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Cheng XY, Qiao PG, Jiang B, Zhang TT, He W. The application value of 3D ASL in evaluating the effectiveness of stent implantation for vertebrobasilar artery stenosis. Magn Reson Imaging 2024; 110:23-28. [PMID: 38552748 DOI: 10.1016/j.mri.2024.03.038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To evaluate the effect of stent implantation for vertebrobasilar artery stenosis,by using 3D arterial spin labeling (3D ASL) technique. METHODS A retrospective analysis was conducted on the clinical and 3D ASL data of 48 patients who underwent vertebral-basilar artery stenting. Post-labeling delay times (PLD) of 1.5 s and 2.5 s were chosen, and the average regional cerebral blood flow (rCBF) values were measured in nine brain regions of the posterior circulation: bilateral thalamus, bilateral occipital lobes, bilateral cerebellar hemispheres, midbrain, pons, and medulla. The 48 patients were divided into two groups based on the presence or absence of acute ischemic stroke in the posterior cerebral circulation region detected by diffusion-weighted imaging (DWI). The preoperative and postoperative rCBF results were statistically analyzed. RESULTS In the infarct group, there were significant increases in rCBF values of all nine brain regions at both PLD = 1.5 s and 2.5 s postoperatively compared to preoperatively. At PLD = 1.5 s, statistically significant differences in rCBF values between the preoperative and postoperative periods were found in the right thalamus, left cerebellum, midbrain, and pons regions (P < 0.05). At PLD = 2.5 s, statistically significant differences in rCBF values between the preoperative and postoperative periods were observed in the left occipital lobe, right cerebellum, midbrain, and pons regions (P < 0.05). When analyzing the rCBF values of the brain regions with recent infarcts in the infarct group, there was a significant increase in postoperative rCBF values compared to preoperative values (P < 0.05). After excluding the data from brain regions with recent infarcts, the CBF values in the remaining brain regions were also increased postoperatively, and some brain regions showed statistically significant differences in rCBF values between the preoperative and postoperative periods (P < 0.05). In the non-infarct group, there were no statistically significant differences in the preoperative and postoperative rCBF values in all brain regions at both PLD = 1.5 s and 2.5 s (P > 0.05). CONCLUSION The application of 3D ASL technology shows significant value in assessing the surgical efficacy of vertebral-basilar artery stenting, especially in patients with acute posterior circulation infarction.
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Affiliation(s)
- Xiao-Yue Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Peng-Gang Qiao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Bin Jiang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Ting-Ting Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wen He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Piccinelli E, Frazzetto F, Pilati M, Butera G. Stent Implantation Across the Atrial Flow Regulator Device. Pediatr Cardiol 2024; 45:695-698. [PMID: 38308059 DOI: 10.1007/s00246-024-03405-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/04/2024] [Indexed: 02/04/2024]
Abstract
The Atrial Flow Regulator (AFR) is a self-expandable double-disc device with a central fenestration, intended to maintain a calibrated communication across the interatrial septum. We reported for the first time a stent implantation across an AFR device in an adolescent born with complex congenital heart disease with duct-dependent systemic circulation and severe combined pulmonary hypertension.
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Affiliation(s)
- Enrico Piccinelli
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Polito BIO Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Fausto Frazzetto
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Mara Pilati
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy.
- Pediatric Cardiology Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
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Leick J, Rheude T, Denne M, Tobias K, Cassese S, Kastrati A, Afzal S, Hug KP, Saad L, Lauterbach M, Werner N. Comparison of long-term outcome in patients with in-stent restenosis treated with intravascular lithotripsy or with modified balloon angioplasty. Clin Res Cardiol 2023:10.1007/s00392-023-02357-3. [PMID: 38112745 DOI: 10.1007/s00392-023-02357-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Modified balloon angioplasty (MB) using a cutting-/scoring balloon or intravascular lithotripsy (IVL) is used in patients with in-stent restenosis (ISR). However, IVL is an off-label use in this setting. The aim of this subgroup analysis of an all-comers registry was to compare IVL to MB angioplasty in patients with ISR. METHODS The subgroup (n = 117) included all patients with an ISR treated by MB or IVL between 2019 and 2021. Primary endpoint was strategy success (< 20% residual stenosis). The secondary endpoint was cardiac death, acute myocardial infarction (AMI) and target lesion failure/revascularization (TVR). Quantitative coronary angiography was performed in all patients. RESULTS A total of n = 36 patients were treated by IVL and n = 81 patients by MB. No significant differences in baseline characteristics were observed between the groups. The primary endpoint was reached in 99 patients (84.6%). Patients in the IVL group had less residual stenosis (2.8% vs. 21.0%; p = 0.012). Multivariate regression analysis revealed that IVL had a significant positive effect on reaching the primary end point (Estimate 2.857; standard error (SE) 1.166; p = 0.014). During the follow-up period (450 days) there were no significant differences in rates of cardiac death (IVL n = 2 (1.7%) vs. MB n = 3 (2.6%); p = 0.643), AMI (IVL n = 2 (1.7%) vs. MB n = 4 (3.4%); p = 0.999) and TVR (IVL n = 5 (4.3%) vs. MB n = 14 (12%); p = 0.851). CONCLUSION IVL results in a significantly lower rate of residual stenosis than MB in patients with ISR. During the long-term follow-up, no differences in rates of cardiac death, AMI or TVR were observed.
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Affiliation(s)
- Jürgen Leick
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany.
| | - Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Michael Denne
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Krause Tobias
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Salvatore Cassese
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Shazia Afzal
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Karsten P Hug
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Louai Saad
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Michael Lauterbach
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Nikos Werner
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
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Scansen BA. Advances in the Treatment of Pulmonary Valve Stenosis. Vet Clin North Am Small Anim Pract 2023; 53:1393-1414. [PMID: 37453894 DOI: 10.1016/j.cvsm.2023.05.013] [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: 07/18/2023]
Abstract
Pulmonary valve stenosis represents the most common congenital heart defect of dogs and appears to be increasing in prevalence due to the growing popularity of brachycephalic breeds. Current treatments include beta-blockade and balloon pulmonary valvuloplasty, though evidence-based approaches to this disease are lacking. Balloon pulmonary valvuloplasty is most effective for fused, doming valves leaving a large population of dogs with thick, dysplastic valves that fail to respond adequately to balloon dilation. Transpulmonary stent implantation is an emerging therapy to consider for dogs with valve dysplasia or who have failed balloon pulmonary valvuloplasty; current experience with transpulmonary stent implantation is provided.
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Affiliation(s)
- Brian A Scansen
- Cardiology & Cardiac Surgery, Department of Clinical Sciences, Colorado State University, 200 West Lake Street, 1678 Campus Delivery, Fort Collins, CO 80523-1678, USA.
