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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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Gostev AA, Osipova OO, Cheban AV, Saaya SB, Rubtsun AA, Ignatenko PV, Karpenko AA, Gouëffic Y. Treatment of Long Femoropopliteal Occlusive Lesions With Self-expanding Interwoven Nitinol Stent: 24 Month Outcomes of the STELLA-SUPERA-SIBERIA Register Trial. J Endovasc Ther 2023:15266028231170125. [PMID: 37128865 DOI: 10.1177/15266028231170125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The efficacy and safety of the Supera stent in superficial femoral artery (SFA) have been reported mostly in shorter lesions with relatively low proportion of occlusions. There are little data on the effectiveness of the Supera stent in long lesions. The aim of this study was to assess the clinical safety and efficiency of the Supera stent in the treatment of long femoropopliteal occlusive lesions (Trans-Atlantic Inter-Society Consensus [TASC] C/D) in patients with symptomatic peripheral artery disease. MATERIALS AND METHODS The STELLA-SUPERA-SIBERIA is a prospective, single-center, single-arm study. Patients with symptomatic (Rutherford stages 3-6) de novo and TASC C/D occlusive lesions of the femoropopliteal segment were treated with Supera stent. The primary endpoint was the 12 month rate of primary sustained clinical improvement (upward shift on the Rutherford classification to a one level without the need for repeated target lesion revascularization (TLR) in surviving patients without the need for unplanned amputation). Secondary endpoints were the 24 month of primary sustained clinical improvement, MALE, limb salvage, the primary patency, the secondary patency, 24 month MACE. Follow-up included clinical examination, duplex scan, and biplane x-ray up to 24 months. RESULTS Between April 2019 and January 2020, 52 symptomatic patients with 55 long femoropopliteal occlusive lesions (52.7% TASC D lesions and 47.3% TASC C lesions) were treated. The mean target lesion length was 205±72 mm. All patients had total occlusions. The mean lesion length of the implanted Supera stents was 198±82 mm. At 12 and 24 months, the primary sustained clinical improvement rate was 80.2% and 63.6%, respectively. The Rutherford category assessment was significantly improved at 24 months compared with baseline (p=0.02). The primary patency rate at 12 and 24 months was 78.1% and 60.0%, respectively. At 12 and 24 months, freedom from TLR was 83.5% and 81.8%, respectively. There were no stent fractures at 24 months. CONCLUSION Supera Stent implantation for TASC C/D femoropopliteal lesions revascularization appears to be a safe and efficient implant given the complexity of the treated lesions. Head-to-head studies are mandatory to establish Supera Stent as an alternative tool to open surgery for long femoropopliteal lesions. CLINICAL IMPACT Our study indicated, that using self-expanding interwoven nitinol stent for TASC C/D femoropopliteal lesions revascularization appears to be a safe and efficient implant given the complexity of the treated lesions. Although bypass grafting is recommended for prolonged femoropopliteal lesions, open surgery is more traumatic and is associated with greater risks than endovascular procedures. Our findings suggest that the use of interwoven nitinol stents can overcome the disadvantages of traditional stents in such cases, which may help to improve patients' outcomes and reduce the risk of adverse events.
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Affiliation(s)
- Alexander A Gostev
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Olesia O Osipova
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey V Cheban
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Shoraan B Saaya
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Artem A Rubtsun
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Pavel V Ignatenko
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Andrey A Karpenko
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Yann Gouëffic
- Laboratoire de Physiopathologie de la Résorption Osseuse, Inserm-UN UMR-957, Nantes, France
- Service de Chirurgie Vasculaire et Endovasculaire, Groupe Hospitalier Paris Saint Joseph, Paris, France
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Violari E, Payomo A, Schiro BJ, Powell A, Gandhi RT, Pena CS. Endovascular Treatment of Infra-Inguinal Peripheral Arterial Disease (PAD): Update on Stent Technology. Tech Vasc Interv Radiol 2022; 25:100840. [DOI: 10.1016/j.tvir.2022.100840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gostev AA, Osipova OS, Saaya SB, Bugurov SV, Cheban AV, Rabtsun AA, Ignatenko PV, Karpenko AA. Bypass Versus Interwoven Nitinol Stents for Long Femoro-Popliteal Occlusions: A Propensity Matched Analysis. Cardiovasc Intervent Radiol 2022; 45:929-938. [PMID: 35581472 DOI: 10.1007/s00270-022-03134-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/23/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE To compare femoro-popliteal bypass and interwoven nitinol stenting for long occlusions of the femoro-popliteal segment. MATERIALS AND METHODS Single center retrospective propensity matching analysis of the symptomatic patients with long occlusion of the femoro-popliteal segment (> 20 cm), who underwent stenting with interwoven nitinol stent or femoro-popliteal bypass from 2012 to 2020. PRIMARY ENDPOINTS primary patency, primary-assisted patency, secondary patency. Secondary endpoints: major adverse cardiovascular events, major adverse limb events, primary sustained clinical improvement, survival. RESULTS A total of 437 patients were enrolled: 294 in the bypass group and 143 in the endovascular therapy (EVT) group. After propensity score matching, 264 and 113 patients remained in the groups, respectively. A median occlusion length was 250 mm. One-year and two-year primary and secondary patency rates were comparable in both groups (two-year primary patency: 68.5% for bypass vs. 68.9% for EVT, p = 1.00). In the "above the knee" subgroup analysis, two-year secondary patency was higher in the EVT group than in the bypass group (90.9% vs. 77.5%, p = 0.048). In "below-the-knee" subgroup analysis, primary and primary assisted patency were statistically significantly higher in the EVT group than in artificial bypass subgroup (66.7% vs. 42.4%, p = .046 and 76.7% vs. 45.5%, p = .011, respectively). However, compared to autovenous bypass, the EVT group showed lower primary patency rates, although the differences are not significant. CONCLUSION A nonselective endovascular strategy can allow for regular successful treatment of femoro-popliteal lesions longer than 25 cm.
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Affiliation(s)
- Alexander A Gostev
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055.
| | - Olesya S Osipova
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Shoraan B Saaya
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Savr V Bugurov
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Alexey V Cheban
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Artem A Rabtsun
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Pavel V Ignatenko
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
| | - Andrey A Karpenko
- Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15'th st., Novosibirsk, Russia, 630055
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Chernonosova VS, Laktionov PP. Structural Aspects of Electrospun Scaffolds Intended for Prosthetics of Blood Vessels. Polymers (Basel) 2022; 14:polym14091698. [PMID: 35566866 PMCID: PMC9105676 DOI: 10.3390/polym14091698] [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] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/12/2022] [Accepted: 04/17/2022] [Indexed: 12/28/2022] Open
Abstract
Electrospinning is a popular method used to fabricate small-diameter vascular grafts. However, the importance of structural characteristics of the scaffold determining interaction with endothelial cells and their precursors and blood cells is still not exhaustively clear. This review discusses current research on the significance and impact of scaffold architecture (fiber characteristics, porosity, and surface roughness of material) on interactions between cells and blood with the material. In addition, data about the effects of scaffold topography on cellular behaviour (adhesion, proliferation, and migration) are necessary to improve the rational design of electrospun vascular grafts with a long-term perspective.
