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Zeller T, Frank U, Bürgelin K, Schwarzwälder U, Flügel PC, Neumann FJ. Initial Clinical Experience with Percutaneous Atherectomy in the Infragenicular Arteries. J Endovasc Ther 2016; 10:987-93. [PMID: 14656170 DOI: 10.1177/152660280301000523] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate the efficacy and safety of a new atherectomy device for the treatment of infragenicular lesions in arteries with a reference diameter of at least 2.5 mm. Methods: Twenty-seven below-the-knee lesions in 17 patients (12 men; mean age 69±12 years) with chronic peripheral arterial occlusive disease were treated with directional atherectomy. The target lesion was in the popliteal artery (segment 3) in 2 (7%) cases, the tibioperoneal trunk in 12 (44%), the peroneal artery in 8 (30%), the anterior tibial artery in 2 (7%), and the posterior tibial artery in 3 (11%). Six (22%) of the lesions were in-stent stenoses. The mean diameter stenosis was 87%±9%, and the mean lesion length was 34±24 mm. Results: All but 2 (7%) of the lesions could be treated successfully (residual stenosis <30%) with the atherectomy catheter (93% technical success) using an average of 5±2 (range 1–10) passes of the device. Six lesions (22%) were treated after predilation and 21 (78%) with primary atherectomy. In 8 (30%) lesions, additional balloon angioplasty was performed. The 2 failures were in heavily calcified lesions through which the device could not pass despite predilation. The mean diameter stenosis after atherectomy was 14%±22% (range 0%–90%); after additional balloon angioplasty, the mean residual stenoses reduced to 12%±21% (range 0%–100%). One (6%) of the 2 patients who failed atherectomy sustained a thrombotic occlusion of the target vessel. This complication was treated successfully with local lysis, but the vessel reoccluded 3 days later; a stent was implanted. The mean ankle-brachial index increased from 0.50±0.27 to 0.86±0.40 before discharge. Conclusions: Below-the-knee native vessel lesions and in-stent restenoses with a diameter of at least 2.5 mm can be treated successfully and safely with this new atherectomy catheter. Additional balloon angioplasty was necessary in only a few cases.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Herz-Zentrum Bad Krozingen, Germany.
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Zeller T, Rastan A, Schwarzwälder U, Frank U, Bürgelin K, Amantea P, Müller C, Krankenberg H, Flügel PC, Neumann FJ. Midterm results after atherectomy-assisted angioplasty of below-knee arteries with use of the Silverhawk device. J Vasc Interv Radiol 2005; 15:1391-7. [PMID: 15590794 DOI: 10.1097/01.rvi.0000138060.05915.9d] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Prospective evaluation of the 3- and 6-month results after atherectomy of below-knee arterial lesions with a reference diameter of at least 2.0 mm with use of the Silverhawk device. MATERIALS AND METHODS Fifty-two below-knee lesions in 33 patients (61% men; mean age, 70 years +/- 11) with chronic peripheral occlusive disease of the lower limbs were treated with directional atherectomy. Target lesions were the popliteal artery (segment 3), n = 4 (8%); tibioperoneal trunk, n = 22 (42%); peroneal artery, n = 18 (34%); anterior tibial artery, n = 5 (10%); posterior tibial artery, n = 3 (6%); and in-stent lesions, n = 8 (16%). All interventions were performed via a 6-F sheath. The average degree of diameter stenosis was 89% +/- 10% (range, 70%-100%; n = 12 [23%] occlusions) and the mean lesion length was 48 mm +/- 28. RESULTS All but one lesion (2%) could be treated with the atherectomy catheter. After additional balloon angioplasty, all but one lesion was treated, with a residual stenosis no greater than 30% (98%), with 7.2 passes per lesion +/- 2.8 (range, 1-12) performed with the device. Fifteen lesions (29%) were treated after predilation and 37 (71%) were treated with primary atherectomy. In 15 lesions (29%), additional balloon angioplasty was performed, and two lesions required stent implantation as a result of dissection. The mean stenosis diameter after atherectomy was 12% +/- 18% (range, 0-100%). After additional therapy, the mean stenosis diameter was 6% +/- 9% (range, 0%-30%). A residual stenosis no greater than 30% was achieved in 50 lesions (96%). The mean ankle-brachial index significantly increased from 0.46 +/- 0.27 to 0.80 +/- 0.34 before discharge and remained improved during follow-up. One procedural complication (3%) was observed in which an intermittent occlusion of the target vessel occurred after an unsuccessful attempt to cross the lesion with the atherectomy device; this was then treated successfully with local lysis. One patient with one treated lesion died during follow-up. The rates of restenosis of at least 70% (diagnosed by duplex ultrasonography) were 14% (seven of 51 lesions) after 3 months and 22% (11 of 51) after 6 months. The 3-month and 6-month cumulative event-free survival were 91% +/- 4.1% and 76.9% +/- 5.8% and the 3-month and 6-month cumulative patency rates were 98% +/- 1.9% and 94.1% +/- 3.3%, respectively. CONCLUSION Below-knee native vessel lesions with a diameter of at least 2.0 mm can be treated with the Silverhawk catheter with a high success rate and a low complication rate. Midterm technical and clinical results are encouraging. Additional balloon angioplasty might be necessary in selected cases.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Heart Center Bad Krozingen, D-79189 Bad Krozingen, Germany.