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Liu P, Zhang H, Shi Y, Li Z, Liu Y, Li P, Tian Y. One-step solution for angioplasty, low-profile stent delivery, and intrastent dilation using a dual-lumen angioplasty balloon microcatheter: technical advances, limitations, outcomes, and literature review. Neurosurg Rev 2023; 46:234. [PMID: 37682426 DOI: 10.1007/s10143-023-02143-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/09/2023]
Abstract
Dual-lumen angioplasty balloon microcatheters make it possible to perform percutaneous transluminal angioplasty (PTA), low-profile stent delivery, and intrastent dilation without the microcatheter exchange technique. This technique has shown many advantages in recent years. We reviewed the techniques and applications in different intracranial vascular diseases and summarized the outcomes and indications. Gateway dual-lumen angioplasty balloon was used for PTA and kept in situ. Stent was delivered and deployed via Gateway microcatheter. Intrastent balloon dilation was performed after stent deployment. We retrospectively reviewed the clinical and imaging data, surgical procedures, technique application, and follow-up outcomes of six patients treated from 2020 to 2023. Neurological function was assessed by the modified Rankin scale (mRS). A literature review was performed using PubMed. All seven patients (4 males, 3 females; mean age, 62.6 ± 6.9 years) underwent percutaneous transluminal angioplasty and stent deployment using a balloon microcatheter. There was one middle cerebral artery (MCA) aneurysm with parent artery stenosis, two MCA dissections, and four intracranial atherosclerotic stenoses (ICASs). The mRS score was 0 in five patients and 1 in two patients. Cerebral dissection with stenosis is the best indication, and its application in stent-assisted aneurysm coiling is inappropriate. This technique is controversial in ICAS treatment.
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Affiliation(s)
- Peixi Liu
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
| | - Hongfei Zhang
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
| | - Yuan Shi
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
| | - Zongze Li
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
| | - Yingtao Liu
- Department of Radiology, Huashan Hospital of Fudan University, Shanghai, 200040, China
| | - Peiliang Li
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China.
- National Center for Neurological Disorders, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
| | - Yanlong Tian
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China.
- National Center for Neurological Disorders, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
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Fu Y, Zhao H, Li J, Li Y, Gong T, An C, Wang R, Li X. Infigratinib, a Selective Fibroblast Growth Factor Receptor Inhibitor, Suppresses Stent-Induced Tissue Hyperplasia in a Rat Esophageal Model. Cardiovasc Intervent Radiol 2023; 46:1267-1275. [PMID: 37491520 DOI: 10.1007/s00270-023-03502-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE Stent-induced tissue hyperplasia remains a challenge for the application of self-expanding metal stents in the management of esophageal stricture. This study aimed to evaluate the efficacy of infigratinib, which is a selective fibroblast growth factor receptor inhibitor, in the prevention of stent-induced tissue hyperplasia in a rat esophageal model. METHODS Twenty-four male Sprague-Dawley rats underwent esophageal stent placement and were randomized to receive 1 ml of vehicle, 5 mg/kg infigratinib in 1 ml of vehicle, or 10 mg/kg infigratinib in 1 ml of vehicle via naso-gastric tube once daily for 28 days. Follow-up fluoroscopy was performed on postoperative day 28, and the stented esophageal tissues were harvested for histological and immunofluorescence examinations. RESULTS All rats survived until euthanasia on postoperative day 28 without procedure-related adverse events. The incidence of stent migration was 12.5%, 12.5% and 25% in the control group, the 5 mg/kg infigratinib group and, the 10 mg/kg infigratinib group, respectively. The percentage of granulation tissue area, the submucosal fibrosis thickness, the number of epithelial layers, the degree of inflammatory cell infiltration, the degree of collagen deposition, the number of fibroblast growth factor receptor 1 (FGFR1)-expressing myofibroblasts, and the number of proliferating myofibroblasts were all significantly lower in both infigratinib groups than in the control group (P < 0.05) but were not significantly different between the two infigratinib groups (P > 0.05). CONCLUSIONS Infigratinib significantly suppresses stent-induced tissue hyperplasia by inhibiting FGFR1-mediated myofibroblast proliferation and profibrotic activities in a rat esophageal model.
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Affiliation(s)
- Yan Fu
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - He Zhao
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jingui Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yawei Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Tao Gong
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Chao An
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ruosu Wang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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Dutilleux T, Farhat N, Bruyère PJ, Seghaye MC. [Natural course of an aortic coarctation in a child]. Rev Med Liege 2023; 78:403-406. [PMID: 37560949] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Aortic coarctation is a frequent congenital heart disease that presents in form of two entities, the infant type and the child or adult type. The infant type is the most frequent and manifests acutely by heart failure or shock. The second one shows a slow and progressive course with no or few initial symptoms. For that reason, the diagnosis is usually missed until symptomatic arterial hypertension or hypertrophic cardiomyopathy develop. We report the case of an initially asymptomatic boy in whom the development of an aortic coarctation could be precisely documented over a period of 10 years by repeated bidimensional and Doppler echocardiography. The patient underwent successful balloon angioplasty of the aortic isthmus and stent implantation. This case points out the importance of strict follow-up in any young child in whom an even mild anomaly of the aortic arch is detected. This is critical in order not to miss an aortic coarctation that influences significantly morbidity in adulthood.
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Affiliation(s)
- Tanguy Dutilleux
- Service de Pédiatrie, Cardiologie pédiatrique, CHU Liège, Belgique
- Klinik für Kinderkardiologie, Universitätsklinikum Aachen, Allemagne
| | - Nesrine Farhat
- Service de Pédiatrie, Cardiologie pédiatrique, CHU Liège, Belgique
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Wang S, Zhu X, Feng R, Qin Y, Wang S, Hu Z. Ultrasound-guided intraoperative inferior vena cava stent implantation for treatment of acute hypotension during orthotopic liver transplantation. J Vasc Surg Cases Innov Tech 2023; 9:101184. [PMID: 37305361 PMCID: PMC10250928 DOI: 10.1016/j.jvscit.2023.101184] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/28/2023] [Indexed: 06/13/2023] Open
Abstract
Severe obstruction of inferior vena cava (IVC) outflow after orthotopic liver transplantation can result in persistent hypotension, leading to transplantation failure and intraoperative circulatory instability and can even threaten the patient's life. IVC stent implantation is a therapeutic approach to relieve the obstruction of IVC outflow. In the present report, we describe two cases of IVC stent implantation assisted by color Doppler ultrasound during orthotopic liver transplantation to manage the persistent hypotension caused by acute obstruction of IVC outflow. At 1 and 3 months of follow-up, the stent position was optimal, and the stent and IVC patency were satisfactory without thrombosis.
