially safe and effective adjunct therapy in patients with femoropopliteal PAD after EVT. CLINICAL IMPACT After undergoing endovascular therapy (EVT) for femoropopliteal artery lesions, the addition of cilostazol to antiplatelet therapy can significantly improve primary patency, reducing the incidence of in-stent restenosis, repeat revascularization, vessel re-occlusion, and major adverse limb events while increasing freedom from target lesion revascularization rate. The simultaneous use of drug-eluting stents in the femoropopliteal artery lesions, combined with cilostazol, potentially results in a synergistic anti-stenotic effect. This therapeutic approach does not appear to be associated with an increased risk of major bleeding events or all-cause mortality. These findings provide additional evidence supporting the treatment of anti-stenosis in patients with femoropopliteal artery lesions after EVT.
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Affiliation(s)
- Qiang Tan
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhilong Chen
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Huaping Wu
- Department of Cardiovascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Haifei Wang
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jingquan Chen
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Kun Lai
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Fuzhao Zhang
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tengyao Kang
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jianghua Zheng
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Chen D, Krinsky C, Phillips M, Allred C, Khan A, Liu LB, Christians U, Yazdani SK. Design and use of an ex vivo peripheral simulating bioreactor system for pharmacokinetic analysis of a drug coated stent. Bioeng Transl Med 2024; 9:e10618. [PMID: 38435812 PMCID: PMC10905536 DOI: 10.1002/btm2.10618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/02/2023] [Accepted: 10/15/2023] [Indexed: 03/05/2024] Open
Abstract
Currently, there are no ex vivo systems that can model the motion of peripheral arteries and allow for the evaluation of pharmacokinetics (PK) of endovascular devices. The objective of this study was to develop a novel peripheral simulating bioreactor system to evaluate drug pharmacokinetics of stents. We utilized 3D-printed and off-the-shelf components to construct a peripheral-simulating bioreactor system capable of mimicking the motion of peripheral arteries. Servo motors were primarily used to shorten/elongate, twist, and bend explanted porcine carotid arteries. To evaluate the pharmacokinetics in the bioreactor, drug-eluting stents were deployed within explanted arteries and subjected to vascular motion along with pulsatile flow conditions. Following 30 min and 24 h, the arteries were removed, and paclitaxel levels were measured. Scanning electron microscopy was also performed to evaluate the stent surface. Arterial paclitaxel levels of the stent-treated arteries were found to be higher at 30 min than at 24 h following pulsatile and no vascular motion and even higher at 24 h following pulsatile flow and vascular motion. The residual drug on the stent significantly decreased from 30 min to 24 h. Scanning electron microscopy confirmed the loss of paclitaxel coating at 24 h and greater disturbance in stents under peripheral motion versus pulsatile only. This system represents the first ex vivo system to determine the PK of drug-eluting stents under physiological flow and vascular motion conditions. This work provides a novel system for a quick and inexpensive preclinical tool to study acute drug tissue concentration kinetics of drug-releasing interventional vascular devices designed for peripheral applications.
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Affiliation(s)
- Danyi Chen
- Wake Forest UniversityDepartment of EngineeringWinston‐SalemNorth CarolinaUSA
| | - Colin Krinsky
- Wake Forest UniversityDepartment of EngineeringWinston‐SalemNorth CarolinaUSA
| | - Mollie Phillips
- Wake Forest UniversityDepartment of EngineeringWinston‐SalemNorth CarolinaUSA
| | - Catherine Allred
- Wake Forest UniversityDepartment of EngineeringWinston‐SalemNorth CarolinaUSA
| | - Ava Khan
- Wake Forest UniversityDepartment of EngineeringWinston‐SalemNorth CarolinaUSA
| | - Linda B. Liu
- Wake Forest UniversityDepartment of EngineeringWinston‐SalemNorth CarolinaUSA
| | - Uwe Christians
- iC42 Clinical Research and DevelopmentUniversity of ColoradoAuroraColoradoUSA
| | - Saami K. Yazdani
- Wake Forest UniversityDepartment of EngineeringWinston‐SalemNorth CarolinaUSA
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Fang Y, Kan Y, Guo W, Hong B, Shu C, Wang F, Dai X, Zhu Y, Guo D, Chen B, Xu X, Shi Z, Jiang J, Yang J, Chen Z, Fu W. A New Drug-Coated Balloon for the Treatment of Superficial Femoropopliteal Artery Disease: 12-Month Results from the IN-DEPT SFA Trial. J Vasc Interv Radiol 2024; 35:251-258. [PMID: 37866474 DOI: 10.1016/j.jvir.2023.10.010] [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: 03/13/2023] [Revised: 10/09/2023] [Accepted: 10/15/2023] [Indexed: 10/24/2023] Open
Abstract
PURPOSE To report the outcomes of the IN-DEPT trial assessing the feasibility, preliminary safety data, and 12-month outcomes of a new drug-coated balloon (DCB) product for peripheral artery disease (PAD) in Chinese patients. MATERIALS AND METHODS This is a prospective, multicenter, single-arm clinical trial. A total of 160 patients with superficial femoral artery (SFA) and/or proximal popliteal artery lesions were treated with a new paclitaxel-coated DCB. The preliminary effectiveness end point was 12-month primary patency. The primary safety end point was freedom from device- and procedure-related mortality over 30 days and freedom from major target limb amputation and clinically driven target lesion revascularization (CD-TLR) within 12 months after the index procedure. RESULTS In total, 160 patients presented with 162 target lesions. A total of 139 lesions (85.8%) were treated with 1 DCB, whereas the other 23 lesions (14.2%) were treated with 2 devices. The device success rate was 100%. A total of 135 subjects reached the preliminary effectiveness end point, with a 12-month primary patency rate of 84.4%. There was no 30-day device- or procedure-related death or unplanned major target limb amputation at 12 months. Five CD-TLRs (3.1%) occurred during the 12-month follow-up period. CONCLUSIONS Results from the IN-DEPT SFA trial showed satisfactory feasibility and safety of the new DCB over 12 months in Chinese patients with PAD and femoropopliteal de novo lesions, including both stenoses and total occlusions.
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Affiliation(s)
- Yuan Fang
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yuanqing Kan
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Biao Hong
- Department of Vascular Surgery, Shanghai Tongren Hospital, Shanghai, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Feng Wang
- Department of Interventional Therapy, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiangchen Dai
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yunfeng Zhu
- Department of Vascular Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Bin Chen
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Xin Xu
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Junhao Jiang
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jue Yang
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Zhong Chen
- Department of Vascular Surgery, Anzhen Affiliated Hospital of Capital Medical University, Beijing, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China.
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Shih M, Pizano A, Solano A, Porras-Colon J, Babb J, Timaran CH, Baig MS, Siah M, Gonzalez-Guardiola G, Kirkwood ML. Impact of routine surveillance duplex ultrasound and subsequent reintervention after superficial femoral artery stenting. J Vasc Surg 2024; 79:102-110. [PMID: 37704092 DOI: 10.1016/j.jvs.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Superficial femoral artery (SFA) stenting is a common treatment for peripheral artery disease. It is effective in the short term; however, in-stent restenosis (ISR) limits long-term success. Surveillance with duplex ultrasound (DUS) can identify patients who develop ISR leading to early reintervention, but data to support this practice is sparce. The purpose of this study was to evaluate whether surveillance and subsequent reintervention improves outcomes in patients with SFA stents. METHODS A single-center, retrospective study was performed with patients undergoing SFA stenting between 2005 and 2020 who had a follow-up with DUS. Five groups were identified based on the presence of ISR on DUS (ISR vs no ISR [NISR]), recurrence of symptoms (symptomatic [SX] vs asymptomatic [ASX]), and if any reintervention was performed (reintervention [R] vs no reintervention [NR]): (1) ISR+SX+R; (2) ISR+SX+NR; (3) ISR+ASX+R; (4) ISR+ASX+NR; and (5) NISR+NR. The primary endpoint was amputation-free survival, and the secondary endpoint was patency. Predictors of mortality and surveillance were identified by multivariable logistic regressions and Cox multivariate regression models. Survival curves were presented as Kaplan-Meier plots using log-rank test for subgroup comparison. RESULTS Two hundred fifty-seven patients were included in the analysis. The indication for intervention was claudication in 28% and chronic limb-threatening ischemia in 72%. A total of 161 patients (63%) underwent reintervention for ISR. Of patients who had restenosis on DUS, those who were symptomatic and did not undergo reintervention (ISR+SX+NR) did the worst, with 50% amputation rate. In contrast, those who were asymptomatic but did undergo reintervention (ISR+ASX+R) had the lowest amputation rate of 13%. Active smoking was a predictor of both loss of patency and amputation (1.72; 95% confidence interval [CI], 1.00-2.98; P = .050; 3.55; 95% CI, 1.53-8.25; P = .003). Post procedure dual antiplatelet therapy had a positive association with limb salvage (hazard ratio [HR], 0.23; 95% CI, 0.09-0.58; P = .001), whereas diabetes (HR, 2.61; 95% CI, 1.21-6.01; P = .019), stent occlusion (HR, 17.0; 95% CI, 5.93-63.1; P < .001), and chronic limb-threatening ischemia presentations (HR, 4.31; 95% CI, 1.86-11.7; P=.002) were negatively associated with limb salvage. CONCLUSIONS Routine surveillance DUS and subsequent reintervention on ISR after SFA stenting is associated with improved patency and amputation-free survival. Surveillance DUS should be routine for patients after stenting, with reintervention strongly considered if ISR is identified for both symptomatic and asymptomatic.
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Affiliation(s)
- Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Alejandro Pizano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Antonio Solano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jesus Porras-Colon
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jackie Babb
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mirza S Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gerardo Gonzalez-Guardiola
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa L Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Zywicka EM, McNally E, Elliott L, Twine CP, Mouton R, Hinchliffe RJ. Exploring the Reporting Standards of Randomised Controlled Trials Involving Endovascular Interventions for Peripheral Arterial Disease: A Systematic Review. Eur J Vasc Endovasc Surg 2024; 67:155-164. [PMID: 37678660 DOI: 10.1016/j.ejvs.2023.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/04/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Endovascular technology innovation requires rigorous evaluation in high quality randomised controlled trials (RCTs). However, due to numerous methodological challenges, RCTs evaluating endovascular interventions are complex and potentially difficult to design, conduct, and report. This systematic review aimed to assess the quality of reporting of RCTs for endovascular interventions for lower limb peripheral arterial disease (PAD). DATA SOURCES AND REVIEW METHODS A systematic review of Medline, Embase, and the Cochrane Library databases from inception to December 2021 was performed to identify RCTs including participants with PAD undergoing any infrainguinal lower limb endovascular intervention. Study data were extracted and assessed against the Consolidating Standards of Reporting Trials extension for Non-Pharmacological Treatments (CONSORT-NPT) and the Template for Intervention Description and Replication (TIDieR) checklists. Descriptive statistics were used to summarise general study details and reporting standards of the trials. RESULTS After screening 6 567 abstracts and 526 full text articles, 112 eligible studies were identified, reporting on 228 different endovascular devices and techniques. Details judged sufficient to replicate the investigated intervention were provided for 47 (21%) interventions. It was unclear whether the description was reported with sufficient details in a further 56 (24%), and the description was judged inadequate in 125 (55%). Any intervention descriptions were provided for 184 (81%), with variable levels of detail (some in 134 [59%] and precise in 50 [22%]). Standardisation of intervention or some aspect of this was reported in 25 (22%) trials, but only one specified that adherence to the study protocol would be monitored. CONCLUSION The quality of the reporting standards of RCTs investigating lower limb endovascular treatments is severely limited because the interventions are poorly described, standardised, and reported. PROSPERO registration number: CRD42022288214.
