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Yeats BB, Galvez D, Sivakumar SK, Holst K, Polsani V, Yadav PK, Thourani VH, Yoganathan A, Dasi LP. 3D Characterization of the Aortic Valve and Aortic Arch in Bicuspid Aortic Valve Patients. Ann Biomed Eng 2024; 52:2258-2268. [PMID: 38734846 DOI: 10.1007/s10439-024-03527-8] [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: 02/13/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
Patients with bicuspid aortic valve (BAV) commonly have associated aortic stenosis and aortopathy. The geometry of the aortic arch and BAV is not well defined quantitatively, which makes clinical classifications subjective or reliant on limited 2D measurements. The goal of this study was to characterize the 3D geometry of the aortic arch and BAV using objective and quantitative techniques. Pre-TAVR computed tomography angiogram (CTA) in patients with BAV and aortic stenosis (AS) were analyzed (n = 59) by assessing valve commissural angle, presence of a fused region, percent of fusion, and calcium volume. The ascending aorta and aortic arch were reconstructed from patient-specific imaging segmentation to generate a centerline and calculate maximum curvature and maximum area change for the ascending aorta and the descending aorta. Aortic valve commissural angle signified a bimodal distribution suggesting tricuspid-like (≤ 150°, 52.5% of patients) and bicuspid-like (> 150°, 47.5%) morphologies. Tricuspid like was further classified by partial (10.2%) or full (42.4%) fusion, and bicuspid like was further classified into valves with fused region (27.1%) or no fused region (20.3%). Qualitatively, the aortic arch was found to have complex patient-specific variations in its 3D shape with some showing extreme diameter changes and kinks. Quantitatively, subgroups were established using maximum curvature threshold of 0.04 and maximum area change of 30% independently for the ascending and descending aorta. These findings provide insight into the geometric structure of the aortic valve and aortic arch in patients presenting with BAV and AS where 3D characterization allows for quantitative classification of these complex anatomic structures.
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Affiliation(s)
- Breandan B Yeats
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Dahlia Galvez
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sri Krishna Sivakumar
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Kimberly Holst
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Marcus Valve Center, Atlanta, GA, USA
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Venkateshwar Polsani
- Department of Cardiology, Piedmont Heart Institute, Marcus Valve Center, Atlanta, GA, USA
| | - Pradeep K Yadav
- Department of Cardiology, Piedmont Heart Institute, Marcus Valve Center, Atlanta, GA, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Marcus Valve Center, Atlanta, GA, USA
| | - Ajit Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Lakshmi P Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
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Zhao TY, Xu GQ, Xue JY, Cai DY, Yang BW, Ba YY, Feng CY, Li TX, Gao BL, Chen ZC. Effects of percutaneous endovascular angioplasty for severe stenosis or occlusion of subclavian artery. Sci Rep 2024; 14:14290. [PMID: 38906992 PMCID: PMC11192942 DOI: 10.1038/s41598-024-65302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/19/2024] [Indexed: 06/23/2024] Open
Abstract
To investigate the effect and safety of percutaneous endovascular angioplasty (PEA) with optional stenting for the treatment of severe stenosis or occlusion of subclavian artery, patients with severe stenosis ≥ 70% or occlusion of subclavian artery treated with PEA were retrospectively enrolled. The clinical data were analyzed. A total of 222 patients were retrospectively enrolled, including 151 males (68.0%) and 71 females (32.0%) aged 48-86 (mean 63.9 ± 9.0) years. Forty-seven (21.2%) patients had comorbidities. Subclavian artery stenosis ≥ 70% was present in 201 (90.5%) patients and complete subclavian occlusion in 21 (9.5%) cases. Angioplasty was successfully performed in all (100%) patients. Balloon-expandable stents were used in 190 (85.6%) cases, and self-expandable stents in 20 (9.0%) cases. Only 12 (5.4%) cases were treated with balloon dilation only. Among 210 patients treated with stent angioplasty, 71 (33.8% or 71/210) cases underwent balloon pre-dilation, 139 (66.2% or 139/210) had direct deployment of balloon-expandable stents, and 2 (1.0% or 2/210) experienced balloon post-dilation. Distal embolization protection devices were used in 5 (2.3% or 5/222) cases. Periprocedural complications occurred in 3 (1.4%) patients, including aortic dissection in 2 (0.9%) cases and right middle cerebral artery embolism in 1 (0.5%). No hemorrhage occurred. Among 182 (82.0%) patients with 6-month follow-up, restenosis > 70% occurred in 1 (0.5%) patient, and among 68 (30.6%) patients with 12-month follow-up, restenosis > 70% took place in 11 (16.2%) patients. Percutaneous endovascular angioplasty can be safely and efficiently performed for the treatment of severe stenosis ≥ 70% or occlusion of subclavian artery.