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Affiliation(s)
- Vera S. Chernonosova
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, 630090 Novosibirsk, Russia;
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 630055 Novosibirsk, Russia
- Correspondence: ; Tel.: +7-(383)-363-51-44
| | - Pavel P. Laktionov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, 630090 Novosibirsk, Russia;
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 630055 Novosibirsk, Russia
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Villar-Matamoros E, Stokes L, Lloret A, Todd M, Tillman BW, Yazdani SK. Understanding the Mechanism of Drug Transfer and Retention of Drug-Coated Balloons. J Cardiovasc Pharmacol Ther 2022; 27:10742484221119559. [PMID: 35972237 PMCID: PMC9549471 DOI: 10.1177/10742484221119559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The purpose of this study was to determine the impact of varying inflation parameters on paclitaxel delivery and retention using a commercially available DCB. Background: Drug-coated balloons (DCB) have become the standard treatment for peripheral artery disease. Clinical data suggest that varying DCB delivery parameters directly impact patient outcome. Differences in delivery parameters can potentially alter the retention of the drug coating on DCBs. Methods: Harvested porcine carotid arteries were utilized in an ex vivo pulsatile flow bioreactor system. The DCBs were then deployed at a DCB-to-artery ratio of 1:1 or 1.25:1, an inflation time of 30 seconds or 1 minute and transit time of 30 seconds or 3 minutes. The amount of drug retention in arterial tissue was evaluated by pharmacokinetic analysis at 1 hour and 1 day post DCB deployment. Results: Arterial paclitaxel levels were found to be less at an inflation ratio of 1:1 with 3-minute transit time as compared to 30 seconds of transit time at 1 hour (12.3 ± 1.6 ng/mg vs. 391 ± 139 ng/mg, P = .036). At 1-day, DCBs deployed at a ratio of 1:1 resulted in less drug retention as compared to 1.25:1 (61.3 ± 23.1 ng/mg vs. 404 ± 195 ng/mg, P = .013). Conclusion: Arterial paclitaxel retention is reduced with extended transit times and sub-optimal expansion of the balloon. Optimization of delivery parameters can serve as an effective strategy to enhance clinical DCB outcomes.
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Affiliation(s)
| | - Lauren Stokes
- Department of Engineering, 8676Wake Forest University, Winston-Salem, NC, USA
| | - Alyssa Lloret
- Department of Engineering, 8676Wake Forest University, Winston-Salem, NC, USA
| | - Meagan Todd
- Department of Engineering, 8676Wake Forest University, Winston-Salem, NC, USA
| | - Bryan W Tillman
- Division of Vascular Surgery, 2647Ohio State University, Columbus, OH, USA
| | - Saami K Yazdani
- Department of Engineering, 8676Wake Forest University, Winston-Salem, NC, USA
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Cioppa A, Franzese M, Gerardi D, Pucciarelli A, Popusoi G, Stabile E, Salemme L, Sada L, Verdoliva S, Burattini O, Fimiani L, Ferrone M, Di Gioia G, Leone A, Esposito G, Tesorio T. Three-year outcome of directional atherectomy and drug coated balloon for the treatment of common femoral artery steno-occlusive lesions. Catheter Cardiovasc Interv 2021; 99:1310-1316. [PMID: 34779119 DOI: 10.1002/ccd.30020] [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: 07/06/2021] [Revised: 10/18/2021] [Accepted: 11/04/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Endarterectomy is considered the gold standard therapy for common femoral artery (CFA) steno-occlusive lesions, but a significant risk of perioperative mortality and complications has been reported. OBJECTIVE Aim of this study is to evaluate the efficacy at a long-term follow-up of patients with CFA steno-occlusive lesions treated with directional atherectomy and drug coated balloon (DCB). MATERIAL AND METHODS In this single-center registry, 78 patients (male: 80.7%; age: 71 ± 15 years; occlusions: 25%) with 80 CFA lesions were included, with 39.7% of them undergoing directional atherectomy and drug coated balloon due to critical limb ischemia and 60.3% due to lower-limb intermittent claudication. The long-term follow-up was completed by 75 patients (3 years). The 31 patients with critical ischemia (39.7%) were further subdivided into 20 (25.6%) patients with pain at rest and 11 (14.1%) with trophic changes, ulcers and/or tissue loss. We considered the primary and the secondary outcome, referring, respectively to peak systolic velocity ratio (PSVR) ≥ 2.4 on duplex or > 50% stenosis on digital subtraction angiography at 36 months and to clinically driven target lesion revascularization at 36 months. RESULTS The primary and secondary outcome was obtained in 84% and 86.7% of patients, at 36 months of follow up. Bailout stenting was necessary in 6/80 cases (7.5%) for suboptimal result. Freedom from MALE was obtained in 98.6% of patients. CONCLUSIONS These results confirm that directional atherectomy and drug coated balloon strategy for the treatment of CFA lesions is effective at a long-term follow-up and could be considered as a good alternative to surgery.
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Affiliation(s)
- Angelo Cioppa
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Michele Franzese
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Donato Gerardi
- Division of Cardiology, AOR "San Carlo", Potenza - "San Giovanni di Dio" Hospital, Melfi, Italy.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Armando Pucciarelli
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Grigore Popusoi
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Luigi Salemme
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Lidia Sada
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | | | - Osvaldo Burattini
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Luigi Fimiani
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Marco Ferrone
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Giuseppe Di Gioia
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Attilio Leone
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Tullio Tesorio
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
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Noble C, Carlson K, Neumann E, Lewis B, Dragomir-Daescu D, Lerman A, Erdemir A, Young M. Finite element analysis in clinical patients with atherosclerosis. J Mech Behav Biomed Mater 2021; 125:104927. [PMID: 34740008 PMCID: PMC8665142 DOI: 10.1016/j.jmbbm.2021.104927] [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: 06/23/2020] [Revised: 12/31/2020] [Accepted: 10/25/2021] [Indexed: 01/03/2023]
Abstract
Endovascular plaque composition is strongly related to stent strut stress and is responsible for strut fatigue, stent failure, and possible in-stent restenosis. To evaluate the effect of plaque on artery wall resistance to expansion we performed in silico analysis of atherosclerotic vessels. We generated finite element models from in vivo intravascular ultrasound virtual histology images to determine local artery surface stiffness and determined which plaque structures have the greatest influence. We validated the predictive capacity of our modeling approach by testing an atherosclerotic peripheral artery ex vivo with pressure-inflation testing at physiological pressures ranging from 10 to 200 mmHg. For this purpose, the in silico deformation of the arterial wall was compared to that observed ex vivo. We found that calcification had a positive effect on surface stiffness with fibrous plaque and necrotic core having negative effects. Additionally, larger plaque structures demonstrated significantly higher average surface stiffness and calcification located nearer the lumen was also shown to increase surface stiffness. Therefore, more developed plaques will have greater resistance to expansion and higher stent strut stress, with calcification located near the lumen further increasing stress in localized areas. Thus, it may be expected that such plaque structures may increase the likelihood of localized stent strut fracture.
