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Benson RA, Wu TY. Carotid Stents: Predicting Restenosis and Keeping them Shipshape. Eur J Vasc Endovasc Surg 2024; 68:442-443. [PMID: 38944267 DOI: 10.1016/j.ejvs.2024.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/16/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Affiliation(s)
- Ruth A Benson
- Department of Surgery and Critical Care, University of Otago, Christchurch, New Zealand; Christchurch Vascular Group, Christchurch, New Zealand; Department of Vascular, Endovascular and Transplant Surgery, Christchurch Public Hospital, Christchurch, New Zealand.
| | - Teddy Y Wu
- Department of Neurology, Christchurch Public Hospital, Christchurch, New Zealand; Department of Medicine, University of Otago, Dunedin, New Zealand
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Jabbour G, Yadavalli SD, Rastogi V, Caron E, Mandigers T, Wang GJ, Nolan BW, Malas M, Lee JT, Davis RB, Stangenberg L, Schermerhorn ML. Outcomes following carotid revascularization in patients with prior ipsilateral carotid artery stenting in the Vascular Quality Initiative. J Vasc Surg 2024:S0741-5214(24)01774-9. [PMID: 39179002 DOI: 10.1016/j.jvs.2024.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 08/04/2024] [Accepted: 08/11/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE The outcomes of carotid revascularization in patients with prior carotid artery stenting (CAS) remain understudied. Prior research has not reported the outcomes after transcarotid artery revascularization (TCAR) in patients with previous CAS. In this study, we compared the peri-operative outcomes of TCAR, transfemoral CAS (tfCAS) and carotid endarterectomy (CEA) in patients with prior ipsilateral CAS using the Vascular Quality Iniatitive. METHODS Using Vascular Quality Initiative data from 2016 to 2023, we identified patients who underwent TCAR, tfCAS, or CEA after prior ipsilateral CAS. We included covariates such as age, race, sex, body mass index, comorbidities (hypertension, diabetes, prior coronary artery disease, prior coronary artery bypass grafting/percutaneous coronary intervention, congestive heart failure, renal dysfunction, smoking, chronic obstructive pulmonary disease, and anemia), symptom status, urgency, ipsilateral stenosis, and contralateral occlusion into a regression model to compute propensity scores for treatment assignment. We then used the propensity scores for inverse probability weighting and weighted logistic regression to compare in-hospital stroke, in-hospital death, stroke/death, postoperative myocardial infarction (MI), stroke/death/MI, 30-day mortality, and cranial nerve injury (CNI) after TCAR, tfCAS, and CEA. We also analyzed trends in the proportions of patients undergoing the three revascularization procedures over time using Cochrane-Armitage trend testing. RESULTS We identified 2137 patients undergoing revascularization after prior ipsilateral carotid stenting: 668 TCAR patients (31%), 1128 tfCAS patients (53%), and 341 CEA patients (16%). In asymptomatic patients, TCAR was associated with a lower yet not statistically significant in-hospital stroke/death than tfCAS (TCAR vs tfCAS: 0.7% vs 2.0%; adjusted odds ratio [aOR], 0.33; 95% confidence interval [CI], 0.11-1.05; P = .06), and similar odds of stroke/death with CEA (TCAR vs CEA: 0.7% vs 0.9%; aOR, 0.80; 95% CI, 0.16-3.98; P = .8). Compared with CEA, TCAR was associated with lower odds of postoperative MI (0.1% vs 14%; aOR, 0.02; 95% CI, 0.00-0.10; P < .001), stroke/death/MI (0.8% vs 15%; aOR, 0.05; 95% CI, 0.01-0.25; P < .001), and CNI (0.1% vs 3.8%; aOR, 0.04; 95% CI, 0.00-0.30; P = .002) in this patient population. In symptomatic patients, TCAR had an unacceptably elevated in-hospital stroke/death rate of 5.1%, with lower rates of CNI than CEA. We also found an increasing trend in the proportion of patients undergoing TCAR following prior ipsilateral carotid stenting (2016 to 2023: 14% to 41%), with a relative decrease in proportions of tfCAS (61% to 45%) and CEA (25% to 14%) (P < .001). CONCLUSIONS In asymptomatic patients with prior ipsilateral CAS, TCAR was associated with lower odds of in-hospital stroke/death compared with tfCAS, with comparable stroke/death but lower postoperative MI and CNI rates compared with CEA. In symptomatic patients, TCAR was associated with unacceptably higher in-hospital stroke/death rates. In line with the postprocedure outcomes, there has been a steady increase in the proportion of patients with prior ipsilateral stenting undergoing TCAR over time.
