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Rammos C, Zeller T, Piorkowski M, Deloose K, Hertting K, Sesselmann V, Tepe G, Gaines P, Lichtenberg M. The BioMimics 3D Helical Centreline Nitinol Stent in Chronic Limb Threatening Ischaemia and Complex Lesions: Three Year Outcomes of the MIMICS-3D Registry. Eur J Vasc Endovasc Surg 2024; 67:923-932. [PMID: 38447693 DOI: 10.1016/j.ejvs.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 02/01/2024] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE There is a need for improved outcomes in the endovascular treatment of patients suffering from chronic limb threatening ischaemia (CLTI), highly calcified lesions, and chronic total occlusions (CTOs). The helical centreline self expanding BioMimics 3D stent might be particularly useful in these high risk subsets, combining flexibility and fracture resistance with radial strength. Herein, the performance of the BioMimics 3D stent was assessed in these high risk subsets. METHODS MIMICS-3D is a prospective, multicentre, European real world registry. This was a post hoc analysis, comparing patients with CLTI vs. intermittent claudication (IC), lesions with bilateral calcification vs. those without (peripheral arterial calcium scoring system [PACSS] 3,4 vs. PACSS 0 - 2), and CTO vs. no CTO. Propensity score matching was performed to reduce the impact of baseline variables. The 36 month endpoints were clinically driven target lesion revascularisation (CD-TLR), death, major target limb amputation, and stent patency. RESULTS A total of 507 patients were enrolled. At 36 months, patients with CLTI had lower freedom from major amputation than patients with IC (92.6% vs. 100%, p < .001). In terms of primary patency, patients with CTO had lower patency rates than those without (63.9% vs. 77.8%, p = .003), but the difference reduced after propensity score matching (70.5% vs. 76.8%, p = .43). Primary patency was not impaired for patients with PACSS 3,4 or patients with CLTI. Freedom from CD-TLR was not significantly different among the groups and was 73.8% for CLTI vs. 78.9% for IC (p = .15), 77.6% for PACSS 3,4 vs. 78.7% for PACSS 0 - 2 (p = .55), and 75.6% for CTO vs. 81.0% for no CTO (p = .11). CONCLUSIONS The outcome of the MIMICS-3D registry suggests that the BioMimics 3D stent is effective in the endovascular treatment of complex femoropopliteal lesions and in CLTI. Future randomised controlled trials should confirm its non-inferiority or superiority compared with existing alternatives.
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Affiliation(s)
- Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre Essen, University Hospital Essen, Germany.
| | - Thomas Zeller
- Universitätsklinikum Freiburg Herzzentrum, Bad Krozingen, Germany
| | | | - Koen Deloose
- Department of Vascular Surgery, AZ Sint-Blasius Dendermonde, Dendermonde, Belgium
| | - Klaus Hertting
- Department of Cardiology and Angiology, Krankenhaus Buchholz und Winsen GmbH, Buchholz, Germany
| | - Volker Sesselmann
- Department of Angiology, SRH Zentralklinikum Suhl GmbH, Suhl, Germany
| | - Gunnar Tepe
- Department of Diagnostic and Interventional Radiology, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Peter Gaines
- Vascular Institute, Sheffield Hallam University, Sheffield, UK
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van Walraven LA, Kalil VM, van der Veen D, Bosiers MJ, Deloose K, Holewijn S, Zeebregts CJ, Reijnen MMPJ. Post hoc analysis of the SuperB and Zilverpass trials for treatment of long and complex superficial femoral artery lesions. J Vasc Surg 2024:S0741-5214(24)00936-4. [PMID: 38604319 DOI: 10.1016/j.jvs.2024.03.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/25/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE In two randomized controlled trials, the outcomes of endovascular treatment of complex femoropopliteal arterial lesions were compared with bypass surgery and considered a valid alternative treatment. The aim of this study was to compare both endovascular treatment options with the hypothesis that implantation of heparin-bonded self-expanding covered stents (Viabahn [SECS]) or drug-eluting stents (ZilverPTX [DES]) are related to similar clinical outcomes at 1-year follow-up. METHODS In a post-hoc analysis, the SuperB trial and Zilverpass databases were merged. Patients in the endovascular treatment arms were included, and data was analyzed in an intention-to-treat (ITT) and a per-protocol (PP) fashion. Data included baseline and lesion characteristics, procedural details, and follow-up data. The primary endpoint of this study was primary patency at 1-year follow-up. The secondary endpoints were secondary patency, target lesion revascularization (TLR), limb loss, and all-cause mortality. RESULTS A total of 176 patients were included; 63 in the SECS arm and 113 in the DES arm. Through 1-year follow-up, there were no significant differences in primary patency (ITT: 63.4% vs 71.1%: P = .183 and PP: 60.8% vs 71.1%; P = .100). Secondary patency rates were not significantly different in the ITT analysis (86.5% vs 95.1%; P = .054), but in the PP analysis, there was a significant difference in favor of the DES group (SECS, 85.6% vs DES, 95.1%; P = .038). There was no significant difference in freedom from TLR between groups (79.6% vs 77.0%; P = .481). No major amputations were performed in the SECS group, and two were performed in the DES group (1.8%). Survival rate was 98.2% in the SECS group, and 91.3% in the DES group after 1-year follow-up (P = .106). Based on diagnosis (intermittent claudication vs chronic limb-threatening ischemia) no differences between patients with intermittent claudication and chronic limb-threatening ischemia were observed in primary patency, secondary patency and freedom from TLR. CONCLUSIONS Treatment of complex femoropopliteal arterial disease with the heparin-bonded Viabahn endoprosthesis and the Zilver PTX drug-eluting stent are related to similar primary and secondary patency, and TLR rates at 1 year, except for secondary patency in the PP analysis. This study further supports the endovascular treatment of long complex lesions in the femoropopliteal artery.
