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Takase Y, Tanaka T, Anai S, Kyaw MP, Michiwaki Y, Itokawa H, Yamane F, Abe T, Matsuno A. Usefulness of non-slip element percutaneous transluminal angioplasty scoring balloons in treating severe calcified lesions of the carotid artery for carotid artery stenting: A case report. Surg Neurol Int 2024; 15:91. [PMID: 38628518 PMCID: PMC11021079 DOI: 10.25259/sni_923_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/21/2024] [Indexed: 04/19/2024] Open
Abstract
Background Treatment of calcified lesions with conventional angioplasty balloons can be difficult due to insufficient lumen expansion, high dissection rates, and repeated revascularization. We report a case in which a scoring balloon was used in lesions resistant to angioplasty with a semi-compliant balloon. Case Description A 72-year-old man presented with severe stenosis and a highly calcified lesion in the right cervical internal carotid artery. Right carotid artery stenting (CAS) was planned to prevent future ischemic stroke events. Conventional semi-compliant balloon angioplasty was unsuccessful. Three inflations of a non-slip element (NSE) percutaneous transluminal angioplasty (PTA) scoring balloon (Nipro, Osaka, Japan) successfully achieved CAS without complications. Conclusion This is the first report to describe the use of this scoring balloon in de novo carotid artery disease. NSE PTA scoring balloon catheters can be a useful option for refractory, highly calcified stenosis.
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Affiliation(s)
- Yukinori Takase
- Department of Neurosurgery, Kouhoukai Takagi Hospital, Fukuoka, Japan
| | - Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita City, Chiba, Japan
| | - Satoshi Anai
- Department of Neurosurgery, Kouhoukai Takagi Hospital, Fukuoka, Japan
| | - May Pyae Kyaw
- Department of Neurosurgery, Kouhoukai Takagi Hospital, Fukuoka, Japan
| | - Yuhei Michiwaki
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita City, Chiba, Japan
| | - Hiroshi Itokawa
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita City, Chiba, Japan
| | - Fumitaka Yamane
- Department of Neurosurgery, International University of Health and Welfare, Narita, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Akira Matsuno
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita City, Chiba, Japan
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Mosarla RC, Armstrong E, Bitton-Faiwiszewski Y, Schneider PA, Secemsky EA. State-of-the-Art Endovascular Therapies for the Femoropopliteal Segment: Are We There Yet? JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1. [PMID: 36268042 PMCID: PMC9581461 DOI: 10.1016/j.jscai.2022.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Peripheral arterial disease is an increasingly prevalent condition with significant associated morbidity, mortality, and health care expenditure. Endovascular interventions are appropriate for most patients with either ongoing symptoms of intermittent claudication despite lifestyle and medical optimization or chronic limb-threatening ischemia. The femoropopliteal segment is the most common arterial culprit responsible for claudication and the most commonly revascularized segment. Endovascular approaches to revascularization of the femoropopliteal segment are advancing with an evolving landscape of techniques for arterial access, device-based therapies, vessel preparation, and intraprocedural imaging. These advances have been marked by debate and controversy, notably related to the safety of paclitaxel-based devices and necessity of atherectomy. In this review, we provide a critical overview of the current evidence, practice patterns, emerging evidence, and technological advances for endovascular intervention of the femoropopliteal arterial segment.
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Affiliation(s)
| | - Ehrin Armstrong
- Adventist Heart and Vascular Institute, St Helena, California
| | | | | | - Eric A. Secemsky
- Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Corresponding author: (E.A. Secemsky)
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Kim M, Cho SB. [Interventional Treatments for Femoropopliteal Arterial Disease and Recent Updates]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:527-540. [PMID: 36238772 PMCID: PMC9432457 DOI: 10.3348/jksr.2021.0057] [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: 04/02/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
Peripheral arterial occlusive disease (PAOD) of the femoropopliteal artery is commonly caused by atherosclerosis. It can present with varying clinical symptoms depending on the degree of disease, ranging from intermittent claudication to critical limb ischemia and tissue loss. Therefore, appropriate and timely treatment is required to improve symptoms and salvage the affected limbs. Interventional approaches for femoropopliteal arterial disease commonly include percutaneous transluminal angioplasty, atherectomy, and stent placement. Over the years, endovascular recanalization has been widely performed for treating PAOD due to continuous developments in its techniques and availability of dedicated devices with the inherent advantage of being minimal invasive. In this review, we introduce various types of endovascular treatment methods, discuss the results of clinical research from existing literature, and illustrate the treatment procedures using representative images.