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Affiliation(s)
- Tong-Yuan Zhao
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Gang-Qin Xu
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Jiang-Yu Xue
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China.
| | - Dong-Yang Cai
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Bo-Wen Yang
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Yue-Yang Ba
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Chen-Yi Feng
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Tian-Xiao Li
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China.
| | - Bu-Lang Gao
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Zhong-Can Chen
- Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
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Langhoff R, Schwindt A, Vajda Z, Gjoreski A, Faurie B, Kedev S, Müller-Hülsbeck S. Navigating complexity with low-crossing profile dual-layer micromesh carotid stent: implications for contemporary carotid artery stenting outcomes (ROADSAVER study insights). THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:205-212. [PMID: 39007554 DOI: 10.23736/s0021-9509.24.13068-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
BACKGROUND The safety and efficacy of carotid artery stenting (CAS) can be affected by certain technical and anatomical factors. However, it is not known whether the use of a dual-layer micromesh stent (DLMS) with a low-crossing profile could reduce the risks associated with complex vascular anatomies during CAS. METHODS This study involved 1965 asymptomatic or symptomatic carotid artery stenosis patients who received the Roadsaver DLMS during CAS, as part of a prospective, multicenter observational ROADSAVER study, conducted from January 2018 to February 2021. The primary outcome was the 30-day rate of major adverse events (MAE; i.e. any death or stroke) after CAS. Procedural details and outcomes were compared between patients with complex anatomical features and those without. RESULTS One or more complex anatomical characteristics were identified in 1639 (83.4%) patents. Patients with complex anatomies were older and had a higher prevalence of arterial hypertension, cardiovascular disease, and prior stroke. Between patients with or without complex anatomical features, no significant differences were found either in procedural techniques, or in 30-day MAE (age-adjusted odds ratio (95% CI) for complexities vs. no complexities: 0.76 (0.35, 1.66); p=0.4905) and any stroke (age-adjusted odds ratio (95% CI) for complexities vs. no complexities: 0.89 (0.37, 2.17); p=0.8032) incidence. Furthermore, neither the presence of specific types of anatomic complexity nor their number (per patient) markedly influenced the 30-day MAE and any stroke incidence. CONCLUSIONS In this real-world cohort of patients undergoing CAS with the Roadsaver DLMS, no significant difference in the occurrence of 30-day MAE and any stroke was observed between patients with or without high-risk anatomical features.
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Affiliation(s)
- Ralf Langhoff
- Department of Angiology, Brandenburg Medical School Theodor Fontane, Campus Clinic Brandenburg, Brandenburg an der Havel and Sankt Gertrauden Hospital, Berlin, Germany -
| | - Arne Schwindt
- Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany
| | - Zsolt Vajda
- Neurovascular Unit, Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
- Department of Radiology, Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| | - Aleksander Gjoreski
- Department for Diagnostic and Interventional Radiology, Clinical Hospital "Acibadem Sistina", Skopje, Republic of North Macedonia
| | | | - Sasko Kedev
- Department of Cardiology, Faculty of Medicine, University Clinic of Cardiology, University of St. Cyril and Methodius, Skopje, Republic of North Macedonia
| | - Stefan Müller-Hülsbeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, DIAKO Hospital gGmbH, Flensburg, Germany
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Perng PS, Chang Y, Wang HK, Huang YT, Wong CE, Chi KY, Lee JS, Wang LC, Huang CY. Systematic Review and Meta-analysis of Radial or Femoral Access for Carotid Stenting. Clin Neuroradiol 2024; 34:3-12. [PMID: 37401948 DOI: 10.1007/s00062-023-01315-w] [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: 02/25/2023] [Accepted: 05/23/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE There is a growing interest in performing coronary artery and neurovascular interventions via the radial artery; however, few studies have examined the outcomes of transradial carotid stenting. Therefore, our study aimed to compare cerebrovascular outcomes and crossover rates in carotid stenting between transradial and traditional transfemoral approaches. METHODS A systematic review was performed by searching three electronic databases from inception to June 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In addition, random effect meta-analysis was used to pool the odds ratios (ORs) for stroke, transient ischemic attack, major adverse cardiac events, death, major vascular access site complications, and procedure crossover rates between the transradial and transfemoral approaches. RESULTS A total of 6 studies were included involving a total of n = 567 transradial and n = 6176 transfemoral procedures. The ORs for stroke, transient ischemic attack, and major adverse cardiac events were 1.43 (95% confidence interval, CI 0.72-2.86, I2 = 0), 0.51 (95% CI 0.17-1.54, I2 = 0), and 1.08 (95% CI 0.62-1.86, I2 = 0), respectively. Neither the major vascular access site complication rate (OR 1.11, 95% CI 0.32-3.87, I2 = 0) nor crossover rate (OR 3.94, 95% CI 0.62-25.11, I2 = 57%) showed statistically significant differences between the two approaches. CONCLUSION The modest quality of the data suggested comparable procedural outcomes between the transradial and transfemoral approaches when performing carotid stenting; however, high level evidence regarding postoperative brain images and risk of stroke in transradial carotid stenting are lacking. Therefore, it is reasonable for interventionists to weigh up the risks of neurological events and potential benefits, including fewer access site complications, before choosing the radial or femoral arteries as access sites. Future large-scale randomized controlled trials are imperative.