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Affiliation(s)
- Laurens A van Walraven
- Department of Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands; Multi-Modality Medical Imaging Group, University of Twente, Enschede, The Netherlands
| | - Vitória M Kalil
- Albert Einstein Hospital College, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | - Michel J Bosiers
- Department of Vascular Surgery, St. Franziskus-Hospital, Munster, Germany; Department of Vascular Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Koen Deloose
- Department of Vascular Surgery, AZ St-Blasius, Dendermonde, Belgium
| | | | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Michel M P J Reijnen
- Multi-Modality Medical Imaging Group, University of Twente, Enschede, The Netherlands; Department of Surgery, Rijnstate, Arnhem, The Netherlands.
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Okuno S, Iida O, Takahara M, Hata Y, Kurata N, Toyoshima T, Asai M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Tsujimura T, Matsuda Y, Mano T. Impact of intravascular ultrasound parameters and platelet reactivity on primary patency after drug-coated balloon angioplasty for femoropopliteal artery disease. Heart Vessels 2023; 38:497-506. [PMID: 36454300 DOI: 10.1007/s00380-022-02201-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022]
Abstract
Although the superiority of DCBs to uncoated balloon angioplasty for the treatment of femoropopliteal (FP) lesions has been demonstrated, the association of clinical factors, including anatomical features evaluated by intravascular ultrasound (IVUS) and platelet reactivity, with the loss of patency has not been systematically studied. The current prospective, observational study enrolled 160 consecutive patients (male 67.5%, mean age 74.7 ± 9.7 years) with 213 FP lesions treated with DCBs under IVUS evaluation. The platelet reactivity was measured in P2Y12 reaction units for all of the patients at the DCB treatment. The primary end point was primary patency at 12 months, while the secondary end points were freedom from target lesion revascularization (TLR), all-cause death, major target limb amputation and bleeding events at 12 months. Mean lesion length was 11.9 ± 9.4 cm and 34 (16.0%) were chronic total occlusions (CTOs). Thirty-four (16.0%) were severely calcified lesions. Primary patency by Kaplan-Meier estimate was 79.2% at 12 months, while the 12-month freedom from TLR, all-cause death and bleeding events were observed in 89.1%, 93.4% and 97.4%, respectively. There were no major target limb amputations through 12 months. Multivariate analysis showed that subintimal angioplasty for CTO lesions was a sole risk factor for loss of 12-month primary patency, while other IVUS parameters and platelet reactivity were not.
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Affiliation(s)
- Shota Okuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Naoya Kurata
- Department of Clinical Engineering, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Taku Toyoshima
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Takuya Tsujimura
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yasuhiro Matsuda
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
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Laksono S, Pasciolly RMRJ, Munirwan H, Pratama AP, Prawara AS. Choosing the appropriate catheter and wire in peripheral intervention. ASIAINTERVENTION 2022; 8:162-170. [PMID: 36483286 PMCID: PMC9706725 DOI: 10.4244/aij-d-22-00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/16/2022] [Indexed: 06/17/2023]
Abstract
Endovascular treatment is becoming more common in managing patients with peripheral arterial disease. A carefully planned procedure is crucial for the outcome of the procedure. Several steps are necessary when performing endovascular procedures, including preplanning with vascular imaging using computed tomography angiography (CTA) or magnetic resonance angiography (MRA), choosing the right access and technique, and using the right devices (guidewires, sheaths, catheters). The length, diameter, stiffness, coating, and tip shape of the guidewire should be adjusted according to the initial information and preparation. A sheath is not always necessary but can be beneficial when several catheter changes are planned. There are three types of angiographic catheter (flush, exchange, and selective), each of which should be considered and used wisely according to its function. The guidewire, sheath, and catheter choices will follow from the initial information gathered, the access and technique chosen, and the availability of the devices.