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Affiliation(s)
- Christopher Noble
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kent Carlson
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Erica Neumann
- Department of Biomedical Engineering and Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bradley Lewis
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Dan Dragomir-Daescu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ahmet Erdemir
- Department of Biomedical Engineering and Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Nowakowski P, Uchto W, Hrycek E, Kachel M, Ludyga T, Polczyk F, Żurakowski A, Kaźmierczak P, Granada JF, Nowakowska I, Kiesz RS, Milewski KP, Buszman PE, Buszman PP. Microcrystalline paclitaxel-coated balloon for revascularization of femoropopliteal artery disease: Three-year outcomes of the randomized BIOPAC trial. Vasc Med 2021; 26:401-408. [DOI: 10.1177/1358863x20988360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of the BIOPAC trial was to determine long-term safety and efficacy of a novel microcrystalline paclitaxel-coated balloon (mcPCB) with a biocompatible polymer as an excipient in the treatment of occlusive femoropopliteal lesions. In this first-in-human prospective controlled randomized trial, 66 patients with femoropopliteal, symptomatic (Rutherford stages 2B to 5) occlusive arterial disease were randomized to either mcPCB (study group) or POBA (plain old balloon angioplasty) (control group) on a 1:1 basis. Late lumen loss (LLL) at 6 months was the primary endpoint of the study and serious adverse events (SAE: death, amputation, repeated revascularization) were considered a composite secondary endpoint. Routine angiography was scheduled for all study subjects at 6-month follow-up; outpatient appointments were scheduled at 12 and 36 months after intervention. At 6 months, the LLL was 63% lower in the mcPCB group compared to the POBA group (0.52 ± 1.2 vs 1.39 ± 1.1 mm; psup < 0.01). Binary restenosis occurred in 23% vs 52% of patients ( p = 0.02). At 3 years, the prevalence of SAE was significantly lower in the mcPCB group (33.3 vs 63.3%; p = 0.02), which mainly resulted from a twofold reduction in target vessel revascularization rate (28.6 vs 59.3%; p = 0.02). The difference in mortality was nonsignificant (7.4 vs 14.3%; p = 0.42). Patients with mcPCB were less symptomatic and less likely to adhere to secondary prevention measures. In this pivotal trial, a novel mcPCB proved superior to POBA concerning LLL at 6-month follow-up, and SAE at 12 months. This result was sustained up to 3 years. There was no difference between groups regarding mortality. ClinicalTrials.gov Identifier: NCT02145065
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Affiliation(s)
- Przemysław Nowakowski
- Lesser Poland Cardiovascular Center of American Heart of Poland, Chrzanów, Poland
- University of Technology, Katowice, Poland
| | - Wojciech Uchto
- Lesser Poland Cardiovascular Center of American Heart of Poland, Chrzanów, Poland
| | - Eugeniusz Hrycek
- Lesser Poland Cardiovascular Center of American Heart of Poland, Chrzanów, Poland
- Andrzej Frycz-Modrzewski, Kraków University, Kraków, Poland
| | - Mateusz Kachel
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | | | | | - Aleksander Żurakowski
- Lesser Poland Cardiovascular Center of American Heart of Poland, Chrzanów, Poland
- Andrzej Frycz-Modrzewski, Kraków University, Kraków, Poland
| | - Paweł Kaźmierczak
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Juan F Granada
- Skirbal Center for Innovation, Cardiovascular Research Foundation, Orangeburg, NY, USA
| | - Iwona Nowakowska
- Department of Balneoclimatology and Biological Regeneration, Chair of Physiotherapy, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Radosław S Kiesz
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
- San Antonio Heart and Endovascular Institute, San Antonio, TX, USA
| | - Krzysztof P Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Paweł E Buszman
- Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | - Piotr P Buszman
- Andrzej Frycz-Modrzewski, Kraków University, Kraków, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
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The Impact of Aortic Valvular Calcium on Transcatheter Heart Valve Distortion. J Interv Cardiol 2021; 2021:8829906. [PMID: 33500684 PMCID: PMC7803404 DOI: 10.1155/2021/8829906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/10/2020] [Accepted: 12/26/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives To investigate the relationship between the eccentric calcification of aortic valve and transcatheter heart valve (THV) distortion and the impact of THV distortion on echo parameters and clinical outcomes. Background The effects of eccentric calcification of the aortic valve on the THV distortion and the relationship between THV distortion and clinical impact were not fully understood. Methods Patients with symptomatic severe aortic stenosis who were undergoing THV implantation were enrolled. Patients underwent preprocedural, postprocedural multislice computed tomography (MSCT), and follow-up transthoracic echocardiogram (TTE). Delta calcium score (ΔCS) is defined as the difference between the maximum and minimal calcium scores of the three cusps, while valve distortion score (VDS) is defined as the difference between the longest and shortest stent frame, as obtained using MSCT. Patients were divided into two groups according to ΔCS: “noneccentric calcification group” and “eccentric calcification group.” Results A total of 118 patients were enrolled (59 patients in noneccentric and 59 in eccentric calcification groups). VDS was significantly lower in the noneccentric calcification group than in the eccentric calcification group (1.31 ± 0.82 mm vs. 1.73 ± 0.76 mm, p=0.004). VDS was not associated with the degree of paravalvular leak (PVL) and aortic valvular mean pressure gradient (AVPG) at 30-day and 1-year follow-up TTE and the cumulative rates of all-cause death and rehospitalization at 2-year clinical follow-up. Conclusions Eccentric valvular calcification was associated with longitudinal THV distortion. However, THV distortion was not associated with PVL, AVPG, and adverse clinical events during midterm follow-up.
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Cawthon CV, Cooper K, Huett C, Lloret A, Villar-Matamoros E, Stokes L, Christians U, Schuler M, Yazdani SK. Pre-Clinical Investigation of Liquid Paclitaxel for Local Drug Delivery: A Pilot Study. Pharmaceuticals (Basel) 2020; 13:ph13120434. [PMID: 33260517 PMCID: PMC7760562 DOI: 10.3390/ph13120434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 12/03/2022] Open
Abstract
The purpose of this pilot study was to investigate the feasibility of a perfusion catheter to deliver liquid paclitaxel into arterial segments. A clinically relevant rabbit ilio-femoral injury model was utilized to determine the impact of liquid paclitaxel delivered locally into the vessel wall using a perfusion catheter at 1 h to 14 days. Treatment by two clinically available forms of liquid paclitaxel, a solvent-based (sb) versus an albumin-bound (nab), along with a control (uncoated balloons), were investigated. Pharmacokinetic results demonstrated an increase in the retention of the sb-paclitaxel versus the nab-paclitaxel at 1 h; however, no other differences were observed at days one, three, and seven. Histological findings at 14 days showed significantly less neointimal area in the sb-paclitaxel treated arteries as compared with the nab-paclitaxel and the uncoated balloon-treated arteries. Additionally, percent area stenosis was significantly less in the sb-paclitaxel group. These results support the concept of local liquid delivery of paclitaxel into the arterial segments.
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Affiliation(s)
- Claire V Cawthon
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA
| | - Kathryn Cooper
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA
| | - Clifton Huett
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA
| | - Alyssa Lloret
- Department of Engineering, Wake Forest University, Winston-Salem, NC 27101, USA
| | | | - Lauren Stokes
- Department of Engineering, Wake Forest University, Winston-Salem, NC 27101, USA
| | - Uwe Christians
- iC42 Clinical Research and Development, University of Colorado, Aurora, CO 80045, USA
| | - Michele Schuler
- Department of Comparative Medicine, University of South Alabama, Mobile, AL 36688, USA
| | - Saami K Yazdani
- Department of Engineering, Wake Forest University, Winston-Salem, NC 27101, USA
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Daher MDEA, Lopez GE, Duarte PV. Stents in the femoropopliteal territory: prevalence of fractures and their consequences. Rev Col Bras Cir 2020; 47:e20202481. [PMID: 32965301 DOI: 10.1590/0100-6991e-20202481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/16/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Endovascular treatment for femoropopliteal arterial disease has made revascularization procedures less invasive, but the self-expanding stents used can suffer great wear in arteries with extreme mobility. To evaluate the prevalence of fractures in stents implanted in the femoropopliteal segment, to identify predisposing factors and consequences on arterial patency. METHOD between March and June 2019, thirty patients previously operated for femoropopliteal obstruction underwent stent X-rays in anteroposterior and lateral views to detect fractures and Doppler to analyze arterial patency. RESULTS we observed 12 cases with fractures (33.3%): 1 type I (2.8%), 3 type II (8.3%), 5 type III (13.9%), 3 type IV (8.3%) and no type V. According to the TASC II we had 1 in group B (8.3%), 6 in group C (50%) and 5 in group D (41.6%) p <0.004. The number of stents per limb was 3.1 (± 1.3) in cases of fracture versus 2.3 (± 1.3) in cases without fracture (p = 0.08). The extension was 274.17mm (± 100.94) in cases of fracture and 230.83mm (± 135.44) in cases without fracture (p = 0.29). On Doppler we had: 17 patients (47.2%) without stenosis, 9 patients (25%) with stenosis> 50% and 10 patients (27.8%) with occlusion (p = 0.37). There was no correlation between fracture and arterial obstruction (p = 0.33). CONCLUSION stent fractures are a frequent finding in the femoropopliteal area (33.3%), being more prevalent in cases of more advanced disease (C and D). There was no association between the finding of fracture and arterial obstruction.