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Affiliation(s)
- Gabriel Jabbour
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sai Divya Yadavalli
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Vinamr Rastogi
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elisa Caron
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tim Mandigers
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Mahmoud Malas
- Division of Vascular Surgery, University of California San Diego, San Diego, CA
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA
| | - Roger B Davis
- Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Lars Stangenberg
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Park S, Kim BJ, Choi HY, Chang DI, Woo HG, Heo SH. Risk factors of in-stent restenosis after carotid angioplasty and stenting: long-term follow-up study. Front Neurol 2024; 15:1411045. [PMID: 39175764 PMCID: PMC11340531 DOI: 10.3389/fneur.2024.1411045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/17/2024] [Indexed: 08/24/2024] Open
Abstract
Background After carotid artery angioplasty with stenting (CAS), it is unclear which risk factors are related to long-term outcomes, including in-stent restenosis (ISR). This study aimed to assess the factors associated with restenosis after CAS with a median follow-up of 35.7 months. Materials and methods Patients who underwent CAS from January 2013 to December 2018 were included if they had symptomatic or asymptomatic carotid artery stenosis. The carotid Doppler ultrasonography (CDU) was followed up after the procedure. We defined at least 50% restenosis using the criteria that the internal carotid artery (ICA) peak systolic velocity (PSV) was greater than 224 cm/s or the ICA to common carotid artery PSV ratio was higher than 3.4. The risk factors for ISR were also assessed. Results Of the 189 patients, 122 had symptomatic carotid artery stenosis, and 67 had asymptomatic carotid artery stenosis. Patients were evaluated by CDU for a median of 35.7 months (interquartile range 19.5 to 70.0). Kaplan-Meier analysis showed that the longest time to ISR was 39 months, and ISR-free was better in the asymptomatic CAS group. In all groups, ISR was independently associated with current smoker [adjusted odds ratio (aOR), 3.425; 95% confidence interval (CI), 1.086 to 10.801] and elevated ICA PSV at baseline (aOR, 1.004; 95% CI, 1.001 to 1.007). Conclusion Independent risk factors for ISR in the CAS group included current smoking and elevated ICA PSV at baseline. In the symptomatic CAS group, alcohol was independently associated with the ISR. ISR did not occur after 39 months from the CAS procedure in our study patients. Future studies with extended follow-up are necessary to fully understand the long-term outcomes of CAS.
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Affiliation(s)
- Sangil Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Hye-Yeon Choi
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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4
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Balakrishnan P, Anderson J, Arcand CM, Krantz M, Kitchen JC. Subclavian-Carotid Bypass as a Solution to Recurrent Carotid Artery Stenosis Post Endarterectomy and Transfemoral Stenting. Cureus 2024; 16:e63087. [PMID: 39055438 PMCID: PMC11270155 DOI: 10.7759/cureus.63087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
We present the case of an 80-year-old man who underwent a subclavian-to-distal internal carotid artery bypass with a reversed saphenous vein due to symptomatic in-stent restenosis, following a carotid endarterectomy 20 years ago and carotid artery stenting 10 years ago. The patient presented with right-sided hemiparesis and dysarthria. Imaging suggested in-stent restenosis of the internal carotid artery stent. He was also found to have stenosis of the common carotid artery origin stent. An initial transfemoral attempt by interventional radiology was unsuccessful. Due to the stenosed common carotid artery origin stent, a common carotid-to-internal carotid artery bypass was not feasible. Therefore, a subclavian-distal carotid artery bypass with a reversed saphenous vein was performed. He did well in the postoperative period and has been seen in the clinic since. Surveillance ultrasound demonstrated a patent graft with non-stenotic proximal and distal anastomoses. We include an in-depth review of the management of recurrent carotid artery stenosis as well.