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Zeller T, Rastan A, Schwarzwälder U, Frank U, Bürgelin K, Amantea P, Müller C, Flügel PC, Neumann FJ. Percutaneous Peripheral Atherectomy of Femoropopliteal Stenoses Using a New-Generation Device:Six-Month Results From a Single-Center Experience. J Endovasc Ther 2004; 11:676-85. [PMID: 15615558 DOI: 10.1583/04-1316r.1] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To report the early and 6-month results after atherectomy of femoropopliteal lesions using a new atherectomy device compatible with a 7-F sheath. METHODS Fifty-two patients (36 men; mean age 67+/-7 years) with stable, chronic lower limb occlusive disease were enrolled prospectively in a study of percutaneous directional atherectomy using the SilverHawk Atherectomy Catheter. The 71 femoropopliteal stenoses were grouped for analysis according to pathology: 30 (42%) primary stenoses, 27 (38%) native vessel restenoses, and 14 (20%) in-stent restenoses. The overall average stenosis length was 48+/-64 mm (range 10-300). There were more diabetics in the primary lesion cohort, whereas the lesion length of the in-stent restenoses was nearly twice as long as the other groups. RESULTS After atherectomy alone, residual stenosis was < or =50% in 68 (96%) lesions and < or =30% in 54 (76%). Additional balloon angioplasty was used in 41 (58%) lesions, primarily to smooth the arterial contour; stents were implanted in 4 (6%) arteries. Acute results after atherectomy and additional therapy were identical for the 3 groups (mean residual stenosis 15% in primary lesions, 8% in restenoses, and 14% in in-stent lesions). At the beginning of the study, 5 cases of tissue embolism were successfully treated with aspiration (device modification solved this problem). Restenosis rates after 6 months were not significantly lower in primary lesions (27%) compared with the other groups (41% for restenoses and 36% for in-stent restenoses). Reintervention after 6 months was also lowest for primary lesions (20% versus 37% for restenoses and 29% for in-stent lesions; p=NS). The ankle-brachial index was significantly improved after 6 months in all groups. At the 6-month follow-up, >80% of all patients were symptom free or had no lifestyle-limiting claudication. CONCLUSIONS Short and medium-length femoropopliteal lesions can be treated successfully and safely in most cases with this new atherectomy catheter. Technical and 6-month clinical outcomes seem to favor primary lesions compared with restenoses.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Herz-Zentrum Bad Krozingen, Germany.
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Zeller T, Frank U, Bürgelin K, Schwarzwälder U, Flügel PC, Neumann FJ. Initial Clinical Experience With Percutaneous Atherectomy in the Infragenicular Arteries. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0987:icewpa>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thrombolysis in the Management of Lower Limb Peripheral Arterial Occlusion—A Consensus Document. J Vasc Interv Radiol 2003; 14:S337-49. [PMID: 14514841 DOI: 10.1016/s1051-0443(07)61244-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this paper is to develop an intercontinental consensus on the use of thrombolytic therapy in occlusive peripheral arterial disease affecting lower limbs. A working party of self-designated angiologists, hematologists, interventional radiologists, and vascular surgeons of Europe and North America convened at 4 closed meetings. All published data known to any of the participants was entered into discussion. The working party discussed the topics outlined in this paper and a first draft was prepared in segments by members of the working party, discussed, and further revised into an interim report. It was then circulated to a number of Societies for their input. A final meeting of the Working Party together with delegates of the Societies collaborated on the definitive version of the text. The Party appreciates that in many areas the scientific evidence is not yet available. Nevertheless, it was felt that enough practical and scientific data were available to establish recommendations for clinical practice as well as for reporting results of thrombolytic therapy, which could be updated as later evidence became available. The guidelines apply only to drugs currently available for clinical use. The data are also considered to be sufficiently cogent that regulatory agencies should move to approve thrombolytic agents for intra-arterial therapy of acute lower extremity ischemia.
