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Kassier A, Soni R, Kassab K, Kumar D, Agrawal Y, Kotaru VP, Saltiel F, Gupta V, Kalavakunta J, Fischell TA. Real world single center experience with saphenous vein grafts interventions: should filters be filtered out? J Invasive Cardiol 2023; 35:398-414. [PMID: 37769613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) can be challenging due to no reflow phenomenon from distal embolization of debris and microvascular vasoconstriction, resulting in myocardial injury post-procedure. Guidelines promote the use of distal embolic protection devices (EPD) to protect the distal arterial bed during SVG PCI. However, this approach has shown less-than-optimal results in many studies. We report our data using the Borgess protocol [prophylactic intracoronary (IC) nicardipine injection and direct stenting], as an alternative to EPDs in a large series of SVG interventions. METHODS This is a retrospective, cohort study of our single center experience with SVG interventions between 2017 and 2021. The primary outcome of the study was major adverse cardiovascular events (MACE) [a composite of death, emergent coronary artery bypass graft surgery (CABG), myocardial infarction (MI), and target vessel revascularization (TVR)] at 30 days post-procedure. RESULTS There were 424 consecutive SVG interventions performed during the study period, and 76% of cases presented with acute coronary syndrome. Full adherence to the Borgess protocol was observed in 36% of cases; IC nicardipine was utilized in 72% of cases. MACE rate was 3.5% at 30 days driven primarily by MI (2.6%). CONCLUSION The Borgess protocol approach to vein graft interventions proved good outcomes when compared to SVG PCI in randomized trials utilizing EPDs. Our study is limited by the retrospective nature and single center experience.
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Affiliation(s)
- Adman Kassier
- Ascension Borgess Hospital, Michigan State University and Western Michigan University, 1521 Gull Rd, GOC 327, Kalamazoo, MI 49048.
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Tashiro N, Kawano H, Hiraoka F, Fukuda S, Nakamura Y, Yano S, Aikawa H, Go Y, Kazekawa K, Matsumoto Y, Yoshimura S. Distal Embolic Protection by Manual Compression of the Vertebral Artery in Subclavian Artery Stenting. J Neuroendovasc Ther 2020; 15:254-259. [PMID: 37501690 PMCID: PMC10370922 DOI: 10.5797/jnet.tn.2020-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/12/2020] [Indexed: 07/29/2023]
Abstract
Objective There is no established method for preventing vertebral artery embolization in percutaneous transluminal angioplasty (PTA) for subclavian artery stenosis. We manually compressed the supraclavicular fossa outside the sternocleidomastoid muscle to disrupt vertebral artery blood flow and prevent embolism. We report the usefulness of this procedure. Case Presentations Between April 2017 and July 2018, three patients with severe stenosis of the subclavian artery of 80% or higher were examined. For these patients, subclavian artery stenting was performed. The approach was via the left brachial artery in one patient and right femoral artery in two patients. After crossing the lesion, the vertebral artery was manually compressed and angiography confirmed that blood flow was blocked. In all patients, stent placement was successfully performed and good dilatation was confirmed by angiography. There were no neurological complications and no findings suggestive of acute cerebral infarction were found on magnetic resonance imaging (MRI). Conclusion Prevention of distal embolism by manual compression is simple, does not require multiple catheters, and is useful for subclavian artery stenting.