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Affiliation(s)
- Pranav Balakrishnan
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Jamie Anderson
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Christina M Arcand
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Matthew Krantz
- Vascular Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - James C Kitchen
- Vascular Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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5
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Eljack A, Shih E, Meidan T, Lanfear A, Taha M, Sayfo S, Gable D, Potluri S. Drug-Coated Balloon Angioplasty for Carotid Artery In-Stent Restenosis: Case Series. J Endovasc Ther 2024; 31:305-311. [PMID: 36154316 DOI: 10.1177/15266028221120763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Few case reports have demonstrated promising results of drug-coated balloons (DCBs) as an emerging management for carotid artery in-stent restenosis (CAISR). Herein, we report 6 cases of CAISR which were treated with a DCB with or without new stent deployment. BACKGROUND Carotid artery in-stent restenosis is a high-risk condition with an estimated incidence rate that varies widely from 6% to 40%. Several strategies are available now for the management of the CAISR including conventional balloon angioplasty, plaque modification balloon angioplasty, and new stent placement. METHODS A retrospective review of consecutive patients with a diagnosis of severe CAISR at Baylor Scott & White The Heart Hospital Plano from 2011 to 2021 was performed. This study was approved by the Baylor Scott & White Research Institute institutional review board. RESULTS Six patients underwent DCB angioplasty with or without stent placement under an embolic protection device. Resolution of CAISR was achieved in all cases with 0% to 10% residual stenosis in all cases. Following the procedure, 1 patient had a brief episode of syncope with balloon inflation with immediate recovery on deflation of the balloon. There were otherwise no significant neurological or cardiac events prior to discharge. All patients were asymptomatic at their follow-up visit with no neurological or cardiac events reported at 12, 24, and 36 months following the procedure. CONCLUSION While CAISR treatment remains a challenging condition, our study shows that the use of DCB with or without stent placement is a feasible and promising treatment option when compared with other conventional treatment options. CLINICAL IMPACT Carotid artery in-stent restenosis treatment remains a challenging condition. Our study shows that the use of drug coated balloon with or without stent placement is a feasible and promising treatment option when compared with current conventional treatment options.
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Affiliation(s)
- Ammar Eljack
- Department of Cardiology, Baylor Scott & White The Heart Hospital-Plano, Plano, TX, USA
| | - Emily Shih
- Department of General Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Talia Meidan
- Department of Cardiology, Baylor Scott & White The Heart Hospital-Plano, Plano, TX, USA
| | - Allison Lanfear
- Department of Cardiology, Baylor Scott & White The Heart Hospital-Plano, Plano, TX, USA
| | - Mohamed Taha
- Department of Cardiology, College of Medicine, Howard University, Washington, DC, USA
| | - Sameh Sayfo
- Department of Cardiology, Baylor Scott & White The Heart Hospital-Plano, Plano, TX, USA
| | - Dennis Gable
- Department of Vascular Surgery, Baylor Scott & White The Heart Hospital-Plano, Plano, TX, USA
| | - Srinivasa Potluri
- Department of Cardiology, Baylor Scott & White The Heart Hospital-Plano, Plano, TX, USA
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Wu CH, Chang FC, Wang YF, Lirng JF, Wu HM, Pan LLH, Wang SJ, Chen SP. Impaired Glymphatic and Meningeal Lymphatic Functions in Patients with Chronic Migraine. Ann Neurol 2024; 95:583-595. [PMID: 38055324 DOI: 10.1002/ana.26842] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This study was undertaken to investigate migraine glymphatic and meningeal lymphatic vessel (mLV) functions. METHODS Migraine patients and healthy controls (HCs) were prospectively recruited between 2020 and 2023. Diffusion tensor image analysis along the perivascular space (DTI-ALPS) index for glymphatics and dynamic contrast-enhanced magnetic resonance imaging parameters (time to peak [TTP]/enhancement integral [EI]/mean time to enhance [MTE]) for para-superior sagittal (paraSSS)-mLV or paratransverse sinus (paraTS)-mLV in episodic migraine (EM), chronic migraine (CM), and CM with and without medication-overuse headache (MOH) were analyzed. DTI-ALPS correlations with clinical parameters (migraine severity [numeric rating scale]/disability [Migraine Disability Assessment (MIDAS)]/bodily pain [Widespread Pain Index]/sleep quality [Pittsburgh Sleep Quality Index (PSQI)]) were examined. RESULTS In total, 175 subjects (112 migraine + 63 HCs) were investigated. DTI-ALPS values were lower in CM (median [interquartile range] = 0.64 [0.12]) than in EM (0.71 [0.13], p = 0.005) and HCs (0.71 [0.09], p = 0.004). CM with MOH (0.63 [0.07]) had lower DTI-ALPS values than CM without MOH (0.73 [0.12], p < 0.001). Furthermore, CM had longer TTP (paraSSS-mLV: 55.8 [12.9] vs 40.0 [7.6], p < 0.001; paraTS-mLV: 51.2 [8.1] vs 44.0 [3.3], p = 0.002), EI (paraSSS-mLV: 45.5 [42.0] vs 16.1 [9.2], p < 0.001), and MTE (paraSSS-mLV: 253.7 [6.7] vs 248.4 [13.8], p < 0.001; paraTS-mLV: 252.0 [6.2] vs 249.7 [1.2], p < 0.001) than EM patients. The MIDAS (p = 0.002) and PSQI (p = 0.002) were negatively correlated with DTI-ALPS index after Bonferroni corrections (p < q = 0.01). INTERPRETATION CM patients, particularly those with MOH, have glymphatic and meningeal lymphatic dysfunctions, which are highly clinically relevant and may implicate pathogenesis for migraine chronification. ANN NEUROL 2024;95:583-595.