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Affiliation(s)
- Marcelo DE Azevedo Daher
- - Hospital Universitário Clementino Fraga Filho - UFRJ, Departamento de Cirurgia Vascular Periférica - Rio de Janeiro - RJ - Brasil
| | - Gaudencio Espinosa Lopez
- - Hospital Universitário Clementino Fraga Filho - UFRJ, Departamento de Cirurgia Vascular Periférica - Rio de Janeiro - RJ - Brasil
| | - Pedro Vaz Duarte
- - Hospital Universitário Clementino Fraga Filho - UFRJ, Departamento de Cirurgia Vascular Periférica - Rio de Janeiro - RJ - Brasil
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Vértes M, Nguyen DT, Székely G, Bérczi Á, Dósa E. Middle and Distal Common Carotid Artery Stenting: Long-Term Patency Rates and Risk Factors for In-Stent Restenosis. Cardiovasc Intervent Radiol 2020; 43:1134-1142. [PMID: 32440962 PMCID: PMC7369259 DOI: 10.1007/s00270-020-02522-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/09/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE In the absence of literature data, we aimed to determine the long-term patency rates of middle/distal common carotid artery (CCA) stenting and to investigate predisposing factors in the development of in-stent restenosis (ISR). MATERIALS AND METHODS Fifty-one patients (30 males, median age 63.5 years), who underwent stenting with 51 self-expandable stents for significant (≥ 60%) stenosis of the middle/distal CCA, were analyzed retrospectively. Patient (atherosclerotic risk factors, comorbidities, medications), vessel (elongation), lesion (stenosis grade, length, calcification, location), and stent characteristics (material, diameter, length, fracture) were examined. Duplex ultrasonography was used to monitor stent patency. The Mann-Whitney U and Fisher's exact tests, Kaplan-Meier analyses, and a log-rank test were used statistically. RESULTS The median follow-up time was 35 months (interquartile range, 20-102 months). Significant (≥ 70%) ISR developed in 14 patients (27.5%; stenosis, N = 10; entire CCA occlusion, N = 4). Primary patency rates were 98%, 92%, 83%, 73%, and 61% at 6, 12, 24, 60, and 96 months, respectively. Reintervention was performed in six patients (11.8%) with nonocclusive ISR. Secondary patency rates were 100% at 6 and 12 months and 96% at 24, 60, and 96 months. In-stent restenosis developed more frequently (P < .001) in patients with hyperlipidemia; primary patency rates were also significantly worse (Chi-square, 11.08; degrees of freedom, 1; P < .001) in patients with hyperlipidemia compared to those without. CONCLUSION Stenting of the middle/distal CCA can be performed with acceptable patency rates. If intervention is unequivocally needed, patients with hyperlipidemia will require closer follow-up care. LEVEL OF EVIDENCE Level 3, Local non-random sample.
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Affiliation(s)
- Miklós Vértes
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary
| | - Dat T Nguyen
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary
| | - György Székely
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary
| | - Ákos Bérczi
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary
| | - Edit Dósa
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary.
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Liistro F, Di Mario C. Paclitaxel-coated balloons in peripheral artery disease: how much is enough? Eur Heart J 2020; 41:2553-2555. [PMID: 32357204 DOI: 10.1093/eurheartj/ehaa239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
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15
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Nakabayashi K, Hata S, Kaneko N, Matsui A, Tanaka K, Ando H, Shimizu M. Pseudo-aneurysm caused by stent fracture in the "sub-acute" phase after endovascular therapy for in-stent restenosis lesions. J Cardiol Cases 2020; 22:11-14. [PMID: 32636961 DOI: 10.1016/j.jccase.2020.03.006] [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: 12/22/2019] [Accepted: 03/14/2020] [Indexed: 10/24/2022] Open
Abstract
Despite the reported favorable patency of stents in the treatment of femoropopliteal lesions, concern regarding stent fracture is increasing. Development of pseudo-aneurysm by stent fracture is rare and has been reported to occur in the chronic phase owing to mechanical fatigue. Here, we present the first report of a pseudo-aneurysm caused by stent fracture in the "sub-acute" phase after endovascular therapy for in-stent restenosis lesion. A 79-year-old man underwent endovascular therapy for an in-stent restenosis lesion of the right superficial femoral artery. Echography 48 days after the treatment showed a saccular pseudo-aneurysm at the proximal stent site, suggestive of stent fracture. Angiography confirmed the pseudo-aneurysm caused by stent fracture. A self-expandable endoluminal stent graft was deployed, which showed complete resolution of the pseudo-aneurysm. A pseudo-aneurysm caused by stent fracture can occur in the "sub-acute" phase after endovascular therapy for in-stent restenosis lesions. <Learning objective: Although rare, a pseudo-aneurysm owing to stent fracture can occur in the "sub-acute" phase after endovascular therapy for in-stent restenosis lesions.>.
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Affiliation(s)
| | - Shinya Hata
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
| | - Nobuhito Kaneko
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
| | - Akihiro Matsui
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
| | - Kazuhiko Tanaka
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
| | - Hiroshi Ando
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
| | - Minoru Shimizu
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
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Draxler MS, Al-Adas Z, Abbas D, Kavousi Y, Kabbani LS, Lin JC, Weaver MR, Shepard AD, Nypaver TJ. Outcome benefit of arterial duplex stent imaging after superficial femoral artery stent implantation. J Vasc Surg 2020; 73:179-188. [PMID: 32437951 DOI: 10.1016/j.jvs.2020.02.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/16/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE In-stent stenosis is a frequent complication of superficial femoral artery (SFA) endovascular intervention and can lead to stent occlusion or symptom recurrence. Arterial duplex stent imaging (ADSI) can be used in the surveillance for recurrent stenosis; however, its uniform application is controversial. In this study, we aimed to determine, in patients undergoing SFA stent implantation, whether surveillance with ADSI yielded a better outcome than in those with only ankle-brachial index (ABI) follow-up. METHODS We performed a retrospective analysis of all patients undergoing SFA stent implantation for occlusive disease at a tertiary care referral center between 2009 and 2016. The patients were divided into those with ADSI and those with ABI follow-up only. Life-table analysis comparing stent patency, major adverse limb events (MALEs), limb salvage, and mortality between groups was performed. RESULTS There were 248 patients with SFA stent implantation included, 160 in the ADSI group and 88 in the ABI group. Groups were homogeneous in clinical indications of claudication and critical limb-threatening ischemia (for ADSI, 39% and 61%; for ABI, 38% and 62%; P = .982) and TransAtlantic Inter-Society Consensus class A, B, C, and D lesions (for ADSI, 17%, 45%, 16%, and 22%; for ABI, 21%, 43%, 16%, and 20%; P = .874). Primary patency was similar between groups at 12, 36, and 56 months (ADSI, 65%, 43%, and 32%; ABI, 69%, 34%, and 34%; P = .770), whereas ADSI patients showed an improved assisted primary patency (84%, 68%, and 54%) vs ABI patients (76%, 38%, and 38%; P = .008) and secondary patency. There was greater freedom from MALEs in the ADSI group (91%, 76%, and 64%) vs the ABI group (79%, 46%, and 46%; P < .001) at 12, 36, and 56 months of follow-up. ADSI patients were more likely to undergo an endovascular procedure as their initial post-SFA stent implantation intervention (P = .001), whereas ABI patients were more likely to undergo an amputation (P < .001). CONCLUSIONS In SFA stent implantation, patients with ADSI follow-up demonstrate an advantage in assisted primary patency and secondary patency and are more likely to undergo an endovascular reintervention. These factors are likely to have effected a decrease in MALEs, indicating the benefit of a more universal adoption of post-SFA stent implantation follow-up ADSI.