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Affiliation(s)
- Pang-Shuo Perng
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan
| | - Yu Chang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan
| | - Hao-Kuang Wang
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-En Wong
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan
| | - Kuan-Yu Chi
- Department of internal medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jung-Shun Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Chao Wang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan
| | - Chih-Yuan Huang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan.
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Batista S, Oliveira LDB, Sousa MP, Pinheiro AC, Borges J, Santana L, Bertani R, Andreão FF, Simões A, Almeida Filho JA. Transradial artery access for carotid artery stenting: A pooled analysis. Neuroradiol J 2024:19714009231224410. [PMID: 38171509 DOI: 10.1177/19714009231224410] [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: 01/05/2024] Open
Abstract
INTRODUCTION Carotid artery stenting (CAS) through transradial access (TRA) is emerging as an alternative to carotid endarterectomy. However, the current evidence base is limited, mainly comprising single-center studies. OBJECTIVE This systematic review and meta-analysis aim to assess the safety and effectiveness of TRA for CAS, providing evidence to support clinical decisions. METHODS We conducted searches on PUBMED, Cochrane Library, Embase, and Web of Science databases, including studies on TRA for CAS. Studies with fewer than 20 patients, non-primary outcomes, and non-full-text articles were excluded. RESULTS We analyzed 14 studies involving 1,166 patients who underwent CAS via TRA. Procedural success rate was high in 13 studies, with a 95% rate (95% CI; 92%-98%). Crossover to TFA access was observed in 12 studies at 6% (95% CI: 3%-9%). Transradial access failure was reported in four studies, with a rate of 0% (95% CI: 0%-0%). Cannulation failure resulted in a rate of 4% (95% CI: 2%-7%). Asymptomatic radial artery occlusion (ARAO) occurred at a rate of 2% based on eight studies (95% CI: 0%-5%). Forearm hematoma was reported in 10 studies, with an occurrence of 1% (95% CI: 0%-2%). Cerebral vascular attacks (CAV) within 30 days were assessed in 13 studies, indicating a 2% occurrence (95% CI: 1%-2%). CONCLUSION The findings suggest that TRA for CAS yields promising outcomes with high success rates and low complication rates. Further research should focus on randomized controlled trials and long-term outcomes to validate and extend findings.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcelo Porto Sousa
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agostinho C Pinheiro
- Department of Neurology, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Laís Santana
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, Brazil
| | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adria Simões
- Department of Neurosurgery, Hospital Geral de Palmas, Tocantins, Brazil
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Lahlouh M, Chenoune Y, Blanc R, Piotin M, Escalard S, Fahed R, Szewczyk J, Passat N. Automated Aortic Anatomy Analysis: from Image to Clinical Indicators. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38082844 DOI: 10.1109/embc40787.2023.10340921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Most cerebrovascular diseases (including strokes and aneurysms) are treated endovascularly with catheters that are navigated from the groin through the vessels to the brain. Many patients have complex anatomy of the aortic arch and supra-aortic vessels, which can make it difficult to select the best catheters for navigation, resulting in longer procedures and more complications or failures. To this end, we propose a framework dedicated to the analysis of the aortic arch and supra-aortic trunks. This framework can automatically compute anatomical and geometrical features from meshes segmented beforehand via CNN-based pipeline. These features such as arch type, tortuosity and angulations describe the navigational difficulties encountered during catheterization. Quantitative and qualitative validation was performed by experienced neuroradiologists, leading to reliable vessel characterization.Clinical relevance- This method allows clinicians to determine the type and the anatomy of the aortic arch and its supra-aortic trunks before endovascular procedures. This is essential in interventional neuroradiology, such as navigation with catheters in this complex area.