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Grants
- MOHW 108-TDU-B-211-133001 Ministry of Health and Welfare, Taiwan
- MOHW107-TDU-B-211-123001 Ministry of Health and Welfare, Taiwan
- MOHW112-TDU-B-211-144001 Ministry of Health and Welfare, Taiwan
- N/A Professor Tsuen CHANG's Scholarship Program from Medical Scholarship Foundation In Memory Of Professor Albert Ly-Young Shen
- V109B-009 Taipei Veterans General Hospital
- V110C-102 Taipei Veterans General Hospital
- V111B-032 Taipei Veterans General Hospital
- V112B-007 Taipei Veterans General Hospital
- V112C-053 Taipei Veterans General Hospital
- V112C-059 Taipei Veterans General Hospital
- V112C-113 Taipei Veterans General Hospital
- V112D67-001-MY3-1 Taipei Veterans General Hospital
- V112D67-002-MY3-1 Taipei Veterans General Hospital
- V112E-004-1 Taipei Veterans General Hospital
- VGH-111-C-158 Taipei Veterans General Hospital
- The Brain Research Center, National Yang Ming Chiao Tung University from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan
- 110-2314-B-075-005 The National Science and Technology Council, Taiwan
- 110-2314-B-075-032 The National Science and Technology Council, Taiwan
- 110-2321-B-010-005- The National Science and Technology Council, Taiwan
- 110-2326-B-A49A-501-MY3 The National Science and Technology Council, Taiwan
- 111-2314-B-075 -086-MY3 The National Science and Technology Council, Taiwan
- 111-2314-B-075-025 -MY3 The National Science and Technology Council, Taiwan
- 111-2314-B-A49-069-MY3 The National Science and Technology Council, Taiwan
- 111-2321-B-A49-004 The National Science and Technology Council, Taiwan
- 111-2321-B-A49-011 The National Science and Technology Council, Taiwan
- 112-2314-B-075-066- The National Science and Technology Council, Taiwan
- 112-2314-B-A49-037 -MY3 The National Science and Technology Council, Taiwan
- 112-2321-B-075-007 The National Science and Technology Council, Taiwan
- NSTC 108-2314-B-010-022 -MY3 The National Science and Technology Council, Taiwan
- 109V1-5-2 Veterans General Hospitals and University System of Taiwan Joint Research Program
- 110-G1-5-2 Veterans General Hospitals and University System of Taiwan Joint Research Program
- VGHUST-112-G1-2-1 Veterans General Hospitals and University System of Taiwan Joint Research Program
- Vivian W. Yen Neurological Foundation
- CI-109-3 Yen Tjing Ling Medical Foundation
- CI-111-2 Yen Tjing Ling Medical Foundation
- CI-112-2 Yen Tjing Ling Medical Foundation
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Affiliation(s)
- Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Feng Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ling Hope Pan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Pin Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
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Marton A, Blényesi E, Török K, Balogh G, Gubucz I, Nardai S, Lenzsér G, Nagy C, Bajzik G, Tollár J, Repa I, Nagy F, Vajda Z. Treatment of In-stent Restenosis of the Internal Carotid Artery Using Drug-eluting Balloons. Clin Neuroradiol 2024; 34:147-154. [PMID: 37676281 DOI: 10.1007/s00062-023-01343-6] [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: 04/04/2023] [Accepted: 07/30/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE In-stent restenosis (ISR) following internal carotid artery (ICA) stenting is relatively common with an estimated incidence of 5%. Treatment options include repeat angioplasty with conventional or drug-eluting balloons (DEB), repeat stent angioplasty and surgical intervention. Application of DEB in ISR of the coronary and peripheral arteries is an established method; however, data on DEB treatment of ICA ISR are sparse. In this work, results from a retrospective cohort of 45 patients harboring 46 ICA ISR lesions treated with DEB angioplasty are presented. METHODS Clinical, procedural and imaging data from DEB angioplasty treatment of 46 high-grade ICA ISR lesions in 45 patients, performed between 2013 and 2021 were collected. A single type of DEB (Elutax, Aachen Resonance, Aachen, Germany) was used in all procedures. Imaging follow-up was performed by regular Doppler ultrasound (DUS), verified by computed tomography angiography (CTA) in cases suspicious for a recurrent ISR. RESULTS Technical success was 100%. Intraprocedural and postprocedural complications were not encountered. Clinical follow-up was obtained in all patients. Recurrent stroke in the affected territory was not encountered. A recurrent ISR following DEB treatment was confirmed by DUS and CTA in 4/46 (8.7%) of the lesions and were retreated with DEB. A third recurrent ISR occurred in a single case (2%) and following a second DEB retreatment there were no signs of a fourth recurrence after 36 months follow-up. CONCLUSION The use of DEB angioplasty is a safe and effective treatment of ICA ISR lesions, yielding significantly better results compared to other modalities. Randomized multicenter studies are warranted.