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Kawamata H, Kumazaki T, Tajima H, Niggemann P. Peripheral directional atherectomy evaluated with a rotational digital angiography system. J NIPPON MED SCH 2000; 67:335-41. [PMID: 11031362 DOI: 10.1272/jnms.67.335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND One of the factors that affect the recurrence rate after peripheral directional atherectomy (DA) is the degree of residual stenosis. A new method of peripheral DA to reduce residual stenoses was evaluated with a rotational digital angiography (RDA) system that provides both angiography and fluoroscopy at multiple projections within 360 degrees. PATIENTS AND METHODS Between March 1995 and July 1999, severe short segmental stenoses of six iliac arteries and two superficial femoral arteries (SFA) in eight patients were treated with the Simpson DA catheter under RDA system guidance. After pre-procedural RDA evaluation, the first series of DA were performed under ordinary PA fluoroscopic guidance. The residual stenoses were evaluated with RDA. If the residual stenoses exceeded 30%, a second series of DA were performed covering the residual plaque with the cutter window of the DA catheter. To this purpose the fluoroscopy of the RDA system was fixed in the direction in which the residual stenoses were largest and most eccentric. The end point was defined to be a residual stenosis of less than 30% evaluated with the RDA system, and the procedures were repeated until the end point was achieved. RESULTS Five of six iliac artery lesions were curved at the pre-procedural RDA evaluation. After the first series of DA, only two of six iliac lesions but all SFA lesions achieved the end point. Among the four other iliac lesions, three achieved the end point with one or two additional series of DA using the RDA system guidance to control the selective cuts of the residual plaques. One patient had a residual stenosis of 50% because the procedure could not be completed by balloon rupture of the DA catheter. In the patients with iliac stenoses, there was no final residual stenosis in one, and the range was from 20% to 25% in the four patients. The residual stenoses were located on the greater curvature side of the curved artery in three of these four patients. CONCLUSION The RDA system is a valuable tool in aiding reduction of the residual stenoses during peripheral DA. Minimal stenoses often remain on the greater curvature side of the wall because the rigid and straight metallic capsule (cylindrical housing) of the Simpson DA catheter does not completely fit the curved wall. This phenomenon was thought to be a mechanical limitation of this device.
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Affiliation(s)
- H Kawamata
- Department of Radiology, Nippon Medical School, Sendagi, Tokyo, Japan. Kawamata/
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Koenigsberg RA, Dave A, McCormick D, Weiss J, Higashida RT, Faro SH, Grandinetti LM, Tsai FY. Complicated stent supported cerebrovascular angioplasty: case analyses and review of literature. SURGICAL NEUROLOGY 2000; 53:465-74. [PMID: 10874146 DOI: 10.1016/s0090-3019(00)00209-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hemodynamic lesions of the cervicocerebral vasculature are currently being treated with stent supported percutaneous transluminal angioplasty. These procedures have met with increasing success when compared to the risks and morbidity of more invasive surgical approaches. The versatility of stent-supported angioplasty as a primary therapeutic modality is examined in the following complex cases. CASE DESCRIPTION We present four cases involving cervical angioplasty with emergent or adjunctive stent placement. Two cases involved the subclavian arteries, whereas the others involved the vertebral and internal carotid arteries. In our experience, complications of cervicocerebral artery angioplasty have been successfully managed by stent placement. CONCLUSION Our cases demonstrate the emerging role of cervical angioplasty and stent implantation as a successful therapeutic modality, highlighted in these complex cases.