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Affiliation(s)
- Siwen Wang
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaofeng Zhu
- Department of Liver Transplantation, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ruijia Feng
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuansen Qin
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shenming Wang
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zuojun Hu
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Metze M, Stöbe S, Pfeiffer D, Hagendorff A, Laufs U, Lenk K. First case report of the use of two stents following coronary artery obstruction during indirect mitral annuloplasty. ESC Heart Fail 2023. [PMID: 37080951 PMCID: PMC10375092 DOI: 10.1002/ehf2.14382] [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] [Received: 02/17/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
The case of a 71-year-old male with end stage heart failure and severe mitral regurgitation is presented, where percutaneous indirect mitral annuloplasty was performed. During device implantation in the coronary sinus the circumflex artery was compromised at two anatomic locations, while the mitral regurgitation was efficiently reduced. After weighing risks and alternative therapeutic options, stent implantation was chosen as bailout strategy to leave the device in place and retain the efficient MR reduction. The anatomical proximity of Cx and coronary sinus in the mitral valve plane bears the risk of circumflex artery damage during surgical and interventional mitral repair. Usually, a device exchange solves the problem of arterial flow limitation in most cases. While stent implantation remains off label use in this setting and should not be performed without critical evaluation, it has been performed successfully in similar clinical settings as well (e.g. artery stenosis by surgical suture).
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Affiliation(s)
- Michael Metze
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | - Stephan Stöbe
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | | | - Andreas Hagendorff
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
| | - Karsten Lenk
- Department of Cardiology, Medical Department IV, University Hospital Leipzig, Leipzig, Germany
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Xu X, Guo Y, Huang M, Fu L, Li F, Zhang H, Gao W, Liu T. Stenting of branch pulmonary artery stenosis in children: initial experience and mid-term follow-up of the pul-stent. Heart Vessels 2023. [PMID: 36820867 DOI: 10.1007/s00380-023-02246-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023]
Abstract
Not all stents are suitable for children. For instance, premounted stents can be used in infants and small children but cannot dilate with age to accommodate adult-sized pulmonary arteries. Conversely, the Pul-Stent adapts to somatic growth. Thus, our hospital implemented the Pul-Stent in pediatric patients with branch pulmonary artery stenosis. This study summarizes our initial experience with Pul-Stents in this patient population, including the efficacy and safety. We implanted 37 Pul-Stents in 35 patients between August 2014 and June 2015. The patients' mean age and weight at stent implantation were 6.7 ± 3.0 years and 20.9 ± 8.7 kg, respectively. Bench testing revealed that axial shortening of the Pul-Stent was minimal with further dilation, and the radial strength did not change. The stents were successfully deployed in all cases, except two with minor malpositioning. Primarily, 8-12 mm mounting balloons were used for the initial implantation, and a long sheath (8-10 F) was used for delivery. After stent implantation, the minimal lumen diameter in the stenosed segment increased by 50% in 97% (34/35) of patients. Furthermore, the pressure gradient across the stenosed segment decreased by 50% in 77% (23/30) of biventricular patients. One stent fracture and one stent restenosis were noted during the follow-up visits (mean follow-up time: 4.6 ± 1.7 years). Eighteen patients (51%) underwent repeat catheterization; ten had successful redilation. No aneurysms or stent fractures were observed. Our initial results indicate that the Pul-Stent is safe and effective in pediatric patients and can be further dilated over time to accommodate somatic growth. Moreover, the Pul-Stent has good compliance and adequate radial strength to treat pulmonary artery stenosis effectively.
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Lv L, Ma X, Xu Y, Zhang Q, Kan S, Chen X, Liu H, Wang H, Wang C, Ma J. The constricting effect of reduced coronary artery compliance on the left ventricle is an important cause of reduced diastolic function in patients with coronary heart disease. BMC Cardiovasc Disord 2022; 22:375. [PMID: 35978296 PMCID: PMC9382726 DOI: 10.1186/s12872-022-02809-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies of left ventricular diastolic function (LVDF) have focused on the decrease in active and passive diastolic function due to ischemic factors but have not investigated if the decrease in compliance of the coronary arteries that bypass the surface of the heart and travel between the myocardium could cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis. Methods and Results 581 patients diagnosed with coronary heart disease (CHD) were divided into A group (patients are the control group), B group (patients with less than 50% coronary artery stenosis), C group (patients with coronary artery stenosis between 50 and 75%), D group (patients with coronary artery stenosis greater than 75%) according to the degree of coronary stenosis. The diastolic function of the ventricle is reflected by applying the relaxation time constant T value, which refers to the time between peak dp/dt and end-diastolic pressure in the left ventricle. It was concluded that there was a statistical difference in Gensini scores between patients in groups B, C and D (P < 0.001). And multiple linear regression analysis showed that T was correlated with Gensini score and C-dp/dtmax (R = 0.711, P < 0.001). Grouping according to the site of stent implantation and the number of stents implanted, it was found out that the changes in T values before and after left anterior descending artery (LAD) stent implantation were greater than left circumflex artery (LCX) and right coronary artery (RCA) (P < 0.001). And multiple linear regression revealed a correlation between T values and stent length, ventricular stiffness, and C-dp/dtmax (P = 0.001). Conclusions The decrease in compliance of the coronary arteries bypassing the surface of the heart and travelling between the myocardium would cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis.
Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02809-0.
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Affiliation(s)
- Liang Lv
- The Third Affiliated Hospital, Southern Medical University or The Third School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Xianghe Ma
- Shanghai Maritime University, Shanghai, China
| | - Yannan Xu
- Anhui University of Science and Technology, Huainan, Anhui, China
| | - Qiong Zhang
- Department of Cardiology, Fengxian Branch of Shanghai 6th People's Hospital, Nanfeng Road 6600#, Shanghai, 201400, China
| | - Shanshan Kan
- Anhui University of Science and Technology, Huainan, Anhui, China
| | - Xiaoming Chen
- Anhui University of Science and Technology, Huainan, Anhui, China
| | - Huajin Liu
- Department of Cardiology, Fengxian Branch of Shanghai 6th People's Hospital, Nanfeng Road 6600#, Shanghai, 201400, China
| | - Hongwei Wang
- Department of Cardiology, Fengxian Branch of Shanghai 6th People's Hospital, Nanfeng Road 6600#, Shanghai, 201400, China
| | - Changhua Wang
- TengZhou City Central People Hospital, Affiliated to Jining Medical University, Jining, Shandong, China
| | - Jiangwei Ma
- The Third Affiliated Hospital, Southern Medical University or The Third School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China. .,Anhui University of Science and Technology, Huainan, Anhui, China. .,Department of Cardiology, Fengxian Branch of Shanghai 6th People's Hospital, Nanfeng Road 6600#, Shanghai, 201400, China.