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Affiliation(s)
- Annamária Marton
- Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Eszter Blényesi
- Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Katalin Török
- Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Gábor Balogh
- Department of Surgery, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - István Gubucz
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Sándor Nardai
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Gábor Lenzsér
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Csaba Nagy
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Gábor Bajzik
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - József Tollár
- Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Imre Repa
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Ferenc Nagy
- Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Zsolt Vajda
- Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary.
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8
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Wu CH, Lin TM, Chung CP, Yu KW, Tai WA, Luo CB, Lirng JF, Chang FC. Prevention of in-stent restenosis with drug-eluting balloons in patients with postirradiated carotid stenosis accepting percutaneous angioplasty and stenting. J Neurointerv Surg 2023; 16:73-80. [PMID: 36914246 PMCID: PMC10804009 DOI: 10.1136/jnis-2022-019957] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To investigate the technical safety and outcome of in-stent restenosis (ISR) prevention with drug-eluting balloon (DEB) in patients with postirradiated carotid stenosis (PIRCS) undergoing percutaneous angioplasty and stenting (PTAS). METHODS Between 2017 and 2021, we prospectively recruited patients with severe PIRCS for PTAS. They were randomly separated into two groups based on endovascular techniques performed with and without DEB. Preprocedural and early postprocedural (within 24 hours) MRI, short-term ultrasonography (6 months after PTAS), and long-term CT angiography (CTA)/MR angiography (MRA), 12 months after PTAS, were performed. Technical safety was evaluated based on periprocedural neurological complications and the number of recent embolic ischemic lesions (REIL) in the treated brain territory on diffusion-weighted imaging of early postprocedural MRI. RESULTS Sixty-six (30 with and 36 without DEB) subjects were enrolled, with one failure in techniques. For 65 patients in the DEB versus conventional groups, technical neurological symptoms within 1 month (1/29 (3.4%) vs 0/36; P=0.197) and REIL numbers within 24 hours (1.0±2.1 vs 1.3±1.5; P=0.592) after PTAS showed no differences. Peak systolic velocity (PSVs) on short-term ultrasonography was significantly higher in the conventional group (104.13±42.76 vs .81.95±31.35; P=0.023). The degree of in-stent stenosis (45.93±20.86 vs 26.58±8.75; P<0.001) was higher, and there were more subjects (n=8, 38.9% vs 1, 3.4%; P=0.029) with significant ISR (≥ 50%) in the conventional group than in the DEB group on long-term CTA/MRA. CONCLUSIONS We observed similar technical safety of carotid PTAS with and without DEBs. The number of cases of significant ISR were fewer and the degree of stenosis of ISR was less in primary DEB-PTAS of PIRCS than for conventional PTAS in the 12-month follow-up.