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Patient-Specific 3D-Print Extracranial Vascular Simulators and Infrared Imaging Platform for Diagnostic Cerebral Angiography Training. Healthcare (Basel) 2022; 10:healthcare10112277. [DOI: 10.3390/healthcare10112277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Tortuous aortic arch is always challenging for beginner neuro-interventionalists. Herein, we share our experience of using 3D-printed extracranial vascular simulators (VSs) and the infrared imaging platform (IRIP) in two training courses for diagnostic cerebral angiography in the past 4 years. A total of four full-scale patient-specific carotid-aortic-iliac models were fabricated, including one type I arch, one bovine variant, and two type III arches. With an angiography machine (AM) as the imaging platform for the practice and final test, the first course was held in March 2018 had 10 participants, including three first-year residents (R1), three second-year residents (R2), and four third-year residents (R3). With introduction of the IRIP as the imaging platform for practice, the second course in March 2022 had nine participants, including 3 R1s, 3 R2s, and 3 R3s. The total manipulation time (TMT) to complete type III aortic arch navigation was recorded. In the first course, the average TMT of the first trial was 13.1 min. Among 3 R1s and 3 R2s attending the second trial, the average TMT of the second trial was 3.4 min less than that of the first trial. In the second course using IRIP, the average TMT of the first and second trials was 6.7 min and 4.8 min, respectively. The TMT of the second trial (range 2.2~14.4 min; median 5.9 min) was significantly shorter than that of the first trial (range 3.6~18 min; median 8.7 min), regardless of whether AM or IRIP was used (p = 0.001). Compared with first trial, the TMT of the second trial was reduced by an average of 3.7 min for 6 R1s, which was significantly greater than the 1.7 min of R2 and R3 (p = 0.049). Patient-specific VSs with radiation-free IRIP could be a useful training platform for junior residents with little experience in neuroangiography.
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Mazurek A, Malinowski K, Rosenfield K, Capoccia L, Speziale F, de Donato G, Setacci C, Wissgott C, Sirignano P, Tekieli L, Karpenko A, Kuczmik W, Stabile E, Metzger DC, Amor M, Siddiqui AH, Micari A, Pieniążek P, Cremonesi A, Schofer J, Schmidt A, Musialek P. Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:4819. [PMID: 36013058 PMCID: PMC9409706 DOI: 10.3390/jcm11164819] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/20/2022] [Accepted: 07/29/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Single-cohort studies suggest that second-generation stents (SGS; “mesh stents”) may improve carotid artery stenting (CAS) outcomes by limiting peri- and postprocedural cerebral embolism. SGS differ in the stent frame construction, mesh material, and design, as well as in mesh-to-frame position (inside/outside). Objectives: To compare clinical outcomes of SGS in relation to first-generation stents (FGSs; single-layer) in CAS. Methods: We performed a systematic review and meta-analysis of clinical studies with FGSs and SGS (PRISMA methodology, 3302 records). Endpoints were 30-day death, stroke, myocardial infarction (DSM), and 12-month ipsilateral stroke (IS) and restenosis (ISR). A random-effect model was applied. Results: Data of 68,422 patients from 112 eligible studies (68.2% men, 44.9% symptomatic) were meta-analyzed. Thirty-day DSM was 1.30% vs. 4.11% (p < 0.01, data for SGS vs. FGS). Among SGS, both Casper/Roadsaver and CGuard reduced 30-day DSM (by 2.78 and 3.03 absolute percent, p = 0.02 and p < 0.001), whereas the Gore stent was neutral. SGSs significantly improved outcomes compared with closed-cell FGS (30-day stroke 0.6% vs. 2.32%, p = 0.014; DSM 1.3% vs. 3.15%, p < 0.01). At 12 months, in relation to FGS, Casper/Roadsaver reduced IS (−3.25%, p < 0.05) but increased ISR (+3.19%, p = 0.04), CGuard showed a reduction in both IS and ISR (−3.13%, −3.63%; p = 0.01, p < 0.01), whereas the Gore stent was neutral. Conclusions: Pooled SGS use was associated with improved short- and long-term clinical results of CAS. Individual SGS types, however, differed significantly in their outcomes, indicating a lack of a “mesh stent” class effect. Findings from this meta-analysis may provide clinically relevant information in anticipation of large-scale randomized trials.