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Affiliation(s)
- Sidhi Laksono
- Department of Cardiology and Vascular Medicine, Central Pertamina Hospital, South Jakarta, Indonesia
- Faculty of Medicine, Universitas Muhammadiyah Prof. Dr. HAMKA, Tangerang, Indonesia
| | | | - Haris Munirwan
- Department of Cardiology and Vascular Medicine, Dr. Zainoel Abidin General Regional Hospital, Aceh, Indonesia and Faculty of Medicine, Syiah Kuala University, Aceh, Indonesia
| | - Ahmad Pandu Pratama
- Department of Cardiology and Vascular Medicine, Central General Hospital Dr. Mohammad Hoesin, Palembang, Indonesia
- Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
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Algorithm of Femoropopliteal Endovascular Treatment. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091293. [PMID: 36143968 PMCID: PMC9501396 DOI: 10.3390/medicina58091293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 12/04/2022]
Abstract
Background and Objectives: Indications for the endovascular treatment of femoropopliteal lesions have steadily increased over the past decade. Accordingly, the number of devices has also increased, but the choice of the best endovascular treatment remains to be defined. Many devices are now available for physicians. However, in order to obtain a high success rate, it is necessary to respect an algorithm whose choice of device is only one step in the treatment. Materials and Methods: The first step is, therefore, to define the approach according to the lesion to be treated. Anterograde approaches (femoral, radial, or humeral) are distinguished from retrograde approaches depending on the patient’s anatomy and surgical history. Secondarily, the lesion will be crossed intraluminally or subintimally using a catheter or an angioplasty balloon. The third step corresponds to the preparation of the artery, which is essential before the implantation of the device. It has a crucial role in reducing the rate of restenosis. Several tools are available and are chosen according to the lesion requiring treatment (stenosis, occlusion). Among them, we find the angioplasty balloon, the atherectomy probes, or intravascular lithotripsy. Finally, the last step corresponds to the choice of the device to be implanted. This is also based on the nature of the lesion, which is considered short, up to 15 cm and complex beyond that. The choice of device will be between bare stents, covered stents, drug-coated balloons, and drug-eluting stents. Currently, drug-eluting stents appear to be the treatment of choice for short lesions, and active devices seem to be the preferred treatment for more complex lesions, although there is a lack of data. Results: In case of failure to cross the lesion, the retrograde approach is a safe and effective alternative. Balloon angioplasty currently remains the reference method for the preparation of the artery, the aim of which is to ensure the intraoperative technical success of the treatment (residual stenosis < 30%), to limit the risk of dissection and, finally, to limit the occurrence of restenosis. Concerning the treatment, the drug-eluting devices seem to present the best results, whether for simple or complex lesions. Conclusions: Endovascular treatment for femoropopliteal lesions needs to be considered upstream of the intervention in order to anticipate the treatment and the choice of devices for each stage.
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Abstract
Endovascular revascularization strategies have advanced tremendously over the years and are now often considered first line for treatment of peripheral arterial disease. Drug-eluting stents (DESs) have been developed as one of the tools to overcome the limitations of elastic recoil and neointimal hyperplasia observed with balloon angioplasty and bare metal stents. While these stents have been extremely successful in coronary revascularization, they have not translated as effectively to the peripheral arteries which differ in their unique mechanical environments and differences in vessel and lesion composition. DESs, through their embedded pharmaceutical agent, seek to inhibit vascular smooth muscle cell (VSMC) proliferation and migration. Paclitaxel, sirolimus, and its derivatives (-limus family) achieve VSMC inhibition through unique mechanisms. Several clinical trials have been performed to evaluate the use of DES in the femoropopliteal and infrapopliteal territory and have demonstrated overall decrease in revascularization rates and improved clinical outcomes.
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Affiliation(s)
- Chetan Velagapudi
- Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, Illinois
| | - Sreekumar Madassery
- Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, Illinois
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Kurata N, Iida O, Takahara M, Asai M, Masuda M, Okamoto S, Ishihara T, Nanto K, Mano T. Predictive Factors for Restenosis Following Stent-Supported Endovascular Therapy with Intravascular Ultrasound Evaluation for Femoropopliteal Chronic Total Occlusion. J Vasc Interv Radiol 2021; 32:712-720.e1. [PMID: 33933251 DOI: 10.1016/j.jvir.2020.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To determine the predictive factors for in-stent restenosis (ISR) following stent-supported endovascular therapy (EVT) with intravascular ultrasound (US) evaluation for femoropopliteal chronic total occlusion. MATERIALS AND METHODS This was a single-center, retrospective, observational study. The study included 276 lesions in 251 patients who underwent stent-supported EVT with intravascular ultrasound evaluation for femoropopliteal chronic total occlusion from July 2012 to June 2019. The wire passage route was assessed using intravascular US, and lesions were classified accordingly into 2 groups: intraluminal and subintimal passage. In this study, the intraluminal group was further divided into 3 subgroups by severity of calcification: none, <180°, and ≥180° circumferential. The subintimal group was further divided into 2 subgroups: subintimal passage without or with calcification. The primary outcome measure was ISR. Cox proportional hazards regression was used to determine the association of clinical characteristics with ISR rates. RESULTS The mean follow-up period was 19 months ±16, during which time ISR was observed in 31% of lesions. After multivariate analysis, an increased degree of plaque burden (hazard ratio [HR] = 1.101) and subintimal passage with calcification (HR = 3.408) were associated with an increased risk of ISR; a larger distal external elastic membrane area (HR = 0.898) and use of a stent graft (HR = 0.130) were significantly associated with a reduced risk of ISR. CONCLUSIONS This study revealed that factors associated with ISR after stent-supported EVT with intravascular US evaluation were distal external elastic membrane area, plaque burden, subintimal passage with calcification, and use of a stent graft.