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Affiliation(s)
- Noriaki Tashiro
- Department of Neurology, Fukuoka Neurosurgical Hospital, Fukuoka, Fukuoka, Japan
| | - Hiroto Kawano
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Fukuoka, Japan
| | - Fumihiro Hiraoka
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Fukuoka, Japan
| | - Shuji Fukuda
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Fukuoka, Japan
| | - Yusuke Nakamura
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Fukuoka, Japan
| | - Shigetoshi Yano
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Fukuoka, Japan
| | - Hiroshi Aikawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Fukuoka, Japan
| | - Yoshinori Go
- Go Neurosurgical Clinic, Chikushi-gun, Fukuoka, Japan
| | - Kiyoshi Kazekawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Fukuoka, Japan
| | | | - Shinichi Yoshimura
- Department of Neurosurgery, The Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Fakih R, Dandapat S, Mendez-Ruiz A, Mendez AA, Farooqui M, Zevallos C, Quispe Orozco D, Hasan D, Rossen J, Samaniego EA, Derdeyn C, Ortega-Gutierrez S. Combined Transradial and Transfemoral Approach With Ostial Vertebral Balloon Protection for the Treatment of Patients With Subclavian Steal Syndrome. Front Neurol 2020; 11:576383. [PMID: 33193028 PMCID: PMC7642489 DOI: 10.3389/fneur.2020.576383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Patients with an obstructive subclavian artery (SA) may exhibit symptoms of vertebrobasilar insufficiency known as subclavian steal syndrome (SSS). Endovascular treatment with stent assisted percutaneous transluminal angioplasty (SAPTA) demonstrates significantly lower percentage of intraoperative and postoperative complications in comparison with open surgery. There is a 1–5% risk of distal intracranial embolization through the ipsilateral vertebral artery (VA) during SAPTA. Objective: To assess the safety and feasibility of a novel technique for distal embolic protection using balloon catheters during SA revascularization with a dual transfemoral and transradial access. Methods: We describe a case series of patients with SSS who underwent SAPTA due to severe stenosis or occlusion of the SA using a combined anterograde/retrograde approach. Transfemoral access to SA was obtained using large bore guide sheaths. Ipsilateral transradial access was obtained using intermediate bore catheters. A Scepter XC balloon catheter was introduced through the transradial intermediate catheter into the ipsilateral VA at the ostium during SAPTA for distal embolic protection. Results: A total of eight patients with SSS underwent subclavian SAPTA. Four patients had the combined anterograde/retrograde approach. Successful revascularization was achieved in three of them. It was difficult to create a channel in the fourth unsuccessful case due to heavily calcified plaque burden. No peri-operative ischemic events were identified. On follow-up, we demonstrated patency of the stents with resolution of symptoms and without any adverse events. Conclusion: Subclavian stenting using a combined transradial and transfemoral access with compliant balloon catheters at the vertebral ostium for prevention of distal emboli may represent an alternative therapeutic approach for the treatment of SA stenosis and occlusions.
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Affiliation(s)
- Rami Fakih
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Sudeepta Dandapat
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Alan Mendez-Ruiz
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Aldo A Mendez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Cynthia Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Darko Quispe Orozco
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - David Hasan
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - James Rossen
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Internal Medicine-Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Colin Derdeyn
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Giannopoulos S, Armstrong EJ. WIRION™ embolic protection system for carotid artery stenting and lower extremity endovascular intervention. Future Cardiol 2020; 16:527-538. [PMID: 32253940 DOI: 10.2217/fca-2020-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: To summarize all available literature regarding the Wirion™ embolic protection system (EPS) and present examples from our center. Materials & methods: A review of literture was performed about the utilization of Wirion EPS. Results: One study was identified investigating the outcomes of Wirion during carotid artery stenting. The study demonstrated 98.3% procedural success with stroke occurring in only 2.5%. Two single arm studies were identified investigating the efficacy of the Wirion filter during lower extremity endovascular interventions. The reported device success ranged from 95.1 to 97.3%. Conclusion: While carotid artery stenting should always be performed with adjunctive EPS in order to decrease the risk of cerebrovascular accidents, the routine use of EPS in femorpopliteal interventions remains an active area of investigation.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO 80045, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO 80045, USA
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Abstract
Peripheral atherectomy is a class of procedures that is rapidly increasing in volume. Multiple classes of devices exist, and newer variants are added to the market annually. The devices see wide application for de novo lesions, in-stent restenosis, and adjunctive therapy for drug-coated balloons. The body of evidence supporting atherectomy is less robust than for many other peripheral therapies. The frequency and severity of complications from atherectomy can be significant compared with angioplasty and stenting, and familiarity with preventative and bailout techniques is essential for the interventionalist.
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Affiliation(s)
- Derek Mittleider
- Vascular & Interventional Physicians, Spectrum Medical Group, Portland, ME.
| | - Erich Russell
- Department of Radiology, Maine Medical Center, Portland, ME
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