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Affiliation(s)
- Adam Mazurek
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University, 31-202 Krakow, Poland
| | - Krzysztof Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Kenneth Rosenfield
- Vascular Surgery, Surgery Department, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Carlo Setacci
- Department of Vascular Surgery, University of Siena, 53100 Siena, Italy
| | - Christian Wissgott
- Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Imland Klinik Rendsburg, 24768 Rendsburg, Germany
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy
| | - Lukasz Tekieli
- Department of Interventional Cardiology, John Paul II Hospital, Jagiellonian University, 31-202 Krakow, Poland
| | - Andrey Karpenko
- Centre of Vascular and Hybrid Surgery, E.N. Meshalkin National Medical Research Center, 630055 Novosibirsk, Russia
| | - Waclaw Kuczmik
- Department of General, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, 40-055 Katowice, Poland
| | | | | | - Max Amor
- Department of Interventional Cardiology, U.C.C.I. Polyclinique d’Essey, 54270 Nancy, France
| | - Adnan H. Siddiqui
- Department of Neurosurgery, SUNY University at Buffalo, Buffalo, NY 14203, USA
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Piotr Pieniążek
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University, 31-202 Krakow, Poland
- Department of Interventional Cardiology, John Paul II Hospital, Jagiellonian University, 31-202 Krakow, Poland
| | - Alberto Cremonesi
- Cardiovascular Department, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy
| | - Joachim Schofer
- MVZ-Department Structural Heart Disease, Asklepios Clinic St. Georg, 20099 Hamburg, Germany
| | - Andrej Schmidt
- Department of Angiology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Piotr Musialek
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University, 31-202 Krakow, Poland
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Comparison of transcarotid artery revascularization and transfemoral carotid artery stenting based on high risk anatomic characteristics. Ann Vasc Surg 2022; 87:21-30. [DOI: 10.1016/j.avsg.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/22/2022]
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10
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Koide T, Ito Y, Hino T, Sato M, Marushima A, Hayakawa M, Matsumaru Y, Ishikawa E. Carotid Artery Stenting Using the Snake Hunt Technique for Highly Tortuous Carotid Artery Stenosis: A Technical Note. NMC Case Rep J 2022; 8:387-391. [PMID: 35079493 PMCID: PMC8769477 DOI: 10.2176/nmccrj.tn.2020-0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/17/2020] [Indexed: 11/20/2022] Open
Abstract
In carotid artery stenting (CAS) for highly tortuous carotid stenosis, it is often difficult to guide rigid devices such as carotid stents. There are various adjunctive techniques using a guidewire: the buddy wire technique, the sheep technique, and the stiff guide technique. We report a case in which the tortuous vessel was straightened and a stent could be inserted. A 64-year-old man with amaurosis had highly tortuous left carotid stenosis. Despite the best medical treatments, he often had transient cerebral ischemic symptoms, so we planned CAS. We could insert the first stent, but the proximal vessel was kinked by the placement of the stent. It was so tortuous that the second stent could not be inserted by adjunctive techniques. Therefore, the proximal balloon was inflated and pulled back to straighten the tortuous vessel, and then we could insert the stent. We named this technique the "snake hunt technique" because it was just like catching a snake given that the tortuous vessel was stretched. This technique could be a troubleshooting step when it is difficult to insert a stiff device such as a stent or balloon even with the use of various adjunctive techniques.
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Affiliation(s)
- Tomoki Koide
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tenyu Hino
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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11
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Zhang J, Basu R, Gaffey A, Glaser J, Kalapatapu V. Retrograde Superior Mesenteric Artery Stenting in Case of SMA Shuttering. Vasc Endovascular Surg 2021; 56:408-411. [PMID: 34965787 DOI: 10.1177/15385744211072948] [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: 11/17/2022]
Abstract
This case describes a patient who underwent endovascular repair for an extent V thoracoabdominal aneurysm with planned coverage of the celiac artery. Following deployment of the stent graft, the superior mesenteric artery was shuttered, and the patient subsequently developed signs and symptoms of bowel ischemia. The patient underwent successful retrograde open superior mesenteric artery stenting with resolution of her symptoms. Although retrograde open mesenteric artery stenting (ROMS) has been primarily shown to be effective in acute mesenteric ischemia, this case demonstrates that ROMS can be used as a salvage option for shuttering during endovascular procedures.