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Affiliation(s)
- Naoya Kurata
- Department of Clinical Engineering, Kansai Rosai Hospital, Amagasaki, Japan.
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Mitusyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsutoshi Asai
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Masaharu Masuda
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Shin Okamoto
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | | | - Kiyonori Nanto
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
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Tadano Y, Kotani JI, Haraguchi T, Watanabe T, Sugie T, Kaneko U, Kobayashi K, Kanno D, Kashima Y, Fujita T. Factors contributing to efficient recanalization procedures for chronic total occlusion of the superficial femoral artery. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:43-49. [PMID: 34266771 DOI: 10.1016/j.carrev.2021.06.133] [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: 02/11/2021] [Revised: 05/29/2021] [Accepted: 06/28/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study aimed to clarify the factors for efficient procedures (EP) in superficial femoral artery (SFA) chronic total occlusion (CTO). METHODS We retrospectively analyzed 200 consecutive limbs that underwent treatment for SFA CTO. The patients were divided into three groups according to the main strategies: subintimal angioplasty (SIA) (n = 123), Crosser use (n = 50), and 0.014″ CTO guidewire (CTO-GW) (n = 27). To determine the factors for an EP (EP; contrast volume <130 mL and procedure time <20 min; derived from non-CTO [control] procedures), the variables (P < 0.2) underwent multivariate analysis. RESULTS SIA included more Trans-Atlantic Inter-Society Consensus C/D lesions and contralateral femoral approaches, and additional GW use (P < 0.05). CTO-GW presented a shorter occlusion length and elapsed time, and used less retrograde approach than the other strategies (P < 0.05). Crossers had a higher incidence of perforation (P = 0.002). The prompt retrograde approach had a similar actual retrograde procedure time, but a shorter total procedure time, compared to that of the delayed adoption (P < 0.001). EP was achieved in 14 limbs (7.0%). Multivariate analysis revealed that occlusion length (adjusted odds ratio [OR], 0.89; 95% CI, 0.81-0.96; P = 0.004) and SIA (OR, 8.71; 95% CI, 1.32-175.27; P = 0.02) were associated with EP. CONCLUSIONS SIA contributed to EP. The timing of the retrograde approach was crucial because its delay resulted in an excessive procedure time.
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Affiliation(s)
- Yutaka Tadano
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
| | - Jun-Ichi Kotani
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Takuya Haraguchi
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | | | - Takuro Sugie
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
| | - Umihiko Kaneko
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
| | - Ken Kobayashi
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
| | - Daitaro Kanno
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
| | | | - Tsutomu Fujita
- Asia Medical Group, Sapporo Cardio Vascular Clinic, Sapporo, Japan
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Hayakawa N, Kodera S, Arakawa M, Kanda J. Successful re-entry using the outback® elite catheter via retrograde popliteal access with IVUS guidance for femoropopliteal occlusion: a case report. CVIR Endovasc 2020; 3:63. [PMID: 32889663 PMCID: PMC7474728 DOI: 10.1186/s42155-020-00156-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 11/27/2022] Open
Abstract
Background There are still cases that are difficult to treat for femoropopliteal chronic total occlusion (CTO). The Outback® Elite catheter is effective re-entry device to treat such kind of difficult cases, however, it might be difficult to use the Outback® Elite catheter antegradely in cases with severely calcified lesions. In this case, we performed EVT using the Outback Elite® catheter via the retrograde popliteal approach. Case presentation We report a case of a 77-year-old male with end-stage renal disease who presented with pain and cyanosis of his left foot. Control angiography showed total occlusion from the middle of the left superficial femoral artery to the proximal portion of the popliteal artery. The CTO lesion was severely calcified, which prevented the antegrade advancement of any guidewire. Retrograde popliteal puncture was performed with the patient in the supine position. After intentional retrograde subintimal wiring, the Outback® Elite catheter was advanced via the retrograde approach after the identification of a suitable re-entry site using intravascular ultrasound. After wire crossing, one nitinol stent was deployed and sufficient antegrade flow was achieved without any complications. Conclusions Using Outback® Elite from retrograde should be considered in cases where antegrade advancement fails and bidirectional wiring cannot pass through the CTO lesion.
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Affiliation(s)
- Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan.