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Horie K, Tanaka A, Taguri M, Inoue N. Impact of Scoring Balloons on Percutaneous Transluminal Angioplasty Outcomes in Femoropopliteal Lesions. J Endovasc Ther 2020; 27:481-491. [DOI: 10.1177/1526602820914618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: To investigate the efficacy of scoring balloons for immediate success of percutaneous transluminal angioplasty (PTA) in femoropopliteal lesions. Materials and Methods: Between 2013 and 2019, 398 consecutive patients with de novo femoropopliteal lesions were treated using PTA in our hospital. The procedure success rate was compared among patients undergoing PTA with vs without scoring balloons after 1:1 propensity score matching on hemodialysis, TransAtlantic Inter-Society Consensus II classification, Peripheral Arterial Calcium Scoring System (PACSS) grade, lesion length, and use of intravascular ultrasound. Propensity matching produced 84 patients (mean age 73.4±8.3; 65 men) treated with scoring balloons and 84 patients (mean age 75.6±8.7; 56 men) treated with plain balloons. Kaplan-Meier analysis investigated patency after the procedure in both groups; estimates are given with the 95% confidence interval (CI). Results: Residual stenosis <30% was achieved more often (77.4% vs 57.1%, p=0.005) and severe arterial dissection occurred less frequently (16.7% vs 29.8%, p=0.043) in the scoring balloon group vs the plain balloon group, respectively. The rate of provisional stenting was significantly lower after scoring balloon use (13.3% vs 29.8%, p=0.008). Multivariable analysis revealed that use of scoring balloons (p<0.001) and prolonged inflation time (p<0.001) were independent predictors of successful angioplasty, whereas chronic total occlusion (p=0.005) and longer lesion length (p=0.005) were predictors of an unsuccessful procedure. Among 108 patients with PACSS 0–3 lesions in the matched population, Kaplan-Meier analysis showed better primary patency at 18 months in the scoring balloon group in the intention to treat analysis [68.6% (95% CI 53.5% to 80.6%) vs 43.0% (95% CI 28.7% to 58.5%), p=0.044]. Conclusion: Scoring balloons may be effective in restoring acute lumen gain and preventing severe arterial dissection in femoropopliteal lesions. Moreover, scoring balloons might be associated with better primary patency at 18 months in PACSS 0–3 lesions.
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Affiliation(s)
- Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Akiko Tanaka
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Masataka Taguri
- School of Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Naoto Inoue
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan
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Karashima E, Yoda S, Yasuda S, Kajiyama S, Ito H, Kaneko T. Usefulness of the “Non-Slip Element” Percutaneous Transluminal Angioplasty Balloon in the Treatment of Femoropopliteal Arterial Lesions. J Endovasc Ther 2019; 27:102-108. [DOI: 10.1177/1526602819887954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate a new scoring balloon, the non-slip element (NSE) percutaneous transluminal angioplasty (PTA) balloon, in the treatment of femoropopliteal lesions by comparing angiographic dissection patterns to those of a conventional balloon. Methods: This retrospective, single-center study included 71 symptomatic patients (mean age 77.4±8.8 years; 33 men) with de novo femoropopliteal lesions <20 cm long treated with balloon angioplasty between January 2017 and May 2018. Thirty-four patients were treated with 3 inflations of an NSE balloon and 37 patients were treated with a conventional balloon. Results: Severe dissections were fewer (8.8% vs 29.7%, p=0.027) and the total dissection length was shorter (11.5±12.8 vs 35.7±24.1 mm, p=0.027) in the NSE group. The bailout stenting rate was also lower in the NSE group (17.6% vs 40.5%, p=0.035). There were no significant differences between the groups regarding lesion length (70.3±50.4 vs 77.8±56.6 mm, p=0.28), inflation time (294±162 vs 353±179 seconds, p=0.08), or inflation pressure (10.6±5.0 vs 11.3±5.3 atm, p=0.31). Conclusion: Three NSE balloon inflations may reduce severe dissections induced by balloon angioplasty in femoropopliteal lesions.