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Li F, Li P, Cai Z, Liu X, Li L, Zhang H, Li H, He Y, Ye L, Yan X. Establishment of two canine models of benign airway stenosis and the effect of mitomycin C on airway stenosis. Int J Pediatr Otorhinolaryngol 2022; 159:111205. [PMID: 35700689 DOI: 10.1016/j.ijporl.2022.111205] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Cuffed endotracheal intubation and stent implantation were employed to simulate two types of benign airway stenosis and further to analysis the different features between them from trachecscopic characteristics, gross anatomy to histopathological changes. In addition, our study explored the therapeutic effect of mitomycin C at different concentrations on granulation tissue caused by stent implantation in order to provide a new therapeutic strategy for clinical treatment of benign airway stenosis. METHODS Twelve beagle dogs were randomly divided into four groups, with three dogs in each group. Group A: Three beagle dogs were intubated through oral trachea after general anesthesia and cuff pressure maintained at 200 mmHg for 24 h. Group B, Group C and Group D: endotracheal coated self-expanding metal stents were placed after general anesthesia under the guidance of bronchoscope. On the Day7 after stent implantation, Group B, as control group, was injected phosphate buffer solution of 1 ml into granulation tissue at the end of stent; Group C was injected mitomycin C of 1 ml at 0.4 mg/ml and Group D was injected mitomycin C of 1 ml at 0.8 mg/ml into granulation tissue at the end of metal airway stent respectively, the same method as Group B. Bronchoscopy was used to observe tracheal lumen on the seventh day, fourteenth day and twenty-first day after modeling and pathological changes were examined on twenty-first day. RESULTS Two models of benign airway stenosis can be established by cuffed endotracheal intubation and stent implantation. There was tracheal rupture in the trachea cartiage ring in the cuffed endotracheal intubation group, but was't in stent implantation group. Histopathological characteristics were different between cuffed endotracheal intubation and stent implantation groups. In stent placement groups, we found that the stenosis degree of mitomycin C at 0.4 mg/ml was approximately 19%-32%, mitomycin C at 0.8 mg/ml was approximately 16%-21% and the control group was approximately 36%-47%. CONCLUSION The two models of canine benign tracheal stenosis induced by cuffed endotracheal intubation and stent implantation are relatively simple, reliable and reproducible and have different characteristics. Mitomycin C could inhibit proliferation of granulation tissue and attenuate the degree of airway stenosis caused by stent implantation.
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Affiliation(s)
- Feng Li
- The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Respiratory Critical Care, Shijiazhuang, China; Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Peipei Li
- The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Respiratory Critical Care, Shijiazhuang, China; Department of Pulmonary and Critical Care Medicine, Hengshui People's Hospital, Hengshui, China
| | - Zhigang Cai
- The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Respiratory Critical Care, Shijiazhuang, China.
| | - Xiaoxu Liu
- The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Respiratory Critical Care, Shijiazhuang, China; The First Department of Pulmonary and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Linyan Li
- Hebei Key Laboratory of Respiratory Critical Care, Shijiazhuang, China; Department of Infectious Diseases, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huiran Zhang
- The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Respiratory Critical Care, Shijiazhuang, China
| | - Haitao Li
- The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Respiratory Critical Care, Shijiazhuang, China
| | - Yanpeng He
- The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Respiratory Critical Care, Shijiazhuang, China; Department of Pulmonary and Critical Care Medicine, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Liyun Ye
- The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Respiratory Critical Care, Shijiazhuang, China
| | - Xixin Yan
- The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Respiratory Critical Care, Shijiazhuang, China
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Djukic T, Saveljic I, Pelosi G, Parodi O, Filipovic N. A study on the accuracy and efficiency of the improved numerical model for stent implantation using clinical data. Comput Methods Programs Biomed 2021; 207:106196. [PMID: 34091419 DOI: 10.1016/j.cmpb.2021.106196] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/17/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Stent implantation procedure should be carefully planned and adapted to the particular patient in order to minimize possible complications. Numerical simulations can provide useful quantitative data about the state of the artery after the implantation, as well as information about the benefits of the intervention from the hemodynamical point of view. METHODS In this paper, a numerical model for stent implantation is presented. This numerical model simulates the stent expansion, the interaction of the stent with arterial wall and the deformation of the arterial wall under the influence of the stent. FE method was used to perform CFD simulations and the effects of stenting were analyzed by comparing the hemodynamic parameters before and after stent implantation. RESULTS Clinical data for overall 34 patients was used for the simulations, and for 9 of them data from follow up examinations was used to validate the results of simulations of stent implantation. CONCLUSIONS The good agreement of results (less than 4.1% of SD error for all the 9 validation cases) demonstrated the accuracy of the presented numerical model. The developed approach can be a valuable tool for the improvement of pre-operative planning and patient-specific treatment optimization.
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Affiliation(s)
- Tijana Djukic
- Bioengineering Research and Development Center, BioIRC, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia; Institute for Information Technologies, University of Kragujevac, Jovana Cvijica bb, 34000 Kragujevac, Serbia.
| | - Igor Saveljic
- Bioengineering Research and Development Center, BioIRC, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia; Institute for Information Technologies, University of Kragujevac, Jovana Cvijica bb, 34000 Kragujevac, Serbia.
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy.
| | - Oberdan Parodi
- Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy.
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Homma Y, Hayabuchi Y. Successful treatment by stent implantation for systemic-to-pulmonary shunt obstruction due to a Staphylococcus aureus abscess: a case report. Cardiol Young 2020; 30:1538-40. [PMID: 32807253 DOI: 10.1017/S1047951120002565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 13-year-old girl with a single ventricle and bilateral systemic-to-pulmonary shunts developed hypoxia due to shunt stenosis, which was caused by a methicillin-sensitive Staphylococcus aureus abscess. Stent implantation associated with appropriate antibiotic administration was crucial to dilate and maintain shunt patency.
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Li M, Zhang L, Zhang K, Zhu Y, Shi Z, Zhang W, Gao B, Li L, Fang Z, Yin L, Chen B, Liu Z. An efficacy and safety study of rivaroxaban for the prevention of deep vein thrombosis in patients with left iliac vein compression treated with stent implantation (PLICTS): study protocol for a prospective randomized controlled trial. Trials 2020; 21:811. [PMID: 32993773 PMCID: PMC7526216 DOI: 10.1186/s13063-020-04742-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/24/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Balloon dilatation with stent implantation has been proved to be an effective option for left iliac vein compression syndrome (LIVCS), but thrombosis may still occur after the operation. Currently, warfarin is used for anticoagulant therapy, but long-term monitoring is required, while rivaroxaban does not need laboratory monitoring, which can simplify treatment. Therefore, this study aimed to compare the efficacy and safety of rivaroxaban and warfarin in anticoagulation. METHODS This study is a multicenter, randomized controlled trial. We will recruit 224 patients with thrombotic LIVCS from 9 hospitals. Moreover, these patients will be randomized to either the experimental group (rivaroxaban) or the control group (warfarin plus nadroparin). The primary outcome is stent occlusion rate. Secondary outcomes are quality of life scale survey results, all-cause mortality, anticoagulation-related mortality, and the proportion of participants with stent displacement/fracture, thrombosis, hemorrhage, and other vascular events. DISCUSSION This study will provide reliable, evidence-based clinical evidence for the efficacy and safety of rivaroxaban antithrombotic therapy after stent implantation. TRIAL REGISTRATION ClinicalTrials.gov NCT04067505 . Registered on August 26, 2019.