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan
| | - Masataka Arakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
| | - Junji Kanda
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan
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Tsubakimoto Y, Isodono K, Fujimoto T, Kirii Y, Shiraga A, Kasahara T, Ariyoshi M, Irie D, Sakatani T, Matsuo A, Inoue K, Fujita H. IVUS-Guided Wiring Improves the Clinical Outcomes of Angioplasty for Long Femoropopliteal CTO Compared with the Conventional Intraluminal Approach. J Atheroscler Thromb 2020; 28:365-374. [PMID: 32669483 PMCID: PMC8147569 DOI: 10.5551/jat.57166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIMS This study aimed to assess the clinical efficacy of intravascular ultrasound (IVUS)-guided intraplaque wiring for femoropopliteal (FP) chronic total occlusion (CTO). METHODS This single-center, retrospective, observational study was performed at the Japanese Red Cross Kyoto Daini Hospital. From March 2013 to June 2017, a total of 75 consecutive patients (mean age: 75.4±8.5 years; 59 males), who underwent endovascular treatment (EVT), having 82 de novo FP-CTO lesions, were enrolled in this study. Eleven of the lesions that met the exclusion criteria were excluded, and the remaining 71 lesions were divided into the IVUS-guided wiring group (n=34) and non-IVUS-guided wiring group (n=37). Primary patency, defined as a peak systolic velocity ratio of <2.4 on duplex ultrasonography, and freedom from clinically driven target lesion revascularization (CD-TLR) at 12 months were the primary outcomes. RESULTS The mean lesion length was 21.6±8.9 cm. The frequencies of primary patency and freedom from CD-TLR were significantly higher in the IVUS-guided wiring group than in the non-IVUS-guided wiring group (70.0% vs. 52.2%, p=0.045; 83.9% vs. 62.8%, p=0.036, respectively). The complete clinically true lumen angioplasty rate was also higher in the IVUS-guided wiring group than in the non-IVUS-guided wiring group (91.1% vs. 51.3%, p<0.001, respectively). The clinically true and false wire passage rates were respectively 97.3% and 2.7% in the IVUS-guided wiring group. CONCLUSION IVUS-guided wiring improves the clinical outcomes of EVT for FP-CTO by achieving a high clinically true lumen wire passage rate.
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Affiliation(s)
| | - Koji Isodono
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital
| | | | - Yosuke Kirii
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital
| | - Akiko Shiraga
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital
| | - Takeru Kasahara
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital
| | - Makoto Ariyoshi
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital
| | - Daisuke Irie
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital
| | | | - Akiko Matsuo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital
| | - Keiji Inoue
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital
| | - Hiroshi Fujita
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital
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Tepe G, Micari A, Keirse K, Zeller T, Scheinert D, Li P, Schmahl R, Jaff MR. Drug-Coated Balloon Treatment for Femoropopliteal Artery Disease: The Chronic Total Occlusion Cohort in the IN.PACT Global Study. JACC Cardiovasc Interv 2020; 12:484-493. [PMID: 30846089 DOI: 10.1016/j.jcin.2018.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/15/2018] [Accepted: 12/04/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study evaluated the 12-month safety and effectiveness of a paclitaxel drug-coated balloon for treatment of intermittent claudication or rest pain in subjects with femoropopliteal chronic total occlusions (CTO). BACKGROUND CTOs are difficult to treat, and the optimal intervention remains to be determined. METHODS The IN.PACT Global Study is an international single-arm study that enrolled 1,535 patients with symptomatic femoropopliteal artery disease. The study contains prospectively defined cohorts with prospectively planned imaging analyses, including a CTO (≥5 cm) cohort in which subjects underwent duplex ultrasonography analyzed by an independent core laboratory. The primary safety endpoint was a composite of freedom from device- and procedure-related mortality through 30 days, and freedom from major target limb amputation and target vessel revascularization through 12 months. An independent Clinical Events Committee adjudicated all adverse events. The primary effectiveness endpoint was primary patency at 12 months, defined as freedom from clinically driven target lesion revascularization and freedom from restenosis. RESULTS The CTO imaging cohort had 126 subjects with 127 lesions (mean lesion length 22.83 ± 9.76 cm). Primary patency by Kaplan-Meier estimate was 85.3% through 12 months. Provisional stenting was performed in 46.8% of lesions. The primary safety composite endpoint was achieved by 88.7% of subjects. There were no device- or procedure-related deaths through 30 days or major target limb amputations through 12 months. CONCLUSIONS The paclitaxel drug-coated balloon was safe and highly effective at 12 months after treatment of subjects with CTO ≥5 cm in the femoropopliteal arteries. (IN.PACT Global Clinical Study; NCT01609296).