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Affiliation(s)
- R A Koenigsberg
- Department of Radiologic Sciences, MCP Hahnemann University, Philadelphia, PA 19129, USA
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8
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Manke C, Geissler A, Seitz J, Lenhart M, Kasprzak P, Gmeinwieser J, Feuerbach S. Temporary Strecker stent for management of acute dissection in popliteal and crural arteries. Cardiovasc Intervent Radiol 1999; 22:141-3. [PMID: 10094995 DOI: 10.1007/s002709900350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Stent placement is a widely used bail-out treatment for dissection of peripheral arteries. Below the level of the superficial femoral artery permanent stenting is complicated by a high incidence of subacute thrombosis and restenosis. We present two cases of arterial occlusion due to acute iatrogenic dissection of the popliteal and distal fibular arteries. Successful treatment was achieved with a new bail-out procedure. Strecker stents were implanted to seal off the dissection flap. Stents were retrieved easily after 24 hr using a myocardial biopsy forceps. After stent retrieval the temporarily stented segments were patent and showed a larger lumen compared with segments treated by balloon dilatation alone. Temporary stenting is a simple and safe procedure and offers the advantage of tacking up dissection membranes and preventing recoil. Persistent presence of a metallic implant as a source of continued injury and stimulus for intimal proliferation is avoided.
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Affiliation(s)
- C Manke
- Department of Radiology, Klinikum der Universität Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
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Thrombolysis in the Management of Lower Limb Peripheral Arterial Occlusion—A Consensus Document fn1fn1This study was supported in part by Abbott Laboratories, Abbott Park, Illinois; Behringweike AG, Marburg, Germany; Boehringer Ingelheim UK, Bracknell, Berkshire, United Kingdom; Boehringer Mannheim AG, Mannheim, Germany; Genentech, Inc., South San Francisco, California; and Knoll AG, Ludwigshafen, Germany. This study was endorsed by the Cardiovascular and Interventional Radiological Society of Europe, Brussels, Belgium; the European Society for Vascular Surgery, Milan, Italy; the Internal Society for Thrombosis and Hemostasis, Chapel Hill, North Carolina; the International Union of Angiology, Lisbon, Portugal; and the Society of Cardiovascular and Interventional Radiology, Fairfax, Virginia.aaDisclaimer: This Consensus Document deals with the use of thrombolytic therapy in the management of lower limb ischemia. Much of the discussion centers on published data. However, it is recognized that in clinical practice each case must be considered on its own merits, and that there may be good clinical reasons for adopting a different approach from those included in these guidelines. Participating societies and individuals wish to emphasize that the comments and recommendations in this Document should be taken as a whole and do not necessarily represent the only correct approach to the treatment of individual patients. Am J Cardiol 1998. [DOI: 10.1016/s0002-9149(97)00894-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Weintraub JL, Sheiman RG, Rosen MP, Porter DH, Kim D. Valvectomy with use of a percutaneous directional atherectomy catheter in failing in situ saphenous vein grafts. J Vasc Interv Radiol 1997; 8:355-8. [PMID: 9152907 DOI: 10.1016/s1051-0443(97)70571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- J L Weintraub
- Department of Interventional Radiology, Hospital University of Pennsylvania, Philadelphia 19104, USA
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Grubnic S, Heenan SD, Buckenham TM, Belli AM. Evaluation of the Pullback Atherectomy Catheter in the treatment of lower limb vascular disease. Cardiovasc Intervent Radiol 1996. [DOI: 10.1007/bf02577611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Korogi Y, Hirai T, Takahashi M. Intravascular ultrasound imaging of peripheral arteries as an adjunct to balloon angioplasty and atherectomy. Cardiovasc Intervent Radiol 1996; 19:1-9. [PMID: 8653738 DOI: 10.1007/bf02560139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article reviews many of the applications of intravascular ultrasound (US) imaging for peripheral arterial diseases. In vitro studies demonstrate an excellent correlation between ultrasound measurements of lumen and plaque cross-sectional area compared with histologic sections. In vivo clinical studies reveal the enhanced diagnostic capabilities of this technology compared with angiography. Intravascular US imaging can provide valuable information on the degree, eccentricity, and histologic type of stenosis before intervention, and on the morphological changes in the arterial wall and the extent of excision after intervention. Intravascular US may also serve as a superior index for gauging the diameter of balloon, stent, laser probe, and/or atherectomy catheter appropriate for a proposed intervention. Significant new insights into the mechanisms of balloon angioplasty and atherectomy have been established by intravascular US findings. Intravascular US imaging has been shown to be a more accurate method than angiography for determining the cross-sectional area of the arterial lumen, and for assessing severity of stenosis. Quantitative assessment of the luminal cross-sectional area after the balloon dilatation should be more accurate than angiography as intimal tears or dissections produced by the dilatation may not be accurately evaluated with angiography. At the present time, intravascular US is still a controversial imaging technique. Outcome studies are currently being organized to assess the clinical value and cost effectiveness of intravascular ultrasound in the context of these interventional procedures.