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Affiliation(s)
- Miaomiao Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China.,School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Libin Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Kaijie Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, Hangzhou, 310016, China
| | - Yuefeng Zhu
- Department of Vascular Surgery, Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, Hangzhou, 310016, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital of Fudan University, Shanghai, 210023, China
| | - Wan Zhang
- Department of Vascular Surgery, Huadong Hospital of Fudan University, Shanghai, 210023, China
| | - Bin Gao
- Department of Vascular Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Lubin Li
- Department of Vascular Surgery, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Zhengdong Fang
- Department of Vascular Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China
| | - Li Yin
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Bing Chen
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Zhenjie Liu
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China.
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Anzai H, Takaesu S, Yaguchi T, Shimizu T, Noto T, Nagashima Y, Nemoto N. Successful stent implantation in the internal jugular vein occlusion using Brockenbrough needle under intravascular ultrasound guidance leading to prevention of vision loss in a hemodialysis patient with neovascular glaucoma. J Cardiol Cases 2020; 23:6-9. [PMID: 33437331 DOI: 10.1016/j.jccase.2020.08.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/31/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022] Open
Abstract
Central venous occlusion (CVO) remains an unresolved issue in hemodialysis patients. We herein present an interesting case of a 42-year-old hemodialysis female patient with complete vision loss in the left eye, who was at high risk of losing vision in her right eye because of neovascular glaucoma (NVG). Computed tomography (CT) showed occlusion of the right internal jugular vein (IJV) just above the junction with the right innominate vein. From the configuration and location of the lesion, it was concluded the occlusion had been caused by venous valvular degeneration. Her NVG with progressive intraocular pressure (IOP) elevation was presumably attributed to the right IJV occlusion. The extra-rigid occlusive lesion was successfully penetrated by means of a Brockenbrough needle and subsequently implanted with a balloon-expandable stent. Intravascular ultrasound (IVUS) guidance allowed us to manipulate the Brockenbrough needle safely. After stent implantation, the right IOP declined dramatically, resulting in the preservation of her eyesight. <Learning objective: Neovascular glaucoma (NVG) is a devastating disease for the occurrence of which various factors are responsible. In this report, the occlusion of the right internal jugular vein was determined as the main cause of the elevated intraocular pressure, which had led to the deterioration of her NVG. Stent implantation provided an immediate reduction in intraocular pressure. The Brockenbrough needle was safely manipulated under intravascular ultrasound guidance.>.
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Affiliation(s)
- Hitoshi Anzai
- Department of Cardiology, SUBARU Health Insurance Ota Memorial Hospital, Ota, Gunma, Japan
| | - Satoru Takaesu
- Department of Cardiology, SUBARU Health Insurance Ota Memorial Hospital, Ota, Gunma, Japan
| | - Tomoyuki Yaguchi
- Department of Cardiology, SUBARU Health Insurance Ota Memorial Hospital, Ota, Gunma, Japan
| | - Takayuki Shimizu
- Department of Cardiology, SUBARU Health Insurance Ota Memorial Hospital, Ota, Gunma, Japan
| | - Tatsunori Noto
- Department of Cardiology, SUBARU Health Insurance Ota Memorial Hospital, Ota, Gunma, Japan
| | - Yoshinori Nagashima
- Department of Cardiology, SUBARU Health Insurance Ota Memorial Hospital, Ota, Gunma, Japan
| | - Naohiko Nemoto
- Department of Cardiology, SUBARU Health Insurance Ota Memorial Hospital, Ota, Gunma, Japan
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Wipfler-Freißmuth E, Dejaco C, Both M. [Long-term complications, monitoring and interventional treatment of large vessel vasculitis]. Z Rheumatol 2020; 79:523-531. [PMID: 32430565 DOI: 10.1007/s00393-020-00807-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Giant cell arteritis (GCA) and Takayasu's arteritis (TAK) both belong to the group of large vessel vasculitides and require long-term drug treatment. Glucocorticoids (GC) are the first choice for the treatment of both diseases. For GCA immunosuppressants, such as tocilizumab or methotrexate should be considered in cases of treatment refractory and relapses or if there is a high risk for GC-related adverse events. In TAK patients the use of immunosuppressive agents should be considered for all patients. In the course of the disease, severe disease-associated and treatment-associated complications can occur. The most frequent disease-associated complications include visual impairment up to blindness in GCA, as well as vascular stenoses with ischemia and aortic aneurysms with possible dissection in GCA and TAK. Percutaneous transluminal angioplasty (PTA) and stenting are minimally invasive, low-risk interventional procedures for GCA and TAK patients with clinically significant vascular stenoses, despite a tendency to restenosis. Interventional procedures should be weighed up against vascular surgical approaches depending on the localization and the total clinical situation. All interventions should be conducted in a phase of stable remission when possible. For monitoring of disease activity in patients with GCA and TAK, assessment of clinical manifestations as well as C‑reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) are useful; however, both are unreliable under interleukin‑6 block with tocilizumab. The value of new biomarkers independent from interleukin‑6 and the importance of imaging (sonography, magnetic resonance angiography, computed tomography and positron emission tomography-CT) for monitoring GCA and TAK still have to be investigated in future studies.
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Affiliation(s)
- E Wipfler-Freißmuth
- Rheumatologische Spezialambulanz, Krankenhaus der Barmherzigen Brüder Graz-Eggenberg, Bergstr. 27, 8010, Graz, Österreich.
| | - C Dejaco
- Landesweiter Dienst für Rheumatologie, Südtiroler Sanitätsbetrieb, Krankenhaus Bruneck, Bruneck, Italien
| | - M Both
- Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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Sasikumar D, Sasidharan B, Rashid A, Ayyappan A, Goplakrishnan A, Krishnamoorthy KM, Sivasubramonian S. Early and late outcome of covered and non-covered stents in the treatment of coarctation of aorta- A single centre experience. Indian Heart J 2020; 72:278-282. [PMID: 32861383 PMCID: PMC7474103 DOI: 10.1016/j.ihj.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/24/2020] [Accepted: 06/21/2020] [Indexed: 11/29/2022] Open
Abstract
Objective Stenting of coarctation of aorta with covered or uncovered stents is the accepted modality of treatment in older children and adults. The indications which mandate the use of covered stents are still unclear. We attempted to study the early and late outcomes after stenting of native and recurrent coarctation of aorta with uncovered and covered stents. Method This is a retrospective study of patients who underwent stenting for coarctation of aorta with covered or non-covered stents at our institute. Early and late outcome for both the groups were studied. Results Twenty patients underwent implantation of covered stent and twenty five patients had uncovered stent implantation. Patients in the covered stent group were older and had greater basal pressure gradient. More patients in the covered stent group had residual gradient >10 mm Hg after the procedure. There was no mortality or aortic wall injury in either group. Four patients in the covered stent group underwent planned re-intervention and two had unplanned re-intervention. None of the patients in the uncovered stent group had re-intervention. Higher incidence of late lumen loss was noted in the covered stent group. Conclusion Uncovered stents can be safely implanted with minimal risk of aortic wall injury in patients with low risk anatomic features. Covered stent implantation is associated with higher incidence of planned and unplanned re-intervention.