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Affiliation(s)
- Gunnar Tepe
- Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany.
| | - Antonio Micari
- Department of Cardiology, Humanitas Gavazzeni, Bergamo, Italy
| | - Koen Keirse
- Department of Vascular Surgery, Regional Hospital Heilig Hart Tienen, Tienen, Belgium
| | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Dierk Scheinert
- Division of Interventional Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Pei Li
- Medtronic, Minneapolis, Minnesota
| | - Randy Schmahl
- Bakken Research Center, Medtronic, Maastricht, the Netherlands
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Zheng H, Li L, Xu C, Liu H, Wang S, Tang X, Zhang Z, Weng W, Ku Y, Wang G, Ding H, Chen Z. A Quantitative Method for Prediction of True Lumen Recanalization in Chronic Total Occlusion of the Superficial Femoral Artery. Ann Vasc Surg 2020; 77:101-108. [PMID: 32339694 DOI: 10.1016/j.avsg.2020.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to examine a quantitative method for evaluating calcification in failure in recanalization (FR) in endovascular treatment of superficial femoral artery (SFA) chronic total occlusion, and to investigate the possibility of using a formula to predict the incidence of true lumen recanalization (TR) in such cases. METHODS Patients who met the inclusion criteria were retrospectively analyzed in our center from January 2012 to September 2017. A Calcification Lesion Analyzing and Scoring System (CLASS) was established to quantify the characteristics of calcification in SFA computed tomography slices, which were ranked as grade 1-4 and class A-E. Corresponding scores were obtained, and the Cumulative Calcification Score (CCSO) of occlusive SFA was calculated on the basis of CLASS. The factors correlating to FR and the formula for predicting TR were evaluated. RESULTS A total of 215 patients were included in this study. There were 150 cases of TR and 65 cases of subintimal recanalization; 12 (5.6%) cases had FR. The maximum CLASS of occlusion was correlated with FR. Not only the formula including Trans-Atlantic Inter-Society Consensus II grade and CCSO but also the formula including occlusion length and CCSO predicted the incidence of TR well. CONCLUSIONS The degree of the most severe calcification in occlusive lesions clearly affects success in recanalization. Two quantitative formulas that combine occlusion length or Trans-Atlantic Inter-Society Consensus II grade with CCSO can predict TR in endovascular treatment of SFA lesions with chronic total occlusion.
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Affiliation(s)
- Huanqin Zheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Li
- The First Hospital of Tsinghua University, Beijing, China
| | - Chuang Xu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Sheng Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaobin Tang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zheng Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenhai Weng
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yijie Ku
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Guangzhi Wang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Hui Ding
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Zhong Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Kokkinidis DG, Katsaros I, Jonnalagadda AK, Avner SJ, Chaitidis N, Bakoyiannis C, Kakkar A, Secemsky EA, Giri JS, Armstrong EJ. Use, Safety and Effectiveness of Subintimal Angioplasty and Re-Entry Devices for the Treatment of Femoropopliteal Chronic Total Occlusions: A Systematic Review of 87 Studies and 4,665 Patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:34-45. [DOI: 10.1016/j.carrev.2019.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
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Ichihashi S, Shibata T, Fujimura N, Nagatomi S, Yamamoto H, Kyuragi R, Adachi A, Iwakoshi S, Bolstad F, Saeki K, Obayashi K, Kichikawa K. Vessel Calcification as a Risk Factor for In-Stent Restenosis in Complex Femoropopliteal Lesions After Zilver PTX Paclitaxel-Coated Stent Placement. J Endovasc Ther 2019; 26:613-620. [DOI: 10.1177/1526602819860124] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: To evaluate the effect of vessel calcification on in-stent restenosis (ISR) after drug-coated stent (DCS) placement in the femoropopliteal segment. Materials and Methods: A retrospective multicenter study was undertaken involving 220 consecutive symptomatic patients (mean age 73.1±8.3 years; 175 men) with femoropopliteal lesions in 230 limbs treated with the Zilver PTX DCS and having duplex surveillance after the endovascular procedures. Mean lesion length was 16.4±9.8 cm (range 2–40); there were 104 (45.2%) total occlusions and 68 (29.6%) in-stent restenoses (ISR). Twenty (8.7%) vessels had no runoff. The majority of lesions (148, 64.3%) were calcified according to the peripheral arterial calcium scoring system (PACSS). Primary patency was evaluated by duplex. Lesions were classified as either PACSS 0–2 (none or unilateral wall calcification) or PACSS 3 and 4 (bilateral wall calcification). Multivariate analysis was performed to identify variables associated with ISR; the results are given as the hazard ratio (HR) and 95% confidence interval (CI). Results: The 1-, 2-, and 5-year primary patency and freedom from clinically-driven target lesion revascularization estimates were 75.9%, 63.6%, and 45.0%, and 84.7%, 73.7%, and 54.2%, respectively. Major amputations were performed on 4 limbs during follow-up. In multivariate analysis, vessel calcification (adjusted HR 1.718, 95% CI 1.035 to 2.851, p=0.036) was significantly correlated with the occurrence of ISR, along with lesion length (adjusted HR 1.041, 95% CI 1.013 to 1.070, p=0.003), and cilostazol administration (adjusted HR 0.476, 95% CI 0.259 to 0.876, p=0.017). Conclusion: This study suggested that bilateral vessel wall calcification was an independent risk factor for ISR in complex femoropopliteal lesions after Zilver PTX DCS placement, along with lesion length; cilostazol administration had a protective effect.