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Affiliation(s)
| | - Ziad Al-Adas
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
| | - Daniyal Abbas
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
| | - Yasaman Kavousi
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
| | - Loay S Kabbani
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
| | - Judith C Lin
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
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Wee I, Tan G, Ng S, Chan ESY, Ng JJ, Samuel M, Choong AMTL. Endovascular versus open surgical endarterectomy for atherosclerotic lesions of the common femoral artery (CFA). Hippokratia 2020. [DOI: 10.1002/14651858.cd013545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ian Wee
- Yong Loo Lin School of Medicine, National University of Singapore; Singapore Singapore
| | - Gerald Tan
- Newcastle University Medicine Malaysia (NUMed Malaysia); Johor Malaysia
| | - Sheryl Ng
- Cardiovascular Research Institute, National University of Singapore; Singapore Singapore
| | | | - Jun Jie Ng
- Cardiovascular Research Institute, National University of Singapore; Singapore Singapore
- SingVaSC, Singapore Vascular Surgical Collaborative; Singapore Singapore
- Yong Loo Lin School of Medicine, National University of Singapore; Department of Surgery; Singapore Singapore
- National University Heart Centre; Division of Vascular Surgery; Singapore Singapore
| | - Miny Samuel
- NUS Yong Loo Lin School of Medicine; Research Support Unit; NUHS Tower Block, Level 11 1E Kent Ridge Road Singapore Singapore 119228
| | - Andrew MTL Choong
- Cardiovascular Research Institute, National University of Singapore; Singapore Singapore
- SingVaSC, Singapore Vascular Surgical Collaborative; Singapore Singapore
- Yong Loo Lin School of Medicine, National University of Singapore; Department of Surgery; Singapore Singapore
- National University Heart Centre; Division of Vascular Surgery; Singapore Singapore
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18
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Tomoi Y, Soga Y, Takahara M, Fujihara M, Iida O, Kawasaki D, Ando K. Spot stenting versus full coverage stenting after endovascular therapy for femoropopliteal artery lesions. J Vasc Surg 2019; 70:1166-1176. [DOI: 10.1016/j.jvs.2018.12.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/22/2018] [Indexed: 11/17/2022]
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The incidence and risk factors of stent fracture in patients treated for proximal common carotid artery stenosis. J Vasc Surg 2019; 71:824-831.e1. [PMID: 31405760 DOI: 10.1016/j.jvs.2019.04.492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/11/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Our aim was to identify the incidence of and predictors for common carotid artery (CCA) stent fractures (SFs) and to examine the effect of SFs on the development of in-stent restenosis (ISR). METHODS Seventy patients (37 women; median age, 60.9 years) who were stented for significant (≥60%) proximal CCA stenosis from 2006 to 2016 and revisited us to determine SF using fluoroscopy in 2018 were evaluated. Seventy stents were deployed; among them 87.1% were balloon-expandable and 12.9% were self-expandable. SFs were classified as type I (fracture of one strut), type II (fracture of multiple struts without stent deformity), type III (fracture of multiple struts with stent deformity), type IV (complete fracture of the stent without a gap), and type V (complete fracture of the stent with a gap). Duplex ultrasound examination was used for monitoring stent patency. Mann-Whitney U and Fisher's exact tests, Kaplan-Meier and logistic regression analyses, and a log-rank test and a gamma correlation analysis were applied as statistical methods. RESULTS The patients were followed for 75.5 months (range, 47-109 months). Significant (≥70%) ISR was observed in eight patients (11.4%). Reintervention was performed in four cases (5.7%). Twenty-seven SFs (38.6%; type I, 8; type II, 10; type III, 4; type IV, 2; and type V, 3) were found. Calcification was shown to be a significant predictor for SF (odds ratio, 13.2; 95% confidence interval, 3.9-45.1; P < .001). There was no significant difference between the fractured and the nonfractured group regarding the number of patients with ISR and reintervention (P = .701 and P = .636, respectively). Neither did the primary patency rates differ significantly (P = .372) in patients with and without SF. CONCLUSIONS Fractures frequently occur in a wide variety of stent devices deployed in the proximal CCA, but SFs seem to have no effect on ISR and reintervention.
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Sato K, Emura S, Tomiyoshi H, Morita S. Morphologic Changes of the Femoropopliteal Arterial Segment with Knee Flexion after Endovascular Therapy. Ann Vasc Dis 2019; 12:210-215. [PMID: 31275476 PMCID: PMC6600111 DOI: 10.3400/avd.oa.18-00162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: The purpose of this study is to investigate morphologic changes of the femoropopliteal arterial segment (FPAS) with knee flexion after endovascular therapy (EVT). Methods: From July 2012 to January 2015, EVT was performed on 12 limbs in 12 consecutive patients who had obliterative lesions in the FPAS. After the implantation of nitinol stents, angiography was performed with the knee in both extension and flexion to investigate morphologic changes of the FPAS. Results: On angiography, the distal end of the implanted stent was placed at various distances (5–10 cm in two cases, 10–15 cm in nine cases, and 15–20 cm in one case) above the knee joint line with the knee in extension. In all cases, although the popliteal artery was highly bent with the knee in flexion, the FPAS morphology was highly variable. However, the most proximal bending point of the FPAS was about 10 cm above the knee joint line. In one case, the artery was occluded at the distal part of the stent 16 months later, probably due to EVT. Conclusion: In EVT of the FPAS, it is important to consider the characteristics and position of the stent to prevent complications.
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Affiliation(s)
- Katsutoshi Sato
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Shogo Emura
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Hideki Tomiyoshi
- Department of Radiology, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Satoru Morita
- Department of Cardiovascular Surgery, National Hospital Organization, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
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van Koeverden ID, Scholtes VPW, den Ruijter HM, Hazenberg SCE, de Kleijn DPV, de Borst GJ. The Impact of Diabetes and Time on the Atherosclerotic Plaque and Cardiovascular Outcome in Patients Undergoing Iliofemoral Endarterectomy. Eur J Vasc Endovasc Surg 2019; 57:832-841. [PMID: 30910497 DOI: 10.1016/j.ejvs.2018.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/13/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The incidence of diabetes is rapidly increasing and diabetes is associated with an increased risk of peripheral artery disease. Recent studies have shown a time dependent decline in vulnerable plaque features and secondary cardiovascular events in iliofemoral endarterectomy (IFE) patients. IFE patients with diabetes have a high risk of cardiovascular events. It is not known, however, whether vulnerable plaque features and cardiovascular events reduce over time in IFE patients with diabetes. METHODS Between 2003 and 2014, 691 atherosclerotic plaques were obtained by IFE, from 212 patients with and 479 patients without diabetes. Plaques were immunohistochemically stained and analysed for the presence of intraplaque haemorrhage, lipid core, calcification, collagen, smooth muscle cells, and macrophages. Patients were stratified according to their diabetic status and year of inclusion. All patients had a follow up of three years in which cardiovascular adverse events were recorded. RESULTS A time dependent decrease was observed in intraplaque haemorrhage, plaque lipid core, and percentage of macrophages in IFE patients with diabetes. After multivariable correction for changes in risk factors over time, intraplaque haemorrhage (64.2% [2002-2005] vs. 39.6% [2012-2014], p = .01) became significantly less prevalent. Interestingly, the percentage of severely calcified plaques remained high over time. The number of secondary events decreased over time in patients without diabetes (HR 1.80, 95% CI 1.15-2.81 (p = .010) for 2002-2005 vs. 2012-2014), but remained high and unchanged in patients with diabetes. CONCLUSION In patients with diabetes undergoing IFE, a time dependent stabilisation of atherosclerotic plaque features was found in line with previous observations in patients with severe atherosclerosis. The presence of severely calcified lesions remained high and unchanged. The secondary event rate remained high in patients with diabetes in contrast to a significant decrease in patients without diabetes. These findings stress the need for improvement of care in IFE patients with diabetes.