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Affiliation(s)
- Ewa M Zywicka
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK; Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | | | - Lucy Elliott
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK; Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Christopher P Twine
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK; Southmead Hospital, North Bristol NHS Trust, Bristol, UK. http://www.twitter.com/TwineVasc
| | - Ronelle Mouton
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK; Southmead Hospital, North Bristol NHS Trust, Bristol, UK. http://www.twitter.com/RonelleMouton
| | - Robert J Hinchliffe
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK; Southmead Hospital, North Bristol NHS Trust, Bristol, UK. http://www.twitter.com/robhinchliffe1
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8
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Schmidt W, Brandt-Wunderlich C, Behrens P, Kopetsch C, Schmitz KP, Andresen JR, Grabow N. Revisiting SFA stent technology: an updated overview on mechanical stent performance. BIOMED ENG-BIOMED TE 2023; 68:523-535. [PMID: 37183602 DOI: 10.1515/bmt-2022-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/28/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES The study investigated mechanical parameters of stent systems indicated for treatment of femoropopliteal (FP) arterial disease to support interpretation of clinical results and the related causalities. METHODS Eight stent system types of same dimensions were investigated (n=2). Parameters were the profile of stent delivery system (SDS), radiopacity, trackability and pushability, bending stiffness (flexibility) and axial stiffness of expanded stents, length change during expansion, radial force, crush resistance, strut thickness and general surface condition. RESULTS The trackability ranged from 0.237 to 0.920 N and the pushability was 47.9-67.6 %. The bending stiffness of SDS was between 108.42 and 412.68 N mm2. The length change during stent release to 5 mm was low, with one exception. The bending stiffness of the expanded stents was 2.73-41.67 N mm2. The normalized radial forces at 5 mm diameter ranged from 0.133 N/mm to 0.503 N/mm. During non-radial compression by 50 %, the forces were 3.07-8.42 N, with one exception (58.7 N). The strut thickness was 153-231 µm. CONCLUSIONS Large differences occurred for flexibility, radial force and length change during expansion. The data should be used when choosing the proper device for restoring vascular function.
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Affiliation(s)
- Wolfram Schmidt
- University Medical Center Rostock, Institute for Biomedical Engineering, Friedrich-Barnewitz-Str. 4, Rostock, 18119, Germany
| | | | - Peter Behrens
- Institute for ImplantTechnology and Biomaterials - IIB e.V., Rostock-Warnemuende, Germany
| | - Christoph Kopetsch
- Westkustenklinikum Heide, Institute of Diagnostic and Interventional Radiology/Neuroradiology, Heide, Schleswig-Holstein, Germany
| | - Klaus-Peter Schmitz
- Institute for ImplantTechnology and Biomaterials - IIB e.V., Rostock-Warnemuende, Germany
| | | | - Niels Grabow
- University Medical Center Rostock, Institute for Biomedical Engineering, Rostock, Germany
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9
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Gross DC, Scandling BW, Leewood AR, Simonetti OP. Computational modeling of the thermal effects of flow on radio frequency-induced heating of peripheral vascular stents during MRI. Biomed Phys Eng Express 2023; 9:065025. [PMID: 37844574 DOI: 10.1088/2057-1976/ad0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/16/2023] [Indexed: 10/18/2023]
Abstract
Purpose. The goal of this study was to develop and validate a computational model that can accurately predict the influence of flow on the temperature rise near a peripheral vascular stent during magnetic resonance imaging (MRI).Methods. Computational modeling and simulation of radio frequency (RF) induced heating of a vascular stent during MRI at 3.0 T was developed and validated with flow phantom experiments. The maximum temperature rise of the stent was measured as a function of physiologically relevant flow rates.Results. A significant difference was not identified between the experiment and simulation (P > 0.05). The temperature rise of the stent during MRI was over 10 °C without flow, and was reduced by 5 °C with a flow rate of only 58 ml min-1, corresponding to a reduction of CEM43from 45 min to less than 1 min.Conclusion. The computer model developed in this study was validated with experimental measurements, and accurately predicted the influence of flow on the RF-induced temperature rise of a vascular stent during MRI. Furthermore, the results of this study demonstrate that relatively low flow rates significantly reduce the temperature rise of a stent and the surrounding medium during RF-induced heating under typical scanning power and physiologically relevant conditions.
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Affiliation(s)
- David C Gross
- MED Institute Inc., West Lafayette, IN, United States of America
| | | | - Alan R Leewood
- MED Institute Inc., West Lafayette, IN, United States of America
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States of America
- Department of Radiology, The Ohio State University, Columbus, OH, United States of America
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10
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Takahara M, Soga Y, Fujihara M, Iida O, Kawasaki D. Association of Smoking, Diabetes, and Dialysis with the Presence of Popliteal Lesions in Femoropopliteal Artery Disease. J Atheroscler Thromb 2023; 30:1327-1335. [PMID: 36596532 PMCID: PMC10564636 DOI: 10.5551/jat.64007] [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: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/29/2022] Open
Abstract
AIM Although recent advances in endovascular devices have markedly improved clinical outcomes of femoropopliteal endovascular therapy, lesions located in the popliteal artery are still a major challenge. This study aimed to determine the association of cardiovascular risk factors, including smoking, diabetes mellitus, and dialysis-dependent renal failure, with the location of atherosclerotic lesions in femoropopliteal artery disease. METHODS We used a multicenter prospective study database registering patients with symptomatic femoropopliteal artery disease undergoing drug-coated balloon treatment. The analysis included 1912 patients with de novo femoropopliteal lesions. The association of clinical characteristics with popliteal lesions was investigated using the logistic regression model. In addition, the femoropopliteal artery was divided into six segments (the proximal, middle, and distal portions of the superficial femoral artery and P1, P2, and P3 segments of the popliteal artery), and the association of clinical characteristics with the presence of atherosclerotic lesions in the respective arterial segments was investigated. RESULTS Smoking and dialysis-dependent renal failure showed a statistically significant inverse and positive association with the presence of popliteal lesions, respectively (adjusted odds ratio, 0.66 [95% confidence interval, 0.51-0.85] and 2.01 [1.62-2.49]; P=0.001 and P<0.001), whereas diabetes mellitus did not (P=0.17). The subsequent per-segment analysis presented similar results. CONCLUSIONS Smoking was inversely associated with popliteal lesions, whereas renal failure on dialysis was positively associated in patients with symptomatic femoropopliteal artery disease who underwent drug-coated balloon treatment. Diabetes mellitus was not significantly associated.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | - Daizo Kawasaki
- Cardiovascular Division, Morinomiya Hospital, Osaka, Japan
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11
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Fan W, Tan J, Li L, Feng B, Shi W, Pei J, Yuan G, Yu B. Efficacy and Safety of Absorb Everolimus-Eluting Bioresorbable Vascular Scaffold in Peripheral Artery Disease: A Single-Arm Meta-Analysis. J Endovasc Ther 2023; 30:651-663. [PMID: 35510722 DOI: 10.1177/15266028221091899] [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: 11/15/2022]
Abstract
PURPOSE This study aimed to evaluate the benefits and risks of patients with peripheral artery disease (PAD) treated with Absorb everolimus-eluting bioresorbable vascular scaffold (BVS) by analyzing all the published studies on the clinical characteristics of patients with PAD. MATERIALS AND METHODS PubMed, Embase, and the Cochrane Library were searched for relevant studies. Efficacy, safety, and basic characteristics were analyzed. RESULTS Four studies were included in meta-analysis, including a total number of 155 patients with PAD. The pooled overall primary patency, freedom from target lesion revascularization (TLR), symptom resolution, and wound healing were 90%, 96%, 94%, and 86%, respectively. The pooled perioperative complication and all-cause mortality were 4% and 9%, respectively. Preoperative total occlusion was detected in 43 of 192 lesions (22%). The mean lesion length was 27.26 mm. In terms of comorbidities, the pooled percentage of hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, chronic kidney disease history, and smoking were 65%, 74%, 49%, 43%, 20%, and 57%, respectively. CONCLUSION Among these studies, hypertension, hyperlipidemia, and diabetes mellitus were the most common comorbidities in patients with PAD. The Absorb everolimus-eluting BVS was safe and showed the favorable clinical outcomes in both patency and TLR, especially in infrapopliteal disease with heavy calcification. The conclusions of this meta-analysis still needed to be verified by more relevant studies with more careful design, more rigorous execution, and larger sample size.
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Affiliation(s)
- Weijian Fan
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, P.R. China
| | - Jinyun Tan
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, P.R. China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai, P.R. China
| | - Lingyu Li
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Boxuan Feng
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Weihao Shi
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, P.R. China
| | - Jia Pei
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Guangyin Yuan
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Bo Yu
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, P.R. China
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12
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Brodmann M, Wissgott C, Brechtel K, Lichtenberg M, Blessing E, Tarra T, Zeller T. Optimized drug-coated balloon angioplasty of the superficial femoral and proximal popliteal arteries using the Tack Endovascular System: Tack Optimized Balloon Angioplasty (TOBA) III 24-month results in standard and long lesions. Catheter Cardiovasc Interv 2023; 102:701-712. [PMID: 37560824 DOI: 10.1002/ccd.30800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/07/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The Tack Endovascular System is a minimal-metal dissection repair device that is purpose-built to treat post-percutaneous angioplasty (PTA) arterial dissections in patients with peripheral arterial disease (PAD). The Tack Optimized Balloon Angioplasty (TOBA) III trial evaluated the safety and effectiveness of the Tack Endovascular System in patients with superficial femoral artery (SFA) and/or proximal popliteal artery (PPA) dissection after PTA with a drug-coated balloon (DCB). The objective of this study is to report the results in the standard- (SL) and long-lesion (LL) cohorts through 24 months. DESIGN The TOBA III study was a prospective, multicenter, single-arm study including patients suffering from Rutherford category 2-4 PAD. Outcomes were assessed according to pre-specified lesion length in SL ( ≥ 20 mm and ≤150 mm) and LL ( > 150 mm and ≤250 mm) cohorts. Follow-up was through 24 months. RESULTS TOBA III enrolled 201 patients, 169 patients in the SL cohort and 32 in the LL cohort. At 24 months, the Kaplan-Meier estimates of freedom from major adverse events were 91.7% and 82.6% for the SL cohort and LL cohort, respectively. Kaplan-Meier estimates of freedom from clinically driven-target lesion revascularization (CD-TLR) were 92.3% in the SL cohort and 82.6% in the LL cohort. At 24 months, 78.8% of SL patients and 69.2% of LL patients experienced an improvement of >2 Rutherford categories (both cohorts p < 0.001). The baseline ankle-brachial index improved from 0.68 ± 0.18 to 0.93 ± 0.16 in the SL (p < 0.001) and from 0.62 ± 0.23 to 0.87 ± 0.15 in the LL cohort (p < 0.001) at 24 months. CONCLUSION The 24-month results of the TOBA III trial support the safety and effectiveness of the Tack Endovascular System in patients who required post-PTA dissection repair in the SFA and PPA following DCB angioplasty for claudication and rest pain. In both the SL and LL cohorts, Tack placement was associated with sustained freedom from CD-TLR through 24 months as well as sustained improvements in Rutherford categories, ankle-brachial index, and quality of life.