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Affiliation(s)
- Jason Zhang
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rohan Basu
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ann Gaffey
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Julia Glaser
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Venkat Kalapatapu
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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12
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Scullen T, Mathkour M, Carr C, Wang A, Amenta PS, Nerva JD, Dumont AS. Anatomical Considerations for Endovascular Intervention for Extracranial Carotid Disease: A Review of the Literature and Recommended Guidelines. J Clin Med 2020; 9:E3460. [PMID: 33121192 PMCID: PMC7693974 DOI: 10.3390/jcm9113460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/15/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022] Open
Abstract
Patient selection for endovascular intervention in extracranial carotid disease is centered on vascular anatomy. We review anatomical considerations for non-traumatic disease and offer guidelines in patient selection and management. We conducted a systematic literature review without meta-analysis for studies involving anatomical considerations in extracranial carotid intervention for non-traumatic disease. Anatomical considerations discussed included aortic arch variants, degree of vessel stenosis, angulation, tortuosity, and anomalous origins, and atheromatous plaque morphology, composition, and location. Available literature suggests that anatomical risks of morbidity are largely secondary to increased procedural times and difficulties in intervention system delivery. We recommend the prioritization of endovascular techniques on an individual basis in cases where accessible systems and surgeon familiarity provide an acceptable likelihood of rapid access and device deployment.
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Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Christopher Carr
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Arthur Wang
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Peter S. Amenta
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - John D. Nerva
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Aaron S. Dumont
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
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13
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Casana R, Bissacco D, Malloggi C, Tolva VS, Odero A, Domanin M, Trimarchi S, Silani V, Parati G. Aortic arch types and postoperative outcomes after carotid artery stenting in asymptomatic and symptomatic patients. INT ANGIOL 2020; 39:485-491. [PMID: 33086779 DOI: 10.23736/s0392-9590.20.04494-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate the influence of the aortic arch type on technical and clinical success of carotid artery stenting (CAS) procedure. METHODS Clinical and anatomical data of consecutive patients who underwent CAS from 2010 to 2018 were prospectively collected and retrospectively analyzed. Primary outcome was technical success, define as successful stent delivery and deployment and <30% residual carotid stenosis. Secondary outcomes were death, stroke, myocardial infarction (MI) and transient ischemic attack (TIA) rates at 30 days after CAS. Subgroups analysis with asymptomatic and symptomatic patients were also performed. RESULTS During the study period, 523 patients were enrolled and analyzed. Among these, 176 (33.6%) had Type I, 227 (43.4%) had Type II and 120 (23.0%) had Type III or bovine aortic arch (BAA) type. Technical success rate was achieved in 96.0% of cases. At 30 days, if compared with Type I or II, patient with Type III or BAA experienced a higher death rate (0 vs. 0 vs. 1.8%, respectively; P=0.056) and combined postoperative stroke/TIA rate (3% vs. 2.8% vs. 9.9%, respectively; P=0.012). No differences for same outcomes between asymptomatic and symptomatic patients were described, although the latter group experienced more postoperative MI. A multivariate analysis revealed Type III or BAA as an independent risk factor for postoperative stroke/TIA (HR 3.23, IC95% 1.40-7.45; P=0.006). CONCLUSIONS In this cohort of patients, death and postoperative neurological complications rates were associated with Type III or BAA, irrespective of symptomatic patients' status. Extremely attention is required during perioperative period in patients who were candidate to CAS and with challenging aortic arch anatomy.
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Affiliation(s)
- Renato Casana
- Istituto Auxologico Italiano IRCCS, Department of Surgery, Milan, Italy - .,Istituto Auxologico Italiano IRCCS, Laboratory of Research in Vascular Surgery, Milan, Italy -
| | - Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Malloggi
- Istituto Auxologico Italiano IRCCS, Laboratory of Research in Vascular Surgery, Milan, Italy
| | - Valerio S Tolva
- Department of Vascular and Endovascular Surgery, Policlinico di Monza, Monza, Italy
| | - Andrea Odero
- Istituto Auxologico Italiano IRCCS, Department of Surgery, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, IRCCS Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, IRCCS Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Istituto Auxologico Italiano IRCCS, Department of Neurology-Stroke and Neuroscience, Ospedale San Luca, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Milan, Italy.,Department of Medicine and Surgery, Università di Milano-Bicocca, Monza, Italy
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14
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Kaneko U, Hachinohe D, Kobayashi K, Shitan H, Mitsube K, Furugen A, Kawamura T, Koshima R, Fujita T. Evolut Self-Expanding Transcatheter Aortic Valve Replacement in Patients with Extremely Horizontal Aorta (Aortic Root Angle ≥ 70°). Int Heart J 2020; 61:1059-1069. [PMID: 32921666 DOI: 10.1536/ihj.20-120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Because of its rigidity and non-steerability, the presence of a horizontal aortic root poses a major anatomical issue during transcatheter aortic valve replacement (TAVR) with Evolut self-expanding valve. Previous studies have elucidated the difficulties of coaxial implantation of the self-expanding valve in patients with horizontal aorta, often resulting in increased complications and a lower device success rate. To date, most patients with extremely horizontal aorta (aortic root angle ≥ 70°) have been excluded from major TAVR clinical trials. Therefore, available data on TAVR with Evolut in this challenging anatomy are limited, and standardized treatment strategies and clinical results remain unknown. Herein, we report a clinical case series of TAVR with Evolut in extremely horizontal aorta. Among seven patients (aged 80-92 years; STS score, 12.6% ± 7.9%) who underwent TAVR with Evolut system, aortic root angle ranged from 71° to 83° (mean, 75.1°± 4.5°). All patients achieved device success with dedicated strategies and were clinically stable at 3-month follow-up. None of the patients had more than mild paravalvular leakage (PVL) at any point during follow-up.Complications in three patients included complete atrioventricular block requiring a permanent pacemaker implantation, cerebral infarction because of atrial fibrillation 3 days after TAVR, and cardiac tamponade requiring pericardiocentesis. In this case series, Evolut self-expanding TAVR in extremely horizontal aorta was effective and feasible with a high device success rate. Based on anatomical features, some dedicated strategies majorly contribute to the success of this procedure. Large-scale multicenter studies are required to confirm our findings.