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Affiliation(s)
- Y Korogi
- Department of Radiology, Kumamoto University School of Medicine, Japan
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Galli M, Goldberg SL, Zerboni S, Almagor Y. Balloon expandable stent implantation after iatrogenic arterial dissection of the left subclavian artery. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 35:355-7. [PMID: 7497510 DOI: 10.1002/ccd.1810350417] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A patient undergoing attempted angioplasty of a left internal mammary artery graft to left anterior descending coronary artery developed an iatrogenic dissection of the left subclavian artery, with symptoms of left arm claudication. A balloon expandable stent was inserted with an excellent angiographic result. The patient has remained free of symptoms or signs of decreased arm flow, with a patent subclavian artery demonstrated on angiography 8 months later. The excellent early-to-moderate term clinical and angiographic results support the efficacy of this technical approach.
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Affiliation(s)
- M Galli
- Centro Cuore Columbus, Milan, Italy
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Walker J, Chalmers N, Gillespie IN. A new use of the Simpson percutaneous atherectomy catheter: resection of retained valve cusps of an in-situ vein graft. Cardiovasc Intervent Radiol 1995; 18:50-2. [PMID: 7788634 DOI: 10.1007/bf02807357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
An in-situ saphenous vein graft occluded because of retained valve cusps. After aspiration thrombectomy, percutaneous transluminal balloon angioplasty was performed, but reocclusion occurred 11 months later. Following a second aspiration thrombectomy, the restenosed retained cusps were resected using the Simpson percutaneous atherectomy catheter. The graft remained patent until the patient's death from unrelated causes 6 months later.
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Affiliation(s)
- J Walker
- Department of Radiology, Royal Infirmary of Edinburgh, Scotland, United Kingdom
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Affiliation(s)
- G K McLean
- Department of Interventional Radiology, Western Pennsylvania Hospital, Pittsburgh 15224
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Bell MR, Reeder GS, Garratt KN, Berger PB, Bailey KR, Holmes DR. Predictors of major ischemic complications after coronary dissection following angioplasty. Am J Cardiol 1993; 71:1402-7. [PMID: 8517384 DOI: 10.1016/0002-9149(93)90600-h] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Coronary dissection is a major cause of abrupt arterial closure after coronary angioplasty but may also be associated with no discernible event. Deciding which dissections should receive further treatment is often a dilemma if the artery remains patent. This case-control study examined predictors of major ischemic complications after coronary dissections. Fifty-eight patients with coronary dissections, but a patent artery at the completion of the angioplasty procedure, subsequently had in-hospital abrupt arterial closure, acute myocardial infarction, emergency coronary bypass surgery, or died; they were matched to 58 control subjects with dissection but no event. Analysis of each angiogram was performed with the examiner unaware of patient's history. Baseline angiographic and clinical characteristics of cases and controls were similar except for an excess of current smokers among the cases (31 vs 16%; p = 0.048). Residual luminal diameter at the dissection site was 1.2 +/- 0.6 mm (cases) versus 1.6 +/- 0.6 mm (controls; p = 0.001) with relative stenosis of 59 +/- 21% vs 43 +/- 21%, respectively (p = 0.0001). Dissections among cases were longer than among controls (11 +/- 7 mm vs 7 +/- 4 mm; p = 0.001). No significant difference was found in dissection morphology using 2 classification schemes or in final Thrombolysis in Myocardial Infarction study flow grade. Transient occlusion during the procedure, however, occurred in 47% of cases versus 5% of controls (p = 0.0001). Transient occlusion, residual percent stenosis > or = 70%, and dissections > or = 6 mm were independently predictive of major ischemic events.
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Affiliation(s)
- M R Bell
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
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Kotb MM, Kadir S, Bennett JD, Beam CA. Aortoiliac angioplasty: is there a need for other types of percutaneous intervention? J Vasc Interv Radiol 1992; 3:67-71. [PMID: 1531773 DOI: 10.1016/s1051-0443(92)72189-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In a retrospective study, the authors compared results in 81 patients who underwent 117 percutaneous transluminal angioplasty (PTA) procedures in the iliac arteries and 21 patients who underwent iliac artery atherectomy. Both groups were similar with respect to symptoms and risk factors. The overall technical success rates were 97.4% for PTA and 100% for atherectomy. The initial clinical success was 92.8% for PTA and 100% for atherectomy. Complications requiring surgery occurred in four of 117 (3.4%) PTA and one of 21 (4.8%) atherectomy procedures. The 2-year patency rate for PTA was similar to that achieved with atherectomy in a smaller patient population. These results indicate that atherectomy does not offer any definite advantage over conventional PTA for the routine management of iliac lesions and make it difficult to justify the additional expense and complexity of this technique.