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Affiliation(s)
- Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Te-Ming Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Ping Chung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kai-Wei Yu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-An Tai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan
- Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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9
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Hrbáč T, Fiedler J, Procházka V, Jonszta T, Roubec M, Pakizer D, Václavík D, Netuka D, Heryán T, Školoudík D. Comparison of carotid endarterectomy and repeated carotid angioplasty and stenting for in-stent restenosis (CERCAS trial): a randomised study. Stroke Vasc Neurol 2023; 8:399-404. [PMID: 36972920 PMCID: PMC10648045 DOI: 10.1136/svn-2022-002075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND AND AIM In-stent restenosis (ISR) belongs to an infrequent but potentially serious complication after carotid angioplasty and stenting in patients with severe carotid stenosis. Some of these patients might be contraindicated to repeat percutaneous transluminal angioplasty with or without stenting (rePTA/S). The purpose of the study is to compare the safety and effectiveness of carotid endarterectomy with stent removal (CEASR) and rePTA/S in patients with carotid ISR. METHODS Consecutive patients with carotid ISR (≥80%) were randomly allocated to the CEASR or rePTA/S group. The incidence of restenosis after intervention, stroke, transient ischaemic attack myocardial infarction and death 30 days and 1 year after intervention and restenosis 1 year after intervention between patients in CEASR and rePTA/S groups were statistically evaluated. RESULTS A total of 31 patients were included in the study; 14 patients (9 males; mean age 66.3±6.6 years) were allocated to CEASR and 17 patients (10 males; mean age 68.8±5.6 years) to the rePTA/S group. The implanted stent in carotid restenosis was successfully removed in all patients in the CEASR group. No clinical vascular event was recorded periproceduraly, 30 days and 1 year after intervention in both groups. Only one patient in the CEASR group had asymptomatic occlusion of the intervened carotid artery within 30 days and one patient died in the rePTA/S group within 1 year after intervention. Restenosis after intervention was significantly greater in the rePTA/S group (mean 20.9%) than in the CEASR group (mean 0%, p=0.04), but all stenoses were <50%. Incidence of 1-year restenosis that was ≥70% did not differ between the rePTA/S and CEASR groups (4 vs 1 patient; p=0.233). CONCLUSION CEASR seems to be effective and save procedures for patients with carotid ISR and might be considered as a treatment option. TRIAL REGISTRATION NUMBER NCT05390983.
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Affiliation(s)
- Tomáš Hrbáč
- Department of Neuroscience, Faculty of Medicine, Univerzity of Ostrava, Ostrava, Czech Republic
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jiří Fiedler
- Department of Neurosurgery, České Budějovice Hospital, České Budějovice, Czech Republic
| | - Václav Procházka
- Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Tomáš Jonszta
- Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Roubec
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - David Pakizer
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Daniel Václavík
- Department of Neurology, Vítkovice Hospital, Ostrava, Czech Republic
| | - David Netuka
- Department of Neurosurgery, Military University Hospital Prague, Praha, Czech Republic
| | - Tomáš Heryán
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - David Školoudík
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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10
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Zarrintan S, Malas MB. What Is the Role of Transcarotid Artery Revascularization? Adv Surg 2023; 57:115-140. [PMID: 37536848 DOI: 10.1016/j.yasu.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Carotid endarterectomy (CEA) is the gold-standard method of carotid revascularization in symptomatic patients with ≥50% and in asymptomatic patients with ≥70% stenosis. Transfemoral carotid artery stenting (TFCAS) has been associated with higher perioperative stroke rates compared to CEA in several studies. On the other hand, transcarotid artery revascularization (TCAR) has outperformed TFCAS in patients who are considered high risk for surgery. There is increasing data that supports TCAR as a safe and efficient technique with outcomes similar to those of CEA, but additional level-one studies are necessary to evaluate the long-term outcomes of TCAR in high- and standard-risk patients.
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Affiliation(s)
- Sina Zarrintan
- Department of Surgery, Division of Vascular and Endovascular Surgery, UC San Diego, San Diego, CA, USA; Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), UC San Diego, San Diego, CA, USA; Altman Center for Clinical and Translational Research, 9452 Medical Center Drive - LL2W 502A, La Jolla, CA 92037, USA
| | - Mahmoud B Malas
- Department of Surgery, Division of Vascular and Endovascular Surgery, UC San Diego, San Diego, CA, USA; Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), UC San Diego, San Diego, CA, USA; Altman Center for Clinical and Translational Research, 9452 Medical Center Drive - LL2W 502A, La Jolla, CA 92037, USA.