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Affiliation(s)
- Umihiko Kaneko
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Daisuke Hachinohe
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Ken Kobayashi
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Hidemasa Shitan
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Keijiro Mitsube
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Azusa Furugen
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Takeshi Kawamura
- Department of Anesthesiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Ryuji Koshima
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
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15
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Conway AM, Nguyen Tran NT, Qato K, Ehidom C, Stoffels GJ, Giangola G, Carroccio A. Complexity of Aortic Arch Anatomy Affects the Outcomes of Transcarotid Artery Revascularization Versus Transfemoral Carotid Artery Stenting. Ann Vasc Surg 2020; 67:78-89. [PMID: 32339690 DOI: 10.1016/j.avsg.2020.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transcarotid artery revascularization (TCAR) has been shown to have half the rates of transient ischemic attack (TIA), stroke, and death compared with transfemoral carotid artery stenting (TFCAS). Successful outcomes of TFCAS require careful patient selection. The aim of this study was to determine the outcomes of TFCAS versus TCAR in both simple (type I) and complex (type II and III) aortic arches. METHODS A retrospective cohort study was performed comparing the outcomes of patients undergoing TFCAS versus TCAR with simple and complex aortic arches using the Vascular Quality Initiative registry from August 2011 to May 2019. The primary outcome was a composite of in-hospital TIA/stroke/death. RESULTS About 6,108 carotid artery interventions were analyzed, including 3,536 (57.9%) patients with type I, 2,013 (33.0%) with type II, and 559 (9.2%) with type III aortic arch. In 3,535 patients with a simple arch, 1,917 underwent TFCAS and 1,619 had TCAR. Mean age was 70.6 (±9.5) years, and 2,382 (67.4%) patients were males. The primary outcome of postoperative TIA/stroke/death was seen significantly less frequently in those undergoing TCAR compared with TFCAS in simple arches (odds ratio [OR], 0.63; 95% confidence interval [95% CI], 0.43-0.94; P = 0.0236). Although the individual outcome of death occurred less often in TCAR (P = 0.0025), there was no difference in the occurrence of in-hospital stroke (P = 0.8836) or TIA (P = 0.4608). On multivariable analysis, TCAR was associated with improved outcomes (P = 0.0062). A worse outcome was associated with increasing age (P < 0.001), a prior stroke (P < 0.0001), and increasing number of stents (P = 0.0483). In 2,572 patients with a complex arch, 1,416 underwent TFCAS and 1,156 had TCAR. Mean age was 73.0 (±9.1) years, and 1,655 (64.4%) were males. In complex arch anatomy, the primary outcome of in-hospital TIA/stroke/death was seen significantly less frequently in TCAR compared with TFCAS (OR, 0.49; 95% CI, 0.31-0.77; P = 0.0022). Again noted was a significant difference in death, with better outcomes in TCAR (P = 0.0133). Although the occurrence of in-hospital TIA was no different between the 2 approaches (P = 0.6158), there were significantly fewer strokes in those treated with TCAR (P = 0.0132). TCAR (P = 0.0146) was associated with improved outcomes. A worse outcome was seen with advancing age (P = 0.0003), prior strokes (P = 0.01), and a left-sided lesion (P = 0.0176). CONCLUSIONS TCAR has improved outcomes of TIA/stroke/death compared with TFCAS in both simple and complex aortic arch anatomy. In simple aortic arches, there is no difference in neurologic outcomes between both approaches. In complex arch anatomy, TCAR has fewer strokes.