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Affiliation(s)
- Ian D van Koeverden
- Laboratory of Experimental Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Vincent P W Scholtes
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Stijn C E Hazenberg
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Dominique P V de Kleijn
- Department of Experimental Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
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Hüttl AB, Hüttl A, Vértes M, Nguyen DT, Bérczi Á, Hüttl K, Dósa E. The presence of long and heavily calcified lesions predisposes for fracture in patients undergoing stenting of the first part of the subclavian artery. J Vasc Surg 2019; 70:1146-1154.e1. [PMID: 30926275 DOI: 10.1016/j.jvs.2019.01.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence and risk factors of subclavian artery stent fractures and to investigate their impact on in-stent restenosis development. METHODS One hundred eight patients (65 females; median age, 58.3 years [interquartile range, 53.4-65.5 years]) with steno-occlusive disease of the first part of the subclavian artery who underwent stenting (N = 108 stents; balloon-expandable, 83.3%; self-expandable, 16.7%) between 2005 and 2015 and returned for a fluoroscopic examination of the implanted stents in 2017 were included in our study. Fractures were type I (single strut fracture), type II (multiple strut fractures without deformation), type III (multiple strut fractures with deformation), type IV (multiple strut fractures with acquired transection but without gap), or type V (multiple strut fractures with acquired transection with gap in the stent body). Stent patency was monitored by duplex ultrasound imaging. The Mann-Whitney U and Fisher's exact tests; Kaplan-Meier, receiver operating characteristic, and logistic regression analyses; as well as a log-rank test were used as statistical methods. RESULTS The median follow-up was 73.8 months (interquartile range, 35.6-104.2 months). Thirty-eight fractures (35.2%) were detected; fractures were type I in 13, type II in 12, type III in 6, type IV in 4, and type V in 3 cases. Multivariable logistic regression analysis revealed the presence of long (≥20 mm) lesions (odds ratio, 3.3; 95% confidence interval, 1.3-8.4; P = .012) and heavy calcification (odds ratio, 4.7; 95% confidence interval, 1.7-12.7; P = .002) to be significant independent predictors of stent fracture. The primary patency rates were significantly worse (P = .035) in patients with stent fracture compared with those without stent fracture. CONCLUSIONS Stent fractures frequently occur. Patients with long and/or heavily calcified lesions require closer follow-up.
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Affiliation(s)
| | - Artúr Hüttl
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Miklós Vértes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dat Tin Nguyen
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ákos Bérczi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Kálmán Hüttl
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Edit Dósa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
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Jorshery SD, Skrip L, Sarac T, Ochoa Chaar CI. Hybrid femoropopliteal procedures are associated with improved perioperative outcomes compared with bypass. J Vasc Surg 2018; 68:1447-1454.e5. [DOI: 10.1016/j.jvs.2018.01.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/30/2018] [Indexed: 01/22/2023]
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Cangiano G, Corvino F, Giurazza F, Silvestre M, Amodio F, Corvino A, Niola R. Endovascular Treatment of Simultaneous Iliac and Superficial Femoral Arterial Pseudoaneurysms After Stenting Procedure Complications. Vasc Endovascular Surg 2018; 53:160-164. [PMID: 30301433 DOI: 10.1177/1538574418805588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE: To report on the endovascular management of a patient affected by concomitant left common iliac artery and right superficial femoral artery (SFA) pseudoaneurysms after stent positioning. CASE REPORT: A 77-year-old man affected by severe lower limb atherosclerosis was previously treated with iliac and femoropopliteal Supera stenting procedures; he presented to our emergency department because of bilateral severe claudication recurrence, back pain, and right groin region swelling. Angio-computed tomography (CT) depicted 2 pseudoaneurysms of the left common iliac artery and right SFA, due to stent fracture and stent intussusception, respectively. A 2-step endovascular treatment was planned using bilaterally covered stent-grafts to exclude vascular lesions from blood flow. The devices were successfully deployed without any complication. At 1 month, angio-CT confirmed patency of the implanted stent-grafts showing complete pseudoaneurysm exclusion without leaks. CONCLUSION: Endovascular approach can be a valid option in the treatment of pseudoaneurysms due to stenting procedure complications.
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Affiliation(s)
- Gianluca Cangiano
- 1 Interventional Radiology Department, AORN "A. Cardarelli," Naples, Italy
| | - Fabio Corvino
- 1 Interventional Radiology Department, AORN "A. Cardarelli," Naples, Italy
| | - Francesco Giurazza
- 1 Interventional Radiology Department, AORN "A. Cardarelli," Naples, Italy
| | - Mattia Silvestre
- 1 Interventional Radiology Department, AORN "A. Cardarelli," Naples, Italy
| | - Francesco Amodio
- 1 Interventional Radiology Department, AORN "A. Cardarelli," Naples, Italy
| | - Antonio Corvino
- 2 Department of Radiology, University of Naples Parthenope, Naples, Italy
| | - Raffaella Niola
- 1 Interventional Radiology Department, AORN "A. Cardarelli," Naples, Italy
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25
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Atigh MK, Turner E, Christians U, Yazdani SK. The use of an occlusion perfusion catheter to deliver paclitaxel to the arterial wall. Cardiovasc Ther 2018; 35. [PMID: 28445625 DOI: 10.1111/1755-5922.12269] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/24/2017] [Accepted: 04/22/2017] [Indexed: 12/17/2022] Open
Abstract
AIM Nonstent drug delivery platforms have recently emerged as an alternative treatment of peripheral arterial disease. Perfusion catheters have the potential to directly deliver antiproliferative agents to the medial arterial layer to prevent restenosis. The purpose of this study was to therefore determine the effectiveness of a perfusion catheter to deliver paclitaxel, a proven antiproliferative agent, to combat restenosis. METHODS A benchtop model was utilized to determine the varying parameters of a novel occlusion perfusion catheter to maximize paclitaxel delivery using pharmacokinetic evaluation and fluorescent microscopy. Parameters tested included concentration of paclitaxel, delivery pressure, duration of delivery, and the use of an excipient. In addition, bilateral rabbit iliac arteries were treated with the perfusion catheter and pharmacokinetic evaluation performed at 1 hour, 1 day and 3 days. RESULTS Benchtop testing demonstrated uniform and circumferential penetration of paclitaxel within the treated arteries. The results of the ex vivo test identified two groups with and without an excipient with similar loading conditions (with excipient: 15.4±8.6 ng/mg vs without excipient: 8.9±6.9 ng/mg, P=.77). The in vivo pharmacokinetic analysis of these two groups demonstrated the use of contrast agent increased arterial paclitaxel levels and maintained initial paclitaxel dosing up to 3 days (With excipient: 1 hour: 107±62 ng vs 3 days: 40±23 ng, P=.824; No excipient: 1 hour: 247±120 ng vs 3 days: 2.92±2.9 ng, P=.009). CONCLUSIONS These results demonstrate the feasibility to deliver paclitaxel directly to the medial layer of an artery via a perfusion catheter.