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11
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Hopf-Jensen S, Müller-Hülsbeck S. First-in-Men Treatment of Carotid Artery In-Stent Restenosis with a Novel Sirolimus-Eluting Balloon Technology. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03408-y. [PMID: 36949183 DOI: 10.1007/s00270-023-03408-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/27/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Silke Hopf-Jensen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, DIAKO Hospital gGmbH Flensburg, Knuthstraße 1, 24939, Flensburg, Germany.
| | - Stefan Müller-Hülsbeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, DIAKO Hospital gGmbH Flensburg, Knuthstraße 1, 24939, Flensburg, Germany
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12
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Takekawa H, Tsukui D, Kobayasi S, Suzuki K, Hamaguchi H. Ultrasound diagnosis of carotid artery stenosis and occlusion. J Med Ultrason (2001) 2022; 49:675-687. [PMID: 36175716 DOI: 10.1007/s10396-022-01259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/14/2022] [Indexed: 11/25/2022]
Abstract
Carotid artery ultrasonography is capable of diagnosing or inferring the presence or absence of stenosis or occlusion of the internal carotid artery (ICA) and vertebral artery (VA), as well as the not directly observable distal ICA, middle cerebral artery (MCA), and basilar artery (BA). Stenosis at the origin of the ICA is mainly evaluated using the parameter peak systolic velocity (PSV), with values of ≥ 200-230 cm/s indicating severe stenosis. Recently, the acceleration time ratio has been reported for diagnosis of ICA origin stenosis. An indicator called the end-diastolic (ED) ratio can be used for diagnosing occlusion of the distal ICA or the M1 segment of the MCA. The PSV of stenosis can be used to diagnose stenosis at the beginning of the VA or V1, and mean flow velocity, mean ratio, and diameter ratio can be used to diagnose distal VA occlusion. Furthermore, the usefulness of the VA pulsatility index and resistance index has been suggested for diagnosing stenosis or occlusion of the BA. This review outlines diagnostic sonography criteria for stenosis and occlusion of extracranial and intracranial arteries.
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Affiliation(s)
- Hidehiro Takekawa
- Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan.
- Department of Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan.
- Center of Medical Ultrasonics, Dokkyo Medical University, Mibu, Tochigi, Japan.
| | - Daisuke Tsukui
- Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
- Department of Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Saro Kobayasi
- Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
- Department of Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan
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13
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Tanaskovic S, Sagic D, Radak D, Antonic Z, Kovacevic V, Vukovic M, Aleksic N, Radak S, Nenezic D, Cvetkovic S, Isenovic E, Vucurevic G, Lozuk B, Babic A, Babic S, Matic P, Gajin P, Unic-Stojanovic D, Ilijevski N. Carotid Restenosis Rate After Stenting for Primary Lesions Versus Restenosis After Endarterectomy With Creation of Risk Index. J Endovasc Ther 2022:15266028221091895. [PMID: 35466778 DOI: 10.1177/15266028221091895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Carotid artery stenting (CAS) is an option for carotid restenosis (CR) treatment with favorable outcomes. However, CAS has also emerged as an alternative to carotid endarterectomy (CEA) for the management of patients with primary carotid stenosis. This study aimed to report CR rates after CAS was performed in patients with primary lesions versus restenosis after CEA, to identify predictors of CR, and to report both neurological and overall outcomes. MATERIALS AND METHODS From January 2000 to September 2018, a total of 782 patients were divided into 2 groups: The CAS (prim) group consisted of 440 patients in whom CAS was performed for primary lesions, and the CAS (res) group consisted of 342 patients with CAS due to restenosis after CEA. Indications for CAS were symptomatic stenosis/restenosis >70% and asymptomatic stenosis/restenosis >85%. A color duplex scan (CDS) of carotid arteries was performed 6 months after CAS, after 1 year, and annually afterward. Follow-up ranged from 12 to 88 months, with a mean follow-up of 34.6±18.0 months. RESULTS There were no differences in terms of CR rate between the patients in the CAS (prim) and CAS (res) groups (8.7% vs 7.2%, χ2=0.691, p=0.406). The overall CR rate was 7.9%, whereas significant CR (>70%) rate needing re-intervention was 5.6%, but there was no difference between patients in the CAS (prim) and CAS (res) groups (6.4% vs 4.7%, p=0.351). Six independent predictors for CR were smoking, associated previous myocardial infarction and angina pectoris, plaque morphology, spasm after CAS, the use of FilterWire or Spider Fx cerebral protection devices, and time after stenting. A carotid restenosis risk index (CRRI) was created based on these predictors and ranged from -7 (minimal risk) to +10 (maximum risk); patients with a score >-4 were at increased risk for CR. There were no differences in terms of neurological and overall morbidity and mortality between the 2 groups. CONCLUSIONS There was no difference in CR rate after CAS between the patients with primary stenosis and restenosis after CEA. A CRRI score >-4 is a criterion for identifying high-risk patients for post-CAS CR that should be tested in future randomized trials.