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Affiliation(s)
- M M Kotb
- Department of Radiology, Duke University Medical Center, Durham, NC
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18
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Murphy TP, Dorfman GS, Segall M, Carney WI. Iatrogenic arterial dissection: treatment by percutaneous transluminal angioplasty. Cardiovasc Intervent Radiol 1991; 14:302-6. [PMID: 1834338 DOI: 10.1007/bf02578455] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Iatrogenic arterial dissection may require intervention, depending on the severity of resulting stenosis and the degree of symptoms. We present 5 cases of iatrogenic arterial dissection: 1 with dissection of the lower abdominal aorta, common iliac artery, and external iliac artery, and 3 with external iliac artery dissections, all managed with percutaneous transfemoral transluminal angioplasty; and 1 with dissection of the superior mesenteric artery with angioplasty performed by the translumbar approach. Four of the 5 patients had no additional therapy; 1 patient eventually underwent surgery for an asymptomatic residual pseudoaneurysm seen on abdominal computed tomography. Angiographic follow-up in 2 patients demonstrated persistent improvement in stenosis, 1 at 2 weeks after angioplasty, and the other, 6 weeks following angioplasty. None of the 5 patients required further therapy for recurrence of symptoms on clinical follow-up obtained up to 1 year after angioplasty. Though the incidence of recurrent arterial stenosis following angioplasty for dissection may be greater than that incurred after intravascular stent placement or surgery, angioplasty may be effective, and has the advantage of being less expensive than both of these treatment modalities, and more widely available and applicable than intravascular stents.
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Affiliation(s)
- T P Murphy
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence 02903
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Bauriedel G, De Maio SJ, Höfling B. Role of angioscopy in the treatment of peripheral vascular disease with percutaneous atherectomy. Am J Cardiol 1991; 68:226-31. [PMID: 1829575 DOI: 10.1016/0002-9149(91)90748-a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The role of adjunctive video angioscopy was evaluated in 43 patients with symptomatic peripheral vascular disease undergoing percutaneous atherectomy with the Simpson atherocath. There were 57 target lesions (superficial femoral, n = 46; popliteal, n = 11) of which 33 were stenotic (86 +/- 11%) and 24 were total occlusions of 0.5 to 10.6 cm in length, determined by angiography. Intraluminal inspection, with angioscopes of 0.85 to 1.5 mm in outer diameter housed within a guide catheter, could be performed in 55 of 57 lesions (96%) before atherectomy and in 39 of these 55 (71%) after atherectomy. Failure to obtain an adequate image was usually due to insufficient irrigation, especially in recanalized vessels. In 13 of 23 successfully recanalized arteries (54%) the occlusion could be crossed by the angioscope itself, whereas in 10 cases (42%) a guidewire or a sheath introducer was necessary. Angioscopic passage revealed that often long total occlusions, determined by angiography, consisted of greater than or equal to 1 discrete occlusion with interposed patent thrombus-free vascular segments. After atherectomy, in 15 instances with an acceptable angiographic result, angioscopy was helpful in identifying residual plaques and flaps which then selectively underwent atherectomy. In conclusion, angioscopy proved to be a useful adjunct to angiography in optimizing vascular recanalization with percutaneous atherectomy.
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Affiliation(s)
- G Bauriedel
- Department of Internal Medicine I, University of Munich, Federal Republic of Germany
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Kim D, Porter DH, Siegel JB, Shapiro ME, Strom TB, Glotzer DJ. Use of a reperfusion catheter after angioplasty dissection for salvage of ischemic renal allograft: case report. Cardiovasc Intervent Radiol 1991; 14:179-82. [PMID: 1831690 DOI: 10.1007/bf02577725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Percutaneous transluminal angioplasty was performed on a right common iliac artery stenosis presumed to be causing renovascular hypertension in a patient with a renal allograft anastomosis to the right external iliac artery. This was complicated by an obstructive dissection resulting in acute threatening renal allograft ischemia. Renal blood flow was restored by means of a transluminal reperfusion catheter until corrective surgery could be performed. This case is reported because such catheters can be acutely helpful to the interventionalist, and they have not been described in the radiology literature.