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Affiliation(s)
- Eiji Karashima
- Department of Internal Medicine, Division of Cardiology, Shimonoseki City Hospital, Yamaguchi, Japan
| | - Shunsuke Yoda
- Department of Internal Medicine, Division of Cardiology, Shimonoseki City Hospital, Yamaguchi, Japan
| | - Shioto Yasuda
- Department of Internal Medicine, Division of Cardiology, Shimonoseki City Hospital, Yamaguchi, Japan
| | - Shota Kajiyama
- Department of Internal Medicine, Division of Cardiology, Shimonoseki City Hospital, Yamaguchi, Japan
| | - Hiroyuki Ito
- Munakata Medical Association Hospital, Fukuoka, Japan
| | - Takeo Kaneko
- Department of Internal Medicine, Division of Cardiology, Shimonoseki City Hospital, Yamaguchi, Japan
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Zeller T, Lopez L, Pigott JP. Acute Outcomes With a Novel Plaque Modification System in Real-World Femoropopliteal Lesions. J Endovasc Ther 2019; 26:333-341. [DOI: 10.1177/1526602819849955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose: To report outcomes of a multicenter feasibility study using the FLEX Vessel Prep (VP) System, a novel technology that facilitates plaque incision and lumen gain in stenosed or occluded femoropopliteal arteries prior to balloon angioplasty. Materials and Methods: Two hundred fifty-five patients (mean age 71.8±9.1 years) were treated with the FLEX VP System at 38 centers between December 2015 and November 2017. Average lesion length was 133±88 mm. Average baseline stenosis was 92%±11%; 112 (44.3%) of 253 patients presented with a chronic total occlusion. Conventional or drug-coated balloon (DCB) angioplasty was performed in all patients after vessel preparation. Vessel measurements were derived from angiograms acquired at baseline, after FLEX passage, and after subsequent ancillary procedures. Logistic regression analyses were performed to identify baseline or procedure variables that predicted the need for provisional stenting. Results: Average percent reduction in vessel stenosis following treatment with the FLEX VP System was 27%±17%. No flow-limiting dissection, vessel perforation, or embolization was observed; 15 (5.9%) patients had minor (type A or B) dissections. Provisional stenting was performed in 49 (19.2%) patients. Average stenosis following angioplasty ± stenting was 9.1%±7.4%; 9 (3.6%) patients had significant residual stenosis ≥30%. Logistic regression analyses found that patients with dissections, longer lesions, and those receiving conventional balloon dilation alone were most likely to undergo stenting. Conclusion: In a real-world patient population with long, complex femoropopliteal lesions, use of the FLEX VP System as vessel preparation for angioplasty improved acute outcomes compared to historical controls. The rate of provisional stenting was low, and no serious vessel complications were observed.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
| | - Louis Lopez
- Allen County Cardiology, Saint Joseph Hospital, Fort Wayne, IN, USA
| | - John P. Pigott
- Jobst Vascular Institute, Promedica Healthcare Systems, Toledo, OH, USA
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Shimada Y, Kino N, Tonomura D, Yamanaka Y, Nishiura S, Yano K, Ito K, Yoshida M, Tsuchida T, Fukumoto H. Efficacy of Cutting Balloon Angioplasty for Chronic Total Occlusion of Femoropopliteal Arteries. Ann Vasc Surg 2019; 58:91-100. [PMID: 30769058 DOI: 10.1016/j.avsg.2018.10.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/27/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) of femoropopliteal artery (FP) continues to be a lesion subset where maintaining long-term patency after endovascular treatment is challenging. We evaluated the efficacy of cutting balloon angioplasty (CBA) for de novo FP-CTOs in patients with symptomatic lower limb ischemia. METHODS Seventy-three limbs of 67 symptomatic patients with de novo FP-CTOs successfully recanalized using CBA alone were enrolled in this study. Primary patency was defined as the absence of recurrent symptoms and no deterioration of the ankle-brachial index (ABI) >0.10 from the immediate postinterventional value. RESULTS The mean age was 73.5 ± 7.3 years, and 59.7% of patients had diabetes mellitus. Most lesions were classified as Trans-Atlantic Inter-Society Consensus II type C (n = 18; 24.7%) or type D (n = 44; 60.3%), with mean lesion and occluded lengths of 24.8 ± 11.4 and 17.8 ± 11.2 cm, respectively. No procedure-related adverse events occurred, except one distal embolization. The ABI significantly increased after intervention from 0.52 ± 0.12 to 0.80 ± 0.15 (P < 0.0001), with marked improvement in clinical symptoms (Rutherford stage: 2.7 ± 1.0 to 1.1 ± 1.2, P < 0.0001). The mean follow-up period was 31.2 ± 18.0 months, and the primary patency rates at 12 and 24 months were 75.3% and 60.6%, respectively. The independent predictive factors of failed patency were baseline hemoglobin A1c (P = 0.031, hazard radio [HR] 1.51 per 1%), occluded length ≥15 cm (P = 0.036, HR 2.90), and severe dissection (P = 0.033, HR 2.85). Vessel calcification and diameter did not affect primary patency. CONCLUSIONS CBA is a feasible option for endovascular treatment of FP-CTOs. Diabetic status, occlusion length, and severe dissection after CBA are independent negative predictors of long-term patency.