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Affiliation(s)
- Slobodan Tanaskovic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Sagic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department for Interventional Radiology, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Djordje Radak
- Scientific Board, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Zelimir Antonic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Department for Interventional Radiology, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Vladimir Kovacevic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Department for Interventional Radiology, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Mira Vukovic
- Department of Healthcare Quality Assurance, General Hospital Valjevo, Valjevo, Serbia
| | - Nikola Aleksic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Department for Angiology, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Sandra Radak
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Department for Angiology, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Dragoslav Nenezic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Cvetkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Esma Isenovic
- Department of Radiobiology and Molecular Genetics, "VINČA" Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Goran Vucurevic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Lozuk
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Aleksandar Babic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Srdjan Babic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Predrag Matic
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Predrag Gajin
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Unic-Stojanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Anesthesiology and Intensive Care, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Nenad Ilijevski
- Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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14
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von Gottberg P, Cimpoca A, Wendl C, Cohen JE, Speck U, Henkes H. Drug-coated Balloons in the Neurovascular Setting: A Comprehensive, Systematic Review of Current Use and Indications. Rev Cardiovasc Med 2022; 23:128. [PMID: 39076219 PMCID: PMC11274058 DOI: 10.31083/j.rcm2304128] [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: 12/10/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 07/31/2024] Open
Abstract
Background Drug-coated balloons (DCB) are an established tool in the prevention and treatment of coronary and peripheral artery restenosis. The underlying effects of restenosis resemble those in the neurovascular field, yet data on the use of DCB in cervical and intracranial arteries is rare. Methods Medline, and international and major national guidelines and recommendations were systematically searched for data addressing the use of DCB in the neurovascular setting. Results Of the 1448 relevant records found in Medline, 166 publications were considered for this review. Conclusions Data on the use of DCB in the neurovascular setting show a possible benefit over preceding alternatives, such as self-expanding stents, and balloon-mounted or drug-eluting stents. Nonetheless, the role of DCB remains under-researched, and publications remain lacking.
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Affiliation(s)
| | - Alexandru Cimpoca
- Neuroradiologische Klinik, Klinikum Stuttgart, 70174 Stuttgart, Germany
| | - Christina Wendl
- Neuroradiologisches Zentrum, Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, 93053 Regensburg, Germany
| | - José E. Cohen
- Department of Neurosurgery, Neuroendovascular Center, Hadassah University Hospital, 91120 Jerusalem, Israel
| | - Ulrich Speck
- Klinik für Radiologie, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, 70174 Stuttgart, Germany
- Medizinische Fakultät, Universität Duisburg-Essen, 45147 Essen, Germany
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15
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Wilson S, Mone P, Kansakar U, Jankauskas SS, Donkor K, Adebayo A, Varzideh F, Eacobacci M, Gambardella J, Lombardi A, Santulli G. Diabetes and restenosis. Cardiovasc Diabetol 2022; 21:23. [PMID: 35164744 PMCID: PMC8845371 DOI: 10.1186/s12933-022-01460-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/21/2022] [Indexed: 01/05/2023] Open
Abstract
Restenosis, defined as the re-narrowing of an arterial lumen after revascularization, represents an increasingly important issue in clinical practice. Indeed, as the number of stent placements has risen to an estimate that exceeds 3 million annually worldwide, revascularization procedures have become much more common. Several investigators have demonstrated that vessels in patients with diabetes mellitus have an increased risk restenosis. Here we present a systematic overview of the effects of diabetes on in-stent restenosis. Current classification and updated epidemiology of restenosis are discussed, alongside the main mechanisms underlying the pathophysiology of this event. Then, we summarize the clinical presentation of restenosis, emphasizing the importance of glycemic control in diabetic patients. Indeed, in diabetic patients who underwent revascularization procedures a proper glycemic control remains imperative.
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Affiliation(s)
- Scott Wilson
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Pasquale Mone
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Urna Kansakar
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Stanislovas S Jankauskas
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Kwame Donkor
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Ayobami Adebayo
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Fahimeh Varzideh
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
| | - Michael Eacobacci
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Jessica Gambardella
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA
- International Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Angela Lombardi
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Gaetano Santulli
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA.
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY, USA.
- International Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
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