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Affiliation(s)
- Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Hakodate Municipal Hospital, Hakodate, Japan
| | - Naoki Fujimura
- Division of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Satoru Nagatomi
- Department of Radiology, Nara Medical University, Kashihara, Japan
- Department of Radiology, Sumitomo Hospital, Osaka, Japan
| | | | - Ryoichi Kyuragi
- Division of Vascular Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Akira Adachi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | | | - Francesco Bolstad
- Department of Clinical English, Nara Medical University, Kashihara, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University, Kashihara, Japan
| | - Kenji Obayashi
- Department of Epidemiology, Nara Medical University, Kashihara, Japan
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Krankenberg H. In Front of Locked Doors-Femoropopliteal Chronic Occlusions: Is Drug-Coated Balloon Angioplasty With Provisional Stenting the Matching Key? JACC Cardiovasc Interv 2019; 12:494-496. [PMID: 30846090 DOI: 10.1016/j.jcin.2018.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 12/26/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Hans Krankenberg
- Vascular Medicine Center, Department of Angiology, Asklepios Klinikum Harburg, Hamburg, Germany.
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Lindquist J, Schramm K. Drug-Eluting Balloons and Drug-Eluting Stents in the Treatment of Peripheral Vascular Disease. Semin Intervent Radiol 2019; 35:443-452. [PMID: 30728660 DOI: 10.1055/s-0038-1676360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In the last 20 years, peripheral artery disease (PAD) has been increasingly recognized as a significant cause of morbidity and mortality in the United States. The endovascular treatment of PAD has seen a marked rise as minimally invasive techniques and devices have been refined. Two newer devices, drug-eluting stents and drug-eluting balloons, are on the forefront of the battle against limb loss from PAD. This review focuses on the data backing the use of drug-eluting technologies for use in the peripheral arterial system.
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Affiliation(s)
- Jonathan Lindquist
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Aurora, Colorado
| | - Kristofer Schramm
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Aurora, Colorado
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Silvestro M, Palena LM, Manzi M, Gómez-Jabalera E, Vishwanath D, Casini A, Ferraresi R. Anterolateral retrograde access to the distal popliteal artery and to the tibioperoneal trunk for recanalization of femoropopliteal chronic total occlusions. J Vasc Surg 2018; 68:1824-1832. [DOI: 10.1016/j.jvs.2018.05.231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022]
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18
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Soga Y, Nakamura M, Hirose K, Ito N, Tomoi Y, Hiramori S, Ando K. Primary Use of the TruePath Crossing Device for Infrainguinal Chronic Total Occlusions With Intravascular Ultrasound Evaluation. J Endovasc Ther 2018; 25:592-598. [PMID: 30117364 DOI: 10.1177/1526602818793901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the use of the TruePath crossing device as the primary recanalization tool for infrainguinal chronic total occlusions (CTO). METHODS A retrospective analysis was conducted of 50 patients (mean age 75 years; 26 men) with 55 infrainguinal CTOs treated with the TruePath between March 2017 and September 2017 at a single center. The mean occlusion length was 138±55 mm, and femoropopliteal lesions accounted for 65% of the 55 lesions. The primary outcome measure was CTO crossing using the TruePath alone; secondary outcomes were assisted success (>50% lumen gain using the TruePath), device-related complications, and intraluminal crossing evaluated by intravascular ultrasound (IVUS). RESULTS Complete success was achieved in 33 (60%) of 55 lesions having a mean occlusion length of 145±72 mm. Among these, the true lumen crossing rate was 97% according to IVUS evaluation. Assisted success was achieved in 15 (68%) of the 22 failures. Complete/assisted success, in which the TruePath was thought to have contributed to CTO crossing, was attained in 48 (87%) of the 55 lesions. Three (5.5%) complications were observed: a perforation, an access-site hematoma, and acute occlusion; only the perforation was device related (1.8%). Multivariate analysis showed PACCS grade 4 (odds ratio 4.5, 95% confidence interval 1.33 to 15.5, p=0.02) was an independent predictor of TruePath failure. CONCLUSION Primary use of the TruePath crossing device for infrainguinal CTOs demonstrated a satisfactory complete success rate and a high rate of IVUS-documented intraluminal crossing with few device-related complications. Severe calcification is an independent predictor of TruePath failure.
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Affiliation(s)
- Yoshimitsu Soga
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Miho Nakamura
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kaoru Hirose
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Nobuhiro Ito
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yusuke Tomoi
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Seiichi Hiramori
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Ko YG. SFA Intervention: Intraluminal or Subintimal? Korean Circ J 2018; 48:685-691. [PMID: 30073806 PMCID: PMC6072663 DOI: 10.4070/kcj.2018.0216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 11/21/2022] Open
Abstract
Subintimal angioplasty (SA) is an endovascular technique to recanalize an occluded arterial segment through an extraluminal channel between the intima and media. Since its introduction in 1989, the technical success rate has improved with the accumulation of procedural experience and the development of retrograde approaches and re-entry devices. To date, no randomized trial has compared SA with intraluminal angioplasty (IA) for chronic total occlusion (CTO) of the superficial femoral artery (SFA). Based on limited data from several registry studies, SA appears to achieve a higher technical success rate than IA, whereas mid-term primary patency rates are comparable for both endovascular wiring strategies for SFA CTO. Additional clinical data are needed to confirm that SA is as effective as IA. The optimal stenting strategy and role of drug-eluting technologies also need to be defined to improve SA outcomes.