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Affiliation(s)
- Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Bijulal Sasidharan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | - Aamir Rashid
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Anoop Ayyappan
- Department of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Arun Goplakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Kavasseri M Krishnamoorthy
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Wang Q, Lei XM. Effects of nursing intervention in patients undergoing stent placement for gastrointestinal stenosis or obstruction. Shijie Huaren Xiaohua Zazhi 2020; 28:777-781. [DOI: 10.11569/wcjd.v28.i16.777] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It has been found that the psychological status and quality of life of patients could be improved effectively by nursing intervention. The purpose of this study was to analyze the effects of quality nursing intervention in patients with gastrointestinal stenosis or obstruction.
AIM To evaluate the effects of quality nursing intervention in patients with gastrointestinal stenosis or obstruction.
METHODS From January 2016 to February 2020, 96 patients with gastrointestinal stenosis or obstruction at our hospital were selected, and all of them underwent endoscopic stent implantation. They were randomly divided into either a control group (receiving routine care) or an observation group (receiving high quality nursing intervention); the improvement of anxiety and depression, vital signs, nursing satisfaction, incidence of adverse reactions such as pain, and quality of life were compared between the two groups.
RESULTS After intervention, the self-rating anxiety scale score and self-rating depression scale score in the observation group were 47.22 ± 3.51 and 45.80 ± 1.33, respectively, which were significantly lower than those of the control group (60.00 ± 3.14 and 55.23 ± 3.15, respectively; P < 0.05). The visual analogue scale score of the observation group was 3.15 ± 0.55, which was significantly lower than that of the control group (5.31 ± 0.67; P < 0.05). The vital signs, nursing satisfaction, and scores of physiological function, psychological function, mental state, and social function in the observation group were significantly higher than those of the control group, while the incidence of adverse reactions was significantly lower than that of the control group (P < 0.05).
CONCLUSION High-quality nursing intervention has significant effects in patients with gastrointestinal stenosis or obstruction treated by stent placement.
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Affiliation(s)
- Qing Wang
- Intensive Care Unit, Yiwu City Central Hospital, Yiwu 322000, Zhejiang Province, China
| | - Xin-Ming Lei
- Department of Gastroenterology, Yiwu City Central Hospital, Yiwu 322000, Zhejiang Province, China
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Li Y, Li Z, Song L, Xie W, Gong X, He D, Zhang X. Medium- and long-term effects of endovascular treatments for severely stenotic basilar arteries supported by multimodal imaging. BMC Neurol 2020; 20:289. [PMID: 32736532 PMCID: PMC7393701 DOI: 10.1186/s12883-020-01863-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the medium-and long-term effect of intravascular interventional therapy for symptomatic severe basilar artery stenosis supported by multimodal imaging. METHOD After strict screening of 67 patients with symptomatic severe basilar artery stenosis (70-99%) with atherosclerotic stenosis, 67 patients with symptomatic recurrence after intensive drug treatment were treated with intravascular balloon dilatation and Enterprise stent implantation. Any stroke or death within 30 days after operation and any stroke and restenosis during medium-and long-term follow-up were recorded. RESULTS ①The mean age of 67 patients (67lesions) was 57 ± 8 years old, and the technical success rate was 100%; ②Preoperative angiography showed that the collateral circulation was poor, and TICI was 1-2a while postoperative angiography showed that TICI was significantly improved to 2b-3; ③The average preoperative stenosis rate was 82 ± 9%, and the postoperative stenosis rate was reduced to 17 ± 10%; ④Before surgery, abnormal perfusion was found in the posterior circulation CTP; After the postoperative re-examination, the posterior circulation of CTP perfusion was significantly improved; ⑤Postoperative symptoms and neurological conditions improved significantly; ⑥Complications of perforating branch event occurred in 1 case after operation, and symptoms were relieved after more than 1 month of medication treatment, and mild neurological dysfunction remained. 1 case developed subacute thrombosis in the stent, which improved after active intra-arterial thrombolysis, and there was no residual neurological dysfunction; and 1 case of micro-guide wire being trapped by the distal vasospasm. ⑦67 patients were followed up by telephone, WeChat or imaging for 36-66 months. CONCLUSIONS In summary intravascular balloon dilation + Enterprise stent implantation is safe and effective for the treatment of symptomatic severe atherosclerotic stenosis of the basilar artery, with high technical success rate, low perioperative complications, and good mid-term and long-term effects.
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Affiliation(s)
- Yuanzhi Li
- Department of Neurosurgery, Affiliated Hengyang Hospital, Southern Medical University (Hengyang Central Hospital), Hengyang, 421001, China
| | - Zhenfa Li
- Department of Vascular Surgery, Affiliated Hengyang Hospital, Southern Medical University (Hengyang Central Hospital), 12# Yancheng road, Hengyang, 421001, Hunan province, China.
| | - Ligang Song
- Department of Neurointervention, Affiliated Tiantan Hospital, Capital Medical University, 119# west south fourth ring road, fengtai district, Beijing, 100050, China.
| | - Weimin Xie
- Department of Gynecology, Affiliated Hengyang Hospital, Southern Medical University (Hengyang Central Hospital), Hengyang, 421001, China
| | - Xianghao Gong
- Department of Science and Education, Affiliated Hengyang Hospital, Southern Medical University (Hengyang Central Hospital), Hengyang, 421001, China
| | - Dongliang He
- Department of Nutrition, Affiliated Hengyang Hospital, Southern Medical University (Hengyang Central Hospital), Hengyang, 421001, China
| | - Xin Zhang
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
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Gijtenbeek M, Haak MC, Ten Harkel ADJ, Bökenkamp R, Eyskens B, Ortibus E, Meyns B, Gewillig M, Lewi L. Critical Coarctation of the Aorta in Selective Fetal Growth Restriction and the Role of Coronary Stent Implantation. Fetal Diagn Ther 2020; 47:1-9. [PMID: 32720919 DOI: 10.1159/000508305] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Monochorionic twins are at increased risk of congenital heart defects (CHDs). Up to 26% have a birth weight <1,500 g, a CHD requiring neonatal surgery, therefore, poses particular challenges. OBJECTIVE The aim of the study was to describe pregnancy characteristics, perinatal management, and outcome of monochorionic twins diagnosed with critical coarctation of the aorta (CoA). METHODS We included monochorionic twins diagnosed with critical CoA (2010-2019) at 2 tertiary referral centers, and we systematically reviewed the literature regarding CoA in monochorionic twins. RESULTS Seven neonates were included. All were the smaller twin of pregnancies complicated by selective fetal growth restriction. The median gestational age at birth was 32 weeks (28-34). Birth weight of affected twins ranged as 670-1,800 g. One neonate underwent coarctectomy at the age of 1 month (2,330 g). Six underwent stent implantation, performed between day 8 and 40, followed by definitive coarctectomy between 4 and 9 months in 4. All 7 developed normally, except for 1 child with neurodevelopmental delay. Three co-twins had pulmonary stenosis, of whom 1 required balloon valvuloplasty. The literature review revealed 10 cases of CoA, all in the smaller twin. Six cases detected in the first weeks after birth were treated with prostaglandins alone, by repeated transcatheter angioplasty or by surgical repair, with good outcome in 2 out of 6. CONCLUSIONS CoA specifically affects the smaller twin of growth discordant monochorionic twin pairs. Stent implantation is a feasible bridging therapy to surgery in these low birth weight neonates.