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Affiliation(s)
- Yoshihisa Shimada
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan.
| | - Naoto Kino
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Daisuke Tonomura
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Yuki Yamanaka
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Satoshi Nishiura
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Kentaro Yano
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Kazato Ito
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Masataka Yoshida
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Takao Tsuchida
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| | - Hitoshi Fukumoto
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
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Baumhäkel M, Chkhetia S, Kindermann M. Treatment of femoro-popliteal lesions with scoring and drug-coated balloon angioplasty: 12-month results of the DCB-Trak registry. ACTA ACUST UNITED AC 2018; 24:153-157. [PMID: 29770768 DOI: 10.5152/dir.2018.17466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Debulking strategies prior to drug-coated balloon (DCB) angioplasty were suggested to improve clinical results in femoro-popliteal lesions. Currently, there are no data regarding plaque modification with a scoring balloon with subsequent DCB-angioplasty. Recently published 6-month results of the DCB-Trak registry in patients treated with scoring-balloon angioplasty and DCB-angioplasty were promising without any safety concerns. Herein, we report the 12-month follow-up data. METHODS In a single center registry, 29 consecutive patients with 32 femoro-popliteal lesions were treated with a scoring-balloon (VascuTrak®) and a DCB subsequently. The primary endpoint was the clinically driven target lesion revascularization (TLR). Secondary endpoints were clinically driven target vessel revascularization (TVR), binary restenosis (peak systolic velocity ratio > 2.4), change in Rutherford classification and ankle-brachial-index (ABI). Safety endpoints were major cardiovascular events (cardiovascular death, myocardial infarction, stroke, death) and need for amputation. RESULTS The procedure was successful in 29 lesions. There were no clinically driven TLRs after 12 months. Two patients required clinically driven TVR and one patient had a binary restenosis. ABI significantly increased after the procedure (0.87±0.24 to 1.04±0.18, P < 0.01) without a relevant change after 6 months (1.01±0.15, P < 0.05) or 12 months (1.01±0.20, P < 0.05). Rutherford classification improved in more than 90% of patients after 6 and 12 months. There was one major cardiovascular event at 6-month follow-up, but no amputations at 6- or 12-month follow-up. CONCLUSION Vessel preparation with a scoring-balloon and subsequent DCB-angioplasty was safe and effective in patients with femoro-popliteal lesions. Further multicenter trials have to validate these results.
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Affiliation(s)
- Magnus Baumhäkel
- Department of Interventional Cardiology/ Angiology), CaritasKlinikum St. Theresia Saarbrücken Klinik, Saarbrücken, Germany
| | - Shalva Chkhetia
- Department of Interventional Cardiology/ Angiology), CaritasKlinikum St. Theresia Saarbrücken Klinik, Saarbrücken, Germany
| | - Michael Kindermann
- Department of Interventional Cardiology/ Angiology, CaritasKlinikum St. Theresia Saarbrücken Klinik, Saarbrücken, Germany
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Feldman DN, Armstrong EJ, Aronow HD, Gigliotti OS, Jaff MR, Klein AJ, Parikh SA, Prasad A, Rosenfield K, Shishehbor MH, Swaminathan RV, White CJ. SCAI consensus guidelines for device selection in femoral-popliteal arterial interventions. Catheter Cardiovasc Interv 2018; 92:124-140. [DOI: 10.1002/ccd.27635] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Herbert D. Aronow
- The Warren Alpert Medical School of Brown University; Providence Rhode Island
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The influence of composition and location on the toughness of human atherosclerotic femoral plaque tissue. Acta Biomater 2016; 31:264-275. [PMID: 26675125 DOI: 10.1016/j.actbio.2015.11.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/18/2015] [Accepted: 11/29/2015] [Indexed: 11/23/2022]
Abstract