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Affiliation(s)
- Allan M Conway
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY.
| | - Nhan T Nguyen Tran
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Khalil Qato
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Clinton Ehidom
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | | | - Gary Giangola
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Alfio Carroccio
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
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16
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Ge B, Wei Y. Comparison of Transfemoral Cerebral Angiography and Transradial Cerebral Angiography Following a Shift in Practice During Four Years at a Single Center in China. Med Sci Monit 2020; 26:e921631. [PMID: 32210222 PMCID: PMC7115118 DOI: 10.12659/msm.921631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Cerebral angiography, or intra-arterial digital subtraction angiography (DSA), is a fluoroscopic imaging technique. In China, until recently, transfemoral access (TFA) has been used, rather than transradial access (TRA). This retrospective study aimed to compare transfemoral cerebral angiography (TFCA) with transradial cerebral angiography (TRCA) consecutively performed by the same operator, at a single center in China, to determine whether there were benefits from the shift from TFA to TRA in terms of efficiency, safety, and feasibility. Material/Methods A review of 1,048 cerebral angiograms in 980 patients was performed by a single operator from June 2014 to May 2018, including the TFA group (n=513) and the transradial access (TRA) group (n=535), and 39 patients underwent both TFA and TRA. The total procedure time, duration of fluoroscopy, catheterization success rate, image quality, length of stay in hospital, complications of the procedure, and patient preference were compared between the groups. Results Compared with TFCA, TRCA resulted in significantly shorter total procedure time, a higher catheterization success rate, better image quality, and shorter duration of hospital stay (P<0.05). There was no significant difference between the TFA and TRA groups for cardiovascular, cerebral, and access site complications. Patients in the TRA group showed a significantly reduced fluoroscopy time at the early stages of operator training (P<0.05). Patient preference included TRA (76.74%), TFA (16.28%), and no preference (6.89%). Conclusions During four years at a single center, and with a single operator, TRCA was safe, feasible, and more rapid when compared with TFCA.
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Affiliation(s)
- Beihai Ge
- Department of Neurology, Guangxi Zhuang Autonomous Region Brain Hospital, Liuzhou, Guangxi, China (mainland)
| | - Yuhua Wei
- Department of Internal Medicine, Guangxi Zhuang Autonomous Region Brain Hospital, Liuzhou, Guangxi, China (mainland)
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17
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Jaroenngarmsamer T, Bhatia KD, Kortman H, Orru E, Krings T. Procedural success with radial access for carotid artery stenting: systematic review and meta-analysis. J Neurointerv Surg 2019; 12:87-93. [PMID: 31201288 DOI: 10.1136/neurintsurg-2019-014994] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/15/2019] [Accepted: 05/19/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Femoral access is the traditional approach for endovascular carotid artery stenting. Radial access is increasingly used as an alternative approach due to its known anatomical advantages in patients with unfavorable aortic arch morphology via the femoral approach and its excellent access site safety profile. Our objective was to analyze procedural success using radial access for carotid artery stenting as reported in the literature. METHODS Three online databases were systematically searched following PRISMA guidelines for studies (n ≥20) using radial artery access for carotid artery stenting (1999-2018). Random-effects meta-analysis was used to pool the procedural success (successful stent placement with no requirement for crossover to femoral access), mortality, and complication rates associated with radial access. RESULTS Seven eligible studies reported procedural success outcomes with a pooled meta-analysis rate of 90.8% (657/723; 95% CI 86.7% to 94.2%; I2=53.1%). Asymptomatic radial artery occlusion occurred in 5.9% (95% CI 4.1% to 8.0%; I2=0%) and forearm hematoma in 1.4% (95% CI 0.4% to 2.9%; I2=0%). Risk of minor stroke/transient ischemic attack was 1.9% (95% CI 0.6% to 3.8%; I2=42.3%) and major stroke was 1.0% (95% CI 0.4% to 1.8%; I2=0%). There were three deaths across the seven studies (0.6%; 95% CI 0.2% to 1.3%; I2=0%). The meta-analysis was limited by statistically significant heterogeneity for the primary outcome of procedural success. CONCLUSION Radial access for carotid artery stenting has a high procedural success rate with low rates of mortality, access site complications, and cerebrovascular complications. The potential benefits of this approach in patients with unfavorable aortic arch access should be explored in a prospective randomized trial.
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Affiliation(s)
| | - Kartik Dev Bhatia
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Hans Kortman
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Emanuele Orru
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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