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Affiliation(s)
- Marzieh K Atigh
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA
| | - Emily Turner
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA
| | - Uwe Christians
- iC42 Clinical Research and Development, University of Colorado, Aurora, CO, USA
| | - Saami K Yazdani
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA
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26
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Mustapha JA, Lansky A, Shishehbor M, Miles McClure J, Johnson S, Davis T, Makam P, Crowder W, Konstantino E, Attaran RR. A prospective, multi-center study of the chocolate balloon in femoropopliteal peripheral artery disease: The Chocolate BAR registry. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27565] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jihad A. Mustapha
- Division of Cardiology; University of Michigan Health; Wyoming Michigan
| | - Alexandra Lansky
- Section of Cardiology, Yale School of Medicine; New Haven Connecticut
- BARTS Heart Center and Queen Mary University of London; London United Kingdom
| | | | | | - Sarah Johnson
- Amita Health- Alexian Brothers Health System; Elk Grove Village Illinois
| | - Thomas Davis
- St. John Hospital & Medical Center; Detroit Michigan
| | - Prakash Makam
- Cardiovascular Institute of North West Indiana; Munster Indiana
| | | | | | - Robert R. Attaran
- Section of Cardiology, Yale School of Medicine; New Haven Connecticut
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27
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Koifman E, Lipinski MJ, Buchanan K, Yu Kang W, Escarcega RO, Waksman R, Bernardo NL. Comparison of treatment strategies for femoro-popliteal disease: A network meta-analysis. Catheter Cardiovasc Interv 2018; 91:1320-1328. [DOI: 10.1002/ccd.27484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/05/2017] [Accepted: 12/17/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Edward Koifman
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Michael J. Lipinski
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Kyle Buchanan
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Won Yu Kang
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Ricardo O. Escarcega
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Nelson L. Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
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28
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Veraldi GF, Mezzetto L, Macrì M, Criscenti P, Corvasce A, Poli R. Comparison of Endovascular Versus Bypass Surgery in Femoropopliteal TASC II D Lesions: A Single-Center Study. Ann Vasc Surg 2017; 47:179-187. [PMID: 28943491 DOI: 10.1016/j.avsg.2017.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with severe occlusive disease (Trans-Atlantic Inter-Society Consensus II D [TASC II D]) of the femoropopliteal segment, the advantages of endovascular versus bypass revascularization still remain debated. Most reports available in literature comparing percutaneous transluminal angioplasty (PTA) ± bare metal stent (BMS) versus synthetic bypass analyze patients with heterogeneous anatomical lesions creating possible bias when results of different treatments are matched. In this study, we compared early and midterm outcomes of PTA ± BMS versus heparin-bonded expanded polytetrafluoroethylene graft (Propaten-Gore) + Linton patch in patient affected by symptomatic femoropopliteal TASC II-D lesions. METHODS Eighty limbs with symptomatic severe occlusive disease (TASC II D) of the femoropopliteal segment observed from January 2013 to January 2017 were included in this retrospective study. Indication to treatment was severe claudication in 17 limbs (21.2%) and critical limb ischemia (CLI) in 63 (78.8%). 36.2% of limbs presented at least 2 distal patent vessels, and 63.8% had only 1 patent vessel. Of these limbs, 40 were treated by means of PTA ± BMS (group A), and 40 were treated by means of femoropopliteal bypass with Propaten-Gore graft + Linton patch (group B). Patients were followed with a clinical assessment and duplex at 1, 6, and 12 months after procedure and then annually. A closer follow-up was performed in case of any complication. Patency, reintervention rate, and limb salvage were compared in the 2 groups. RESULTS The mean length of arterial occlusion was 22.1 cm (range, 8-37) in group A versus 25.2 cm (range, 9-41) in group B, P = ns. A slight difference in mean procedural time was observed (83.5 min of group A versus 114 min of group B, minutes, P = 0.02). Mean follow-up was 26.7 months (range, 3-46). Primary patency at 6, 12, and 24 months of group A versus group B was 76.9% vs. 97.5% (P = 0.007), 65.7% vs. 89.1% (P = 0.05), and 52.6% vs. 78.1% (P = 0.005), respectively. Assisted primary patency was 76.9% vs. 97.5% (P = 0.007), 68.5% vs. 91.8% (P = 0.02), and 57.8% vs. 87.5% (P = 0.001), respectively. Secondary patency was 94.8% vs. 97.5% (P = ns), 85.7% vs. 97.2% (P = ns), 73.6% vs. 93.7% (P = 0.004), respectively. Rate of reintervention at 24 months was 45% in group A vs. 20% in group B (P = 0.03). Limb salvage rate at 24 months was 90% for group A vs. 92.5% for group B (P = ns). Univariate analysis showed CLI and poor runoff to be independent risk factors for significant restenosis/occlusion of target artery and reintervention. CONCLUSIONS In patients with severe femoropopliteal occlusive disease (TASC II D), the surgical revascularization by means of Propaten-Gore bypass + Linton patch can be considered safe and effective. Early and midterm results of this approach seem to be superior to PTA ± BMS in terms of restenosis/occlusion and reintervention rates. Larger cohort and longer term results are mandatory to better define this advantage.
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Affiliation(s)
- Gian Franco Veraldi
- Department of Vascular Surgery, University of Verona, School of Medicine, University Hospital of Verona, Verona, Italy.
| | - Luca Mezzetto
- Department of Vascular Surgery, University of Verona, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Marco Macrì
- Department of Vascular Surgery, University of Verona, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Paolo Criscenti
- Department of Vascular Surgery, University of Verona, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Arianna Corvasce
- Department of Upper GI Surgery, University of Verona, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Ranieri Poli
- Department of Medical Direction and Public Health, University of Verona, School of Medicine, University Hospital of Verona, Verona, Italy
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29
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de Boer SW, van den Heuvel DAF, de Vries-Werson DAB, Vos JA, Fioole B, Vroegindeweij D, Elgersma OE, Tutein Nolthenius RP, Heyligers JMM, Bosma GPT, de Leeuw B, Bouwman LH, Böckler D, Dovzhanskiy DI, Vos FWF, Vink TWF, Hooijboer PGA, Hissink RJ, de Vries JPPM. Short-term Results of the RAPID Randomized Trial of the Legflow Paclitaxel-Eluting Balloon With Supera Stenting vs Supera Stenting Alone for the Treatment of Intermediate and Long Superficial Femoral Artery Lesions. J Endovasc Ther 2017; 24:783-792. [DOI: 10.1177/1526602817725062] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sanne W. de Boer
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Jan Albert Vos
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Damnis Vroegindeweij
- Department of Interventional Radiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Otto E. Elgersma
- Department of Interventional Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | - Jan M. M. Heyligers
- Department of Vascular Surgery, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | - Gerlof P. T. Bosma
- Department of Interventional Radiology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | - Bernart de Leeuw
- Department of Interventional Radiology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Lee H. Bouwman
- Department of Vascular Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Dittmar Böckler
- Clinic for Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | | | - Floris W. F. Vos
- Department of Vascular Surgery, Medical Centre Leeuwarden, the Netherlands
| | - Ted W. F. Vink
- Department of Interventional Radiology, Medical Centre Leeuwarden, the Netherlands
| | | | - Rutger J. Hissink
- Department of Vascular Surgery, Scheper Hospital, Emmen, the Netherlands
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30
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Sarkar R. Invited commentary. J Vasc Surg 2017; 66:593. [DOI: 10.1016/j.jvs.2017.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 11/17/2022]
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31
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Juszkat R, Klimont M, Śliwa M, Krasiński Z. Fractured Superior Mesenteric Artery Stent With Stent Displacement Leading to Recurrent Symptoms of Superior Mesenteric Ischemia. Vasc Endovascular Surg 2017; 51:400-402. [PMID: 28602156 DOI: 10.1177/1538574417714395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We report a case of a patient with recurrent symptoms of superior mesenteric ischemia 7 months after successful percutaneous angioplasty and implantation of a stent in the superior mesenteric artery (SMA). Stent fracture and stent displacement were observed. To the best of our knowledge, this is the first report of SMA stent fracture with stent displacement.
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Affiliation(s)
- Robert Juszkat
- 1 Department of Radiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Michał Klimont
- 1 Department of Radiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Magdalena Śliwa
- 1 Department of Radiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Zbigniew Krasiński
- 2 Department of Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
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32
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Powell RJ, Jaff MR, Schroë H, Benko A, Diaz-Cartelle J, Müller-Hülsbeck S. Stent placement in the superficial femoral and proximal popliteal arteries with the innova self-expanding bare metal stent system. Catheter Cardiovasc Interv 2017; 89:1069-1077. [PMID: 28296239 DOI: 10.1002/ccd.26976] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/16/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The SuperNOVA trial was designed to evaluate performance of the Innova Vascular Self-Expanding Stent System (Boston Scientific, Marlborough, MA) for treating lesions in the femoropopliteal arteries. METHODS Patients with chronic lower limb peripheral artery disease (Rutherford category 2, 3, or 4) and atherosclerotic lesions in the native superficial femoral and/or proximal popliteal artery (lengths 30-190 mm) were enrolled in this single-arm, multinational study. Major adverse events (MAEs) were defined as all-cause death through 1 month, target limb major amputation, and target lesion revascularization (TLR). Vessel primary patency was defined as core laboratory-adjudicated duplex ultrasonography-derived peak systolic velocity ratio ≤2.4 in the absence of TLR, surgical bypass of the target lesion, or major amputation of the target limb. Primary safety and efficacy endpoints were evaluated at 12 months, with follow-up through 24 months also reported. RESULTS SuperNOVA patients (N = 299; mean age 67.4 ± 9.7 years, 74% men, 41% with diabetes) had a mean lesion length of 93.2 mm. The MAE-free rate was 99.7% at 30 days, 85.8% at 12 months, and 77% at 24 months. Kaplan-Meier estimates of primary patency and TLR-free rates were 68.7% and 78.0%, respectively, at 24 months. Clinical improvements were sustained through 2 years, with 80% of patients displaying no or minimal symptoms (Rutherford category 0-1) at 24 months. CONCLUSIONS In the SuperNOVA study, the Innova Stent System demonstrated an excellent safety profile and acceptable clinical outcomes despite the challenging anatomical characteristics of the lesions. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Michael R Jaff
- VasCore, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | | | - Andrew Benko
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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Abstract
The superficial femoral artery is a complex artery subject to a unique set of biomechanical loading conditions in its course through the leg. Plain balloon angioplasty and balloon-expandable stents had unacceptably high rates of restenosis, necessitating target vessel revascularization. Nitinol alloy is well suited to provide the strength and flexibility needed of stents to withstand the external forces posed by the environment of the superficial femoral artery. Advances in stent technology with the addition of a slow-releasing antiproliferative agent and changes in scaffold design have shown promise in reducing the rates of stent fracture and in-stent restenosis.