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Affiliation(s)
| | | | - Klaus Brechtel
- Interventional Radiology, Franziskus-Hospital Berlin, Berlin, Germany
| | | | - Erwin Blessing
- SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Trisha Tarra
- Philips North America, LLC, Cambridge, Massachusetts, USA
| | - Thomas Zeller
- Universitaets-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany
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13
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Li M, Tu H, Yan Y, Guo Z, Zhu H, Niu J, Yin M. Meta-analysis of outcomes from drug-eluting stent implantation in femoropopliteal arteries. PLoS One 2023; 18:e0291466. [PMID: 37733656 PMCID: PMC10513203 DOI: 10.1371/journal.pone.0291466] [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: 07/10/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE In recent years, studies of drug-eluting stent (DES) for femoropopliteal artery diseases (FPADs) have been gradually published. To explore whether this type of stent is superior to the traditional bare metal stent (BMS), we performed this study. METHODS A systematic search for randomized controlled trials (RCTs) in Excerpta Medica Database (Embase), PubMed, Web of Science (WOS), and Cochrane Library was performed on November 29, 2022. We innovatively adopted the hazard ratio (HR), the most appropriate indicator, as a measure of the outcomes that fall under the category of time-to-event data. The HRs was extracted directly or indirectly. Then, the meta-analyses using random effects model were performed. The bias risks of included papers were assessed by the Cochrane Risk of Bias 2.0 tool. This study was registered on the PROSPER platform (CRD42023391944) and not funded. RESULTS Seven RCTs involving 1,889 participants were found. After pooled analyses, we obtained results without propensity on each of the following 3 outcomes of interest: in-stent restenosis (ISR) -free survival, primary patency (PP) survival, and target lesion revascularization (TLR) -free survival (P >0.05, respectively). Because the results of pooled analyses of the other two outcomes of interest (all-cause death free survival and clinical benefit survival) had high heterogeneity both, they were not accepted by us. CONCLUSION For FPADs, the DES has not yet demonstrated superiority or inferiority to BMS, in the ability to maintain PP, avoid ISR and TLR.
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Affiliation(s)
- Mingxuan Li
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Haixia Tu
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Yu Yan
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Zhen Guo
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | - Haitao Zhu
- Beijing Fengtai You’anmen Hospital, Beijing, China
| | | | - Mengchen Yin
- Beijing Fengtai You’anmen Hospital, Beijing, China
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14
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Salamaga S, Stępak H, Żołyński M, Kaczmarek J, Błaszyk M, Stanišić MG, Krasiński Z. Three-Year Real-World Outcomes of Interwoven Nitinol Supera Stent Implantation in Long and Complex Femoropopliteal Lesions. J Clin Med 2023; 12:4869. [PMID: 37510984 PMCID: PMC10381725 DOI: 10.3390/jcm12144869] [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: 06/16/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Peripheral artery disease (PAD) remains a major issue in modern societies and affects more than 200 million people around the world. Endovascular methods have been evaluated to be safe and effective in limb salvage. The Supera is able to withstand increased compression, biomechanical stress and to have higher radial force. The objective of this study is to evaluate performance, durability and 3-year patency of Supera stent implantation in severe femoropopliteal disease. METHODS A retrospective real-world analysis was performed with consideration of 77 patients that had a Supera stent implanted with femoropopliteal atherosclerotic disease at a single center. Among the 77 individuals, 92 Supera stents were implanted. Analysis of patients' demographics, lesions characteristics, reintervention rates and patency rates was performed. RESULTS The median follow-up was 33 months and ranged from 0 to 84 months. Chronic limb-threatening ischemia was observed among 43 patients. Mean lesion length was 152.8 ± 94.6 mm. Chronic total occlusions were observed in a majority of lesions. Overall, primary patency rates at 6, 12, 24 and 36 months were 85.0%, 73.6%, 59.2% and 53.2%, respectively. CONCLUSIONS The Supera stent is effective in the management of long and complex lesions. The results of patency rates were evaluated to be worse among lesions extending to the popliteal artery.
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Affiliation(s)
- Szymon Salamaga
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, Długa Street, 61-848 Poznan, Poland
| | - Hubert Stępak
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, Długa Street, 61-848 Poznan, Poland
| | - Mikołaj Żołyński
- Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, Ul. Przybyszewskiego 49, 60-355 Poznan, Poland
| | - Jagoda Kaczmarek
- Faculty of Medicine, Poznan University of Medical Sciences, 1/2 Długa Street, 61-848 Poznan, Poland
| | - Maciej Błaszyk
- Department of Radiology, Poznan University of Medical Sciences, 1/2 Długa Street, 61-848 Poznan, Poland
| | - Michał-Goran Stanišić
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, Długa Street, 61-848 Poznan, Poland
| | - Zbigniew Krasiński
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, Długa Street, 61-848 Poznan, Poland
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15
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Channane H, Shaporov A, Sandica A, Atay S, Snopok I, Frunza T, Viebahn R. Popliteal endarterectomy at the leg level with venous enlargement patch: about 14 cases. J Surg Case Rep 2023; 2023:rjad398. [PMID: 37426043 PMCID: PMC10329460 DOI: 10.1093/jscr/rjad398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
The incidence of lesions of the popliteal artery below the knee constitutes one of the greatest problems in revascularization of the lower limb. Firstly, this segment constitutes the departure of the leg tripod, decisive crossroads for a subsequent endovascular intervention. On the other hand, it constitutes a fairly used relay point in the event of an indication for a pedal bypass. It is assumed that the performance of a popliteal endarterectomy with an enlargement by medial approach in patients with a localized lesion at this level constitutes an effective therapeutic approach and can facilitate any gesture of crural bypass or endovascular dilation later. We present a retrospective review of all patients who underwent popliteal endarterectomy with venous patch plasty for localized popliteal disease in our institution over the past 3 years.
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Affiliation(s)
- Hamid Channane
- Correspondence address. Department of General and Vascular Surgery, Ruhr University, In der Schornau, 23–25, 88492 Bochum, Germany. Tel: +4923429980097; Fax: +492342993209; E-mail:
| | - A Shaporov
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - A Sandica
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - S Atay
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - I Snopok
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - T Frunza
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
| | - R Viebahn
- Department of General and Vascular Surgery, Ruhr University, Bochum, Germany
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16
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Brodmann M, Werner M, Sood A, Gray WA. Treating post-angioplasty dissection in the femoropopliteal arteries using the tack endovascular system: Tack optimized balloon angioplasty II 24-month results. Vascular 2023:17085381231162128. [PMID: 36919606 DOI: 10.1177/17085381231162128] [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: 03/16/2023]
Abstract
OBJECTIVES The TOBA (Tack Optimized Balloon Angioplasty) II trial is a prospective, single-arm, multicenter study that investigated Tack treatment for patients with dissection after angioplasty in the superficial femoral artery and/or proximal popliteal artery. The Tack device is a nitinol-based, short (6 mm), stent-like implant with low outward force that can be deployed in a targeted fashion to treat vascular dissection. TOBA II primary results through 12 months have been published previously. This report provides follow-up safety and efficacy results through 24 months (RC). METHODS The TOBA II trial enrolled 213 patients with Rutherford classification 2 to 4 and a de novo or non-stented restenotic lesion in the superficial femoral artery and/or proximal popliteal artery who developed a dissection of any grade after treatment with plain balloon or drug-coated balloon (DCB) angioplasty. Participants were followed for 30 days, 6 months, 12 months, 24 months, and 36 months following the procedure. Evaluations included clinically driven target lesion revascularization (CD-TLR), ankle-brachial index, Rutherford classification, peripheral artery questionnaire, quality of life assessed by the EQ-5D-3L, and the Walking Impairment Questionnaire. RESULTS At enrollment, mean age was 68.2 ± 9.1 years, 70.9% were male, and 95.8% of patients were categorized as RC 2 or 3. The distribution of balloon types in the study were standard balloons: 42.3%; and drug-coated balloons: 57.7%. At 24-month follow-up, 167 patients (78.4%) had available data. The overall survival rate at 24 months was 95.4% and there were no major amputations during this time. After 24 months of follow-up, the Kaplan-Meier freedom from CD-TLR was 77.7%. Rutherford classification, ankle-brachial index, and quality of life were significantly improved compared with baseline through 24 months. CONCLUSIONS The TOBA II 24-month data demonstrate durable intermediate-term outcomes with the use of the Tack Endovascular System. Tack deployment was a safe and effective therapeutic option for dissection repair following angioplasty.
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Affiliation(s)
| | - Martin Werner
- Department of Angiology, Hanusch Hospital, Vienna, Austria
| | - Ami Sood
- Philips North America LLC, Cambridge, MA, USA
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17
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Koeckerling D, Raguindin PF, Kastrati L, Bernhard S, Barker J, Quiroga Centeno AC, Raeisi-Dehkordi H, Khatami F, Niehot C, Lejay A, Szeberin Z, Behrendt CA, Nordanstig J, Muka T, Baumgartner I. Endovascular revascularization strategies for aortoiliac and femoropopliteal artery disease: a meta-analysis. Eur Heart J 2023; 44:935-950. [PMID: 36721954 PMCID: PMC10011342 DOI: 10.1093/eurheartj/ehac722] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/24/2022] [Accepted: 11/22/2022] [Indexed: 02/02/2023] Open
Abstract
AIMS Optimal endovascular management of intermittent claudication (IC) remains disputed. This systematic review and meta-analysis compares efficacy and safety outcomes for balloon angioplasty (BA), bare-metal stents (BMS), drug-coated balloons (DCB), drug-eluting stents (DES), covered stents, and atherectomy. METHODS AND RESULTS Electronic databases were searched for randomized, controlled trials (RCT) from inception through November 2021. Efficacy outcomes were primary patency, target-lesion revascularization (TLR), and quality-of-life (QoL). Safety endpoints were all-cause mortality and major amputation. Outcomes were evaluated at short-term (<1 year), mid-term (1-2 years), and long-term (≥2 years) follow-up. The study was registered on PROSPERO (CRD42021292639). Fifty-one RCTs enrolling 8430 patients/lesions were included. In femoropopliteal disease of low-to-intermediate complexity, DCBs were associated with higher likelihood of primary patency [short-term: odds ratio (OR) 3.21, 95% confidence interval (CI) 2.44-4.24; long-term: OR 2.47, 95% CI 1.93-3.16], lower TLR (short-term: OR 0.33, 95% CI 0.22-0.49; long-term: OR 0.42, 95% CI 0.29-0.60) and similar all-cause mortality risk, compared with BA. Primary stenting using BMS was associated with improved short-to-mid-term patency and TLR, but similar long-term efficacy compared with provisional stenting. Mid-term patency (OR 1.64, 95% CI 0.89-3.03) and TLR (OR 0.50, 95% CI 0.22-1.11) estimates were comparable for DES vs. BMS. Atherectomy, used independently or adjunctively, was not associated with efficacy benefits compared with drug-coated and uncoated angioplasty, or stenting approaches. Paucity and heterogeneity of data precluded pooled analysis for aortoiliac disease and QoL endpoints. CONCLUSION Certain devices may provide benefits in femoropopliteal disease, but comparative data in aortoiliac arteries is lacking. Gaps in evidence quantity and quality impede identification of the optimal endovascular approach to IC.