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Affiliation(s)
- Manon Gijtenbeek
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique C Haak
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Regina Bökenkamp
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Benedicte Eyskens
- Department of Pediatrics, Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Pediatrics, Pediatric Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Pediatrics, Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Liesbeth Lewi
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium,
- Department of Obstetrics and Gynecology, Obstetrics, University Hospitals Leuven, Leuven, Belgium,
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Rukosujew A, Weber R, Kasprzak B, Dell'Aquila AM. Stent erosion after treatment of coarctation of right-sided aorta and successful surgical management. Eur J Cardiothorac Surg 2020; 57:1007-1008. [PMID: 31633160 DOI: 10.1093/ejcts/ezz281] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 11/14/2022] Open
Abstract
We present a case of surgical treatment of a pseudoaneurysm of the right-sided aortic arch after stent implantation for primary coarctation in a 36-year-old woman with a previous history of ventricle septal defect closure in early childhood. As a first step, she underwent a left carotid to subclavian artery bypass for an aberrant left subclavian artery and as a second step a 'beating heart' aortic arch and descending aorta replacement via resternotomy. The postoperative course was uneventful.
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Affiliation(s)
- Andreas Rukosujew
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Raluca Weber
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Bernd Kasprzak
- Department of Vascular and Endovascular Surgery, University Hospital Muenster, Muenster, Germany
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23
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Li H, Zhang Y, Zhang L, Li Z, Xing P, Zhang Y, Hong B, Yang P, Liu J. Endovascular Treatment of Acute Ischemic Stroke Due to Intracranial Atherosclerotic Large Vessel Occlusion : A Systematic Review. Clin Neuroradiol 2020; 30:777-87. [PMID: 31616958 DOI: 10.1007/s00062-019-00839-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of endovascular treatment (ET) of acute ischemic stroke (AIS) caused by intracranial atherosclerotic large vessel occlusion (ICAS-LVO). METHODS A systemic review and meta-analysis were conducted on studies published between July 2005 and October 2018 on the outcomes of ET in patients with AIS due to ICAS-LVO. The outcomes of the ICAS-LVO and embolic LVO groups were also compared. RESULTS A total of 17 studies including 1315 subjects with ICAS-LVO were included. In the single-arm meta-analysis, the pooled estimates of successful recanalization rate, favorable outcomes, symptomatic intracranial hemorrhage and mortality were 88% (95% CI (95% confidence interval), 84-92%), 52% (95% CI, 47-56%), 5% (95% CI, 3-7%) and 15% (95% CI, 12-19%) respectively. The preferred primary treatment was stent-retriever thrombectomy (84.1%) and the preferred rescue treatment was stent implantation with or without percutaneous transluminal angioplasty (PTA, 32.7%). In the double-arm meta-analysis, the incidence of symptomatic intracranial hemorrhage was lower in the ICAS-LVO compared to the embolic-LVO group (OR (odds ratio) = 0.60, 95% CI, 0.46-0.77, p < 0.01), whereas the implementation of rescue treatment (OR = 5.94, 95% CI, 3.15-11.19, p < 0.01) and stenting rate (OR = 10.06, 95%CI, 4.43-22.85, p < 0.01) were higher in the ICAS-LVO group. Other parameters were similar in both groups. CONCLUSION The use of ET is a safe and effective therapeutic option for AIS due to ICAS-LVO. Stent-retriever thrombectomy and stent-implement are the preferred primary and rescue therapies respectively for ICAS-LVO. Less symptomatic intracranial hemorrhage and higher stenting were observed in the ICAS-LVO compared to the embolic-LVO group.
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24
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Fuertes Ferre G, Caballero Jambrina I, Ruiz Aranjuelo A, Jimeno Sánchez J, Galache Osuna JG, Andrés Esteban EM, Casasnovas Lenguas JA, Diarte de Miguel JA. Frequency and Reasons of Dual Antiplatelet Therapy Discontinuation and Switching of P2Y12 Inhibitors in Patients with Acute Coronary Syndrome Treated with Stent Implantation. Cardiology 2019; 142:203-207. [PMID: 31266007 DOI: 10.1159/000500977] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Incidence and reasons of dual antiplatelet therapy (DAPT) discontinuation and switching between P2Y12 inhibitors in acute coronary syndrome (ACS) patients treated with a stent have been poorly studied. METHODS AND RESULTS In a prospective single-center study, 283 consecutive patients presenting with ACS were treated with stent implantation between July 2015 and January 2016. Follow-up was achieved at 12 months in 273 patients using the electronic patient file and telephone interview. Switching from clopidogrel to a new antiplatelet agent (ticagrelor or prasugrel) or vice versa occurred in 60 (21.2%) patients. The most frequent reasons for switching were medical decisions not associated with bleeding events and concomitant use of chronic oral anticoagulation. Among the patients with a 1-year follow-up, 42 (15.4%) prematurely discontinued DAPT; 25 of them did so due to the need for an invasive procedure. DAPT premature discontinuation was not significantly associated with an increased 1-year risk of cardiovascular death or serious cardiac ischemic events (HR 2.08 [CI 95%: 0.88-4.94, p = 0.099]). CONCLUSIONS DAPT discontinuation and switching between P2Y12 inhibitors are not uncommon in patients with ACS treated with a stent. The most frequent reasons were the need for an invasive procedure and medical decisions.
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25
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Klotz LV, Eberhardt R, Herth FJF, Winter H. [Interventional treatment of tracheopleural and bronchopleural fistulas]. Chirurg 2019; 90:697-703. [PMID: 31161248 DOI: 10.1007/s00104-019-0977-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Interventional bronchoscopy is an indispensable option to manage bronchopleural and tracheopleural fistulas in patients in a poor general condition and at high risk for developing postoperative complications. METHODS This article is based on a search in the PubMed database for relevant publications and own experiences as surgeons and pneumologists. RESULTS Various interventional techniques can be used for the treatment of bronchopleural and tracheopleural fistulas. Currently, the insertion of stents or endobronchial valves is the most frequently used treatment. Ideally, the attending anesthesiologist will have experience with high frequency jet ventilation and the attending surgeon will have experience with rigid bronchoscopy, flexible bronchoscopy, and interventional bronchoscopy. DISCUSSION Due to a lack of standardized treatment recommendations, individual treatment plans must be decided according to the location of the bronchopleural or tracheopleural fistula and taking existing comorbidities into account.