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Affiliation(s)
- Ashwin Nathan
- Cardiovascular Medicine Division, Perelman Center, Hospital of the University of Pennsylvania, South Tower, 11th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Penn Cardiovascular Quality, Outcomes, and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Taisei Kobayashi
- Cardiovascular Medicine Division, Perelman Center, Hospital of the University of Pennsylvania, South Tower, 11th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Penn Cardiovascular Quality, Outcomes, and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jay Giri
- Cardiovascular Medicine Division, Perelman Center, Hospital of the University of Pennsylvania, South Tower, 11th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Penn Cardiovascular Quality, Outcomes, and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA, USA.
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Tang X, Tang F, Hu C, Wang Q, Long W, Li L. Dynamic Respiratory Tortuosity of the Vertebral Artery Ostium. J Endovasc Ther 2016; 24:124-129. [PMID: 27831484 DOI: 10.1177/1526602816676254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the prevalence of dynamic respiratory tortuosity (DRT) of the vertebral artery ostium (VAO) as well as to evaluate its correlation with in-stent restenosis (ISR) and stent fracture. METHODS From March 2012 to June 2015, 178 consecutive patients (mean age 65.2±5.8 years; 124 men) with symptoms of atherosclerotic vertebrobasilar ischemia underwent angiography prior to stent implantation in the vertebral, subclavian, and/or carotid arteries. In this cohort, 54 patients (mean age 67.3±5.3 years; 40 men) had VAO stent implantation. Angiography of the vertebral artery was recorded in 2 phases with breath-hold: deep inspiration (DIP) and deep expiration (DEP). Obvious VAO tortuosity was defined as any VAO angle ≤120° in DIP. Obvious VAO-DRT was defined as any VAO angle increasing ≥60° from DIP to DEP. Computed tomography angiography (CTA) or digital subtraction angiography was used in follow-up to detect ISR and stent fracture. RESULTS Of the 178 patients in this study, 21 (11.8%) had obvious VAO tortuosity and 8 (4.5%) had obvious VAO-DRT. Two of the 21 patients with obvious VAO tortuosity also had obvious VAO-DRT. Three of the 54 VAO stent patients had VAO-DRT. There were no correlations between VAO-DRT and age, sex, risk factors, body mass index, chronic obstructive pulmonary disease, asthma, or obvious VAO tortuosity (p>0.05). Over a mean follow-up of 28±10 months, there were 4 (7.4%) asymptomatic VAO ISR cases. Two (3.7%) were occlusions at 6 and 12 months, respectively; both were associated with stent fracture in patients with obvious VAO-DRT before stenting. Both stents fractured at the tortuous VAO region. VAO-DRT was correlated with stent fracture (Spearman ρ=0.81, p<0.01) and ISR (Spearman ρ=0.55, p<0.01). CONCLUSION VAO-DRT could be a risk factor for stent fracture and restenosis after VAO stent implantation. Angiography in both inspiration and expiration phases, especially the latter, should be considered before VAO stenting. Using a shorter stent to avoid crossing the tortuosity could reduce the occurrence of fracture.
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Affiliation(s)
- Xiaobin Tang
- 1 Vascular Surgery Department, Beijing Anzhen Hospital, Beijing, China
| | - Feng Tang
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Chang Hu
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Qian Wang
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Whitney Long
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Lei Li
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
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35
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Rundback JH, Armstrong EJ, Contos B, Iida O, Jacobs D, Jaff MR, Matsumoto AH, Mills JL, Montero-Baker M, Pena C, Tallian A, Uematsu M, Wilkins LR, Shishehbor MH. Key Concepts in Critical Limb Ischemia: Selected Proceedings from the 2015 Vascular Interventional Advances Meeting. Ann Vasc Surg 2016; 38:191-205. [PMID: 27569717 DOI: 10.1016/j.avsg.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 01/28/2023]
Abstract
Over 500,000 patients each year are diagnosed with critical limb ischemia (CLI), the most severe form of peripheral artery disease. CLI portends a grim prognosis; half the patients die from a cardiovascular cause within 5 years, a rate that is 5 times higher than a matched population without CLI. In 2014, the Centers for Medicare and Medicaid Services paid approximately $3.6 billion for claims submitted by hospitals for inpatient and outpatient care delivered to patients with CLI. Although significant advances in diagnosis, treatment, and follow-up of patients with CLI have been made, many challenges remain. In this article, we summarize selected presentations from the 2015 Vascular Interventional Advances Conference related to the modern demographics, diagnosis, and management of patients with CLI.
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Affiliation(s)
- John H Rundback
- Interventional Institute, Holy Name Medical Center, Teaneck, NJ.
| | - Ehrin J Armstrong
- Department of Vascular Surgery, VA Eastern Colorado Healthcare System and University of Colorado, Denver, CO
| | | | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Donald Jacobs
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO
| | - Michael R Jaff
- Department of Vascular Medicine, Massachusetts General Hospital, Boston, MA
| | - Alan H Matsumoto
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX
| | - Miguel Montero-Baker
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX
| | - Constantino Pena
- Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, FL
| | | | - Masaaki Uematsu
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Luke R Wilkins
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Mehdi H Shishehbor
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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Fatigue of Metallic Stents: From Clinical Evidence to Computational Analysis. Ann Biomed Eng 2015; 44:287-301. [PMID: 26438450 DOI: 10.1007/s10439-015-1447-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
The great success of stents in treating cardiovascular disease is actually undermined by their long-term fatigue failure. The high variability of stent failure incidence suggests that it is due to several correlated aspects, such as loading conditions, material properties, component design, surgical procedure, and patient functional anatomy. Numerical and experimental non-clinical assessments are included in the recommendations and requirements of several regulatory bodies and they are thus exploited in the analysis of stent fatigue performance. Optimization-based simulation methodologies have been developed as well, to improve the fatigue endurance of novel designs. This paper presents a review on the fatigue issue in metallic stents, starting from a description of clinical evidence about stent fracture up to the analysis of computational approaches available from the literature. The reported discussion on both the experimental and numerical framework aims at providing a general insight into stent lifetime prediction as well as at understanding the factors which affect stent fatigue performance for the design of novel components.
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37
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Gouëffic Y, Kaladji A. Commentary: the clinical relevance of superficial femoral artery stent fractures remains obscure. J Endovasc Ther 2015; 22:327-9. [PMID: 25904487 DOI: 10.1177/1526602815583662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yann Gouëffic
- CHU Nantes, l'institut du thorax, service de chirurgie vasculaire, Nantes, France Laboratoire de Physiopathologie de la Résorption osseuse, Inserm-UN UMR-957, Nantes, France
| | - Adrien Kaladji
- CHU Nantes, l'institut du thorax, service de chirurgie vasculaire, Nantes, France
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