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Affiliation(s)
- David Koeckerling
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Peter Francis Raguindin
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland.,Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse, 36002 Lucerne, Switzerland
| | - Lum Kastrati
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Sarah Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Joseph Barker
- Department of Cardiovascular Sciences, University of Leicester, University Rd, Leicestershire LE1 7RH, UK
| | | | - Hamidreza Raeisi-Dehkordi
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Farnaz Khatami
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Community Medicine Department, Tehran University of Medical Sciences, PourSina St., Tehran 1417613151, Iran
| | - Christa Niehot
- Literature Searches Support, 3314SC Dordrecht, the Netherlands
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, XII. Városmajor u. 68., 1122 Budapest, Hungary
| | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Alphonsstraße 14, 22043 Hamburg, Germany
| | - Joakim Nordanstig
- Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg University, Blå stråket 5, 413 45 Gothenburg, Sweden
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Epistudia, 3011 Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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18
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Shishehbor MH, Scheinert D, Jain A, Brodmann M, Tepe G, Ando K, Krishnan P, Iida O, Laird JR, Schneider PA, Rocha-Singh KJ, Zeller T. Comparison of Drug-Coated Balloons vs Bare-Metal Stents in Patients With Femoropopliteal Arterial Disease. J Am Coll Cardiol 2023; 81:237-249. [PMID: 36332764 DOI: 10.1016/j.jacc.2022.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Endovascular treatment of femoropopliteal artery disease has shifted toward drug-coated balloons (DCB). However, limited data are available regarding the safety and efficacy of DCB vs bare-metal stents (BMS). OBJECTIVES The purpose of this study was to compare DCB vs BMS outcomes in a propensity-adjusted, pooled analysis of 4 prospective, multicenter trials. METHODS Patient-level data were pooled from 4 prospective, multicenter studies: the IN.PACT SFA I/II and IN.PACT SFA Japan randomized controlled DCB trials and the Complete SE and DURABILITY II single-arm BMS studies. Outcomes were compared using inverse probability of treatment weighting (IPTW). Clinical endpoints were 12-month primary patency, freedom from 36-month clinically driven target lesion revascularization, and cumulative 36-month major adverse events (MAE). RESULTS The primary analysis included 771 patients (288 DCB, 483 BMS). IPTW-adjusted demographic, baseline lesion, and procedural characteristics were matched between groups. The adjusted mean lesion length was 8.1 ± 4.7 cm DCB and 7.9 ± 4.5 cm BMS. The IPTW-adjusted Kaplan-Meier estimates of 12-month primary patency (90.4% DCB, 80.9% BMS, P = 0.007), freedom from 36-month clinically driven target lesion revascularization (85.6% DCB, 73.7% BMS, P = 0.001), and cumulative incidence of 36-month MAE (25.3% DCB, 38.8% BMS, P < 0.001) favored DCB. There were no statistically significant differences observed in all-cause mortality, target limb major amputation, or thrombosis through 36 months. CONCLUSIONS In a patient-level, IPTW-adjusted pooled analysis of prospective, multicenter pivotal studies, DCB demonstrated significantly higher patency, lower revascularization and MAE rates, and no statistically significant differences in mortality, amputation, or thrombosis vs BMS. This analysis supports DCB use vs BMS in moderately complex femoropopliteal lesions amenable to both treatments.
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Affiliation(s)
- Mehdi H Shishehbor
- University Hospitals Health System, Harrington Heart & Vascular Institute, Cleveland, Ohio, USA.
| | | | - Ashit Jain
- Mission Cardiovascular Research Institute, Fremont, California, USA
| | | | | | | | - Prakash Krishnan
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Osamu Iida
- Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - John R Laird
- Adventist Heart and Vascular Institute, St Helena, California, USA
| | - Peter A Schneider
- Kaiser Permanente, Moanalua Medical Center and Clinic, Honolulu, Hawaii, USA (current address: University of California San Francisco, San Francisco, California, USA)
| | - Krishna J Rocha-Singh
- Department of Cardiology, Prairie Heart Institute at St. John's Hospital, Springfield, Illinois, USA
| | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
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19
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Jang BS, Kim E, Gwak MA, Park SA, Park WH. Fabrication and application of drug eluting stent for peripheral artery disease. KOREAN J CHEM ENG 2023. [DOI: 10.1007/s11814-022-1286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Jiang X, Fan L, Chen B, Jiang J, Liu J, Qiao G, Ju S, Shi Y, Ma T, Lin C, Fang G, Guo D, Xu X, Dong Z, Fu W. Excimer laser ablation combined with drug-coated balloon versus drug-coated balloon in the treatment of de novo atherosclerotic lesions in lower extremities (ELABORATE): study protocol for a real-world clinical trial. BMC Cardiovasc Disord 2022; 22:317. [PMID: 35842583 PMCID: PMC9287897 DOI: 10.1186/s12872-022-02751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background The efficacy and validity of excimer laser ablation (ELA) in the in-stent restenosis (ISR) has been confirmed. However, its application in de novo atherosclerotic lesions of lower extremity artery disease (LEAD) has not been clearly defined and its procedure has not been standardized. Methods ELABORATE is a prospective, multicenter, real-world study designed to evaluate the efficacy and safety between ELA combined with drug-coated balloon (DCB) and DCB alone in de novo atherosclerotic lesions of LEAD. Discussion ELABORATE is a prospective, multicenter, real-world study designed to assess the efficacy and safety between ELA combined with drug-coated balloon (DCB) and DCB alone in patients with de novo atherosclerotic lesions of LEAD. According to the real-world situation, eligible patients will be allocated to ELA + DCB group (group E) and DCB group (group C). Baseline and follow-up information (at 3, 6, and 12 months) will be collected. The primary efficacy point is primary patency at 12-months, and the secondary efficacy points include clinically driven target lesion reintervention (CD-TLR), change of Rutherford class, ankle-brachial index and ulcer healing rate. These indexes will be assessed and recorded at 3, 6, and 12-month follow-up. Also, safety evaluation, including major adverse event, all-cause mortality through 30-day follow-up, unplanned major amputation, bailout stent and distal embolization, will also be evaluated by an independent core laboratory. All the data will be collected and recorded by the electric data capture system. This study will be finished in 3 years and the 12-month results will be available in 2023. All the patients will be followed for 5 years. Trial registration number Chinese Clinical Trial Registry (ChiCTR2100051263). Registered 17 September 2019. http://www.chictr.org.cn/listbycreater.aspx.
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Affiliation(s)
- Xiaolang Jiang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Longhua Fan
- Department of Vascular Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East Gongyuan Road, Shanghai, 201715, China
| | - Bin Chen
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Junhao Jiang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Jianjun Liu
- Department of Vascular Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East Gongyuan Road, Shanghai, 201715, China
| | - Guanyu Qiao
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Shuai Ju
- Department of Vascular and Wound Treatment Center, Jinshan Hospital, Fudan University, Shanghai, 200540, China
| | - Yun Shi
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Tao Ma
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Changpo Lin
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Gang Fang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Daqiao Guo
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Xin Xu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Zhihui Dong
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China.
| | - Weiguo Fu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
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21
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Pelicon K, Petek K, Boc A, Boc V, Kejžar N, Vižintin Cuderman T, Blinc A. Clinical Outcomes after Endovascular Revascularisation of the Femoropopliteal Arterial Segment in Patients with Anticoagulant versus Antiplatelet Therapy: A Single-Centre Retrospective Cohort Study. J Cardiovasc Dev Dis 2022; 9:jcdd9070207. [PMID: 35877569 PMCID: PMC9319551 DOI: 10.3390/jcdd9070207] [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: 05/26/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 12/24/2022] Open
Abstract
To prevent atherothrombotic events, patients with peripheral arterial disease are typically prescribed antiplatelet therapy (APT). However, some of them receive anticoagulant therapy (ACT) due to comorbidities. Our aim was to determine possible differences in the effectiveness and safety of both treatments in patients after endovascular femoropopliteal revascularisation. We retrospectively analysed 1247 patients after successful femoropopliteal revascularisation performed in a single tertiary medical centre and classified them into the ACT or APT group, based on their prescribed treatment. The groups were characterised by descriptive statistics, and their characteristics were adjusted for confounders by propensity score matching. Effectiveness and safety outcomes were assessed within one year after revascularisation. The odds ratio for the composite outcome of all-cause death, PAD exacerbation, and major amputation due to vascular causes with ACT versus APT was 1.21 (95% CI 0.53–2.21; p = 0.484). The odds ratio for major bleeding as defined by the International Society on Thrombosis and Haemostasis with ACT versus APT was 0.77 (95% CI 0.13–3.84; p = 0.251). We found no statistically significant difference in the effectiveness and safety of ACT, when compared to APT in patients with similar cardiovascular risk factors and other baseline characteristics. Further prospective research is warranted.
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Affiliation(s)
- Kevin Pelicon
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (K.P.); (K.P.); (A.B.); (V.B.); (T.V.C.)
| | - Klemen Petek
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (K.P.); (K.P.); (A.B.); (V.B.); (T.V.C.)
| | - Anja Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (K.P.); (K.P.); (A.B.); (V.B.); (T.V.C.)
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (K.P.); (K.P.); (A.B.); (V.B.); (T.V.C.)
| | - Nataša Kejžar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Tjaša Vižintin Cuderman
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (K.P.); (K.P.); (A.B.); (V.B.); (T.V.C.)
| | - Aleš Blinc
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (K.P.); (K.P.); (A.B.); (V.B.); (T.V.C.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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22
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Low J, Shih T, Lu E, Derubertis BG, Baril DT. Midterm Results of the Supera Stent for the Treatment of Femoropopliteal Occlusive Disease. Ann Vasc Surg 2022; 86:177-183. [PMID: 35779806 DOI: 10.1016/j.avsg.2022.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/20/2022] [Accepted: 05/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Supera (Abbott Vascular, Santa Clara, CA) stent is an interwoven nitinol, shape-memory stent with high strength and flexibility characteristics which are purported to increase resistance to kinking and compression. The purpose of this study was to review single-center outcomes of the use of this stent in the femoropopliteal segment. METHODS We performed a single-center, retrospective analysis of patients who underwent Supera stent placement for femoropopliteal occlusive disease from 2016-2019. Data was collected on patient demographics and procedural details. Follow-up imaging data, including duplex imaging and ankle-brachial indices, and clinical data were abstracted from encounter notes. RESULTS Sixty-two patients with 72 unique Supera stent placements were identified. Mean age was 76 and 69% were male. 56% of patients had severe calcification and 11% had moderate calcification. 48% of lesions were Trans-Atlantic Inter-Society Consensus Document C or D lesions. Primary patency rates at 12, 24, and 36 months were 85%, 82%, and 75%, respectively. Primary patency was not affected significantly by lesion length, degree of calcification, number of outflow vessels, concomitant interventions, or stent size. CONCLUSIONS These results demonstrate sustained primary patency with the Supera stent over a 3-year interval in treatment of patients with femoropopliteal occlusive disease, including in the setting of severely calcified vessels.
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Affiliation(s)
- Josiah Low
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Terri Shih
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Eileen Lu
- Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Brian G Derubertis
- Division of Vascular Surgery, Weill Cornell Medical College, New York, NY
| | - Donald T Baril
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
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23
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Intensive exercise therapy for restenosis after superficial femoral artery stenting: the REASON randomized clinical trial. Heart Vessels 2022; 37:1596-1603. [PMID: 35396952 PMCID: PMC9349080 DOI: 10.1007/s00380-022-02060-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/18/2022] [Indexed: 11/20/2022]
Abstract
Endovascular treatment (EVT) is the main treatment for peripheral artery disease (PAD). Despite advances in device development, the restenosis rate remains high in patients with femoropopliteal lesions (FP). This study aimed to evaluate the effectiveness of exercise training in reducing the 1-year in-stent restenosis rate of bare metal nitinol stents for FPs. This prospective, randomized, open-label, multicenter study was conducted from January 2017 to March 2019. We randomized 44 patients who had claudication with de novo stenosis or occlusion of the FP into an intensive exercise group (n = 22) and non-intensive exercise group (n = 22). Non-intensive exercise was defined as walking for less than 30 min per session, fewer than three times a week. We assessed exercise tolerance using an activity meter at 1, 3, 6, and 12 months, and physiotherapists ensured maintenance of exercise quality every month. The primary endpoint was instant restenosis defined as a peak systolic velocity ratio > 2.5 on duplex ultrasound imaging. Kaplan–Meier analysis was used to evaluate the data. There were no significant differences in background characteristics between the groups. Six patients dropped out of the study within 1 year. In terms of the primary endpoint, intensive exercise significantly improved the patency rate of bare nitinol stents at 12 months. The 1-year freedom from in-stent restenosis rates were 81.3% in the intensive exercise group and 47.6% in the non-intensive exercise group (p = 0.043). No cases of stent fracture were observed in the intensive exercise group. Intensive exercise is safe and reduces in-stent restenosis in FP lesions after endovascular therapy for PAD. Clinical trial registration: University Hospital Medical Information Network Clinical Trials Registry (No. UMIN 000025259).