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Affiliation(s)
- D Kim
- Department of Radiology, Beth Israel Hospital, Boston, Massachusetts 02215
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21
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Nakagawa N, Cragg AH, Smith TP, Landas SK, De Jong SC. Peripheral atherectomy: experimental results with a new device. J Vasc Interv Radiol 1990; 1:127-32. [PMID: 2134030 DOI: 10.1016/s1051-0443(90)72517-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The size of present rotational atherectomy devices is limited in part by a tendency to produce vessel torsion. The authors designed and investigated a large-bore rotational atherectomy device for peripheral atherectomy in a single pass without significant torsion. A plaque was retrieved from 36 of 40 cadaveric iliac arteries. The mean plaque size was 8.4 x 3.9 mm, and the average number retrieved per artery was two. Thirty of 34 severely calcified arteries were treated successfully. Effluent study revealed no distal embolization; however, six perforations and four dissections occurred. Preliminary results suggest that a cutting surface with a relatively large diameter can be designed to be effective without producing vessel torsion. Changes in future designs will include added flexibility and expandable cutting surfaces to enhance safety and minimize entry diameter.
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Affiliation(s)
- N Nakagawa
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52242
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22
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Lasala JM, Remetz MS, Cleman MW, Cabin HS. Inadvertent "atherectomy" during ostial right coronary artery angioplasty. Am Heart J 1990; 120:423-4. [PMID: 2382619 DOI: 10.1016/0002-8703(90)90089-g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- J M Lasala
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510
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23
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Lee TC, Hartzler GO, Rutherford BD, McConahay DR. Removal of an occlusive coronary dissection flap by using an atherectomy catheter. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1990; 20:185-8. [PMID: 2364417 DOI: 10.1002/ccd.1810200307] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- T C Lee
- Cardiovascular Consultants, Inc., Kansas City, MO 64111
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24
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Matsumoto AH, Barth KH, Teitelbaum GP. Percutaneous management of emboli associated with hot tip laser-assisted angioplasty. Cardiovasc Intervent Radiol 1990; 13:71-4. [PMID: 2143694 DOI: 10.1007/bf02577353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We describe the percutaneous management of emboli that occurred in 3 patients during hot tip laser-assisted angioplasty procedures. One embolus was lysed with direct, local infusion of urokinase using an open-ended guidewire. Another embolus was removed using the transcatheter aspiration technique. The third embolus was partially lysed and then, using a steerable guidewire, displaced placed into a distal side branch. In all 3 cases of embolization, distal blood flow was reestablished using percutaneous techniques, obviating the need for surgical intervention.
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Affiliation(s)
- A H Matsumoto
- H.C.A. L.W. Blake Hospital, Bradenton, Florida 34209
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25
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Wilms G, Pauwels P, Peene P, Baert AL, Vermylen J, Nevelsteen A, Suy R. Percutaneous transluminal atherectomy: preliminary results. Cardiovasc Intervent Radiol 1990; 13:18-21. [PMID: 2140293 DOI: 10.1007/bf02576932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Percutaneous transluminal atherectomy with the Simpson atherectomy catheter was performed in 10 patients with 14 severe atheromatous stenoses of the femoropopliteal arteries. Removal of plaque material with restoration of vessel patency was successful in all patients without complication. Further clinical follow-up will have to determine whether the recurrence rate of stenoses will be lower with this method than with conventional balloon angioplasty.
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Affiliation(s)
- G Wilms
- Department of Radiology, University Hospitals K.U. Leuven, Belgium
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26
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Castaneda F, Moradian G, Hunter D, Castaneda-Zuniga W, Amplatz K. Percutaneous intravascular biopsy using a Simpson atherectomy catheter: technical note. Cardiovasc Intervent Radiol 1989; 12:342-3. [PMID: 2516778 DOI: 10.1007/bf02575436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The design of the Simpson atherectomy catheter makes this device a potentially safe and technically easy tool to obtain adequate pathologic intravascular or intraluminal specimens. The risk of perforation should be low, but this use has to be further studied. We describe the first intravascular biopsy performed with the Simpson catheter.
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Affiliation(s)
- F Castaneda
- Department of Radiology, University of Minnesota Hospitals and Clinics, Minneapolis 52242
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