The toughness of femoral atherosclerotic tissue is of pivotal importance to understanding the mechanism of luminal expansion during cutting balloon angioplasty (CBA) in the peripheral vessels. Furthermore, the ability to relate this parameter to plaque composition, pathological inclusions and location within the femoral vessels would allow for the improvement of existing CBA technology and for the stratification of patient treatment based on the predicted fracture response of the plaque tissue to CBA. Such information may lead to a reduction in clinically observed complications, an improvement in trial results and an increased adoption of the CBA technique to reduce vessel trauma and further endovascular treatment uptake. This study characterises the toughness of atherosclerotic plaque extracted from the femoral arteries of ten patients using a lubricated guillotine cutting test to determine the critical energy release rate. This information is related to the location that the plaque section was removed from within the femoral vessels and the composition of the plaque tissue, determined using Fourier Transform InfraRed spectroscopy, to establish the influence of location and composition on the toughness of the plaque tissue. Scanning electron microscopy (SEM) is employed to examine the fracture surfaces of the sections to determine the contribution of tissue morphology to toughness. Toughness results exhibit large inter and intra patient and location variance with values ranging far above and below the toughness of healthy porcine arterial tissue (Range: 1330-3035 for location and 140-4560J/m(2) for patients). No significant difference in mean toughness is observed between patients or location. However, the composition parameter representing the calcified tissue content of the plaque correlates significantly with sample toughness (r=0.949, p<0.001). SEM reveals the presence of large calcified regions in the toughest sections that are absent from the least tough sections. Regression analysis highlights the potential of employing the calcified tissue content of the plaque as a preoperative tool for predicting the fracture response of a target lesion to CBA (R(2)=0.885, p<0.001). STATEMENT OF SIGNIFICANCE This study addresses a gap in current knowledge regarding the influence of plaque location, composition and morphology on the toughness of human femoral plaque tissue. Such information is of great importance to the continued improvement of endovascular treatments, particularly cutting balloon angioplasty (CBA), which require experimentally derived data as a framework for assessing clinical cases and advancing medical devices. This study identifies that femoral plaque tissue exhibits large inter and intra patient and location variance regarding tissue toughness. Increasing calcified plaque content is demonstrated to correlate significantly with increasing toughness. This highlights the potential for predicting target lesion toughness which may lead to an increased adoption of the CBA technique and also further the uptake of endovascular treatment.
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Burket MW. Drug-Eluting Stents Are the Default Strategy for Superficial Femoral Artery Intervention NowResponse to Burket. Circulation 2016; 133:320-9; discussion 329. [DOI: 10.1161/circulationaha.115.018034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Iezzi R, Posa A, Santoro M, Nestola M, Contegiacomo A, Tinelli G, Paolini A, Flex A, Pitocco D, Snider F, Bonomo L. Cutting Balloon Angioplasty in the Treatment of Short Infrapopliteal Bifurcation Disease. J Endovasc Ther 2015; 22:485-92. [PMID: 26187973 DOI: 10.1177/1526602815594250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the safety, feasibility, and effectiveness of cutting balloon angioplasty in the management of infrapopliteal bifurcation disease. METHODS Between November 2010 and March 2013, 23 patients (mean age 69.6±9.01 years, range 56-89; 16 men) suffering from critical limb ischemia were treated using cutting balloon angioplasty (single cutting balloon, T-shaped double cutting balloon, or double kissing cutting balloon technique) for 47 infrapopliteal artery bifurcation lesions (16 popliteal bifurcation and 9 tibioperoneal bifurcation) in 25 limbs. Follow-up consisted of clinical examination and duplex ultrasonography at 1 month and every 3 months thereafter. RESULTS All treatments were technically successful. No 30-day death or adverse events needing treatment were registered. No flow-limiting dissection was observed, so no stent implantation was necessary. The mean postprocedure minimum lumen diameter and acute gain were 0.28±0.04 and 0.20±0.06 cm, respectively, with a residual stenosis of 0.04±0.02 cm. Primary and secondary patency rates were estimated as 89.3% and 93.5% at 6 months and 77.7% and 88.8% at 12 months, respectively; 1-year primary and secondary patency rates of the treated bifurcation were 74.2% and 87.0%, respectively. The survival rate estimated by Kaplan-Meier analysis was 82.5% at 1 year. CONCLUSION Cutting balloon angioplasty seems to be a safe and effective tool in the routine treatment of short/ostial infrapopliteal bifurcation lesions, avoiding procedure-related complications, overcoming the limitations of conventional angioplasty, and improving the outcome of catheter-based therapy.