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24
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Zhao S, Li L, Cui K. Network Analysis of Endovascular Treatment Strategies for Femoropopliteal Arterial Occlusive Disease. J Endovasc Ther 2022:15266028221090434. [PMID: 35392691 DOI: 10.1177/15266028221090434] [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: 02/05/2023]
Abstract
PURPOSE Endovascular treatment of femoropopliteal arterial diseases remains controversial. We conducted a Bayesian network meta-analysis of randomized controlled trials aiming to investigate the efficacy differences between paclitaxel- or sirolimus-eluting stents, covered stents, drug-coated balloons, bare metal stents, and percutaneous transluminal angioplasty. METHOD MEDLINE, Embase, Ovid, and other relevant online material were searched up to October 21, 2020. Primary endpoints were primary patency and target lesion revascularization at 6, 12, and more than 24 months. RESULTS Thirty-eight eligible trials included 6026 patients. In terms of primary patency, drug eluting stents were ranked as the most effective treatment based on the surface under the cumulative ranking curve values at 6 (80.6), 12 (78.4), and more than 24 months (96.5) of follow-ups. In terms of target lesion revascularization, drug eluting stents were ranked as the most effective treatment based on the surface under the cumulative ranking curve values at 6 (90.3), 12 (71.3), and more than 24 months (82.1) of follow-ups. Covered stents and bare metal stents had higher ranks in target lesion revascularization than those in primary patency. Sirolimus stents had a higher rank than paclitaxel stents. CONCLUSION Drug eluting stents showed encouraging results in primary patency rates and freedom from target lesion revascularization at all phases of follow-up for femoropopliteal arterial diseases. Sirolimus stents appear to be more effective in femoropopliteal segment than paclitaxel stent.
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Affiliation(s)
- Shenyu Zhao
- Department of Cardiovascular Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Lingzhi Li
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiovascular Medicine, West China Hospital of Sichuan University, Chengdu, China
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25
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Bontinis A, Bontinis V, Koutsoumpelis A, Giannopoulos A, Ktenidis K. A systematic review aggregated data and individual participant data meta-analysis of spot stenting in the treatment of lower extremity peripheral arterial disease. Ann Vasc Surg 2022; 85:424-432. [DOI: 10.1016/j.avsg.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/20/2022] [Accepted: 03/25/2022] [Indexed: 11/01/2022]
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26
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Mori S, Hirano K, Takahara M, Shirai S, Makino K, Honda Y, Tsutsumi M, Kobayashi N, Yamawaki M, Ito Y. Accuracy of quantitative vessel analysis in endovascular treatment for femoropopliteal lesions. Quant Imaging Med Surg 2022; 12:568-575. [PMID: 34993102 DOI: 10.21037/qims-20-1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Our aim was to evaluate the accuracy of quantitative vessel analysis (QVA) in measuring the reference vessel diameter (RVD) of femoropopliteal lesions. METHODS Between October 2014 and September 2015, 30 consecutive femoropopliteal lesions in 25 patients who underwent endovascular therapy (EVT) under intravascular ultrasound (IVUS) guidance were analyzed. RVDs measured using QVAsheath (calibrated using a 6-Fr sheath in the common femoral artery) and QVAruler (calibrated using a ruler on the angiography table) were compared to those obtained using IVUS as the reference values. RESULTS The mean QVAsheath-measured RVD was significantly larger than the mean IVUS-measured RVD (5.34±1.29 vs. 5.07±1.20 mm, P=0.001). In contrast, mean QVAruler-measured RVD was 4.60±1.04 mm, which was significantly smaller than both the mean IVUS- and mean QVAsheath-measured RVD (both P<0.001). Bland-Altman analysis revealed that the 95% limits of agreement versus IVUS ranged from -0.94 to 1.49 mm for QVAsheath and -1.69 to 0.76 mm for QVAruler, respectively. Agreement with tolerance of ±1.00 mm accounted for 88% of QVAsheath and 83% of QVAruler (P=0.60). The difference between QVA- and IVUS-measured RVDs was inversely correlated with the distance from the table (P=0.029 for QVAsheath and P=0.003 for QVAruler). CONCLUSIONS The accuracy of both QVAsheath and QVAruler in measuring RVD were similarly suboptimal. Over- and under-estimation of RVD is not rare in QVA.
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Affiliation(s)
- Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Keisuke Hirano
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shigemitsu Shirai
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Kenji Makino
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yohsuke Honda
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Masakazu Tsutsumi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
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27
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Abstract
Background: Disabling peripheral arterial disease (PAD) of femoropopliteal segment is usually treated with percutaneous balloon dilatation, and when this is not successful, stent is placed. Long-term patency of stent is often compromised due to in-stent restenosis (ISR). We aimed to identify factors associated with bailout stenting, and to recognise risk factors for ISR in procedures without paclitaxel application. Patients and methods: We analysed 592 consecutive successful femoropopliteal interventions performed in patients with either disabling intermittent claudication or chronic critical limb ischemia (CLI). In patients with stent implantation, clinical and ultrasound (US) examination were performed one year after the intervention to establish the presence of ISR, defined as >50% stenosis on US imaging. Results: Bailout stenting was required in 133 (22.5%) procedures. Patients with stent placement were younger (70±10 vs 72±11 years, p=0.007) and less often presented with CLI (29.3% vs 40.5%, p=0.019). They more often reported smoking (63.2% vs 49.2%, p=0.005), less often had diabetes mellitus (35.3% vs 47.5%, p=0.013) and arterial hypertension (82.0% vs 90.8%; p=0.004). Stenting was also dependent on lesion complexity (TASC II C>B>A; p<0.001). Subgroup analysis of 110 procedures with bare metal stent (BMS) placement performed in 107 patients revealed ISR in 46.4% of stents, in half of cases it was symptomatic. Neither clinical nor lesion characteristics proved to differ between the group of procedures with ISR and group of procedures without ISR. Conclusions: Factors associated with bailout stenting were age, diabetes mellitus, arterial hypertension, smoking, clinical picture of PAD and complexity of treated lesions. We did not find any risk factors influencing development of ISR in BMS.
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Affiliation(s)
- Anja Boc
- Faculty of Medicine, Institute of Anatomy, University of Ljubljana, Ljubljana, Slovenia.,Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Barbara Eržen
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rok Luciano Perme
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
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28
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Sheorain VS, Parakh R, Grover T, Sahu T, Aher A. Supera Stent Implantation with Ultrasound Guidance for Complex Ostial Lesions of Superficial Femoral Artery by Retrograde Approach: The SUGAR Technique. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1728976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Purpose The aim of this study was to describe a modified technique for accurate deployment of the Supera stent under ultrasound (US) guidance for complex lesions involving superficial femoral artery (SFA) ostium without jailing profunda femoral artery (PFA) by retrograde approach.
Technique Retrograde pedal access was initially taken in all the cases. The stenotic or occlusive femoropopliteal lesions involving the SFA ostium were crossed retrogradely and additional contralateral common femoral artery (CFA) access was taken only if we failed to cross the lesion. In addition to fluoroscopy, extravascular US guidance was freely used whenever required throughout the procedure. After desired predilatation of the SFA lesion, US guidance (gray scale and color Doppler) was used to start deployment of the proximal few centimeters of Supera stent ensuring that the landing of first crown was exactly from the SFA ostium not extending into CFA or jailing the PFA ostium. The rest of the stent was deployed under fluoroscopic guidance. Retrograde pedal access site hemostasis was achieved by manual compression. The Supera stent implantation with Ultrasound Guidance for complex ostial lesions of superficial femoral Artery by Retrograde approach (SUGAR) technique was applied successfully in 35 patients (mean age 58.1 ± 4.4 years; 24 males) with critical limb ischemia via the distal pedal approach. No access site or remote complications were observed.
Conclusion The SUGAR technique has superior advantage of utilizing a simple tool like extravascular US in addition to fluoroscopy for retrograde Supera stent deployment by allowing very precise landing at SFA ostium, bypassing the need for multiple oblique projections, unwanted radiation exposure, and extra contrast dye overload.
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Affiliation(s)
- Virender Singh Sheorain
- Department of Peripheral Vascular and Endovascular Sciences, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Rajiv Parakh
- Department of Peripheral Vascular and Endovascular Sciences, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Tarun Grover
- Department of Peripheral Vascular and Endovascular Sciences, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Tapish Sahu
- Department of Peripheral Vascular and Endovascular Sciences, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Ashutosh Aher
- Department of Peripheral Vascular and Endovascular Sciences, Medanta - The Medicity, Gurgaon, Haryana, India
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Comparative effectiveness of endovascular treatment modalities for de novo femoropopliteal lesions in intermittent claudication: A network meta-analysis of randomized controlled trials. Int J Cardiol 2021; 343:122-130. [PMID: 34461162 DOI: 10.1016/j.ijcard.2021.08.038] [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: 02/19/2021] [Revised: 08/01/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the most effective endovascular treatment modalities for de novo femoropopliteal lesions in intermittent claudication (IC) in terms of technical success, primary patency, target lesion revascularization (TLR) and all-cause mortality through network meta-analysis of randomized controlled trials. METHODS Medical databases were searched on December 3, 2020. 16 studies (3265 patients) and 7 treatments were selected. Outcomes were technical success, primary patency, TLR and mortality at 6 and/or 12 months. RESULTS Regarding 6-month primary patency, drug-eluting stents (DES) was better than balloon angioplasty (BA; odds ratio [OR], 23.27; 95% confidence interval [CI], 12.57-43.06), drug-coated balloons (DCB; OR, 5.63; 95% CI, 2.26-14.03) and directional atherectomy (DA; OR, 31.52; 95% CI, 7.81-127.28), and bare nitinol stents (BNS) was better than BA (OR, 17.91; 95% CI, 7.22-44.48), DCB (OR, 4.33; 95% CI, 1.40-13.45) and DA (OR, 24.27; 95% CI, 5.16-114.11). Regarding 12-month primary patency, DES was better than BA (OR, 10.05; 95% CI, 4.56-22.16), DCB (OR, 3.70; 95% CI, 1.54-8.89) and DA (OR, 29.54; 95% CI, 7.26-120.26). DCB and combination of balloon and atherectomy were the most effective treatment regarding 12-month TLR and technical success (residual stenosis <30%), respectively. DES, BNS and DA with DCB (DA-DCB) were included in the best cluster in the clustered ranking plot combining 12-month primary patency and TLR. CONCLUSIONS Balloon and atherectomy may confer advantages over other treatments for technical success; DCB may for TLR. Stent technologies confer substantial advantages regarding primary patency. Stent technologies and DA-DCB should be given priority in treating femoropopliteal lesions in IC.
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30
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Zhu Q, Ye P, Wang J, Chang Z. Inhibition of edge stenosis of endografts in swine iliac arteries by a novel endograft with biodegradable coating at both ends. JVS Vasc Sci 2021; 2:207-218. [PMID: 34761240 PMCID: PMC8567203 DOI: 10.1016/j.jvssci.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Abstract
Objective This study evaluated the effectiveness and safety of a novel endograft with a biodegradable coating at both ends in preventing edge stenosis in swine iliac arteries. The biodegradable coating was composed of polylactide and paclitaxel. Methods Four types of endograft were implanted in the iliac arteries of healthy swine: an endograft without coating (control group) and endografts with polylactide and paclitaxel coating containing 0.1, 0.3, or 3.6 μg/mm2 of paclitaxel. The edge stenosis of these endografts in swine iliac arteries was assessed using angiographic image data at 30, 90, and 180 days after the operation. After terminal angiography, histologic evaluation of the treated arteries was performed. The treated sections of iliac arteries and blood samples were obtained at 1, 7, 30, 90, and 180 days for pharmacokinetic analysis. Results The results of angiographic and histologic evaluation demonstrated that intimal hyperplasia contributed to edge stenosis and polylactide-paclitaxel coating effectively inhibited edge stenosis. At 30 days, edge stenosis was observed at both the proximal and distal edges of the endograft without coating. At 90 days, edge stenosis was detected for the endograft coated with 0.1 μg/mm2 paclitaxel, and ectasia dilation occurred at the proximal and distal edges of the endograft coated with 3.6 μg/mm2 paclitaxel. No edge stenosis or other adverse effects were observed at 90 and 180 days for the endograft coated with 0.3 μg/mm2 paclitaxel. In addition, for the endograft coated with 0.3 μg/mm2 paclitaxel, a pharmacokinetic analysis showed that the paclitaxel concentration of treated segments decreased from 14 264 ± 1020 ng/g at day 1 to 80 ± 70 ng/g at day 90, and 20 ± 40 ng/g at day 180. The plasma paclitaxel concentration was low at day 1 and no longer detected after 7 days. Conclusions Polylactide and paclitaxel coating containing 0.3 μg/mm2 paclitaxel at both ends of endografts effectively and safely inhibits edge stenosis in swine iliac arteries.