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Affiliation(s)
- Young Guk Ko
- Division of Cardiology and Cardiovascular Research Institute, Severance, Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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20
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Kondapalli A, Jeon-Slaughter H, Lu H, Xu H, Khalili H, Prasad A, Armstrong EJ, Brilakis ES, Banerjee S. Comparative assessment of patient outcomes with intraluminal or subintimal crossing of infrainguinal peripheral artery chronic total occlusions. Vasc Med 2017; 23:39-45. [DOI: 10.1177/1358863x17735192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study compares procedural complications and clinical outcomes between subintimal crossing versus intraluminal crossing during endovascular treatment of infrainguinal peripheral artery chronic total occlusions (CTO). We identified 1335 CTO interventions in 1001 patients from the multicenter Excellence in Peripheral Artery Disease (XLPAD) registry from January 2005 to October 2015. Outcomes included 30-day and 12-month all-cause death, non-fatal myocardial infarction or stroke, peripheral artery stent, or vessel, thrombosis (ST), need for any target limb endovascular or surgical revascularization, target limb major amputation and procedural complications. A subintimal crossing technique was necessary in 388 lesions (27% overall in 1335 lesions; 34% ( n=351) in 1023 femoropopliteal lesions, and 12% ( n=37) in 312 infrapopliteal lesions, p<0.01) with a lower procedural ( p<0.01) and technical ( p<0.01) success than the intraluminal in both femoropopliteal and infrapopliteal interventions. There were no significant differences in procedural complications, major adverse cardiac events, or clinically driven target limb revascularization at 1 year between the two groups, except a higher residual dissection rate in the subintimal crossing group than the intraluminal group in femoropopliteal target vessels ( p = 0.04).
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Affiliation(s)
- Ananya Kondapalli
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Haekyung Jeon-Slaughter
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- VA North Texas Healthcare System, Dallas, TX, USA
| | - Hua Lu
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hao Xu
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Houman Khalili
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- VA North Texas Healthcare System, Dallas, TX, USA
| | - Anand Prasad
- Department of Cardiology, University of Texas Health Science Center at San Antonio, TX, USA
| | | | - Emmanouil S Brilakis
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Center for Advanced Coronary Interventions at the Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Subhash Banerjee
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- VA North Texas Healthcare System, Dallas, TX, USA
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Cannavale A, Ali T, Shen CY, Kassimis G, Krokidis M. Recanalization of peripheral chronic total occlusions: 'no fancy devices, just a crossing catheter'. Expert Rev Cardiovasc Ther 2017; 15:221-225. [PMID: 28256175 DOI: 10.1080/14779072.2017.1297229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic total occlusions (CTOs) are challenging to treat endovascularly. Classic subintimal approach is offering only moderate success rates mainly due of the lack of dedicated crossing catheters. Purpose of this study is to assess the acute procedural success of the use of a novel hydrophilic crossing catheter in the recanalization of peripheral CTOs. MATERIALS AND METHODS This is a retrospective, single-centre study of patients with femoropopliteal CTOs. Revascularization was performed with the use of the NaviCross®- crossing catheter (Terumo Europe). Technical, procedural success and complications were assessed. RESULTS Thirty-two patients were included in the study. Mean age was 65.9 (46-85) years; Critical limb ischemia was the indication for the procedure in 26 (81%). Target vessels included 12 superficial femoral arteries, 9 popliteal, and 11 femoropopliteal segment lesions. Mean length was 85 (50-350) mm; 21(65.6%) lesions were heavily calcified. In all cases a sub-intimal approach was used; in 21 cases the procedure was performed as a day case. Technical success was achieved in 31 (96.8%) cases. Recanalization was achieved with a guidewire in 22 (71%) lesions and with the catheter alone in 9 (29%) cases. Procedural success was achieved in all lesions. No major adverse events occurred. CONCLUSION The use of the NaviCross®- crossing catheter showed high rate of technical and procedural success in challenging femoropopliteal CTOs without significant complications. The use of this catheter needs to be considered as the first approach for CTOs prior to the use of any other more complex re-entry device.
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Affiliation(s)
- Alessandro Cannavale
- a Department of Radiology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Tariq Ali
- a Department of Radiology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Chen-Yang Shen
- b Department of Peripheral Vascular Surgery , Fuwai Hospital, National Center for Cardiovascular Diseases , Beijing , China
| | - George Kassimis
- c Department of Cardiology , Gloucestershire Hospitals NHS Foundation Trust , Cheltenham , UK
| | - Miltiadis Krokidis
- a Department of Radiology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
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