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Affiliation(s)
- Roberto Iezzi
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Alessandro Posa
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Marco Santoro
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Massimiliano Nestola
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Andrea Contegiacomo
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Giovanni Tinelli
- Institute of Vascular Surgery, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Alessandra Paolini
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Andrea Flex
- Department of Medicine, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Dario Pitocco
- Department of Medicine, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Francesco Snider
- Institute of Vascular Surgery, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Lorenzo Bonomo
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
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Shammas NW. An overview of optimal endovascular strategy in treating the femoropopliteal artery: mechanical, biological, and procedural factors. Int J Angiol 2014; 22:1-8. [PMID: 24436577 DOI: 10.1055/s-0032-1331840] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Treatment of the femoropopliteal (FP) artery remains a challenge to the endovascular specialist. Long-term patency is low with a high rate of target lesion revascularization. The true patency rate varies considerably between studies partly because there is a lack of uniform performance criteria and reporting standards in peripheral arterial interventions. Literature review supports three principles that emerge as important components of an optimal strategy in treating the FP artery: (1) improving vessel compliance and subsequently less dissections and bailout stenting, (2) reducing smooth muscle cell proliferation, and (3) protecting outflow vessels from distal embolization. In this overview, we examine current data that support the validity of this strategy.
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Cutting-Balloon Angioplasty Versus Balloon Angioplasty as Treatment for Short Atherosclerotic Lesions in the Superficial Femoral Artery: Randomized Controlled Trial. Cardiovasc Intervent Radiol 2013; 36:1500-1507. [DOI: 10.1007/s00270-013-0603-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/07/2013] [Indexed: 11/25/2022]
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Cenizo Revuelta N, Gastambide V, San-Norberto EM, Ibáñez MA, Martín-Pedrosa M, Taylor J, Gutiérrez V, Vaquero C. Retrograde approach for endovascular salvage of an infrapopliteal vein bypass. Ann Vasc Surg 2012; 26:421.e1-4. [PMID: 22284773 DOI: 10.1016/j.avsg.2011.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 06/28/2011] [Accepted: 07/03/2011] [Indexed: 10/14/2022]
Abstract
Endovascular treatment through femoropopliteal and infragenicular percutaneous transluminal angioplasty, both in native vessels and in bypass salvage, has been an emerging technique in recent years. However, in some cases, a difficult anterograde access in distal occlusions has limited the technical success of this procedure. Combined subintimal arterial flossing with antegrade-retrograde intervention is used as a resource technique to obtain precise recanalization in these cases. Here, we present the case of a retromalleolar access of the posterior tibial artery, based on subintimal arterial flossing with antegrade-retrograde intervention technique, to achieve femoral-posterior tibial bypass salvage.
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The Role of “Cutting” Balloon Angioplasty for the Treatment of Short Femoral Bifurcation Steno-Obstructive Disease. Cardiovasc Intervent Radiol 2010; 33:921-8. [DOI: 10.1007/s00270-010-9802-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 01/04/2010] [Indexed: 11/27/2022]
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Cutting-balloon angioplasty of resistant ureteral stenosis as bridge to stent insertion. Eur J Radiol 2009; 79:12-4. [PMID: 19959311 DOI: 10.1016/j.ejrad.2009.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 10/24/2009] [Accepted: 11/04/2009] [Indexed: 11/23/2022]
Abstract
Ureteral stenting is a routine, minimally invasive procedure performed for relief of benign or malignant obstruction. In case of ureteral stenosis, to allow a correct insertion of the stent, a predilatation of the ureter stenosis with a conventional balloon catheter can be necessary. In exceptional cases, it can be difficult to advance an 7-8 Fr JJ-catheter over a tight resistant ureter stenosis following unsuccessful high-pressure balloon dilatation. In the present report, we describe two cases of resistant ureter stenosis successfully dilated by a cutting-balloon following the failure of high-pressure balloon dilatation, allowing a correct and uncomplicated antegrade stent insertion.
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Cotroneo AR, Iezzi R. Short femoropopliteal arterial stenoses: is cutting balloon angioplasty the solution? Radiology 2009; 251:304; author reply 304-5. [PMID: 19332859 DOI: 10.1148/radiol.2511081782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Parmar V. Re: "Cutting balloon versus conventional balloon angioplasty in short femoropopliteal arterial stenoses". J Endovasc Ther 2008; 15:628-9; author reply 629-30. [PMID: 18840055 DOI: 10.1583/08-2518l.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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