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Affiliation(s)
- Qing Zhu
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China.,Shanghai MicroPort Endovascular MedTech (Group) Co., Ltd, Shanghai, PR China
| | - Ping Ye
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Jinyao Wang
- Shanghai MicroPort Endovascular MedTech (Group) Co., Ltd, Shanghai, PR China
| | - Zhaohua Chang
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China.,Shanghai MicroPort Endovascular MedTech (Group) Co., Ltd, Shanghai, PR China
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Krishnan P, Tarricone A, Gee A, Farhan S, Kamran H, Kapur V, Gujja K, Kini A, Sharma S. Analysis of Interwoven Nitinol Stenting for the Treatment of Critical Limb Ischemia: Outcomes From an Average 3-Year Follow-up Period. Angiology 2021; 73:407-412. [PMID: 34617824 DOI: 10.1177/00033197211043406] [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: 11/17/2022]
Abstract
We assessed the clinical outcomes of patients with critical limb-threatening ischemia (CLTI) who underwent interwoven nitinol stent (Supera) implantation for significant stenoses of the femoropopliteal segment. In this retrospective cohort study, 116 consecutive patients with CLTI who were treated with Supera stents between September 2015 and March 2020 were included in this analysis. Primary endpoint analysis was completed for amputation-free survival, target lesion revascularization (TLR), and mortality. After a mean follow-up time of 3.4 years, 21 (18%) patients had undergone amputations, 3 (2.6%) died, and, overall, the amputation-free survival rate was 81%. TLR occurred in 21 (18%) patients, resulting in the freedom from target lesion revascularization of 82%. The average Wagner score for all patients was 2.8 ± 1.1. A subgroup analysis of 57 patients revealed a median ulcer size of 3.0 cm2 [1.65, 9.0], with complete healing for 45 patients by 20 months. The Wagner score of this subgroup decreased by an average of 3.4 ± .9 points. Supera stents can be used together with other endovascular therapies and are a safe and effective treatment modality for CLTI.
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Affiliation(s)
- Prakash Krishnan
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arthur Tarricone
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allen Gee
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Serdar Farhan
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Haroon Kamran
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vishal Kapur
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karthik Gujja
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annapoorna Kini
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samin Sharma
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Allan RB, Wise NC, Wong YT, Delaney CL. Comparison of Angiographic Dissection Classification Systems in the Femoropopliteal Arteries Using IVUS Validation and Reliability Testing. J Endovasc Ther 2021; 29:193-203. [PMID: 34609223 DOI: 10.1177/15266028211047952] [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: 11/15/2022]
Abstract
PURPOSE Objective assessment of dissection severity is difficult. Recognition of this has led to the creation of classification systems. This study investigated the performance of the National Heart Lung and Blood Institute (NHLBI) and Kobayashi systems at differentiating severity of femoropopliteal dissection using intravascular ultrasound (IVUS) as the reference standard. Comparison between the 2 systems and the inter- and intra-observer reliability were also investigated. MATERIALS AND METHODS Angiographic and IVUS imaging was assessed in 51 cases sourced from a RCT investigating the use of IVUS in femoropopliteal disease. A total of 2 readers independently scored the angiography images according to NHLBI and Kobayashi dissection classification systems and a consensus score was obtained for each system in each case. The NHLBI classification was condensed into 3 grades of dissection to allow comparison between systems. Dissection length, dissection arc, minimum lumen area, and lumen area stenosis were obtained from the IVUS imaging. IVUS parameters were compared between grades of severity for both systems. Agreement in grading between the systems was assessed and IVUS parameters for each level of dissection severity were compared between systems. Inter and intra-observer agreement tested for each system. RESULTS Dissection was present on IVUS in 92.2% (47/51) of cases and angiography identified 78.7% (37/47) of these. No difference was present in any IVUS parameters between mild and severe dissections with either classification system. No difference in IVUS findings was present for the same grades of dissection between systems. The 2 systems agreed on severity grade in 47 of 51 cases. The inter-observer agreement was for NHLBI was k=0.549 and k=0.627 for Kobayashi. Intra-observer agreement for NHLBI was k=0.633 and k=0.633 and for Kobayashi was k=0.657 and k=0.297. CONCLUSION The lack of difference in IVUS parameters between mild and severe dissection for the NHLBI and Kobayashi systems raises doubts about their ability to effectively differentiate dissection severity. Weak to moderate reliability suggests that variability in interpreting dissection may be higher than acceptable. IVUS imaging is more sensitive for detecting dissection than angiography and research is required to establish the value of adding IVUS to dissection classification systems.
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Affiliation(s)
- Richard Barry Allan
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nadia Clare Wise
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Yew Toh Wong
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Christopher Luke Delaney
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Characteristics of atherosclerosis in femoropopliteal artery and its clinical relevance. Atherosclerosis 2021; 335:31-40. [PMID: 34547588 DOI: 10.1016/j.atherosclerosis.2021.09.012] [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: 05/06/2021] [Revised: 08/28/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
Atherosclerosis is a systemic disease with different faces. Despite identical or similar pathogenetic mechanisms, atherosclerotic lesions and their clinical manifestations vary in different parts of the vascular system. Peripheral arterial disease (PAD) represents one of the most frequent clinical manifestations of atherosclerosis with predominant location in the superficial femoral artery (SFA). Morphological characteristics of atherosclerotic plaques in peripheral arteries differ from lesions in the coronary and carotid arteries. Plaques in SFA have more fibrotic components, less lipids and inflammatory cells, which makes them more stable and less prone to rupture. Factors that determine the different structure of plaques in SFA compared to coronary arteries include hemodynamic forces, vasa vasorum and calcification. Low shear stress in SFA in the adductor canal is one of the factors which determines frequent atherosclerotic lesions in this region. Lower lipid content and fewer inflammatory cells explain higher stability of SFA plaques. The specific structure of SFA plaques may require preventive and therapeutic measures, which to some extent differ from prevention of coronary atherosclerosis and may include inhibition of fibrotic proliferation in SFA plaques and calcification. Revascularization of PAD differs from procedures used in coronary arteries and requires specific technical expertise and devices.
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Karashima E, Takahara M, Hozawa K, Yamauchi Y, Suzuki K, Suematsu N, Miyashita Y, Enomoto S, Tokuyama H, Murata N, Haraguchi K, Soga Y. Three-Year Clinical Outcomes of the Innova™ Self-Expanding Nitinol Stent for the Treatment of Femoropopliteal Lesions. Cardiovasc Intervent Radiol 2021; 44:1722-1727. [PMID: 34523023 DOI: 10.1007/s00270-021-02960-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/29/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To report the 3-year results of Innova™ stent implantation for the treatment of femoropopliteal (FP) lesions in a real-world setting. METHODS This single-arm, retrospective, multicenter clinical study analyzed 481 lesions from 453 consecutive patients with symptomatic peripheral artery diseases (Rutherford category 1-6) who underwent endovascular therapy with implantation of Innova™ self-expanding nitinol stent for FP lesions. The primary outcome measure was the 3-year restenosis rate based on doppler-ultrasound or angiographic criteria. The secondary outcome measures included the rates of 3-year major amputation and major adverse limb events. RESULTS Restenosis following Innova™ implantation was found in 61% of the cases at 3 years. At the end of 3 years, the rates of major amputations and major adverse limb events were 3 and 31%, respectively. In cases free from restenosis at 1 year, no predictive factors for restenosis at 3 years could be determined. CONCLUSION The present study demonstrated mid-term clinical outcomes after Innova™ stent implantation for the treatment of FP lesions in a real-world population. The Innova™ stent demonstrated acceptable clinical outcomes in a real-world setting.
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Affiliation(s)
- Eiji Karashima
- Department of Cardiology, Shimonoseki City Hospital, 1-13-1 Kouyou-chou, Shimonoseki, Yamaguchi, 750-8520, Japan.
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | | | - Kenji Suzuki
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Nobuhiro Suematsu
- Department of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Yusuke Miyashita
- Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | | | - Hideo Tokuyama
- Department of Cardiology, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Naotaka Murata
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kazuki Haraguchi
- Division of Cardiovascular Medicine, Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Stavroulakis K, Torsello G, Bosiers M, Argyriou A, Tsilimparis N, Bisdas T. 2-Year Outcomes of the Eluvia Drug-Eluting Stent for the Treatment of Complex Femoropopliteal Lesions. JACC Cardiovasc Interv 2021; 14:692-701. [PMID: 33736776 DOI: 10.1016/j.jcin.2021.01.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the 2-year performance of a polymer-based drug-eluting stent (DES) for the treatment of complex femoropopliteal lesions. BACKGROUND Despite the promising early outcomes of the Eluvia DES, the long-term safety and efficacy of the device in a real-world scenario remain unclear. METHODS Between March 2016 and December 2018, 130 patients (137 lesions) with symptomatic femoropopliteal disease were included in this study. The primary outcome measure of this analysis was primary patency. Secondary patency, freedom from target lesion revascularization, freedom from surgical conversion, and overall mortality and morbidity were additionally analyzed. RESULTS The majority of patients presented with lifestyle-limiting claudication (n = 90 [69%]). The mean lesion length was 194 ± 108 mm, 74% of the lesions (n = 101) were chronic total occlusions, and 72% (n = 99) were calcified. Moderate to severe calcification (Peripheral Arterial Calcium Scoring Scale score 3 or 4) was observed in 48% of the treated vessels (n = 67). At 24 months, the Kaplan-Meier estimate of primary patency was 71%, whereas both the secondary patency rate and freedom from target lesion revascularization were 80%. Overall survival amounted to 85%. Freedom from major amputation was 98%, while freedom from surgical conversion was 89%. Degeneration of the vessel wall was observed in 27 lesions (20%). CONCLUSIONS In this study, use of the Eluvia polymer-based DES for the treatment of complex femoropopliteal disease showed promising 2-year results. Nonetheless, a relatively high rate of vessel wall degeneration was observed after DES deployment.
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Affiliation(s)
- Konstantinos Stavroulakis
- Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany; Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany
| | - Michel Bosiers
- Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany
| | - Angeliki Argyriou
- Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital, Muenster, Germany; Department of Vascular and Endovascular Surgery, Athens Medical Center, Athens, Greece
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Li H, Rha SW, Choi BG, Choi SY, Moon SK, Jang WY, Kim W, Ahn JH, Park SH, Choi WG, Yang RF, Bai WW, Choi CU, Ryu YG, Baek MJ, Oh DJ. Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent. BMC Cardiovasc Disord 2021; 21:323. [PMID: 34193057 PMCID: PMC8246708 DOI: 10.1186/s12872-021-02141-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/24/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Self-expanding nitinol stent (SENS) implantation is commonly oversized in the superficial femoral artery (SFA), and leads to chronic outward force (COF) and in-stent restenosis (ISR). This study aimed to investigate the impact of COF of oversizing SENS on ISR of SFA. METHODS In patients with implanted SENS in SFA, intimal hyperplasia especially between proximal segment and distal segment was evaluated by quantitative angiography, and the impact of COF on mid-term angiographic outcomes was investigated. In addition, porcine model with implanted SENS was used to evaluate the impact of COF on angiographic and histopathologic outcomes at 1 month. Excised stented arteries were evaluated by histopathologic analysis. RESULTS We analyzed 65 SENS in 61 patients with follow-up angiography at 6 months to 1 year. The baseline diameter was 6.8 ± 0.71 mm and length were 97.0 ± 33.8 mm for the SENS. The ratio of the diameter of the stent to the reference vessel was 1.3 ± 0.24 at the proximal portion and 1.53 ± 0.27 at the distal portion (P < 0.001). In the long SFA stent, stent-to-vessel ratio was significantly higher in the distal stent than in the proximal stent (1.3 ± 0.2 vs. 1.55 ± 0.25, P = 0.001). ISR incidence was higher at the distal stent (37.3% vs 52.6%, P = 0.029). All 11 pigs survived for 4 weeks after SENS implantation. The vessel diameter was 4.04 ± 0.40 mm (control group) vs 4.45 ± 0.63 mm (oversized group), and the implanted stent diameter was 5.27 ± 0.46 mm vs. 7.18 ± 0.4 mm (P = 0.001). The stent-to-vessel diameter ratio was 1.31 ± 0.12 versus 1.63 ± 0.20 (P < 0.001). After 4 weeks, restenosis % was 29.5 ± 12.9% versus 46.8 ± 21.5% (P = 0.016). The neointimal area was 5.37 ± 1.15 mm2 vs. 8.53 ± 5.18 mm2 (P = 0.05). The restenosis % was 39.34 ± 8.53% versus 63.97 ± 17.1% (P = 0.001). CONCLUSIONS COF is an important cause of restenosis in the distal portion of the SFA stent. Optimal sizing of the SFA stent is important to reduce the incidence of restenosis. Therefore, COF was an important factor of restenosis following distal SFA stenting.
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Affiliation(s)
- Hu Li
- Department of Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.,Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Se Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Sang Ki Moon
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Won Young Jang
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Ji Hun Ahn
- Department of Cardiology, Soon Chun Hyang University Gumi Hospital, Gumi-si, Republic of Korea
| | - Sang-Ho Park
- Department of Cardiology, Soonchunhyang University Cheonan Hospital Korea, Cheonan-Ii, Republic of Korea
| | - Woong Gil Choi
- Department of Internal Medicine, School of Medicine, Konkuk University, Chungju, Republic of Korea
| | - Rui Feng Yang
- Department of Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Wen Wei Bai
- Department of Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Yang Gi Ryu
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Man Jong Baek
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Dong Joo Oh
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
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Doyle MD, Hastings G, Dontsi M, Ishibashi MA, Weintraub MR, Pollard JD. The Correlation of the Trans-Atlantic Inter-Society Consensus Classification to Outcomes of Pedal Amputations. J Foot Ankle Surg 2021; 59:1013-1018. [PMID: 32703650 DOI: 10.1053/j.jfas.2020.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 02/03/2023]
Abstract
In an attempt at limb salvage for patients with peripheral arterial disease, revascularization is often performed prior to pedal amputation. The purpose of this study was to evaluate the association between proximal arterial lesions, based on Trans-Atlantic Inter-Society Consensus aortoiliac, femoropopliteal, and infrapopliteal classifications, and healing pedal amputations post endovascular revascularization. Patients with revascularization up to 90 days prior to pedal amputation with a minimum of 12 months postoperative follow-up were included. Each level of proximal disease was subdivided into Trans-Atlantic Inter-Society Consensus classifications A through D, which range in severity from a single short stenosis or occlusion to more complex stenoses and chronic total occlusion. For comparison, we categorized A and/or B lesions into Group 1 and C and/or D lesions into Group 2. The frequency of proximal lesions was recorded as either isolated, bi-level, or multilevel disease. Chi-square and Fisher's exact tests were used to compare categorical variables. Of the 310 patients, there were a total of 68 aortoiliac, 256 femoropopliteal, and 172 infrapopliteal lesions; 140 patients had isolated lesions, 154 had bi-level disease, and 16 had multilevel disease. Although not statistically significant, patients in Group 1 (A and/or B lesions) had higher proportion of failed amputation compared to Group 2 (C and/or D lesions) in either aortoiliac (84.4% vs 15.6%, p = .17), femoropopliteal (61.2% vs 38.8%, p = .72), or infrapopliteal (57.3% vs 42.7%, p = .44). Bi-level disease showed a higher proportion of failure (50.6%) compared to isolated lesions (43.8%) and multilevel disease (5.6%), (p = .86). To our knowledge, this is the first study to evaluate the association between Trans-Atlantic Inter-Society Consensus arterial lesions and incisional healing of pedal amputations. Despite our belief, there was no correlation between patients with simple, isolated lesions compared to either complex arterial lesions or multilevel disease in healing pedal amputations.
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Affiliation(s)
- Matthew D Doyle
- Fellow, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, CA.
| | - Geoffrey Hastings
- Attending Physician, Department of Interventional Radiology, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - Makdine Dontsi
- Senior Consulting Data Analyst, Division of Research, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - Megan A Ishibashi
- Resident, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - Miranda Ritterman Weintraub
- Senior Research Project Manager, Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - Jason D Pollard
- Attending Staff and Research Director, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Permanente Oakland Medical Center, Oakland, CA
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Mahé G, Boge G, Bura-Rivière A, Chakfé N, Constans J, Goueffic Y, Lacroix P, Le Hello C, Pernod G, Perez-Martin A, Picquet J, Sprynger M, Behar T, Bérard X, Breteau C, Brisot D, Chleir F, Choquenet C, Coscas R, Detriché G, Elias M, Ezzaki K, Fiori S, Gaertner S, Gaillard C, Gaudout C, Gauthier CE, Georg Y, Hertault A, Jean-Baptiste E, Joly M, Kaladji A, Laffont J, Laneelle D, Laroche JP, Lejay A, Long A, Loric T, Madika AL, Magnou B, Maillard JP, Malloizel J, Miserey G, Moukarzel A, Mounier-Vehier C, Nasr B, Nelzy ML, Nicolini P, Phelipot JY, Sabatier J, Schaumann G, Soudet S, Tissot A, Tribout L, Wautrecht JC, Zarca C, Zuber A. Disparities Between International Guidelines (AHA/ESC/ESVS/ESVM/SVS) Concerning Lower Extremity Arterial Disease: Consensus of the French Society of Vascular Medicine (SFMV) and the French Society for Vascular and Endovascular Surgery (SCVE). Ann Vasc Surg 2021; 72:1-56. [DOI: 10.1016/j.avsg.2020.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
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The 100 most cited articles in the diagnosis and management of peripheral artery disease. J Vasc Surg 2021; 74:135-152.e4. [PMID: 33592290 DOI: 10.1016/j.jvs.2021.02.002] [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: 08/23/2020] [Accepted: 02/04/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Peripheral artery disease (PAD) is a highly prevalent disease that places major lifestyle limitations and mortality risk on affected individuals. As the understanding of the disease has grown in the medical community, it is unknown which literature has made the greatest impact on the knowledge of PAD. We performed a bibliometric analysis using the number of citations as an indication of impact to analyze the top 100 most influential articles on PAD management. METHODS A retrospective search of the Web of Science (Thomson Reuters, New York, NY) database for English-only publications was conducted in November 2020. We identified initial references from the database using the search terms "Peripheral Arterial Disease," "Peripheral Vascular Disease," "Claudication," "Critical Limb Ischemia," "Chronic Limb Threatening Ischemia," "Rest Pain," "Ischemic Ulcer," "Toe Gangrene," "Ankle Brachial Index," and "Leg Ischemia" in Web of Science Core Collections. Articles were ranked based on the number of citations and then analyzed based on citation count and average number of citations per year. Additional metrics included the overall average number of publications per year, the journals, journal discipline, author (including degree and gender), institution, country, topic area, and the level of evidence. RESULTS The most popular articles were published between 1959 and 2017, with 46,716 citations in total (average 27.26 citations/y). The most popular article had 2225 citations in total and was Rutherford's "Recommended standards for reports dealing with lower extremity ischemia: Revised version." Peak years of citations were 2016, 2014, and 2018 (2753, 2674, and 2639 citations, respectively). Top journals for the most cited publications were Circulation, Journal of Vascular Surgery, and the Lancet with 21, 13, and 7 articles, respectively. A majority of articles originated from the United States (58 articles), followed by the United Kingdom (15 articles) and Germany (13 articles). Major topic areas of interest and trends in the progressive understanding of PAD were noted. Top areas of focus included surgical interventions (29%), therapeutic angiogenesis (15%), epidemiological studies in PAD (14%), and diagnosis and evaluation (13%). In the top cited literature, 48% (14/29) of surgical articles investigated endovascular interventions for PAD. CONCLUSIONS Overall, PAD research has evolved from basic epidemiological studies to advanced management with continued investigation toward future, improved treatments for PAD.
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Marques L, Hopf-Jensen S, Preiss M, Mueller-Huelsbeck S. An Update on Drug-eluting Technology in Peripheral Arteries to Treat Peripheral Arterial Disease. Heart Int 2021; 15:73-78. [DOI: 10.17925/hi.2021.15.2.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022] Open
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Morrison JT, Hsia J, Bonaca MP. Medical Therapy for Secondary Prevention of Atherothrombotic Events in Peripheral Artery Disease. Heart Int 2021; 15:14-19. [DOI: 10.17925/hi.2021.15.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
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Significance of Distal Runoff Score as a Key Influencer on Clinical Outcomes after Endovascular Interventions for Superficial Femoral Artery Disease. Ann Vasc Surg 2020; 73:234-243. [PMID: 33359690 DOI: 10.1016/j.avsg.2020.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Endovascular therapy (EVT) is being adopted by many surgeons as a suitable first choice in the treatment of most femoropopliteal disease when clinically indicated. However, there are multiple factors affecting the outcome of EVT including the anatomy of lesions and distal runoff status. The evidence of runoff effect on the outcome of superficial femoral artery (SFA) interventions is still scarce and not well studied in the current literature. The aim of this study was to investigate the effect of runoff score on the outcomes of SFA endovascular interventions. METHODS Retrospective analysis was carried out on prospectively collected data on patients who underwent SFA endovascular intervention for critical limb ischemia (CLI) in a single tertiary center. Patients with Rutherford categories 4, 5, and 6 who did not have any previous vascular interventions were included in the study. The modified SVS runoff score was used after calculating scores from popliteal and all tibial vessels. Runoff was stratified into good (score <5), compromised (score 5-10), and poor (score >10). Amputation-free survival, patency rates, and overall survival were compared between all groups at 5 years. RESULTS Between 2011 and 2018, 254 procedures were performed in 220 patients. Technical success was >92%; 66 patients required SFA stents, and 55 had concomitant tibial angioplasty. There was no significant difference between good, compromised, or poor runoff groups regarding complication rates, with 3.5% overall perioperative mortality (5 cases in the compromised group and 4 in the poor runoff group). A runoff score of <5 was associated with significantly marked clinical improvement (P < 0.001). Patency rates were significantly worse in the compromised and poor runoff groups, with 5-year cumulative primary patency rates of 80%, 50%, and 22% in the good, compromised, and poor runoff groups, respectively (P < 0.001). Amputation-free survival worsened as the runoff got poorer with 98%, 91%, and 78% in the good, compromised, and poor runoff groups, respectively, at 5 years (P < 0.001). SFA stenting and concomitant tibial angioplasty led to slight improvement in patency rates in the poor runoff group. CONCLUSIONS Poor runoff with a score of >10 was associated with significantly reduced amputation-free survival and patency rates at 5 years in patients undergoing SFA endovascular intervention for CLI. Patients with a runoff score of <5 showed marked clinical improvement postoperatively when compared with patients with a runoff score of ≥5.
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Ye W, Zhang X, Dai X, Huang X, Liu Z, Jiang M, Liu C. Reewarm™ PTX drug-coated balloon in the treatment of femoropopliteal artery disease: A multi-center, randomized controlled trial in China. Int J Cardiol 2020; 326:164-169. [PMID: 33127414 DOI: 10.1016/j.ijcard.2020.10.060] [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: 02/20/2020] [Revised: 09/28/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Drug-coated balloons (DCB) have demonstrated satisfactory clinical results in the treatment of femoropopliteal artery diseases. OBJECTIVE To evaluate the efficacy and safety of the Reewarm™ PTX DCB in the treatment of femoropopliteal artery lesions compared with plain balloon. METHODS This was a multi-center, parallel-group, randomized controlled trial in patients with femoropopliteal artery lesions in China,. The participants were randomized 1:1 to percutaneous transluminal angioplasty with Reewarm™ PTX DCB or with standard plain balloon (PTA group) after pre-dilatation with a residual stenosis less than 70%. The primary endpoint was late lumen loss (LLL) at 6 months in the intent-to-treat set. The secondary endpoints included the target lesion revascularization (TLR) and major advance events(MAE)rate at 12 months. RESULTS Between July 2014 and April 2017, a total of 200 patients were enrolled. The mean age of the subjects was 67.8 ± 9.2 years in the DCB group (n = 100) and 69.4 ± 10.3 years in the PTA group (n = 100). The LLL at 6 months in the DCB group was significantly lower than in the PTA group (0.5 ± 0.8 mm vs. 1.5 ± 1.2 mm, P < 0.001). The TLR rate in the DCB group was lower than in the PTA group at 12 months (15.0% vs. 29.0%, P < 0.05). The occurrence of MAE4 in the DCB group by 12 months was lower than in the PTA group (23.0% vs. 38.0%, P < 0.05). CONCLUSION Reewarm-PTX drug-coated balloon is associated with better efficacy and safety than the plain balloon for femoropopliteal lesion.
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Affiliation(s)
- Wei Ye
- Department of Vascular Surgery, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Beijing, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Xiangchen Dai
- Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaojin Huang
- Department of vascular surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Zhaoyu Liu
- Department of Vascular Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mi'er Jiang
- Department of Vascular Surgery, Shanghai the Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Changwei Liu
- Department of Vascular Surgery, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Beijing, China.
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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.
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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
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Management of endovascular treatment in spontaneous iliac artery dissections: Applications enabling classical surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:601-608. [PMID: 33403132 PMCID: PMC7759031 DOI: 10.5606/tgkdc.dergisi.2020.19668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/07/2020] [Indexed: 01/22/2023]
Abstract
Background
This study aims to investigate the effectiveness of endovascular applications for the treatment of spontaneous iliac artery dissections.
Methods
The medical records of 13 patients (12 males, 1 female; mean age 67.9±5.7 years; range, 58 to 75 years) with spontaneous iliac artery dissection between January 2017 and December 2019 were retrospectively reviewed. The diagnosis of spontaneous iliac artery dissection was made based on contrast-enhanced computed tomography. Demographic and clinical characteristics of the patients, physical examination and imaging findings, and hybrid treatments applied during endovascular treatment were analyzed.
Results
The mean follow-up was 12.5±1.1 (range, 6 to 16) months. Five patients received hybrid treatment during endovascular treatment. The re-entry site was closed by a patch plasty over the common femoral artery in one of these patients. Embolectomy was performed in the remaining four patients for the treatment of acute ischemia of the extremities. Since no patency could be achieved in two of the patients undergoing embolectomy, a femoropopliteal bypass was performed. The technical success and primary patency rates were 100%. No new false lumen formation, intra-stent occlusion or arterial occlusion was observed during the hospital stay and follow-up.
Conclusion
Endovascular methods can be safely used in the treatment of spontaneous iliac artery dissections; however, hybrid treatments may be also required in selected cases. We believe that it is effective and safe to apply endovascular and hybrid treatments without preventing possible surgical treatments which may be required in the future.
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Krishnappa S, Rachaiah JM, Mariappa HM, Doddamadaiah C, Nanjappa MC. Endovascular Interventions to Superficial Femoral Artery Occlusion: Different Approaches, Technique, and Follow-up. Heart Views 2020; 21:65-74. [PMID: 33014298 PMCID: PMC7507906 DOI: 10.4103/heartviews.heartviews_34_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/19/2019] [Indexed: 12/24/2022] Open
Abstract
Background Superficial femoral artery lesion is one of the main causes for intermittent claudication or critical limb ischemia. Percutaneous transluminal angioplasty is one of the approved therapies for this medical entity. Anatomical factors should be considered in choosing the right approach and puncture.The purpose of this study is to discuss the anatomical, radiological, and technical factors which determine the preference of various approaches and to determine its safety, efficacy, and mid-term clinical and radiological outcome. Methods Retrospectively, data were collected from patients who underwent angioplasty to superficial femoral arteries for total occlusion from January 2015 and June 2018 in our center, we performed angioplasty to 59 occluded superficial femoral artery patients at our center. The ipsilateral femoral artery, ipsilateral popliteal artery, contralateral femoral artery, or upper limb approaches were used depending on the various anatomical factors determined by radiological imaging before the procedure. Results Acute success rate was 91.52%. There were no significant periprocedural complications. At the latest clinical follow-up of mean 25.8 months (10-51), a restenosis rate of 16.67% in infrainguinal arteries and 5.88% in suprainguinal arteries were noted. Conclusions Percutaneous transluminal angioplasty of superficial femoral artery is a proven, viable, safer, and effective option, with good mid-term clinical results and patency rates. Different approaches to be chosen depends on the anatomical and technical factors to get the best possible outcome.
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Affiliation(s)
- Santhosh Krishnappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
| | | | - Harsha Mullusoge Mariappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
| | - Chaitra Doddamadaiah
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
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Abstract
CHD is closely related to respiratory system diseases (Mok Q, Front Pediatr 2017; 5: 2296-2360). Flexible fibreoptic bronchoscopy will diagnose anatomical lesions of the trachea and perform interventions at the same time for children with indications. We report a case of pulmonary artery sling with severe tracheostenosis in a 11-month-old boy. Tracheal stents were placed with good prognosis.
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Tanaka R. Recent Update on Peripheral Arterial Endovascular Therapy for Peripheral Arterial Occlusive Disease. INTERVENTIONAL RADIOLOGY 2020; 5:120-127. [PMID: 36284758 PMCID: PMC9550384 DOI: 10.22575/interventionalradiology.2020-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/07/2020] [Indexed: 12/24/2022]
Abstract
Endovascular treatment is effective for symptomatic peripheral arterial disease (PAD). Following recent device improvements, favorable long-term outcomes have been achieved in iliac arteries as well as small arteries such as the femoral and popliteal arteries. This paper outlines the history and recent advances in endovascular treatment of peripheral vascular diseases as well as the characteristics and usage of devices. The history and the advances in endovascular treatment of peripheral vascular disease have been parallel, with the development of devices such as catheters and stents. Accordingly, endovascular treatment is now recommended in guidelines as the first-line for PAD.
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Affiliation(s)
- Ryoichi Tanaka
- Division of Dental Radiology, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University, Iwate
- Department of Radiology, Iwate Medical University, Iwate
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Chae IH, Yoon CH, Ko YG, Min PK, Lee JH, Yu CW, Lee SW, Lee SR, Choi SH, Koh YS, Choi D. Differential efficacy between stenting and plain balloon angioplasty for femoropopliteal disease with or without total occlusion. Korean J Intern Med 2020; 35:1114-1124. [PMID: 32088945 PMCID: PMC7487302 DOI: 10.3904/kjim.2019.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/02/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/AIMS Whether the presence of chronic total occlusion (CTO) affects patency after stenting in femoropopliteal lesions is unknown. We determined the effects of plain balloon angioplasty (POBA) in comparison with those of stenting on patency for femoropopliteal CTO and stenosis (non-CTO). METHODS We analyzed data from the Korean Vascular Intervention Society Endovascular Therapy in Lower-Limb Artery Diseases Registry, a multicenter cohort of patients with lower extremity peripheral arterial disease. Data from 1,329 patients and 1558 limbs treated with endovascular intervention for at least one femoropopliteal lesion were evaluated. RESULTS Among the 1,558 limbs, 345, 432, 275, and 506 were in the non-CTO-POBA, non-CTO-stent, CTO-POBA, and CTO-stent groups, respectively. During follow-up, loss of clinical primary patency, a composite of freedom from restenosis or clinically driven target lesion revascularization, occurred in 65 (18.8%), 68 (15.7%), 62 (22.5%), and 113 limbs (22.3%) in the non-CTO-POBA, non-CTO-stent, CTO-POBA, and CTO-stent groups, respectively. The patients in the non-CTO-stent group showed a significantly better clinical primary patency than those in the no-CTO-POBA group, whereas those in the CTO-stent and CTO-POBA groups showed no significant differences. After inverse probability of treatment weighting to balance the differences among covariates between the non-CTO-stent and non-CTO-POBA groups, the non-CTO-stent group still showed superior clinical primary patency as compared with the non-CTO-POBA group. CONCLUSION In the patients with femoropopliteal stenosis without CTO, stenting resulted in better clinical outcomes than balloon angioplasty. The presence of CTO in the femoropopliteal lesion should be considered when selecting a suitable device for performing endovascular procedures.
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Affiliation(s)
- In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Korea
- Correspondence to Chang-Hwan Yoon, M.D. Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7052 Fax: +82-31-787-4052 E-mail:
| | - Young-Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil-Ki Min
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejon, Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seung Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Rok Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Seung Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Seok Koh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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Khan MS, Zou F, Khan AR, Moustafa A, Schmid CH, Baig M, Hyder ON, Aronow HD. Meta-Analysis Comparing Endovascular Treatment Modalities for Femoropopliteal Peripheral Artery Disease. Am J Cardiol 2020; 128:181-188. [PMID: 32650917 DOI: 10.1016/j.amjcard.2020.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 11/28/2022]
Abstract
Endovascular interventions are commonly utilized for treatment of femoropopliteal peripheral artery disease. The relative efficacy of these interventions remains unclear. A Bayesian network meta-analysis was performed comparing 5 endovascular treatment modalities: balloon angioplasty (BA), bare metal stent (BMS), covered stent (CS), drug-coated balloon (DCB), drug-eluting stent (DES) for femoropopliteal peripheral artery disease. The primary efficacy end points were freedom from target lesion revascularization (TLR) and primary patency at 12 months. BA was the reference treatment. Twenty-two trials including 4,381 participants provided data on TLR. Sixteen trials including 3,691 participants provided data on primary patency. Point estimates for DCB suggested that it was the most efficacious treatment for freedom from TLR (odds ratio [OR] 4.23; 95% credible intervals [CrI] 2.43 to 7.66) followed by CS (OR 3.65; 95% CrI 1.11 to 12.55), DES (OR 2.64; 95% CrI 0.72 to 9.77), and BMS (OR 2.3; 95% CrI 1.11 to 4.76). Similarly, point estimates for primary patency were highest with DES (OR 8.93; 95% CrI 3.04, 27.14) followed by CS (OR 3.91; 95% CrI 1.18, 13.84), DCB (OR 3.32; 95% CrI 1.8, 6.25), and BMS (OR 3.5; 95% CrI 1.58, 7.99). In conclusion, DCB has the lowest need for TLR whereas DES has the highest primary patency rate. DCB, CS, and BMS were associated with significant reductions in TLR compared with BA, whereas DCB, DES, CS, and BMS were associated with significantly improved primary patency compared with BA.
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Affiliation(s)
- Mohammad Saud Khan
- Department of Medicine, Division of Hospitalist Medicine, Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Fuyu Zou
- Department of Biostatistics, Brown University, Providence, Rhode Island
| | - Abdur Rahman Khan
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Abdelmoniem Moustafa
- Department of Medicine, Division of Hospitalist Medicine, Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Muhammad Baig
- Department of Medicine, Division of Hospitalist Medicine, Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Omar N Hyder
- Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Herbert D Aronow
- Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
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