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Li DD, Huang H, Fang JH, Fu FW, Lin J, Bai GH, Xu SY, Sheng HS, Zhou Q, Zhang N, Yin B. Solitaire Stent Permanent Implantation as an Effective Rescue Treatment for Emergency Large Artery Occlusion. World Neurosurg 2019; 124:e533-e539. [PMID: 30664959 DOI: 10.1016/j.wneu.2018.12.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND In this study, we present our experiences on the feasibility of rescue permanent Solitaire stent placement for failed mechanical thrombectomy (MT) and our protocol to avoid ineffective stent placement. METHODS We retrospectively evaluated the data for consecutive patients admitted into the Second Affiliated Hospital of Wenzhou Medical University and 2 collaboration hospitals from August 2014 to May 2018 for emergency large artery occlusion. The baseline clinical characteristics and radiologic assessment, interventional data, clinical outcome, and angiographic follow-up data were assessed. Notably, we introduced our protocol for antegrade flow assessment before Solitaire stent detachment to ensure an effective stent implantation. RESULTS Thirty-nine patients (mean age, 68.1 years, mean preprocedural National Institute of Health Scale Score, 22.1) were included, in which 34 patients had anterior circulation large artery occlusion and 5 patients had posterior circulation large artery occlusion. The MT attempts ranged from 1-5 (3.6 on average). The mean onset-to-puncture time was 4.8 hours (ranging from 2.1-7.8 hours) and the mean procedure time was 87.4 minutes (ranging from 32-124 minutes). Modified thrombolysis in cerebral infarction 2b-3 reperfusions were noted in all cases. The immediate, average postprocedure stenosis rate was 25.3%, and the average stenosis rate at the 3-month angiographic follow-up was 34.7% (data from 15 patients). Three patients died. Nineteen (48.7%) patients had good outcome (modified Rankin Scale, mRS ≤2) at the 3-month follow-up. CONCLUSIONS Permanent Solitaire stent placement might be a feasible therapy for patients with MT-failed emergency large artery occlusion. For a successful revascularization, careful antegrade flow assessment before stent detachment is critical.
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Affiliation(s)
- Dan-Dong Li
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Huan Huang
- Department of Radiology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Jun-Hao Fang
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Fang-Wang Fu
- Department of Neurology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Jian Lin
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Guang-Hui Bai
- Department of Radiology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Shang-Yu Xu
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Han-Song Sheng
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Qian Zhou
- Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Nu Zhang
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Bo Yin
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China.
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Kitano M, Hoashi T, Kakuta T, Fujimoto K, Miyake A, Kurosaki KI, Ichikawa H, Shiraishi I. Primary Draining Vein Stenting for Obstructive Total Anomalous Pulmonary Venous Connection in Neonates with Right Atrial Isomerism and Functional Single Ventricle Improves Outcome. Pediatr Cardiol 2018; 39:1355-1365. [PMID: 29777280 DOI: 10.1007/s00246-018-1902-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/08/2018] [Indexed: 11/25/2022]
Abstract
For neonates with right atrial isomerism (RAI), functional single ventricle (f-SV), and obstructive total anomalous pulmonary venous connection (TAPVC), primary TAPVC repair (TAPVCR) has a poor outcome. At our hospital, the survival rate at 1 year of such neonates undergoing primary TAPVCR between 1999 and 2010 (TAPVCR group) was 30% (3/10). Most deceased cases suffered from capillary leak syndrome and unstable pulmonary resistance after the surgeries. We sought to determine whether less invasive primary draining vein stenting (DVS) improved the outcome of these neonates. We investigated outcomes in consecutive nine such neonates (median gestational age 38 weeks, birth weight 2.8 kg, females 4) who underwent primary DVS with 6-mm-diameter Palmaz® Genesis® stents at our hospital between 2007 and 2017 (DVS group). Eight patients underwent subsequent surgeries to adjust the pulmonary flow after decreased pulmonary resistance. The survival rate at 1 year after the first interventions in the DVS group improved to 77% (7/9), although there was a difference between the interventional eras of the two groups. Of the seven patients who underwent multiple stent redilations with a larger balloon or additional stenting in other sites until the next stage of surgery at a median age of 8 months, four received a bidirectional Glenn (BDG) shunt and TAPVCR and three underwent TAPVCR, with two of those cases reaching BDG. Less invasive primary DVS improved the outcome of neonates with RAI, f-SV, and obstructive TAPVC, with many reaching BDG. Patient selection to advance toward Fontan is thought to further improve the outcome.
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Affiliation(s)
- Masataka Kitano
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takashi Kakuta
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazuto Fujimoto
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akira Miyake
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Ken-Ichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hazime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Şenocak R, Coşkun AK, Kaymak Ş, Serdar Sakin Y. Successful conservative treatment of type 3 injury (ductal injury) developing after ERCP. Arab J Gastroenterol 2018; 19:88-90. [PMID: 29861380 DOI: 10.1016/j.ajg.2018.02.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 07/29/2017] [Accepted: 02/04/2018] [Indexed: 11/15/2022]
Abstract
Although endoscopic retrograde cholangio-pancreatography (ERCP) is considered a safe procedure, it is associated with complications such as pancreatitis, bleeding and perforation of the bile duct, pancreatic duct and duodenum. In recent years, successful conservative treatment in selected patients with complications have increased. We present a case with successful conservative treatment of rare injury (type 3) developing after ERCP.
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Affiliation(s)
- Rahman Şenocak
- Department of General Surgery, Gulhane Military Medical Faculty, Ankara, Turkey.
| | - Ali Kağan Coşkun
- Department of General Surgery, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Şahin Kaymak
- Department of General Surgery, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Yusuf Serdar Sakin
- Department of Gastroenterology, Gulhane Military Medical Faculty, Ankara, Turkey
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29
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Iversen E, Packer EJS, Sandberg SM, Bleie Ø, Hoff PI, Schuster P. Long-term follow-up in patients treated by stent implantation for post-ablation pulmonary vein stenosis. J Interv Card Electrophysiol 2018; 53:309-15. [PMID: 29671104 DOI: 10.1007/s10840-018-0370-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Symptomatic severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF) is a rare but well-recognized complication. Treatment options include pulmonary vein angioplasty with or without drug eluting balloons or angioplasty with stent implantation. The treatment of choice is unclear. In our center, pulmonary vein stenting is the treatment of choice for significantly stenotic veins. We present the long-term clinical outcome of 9 patients treated with stent implantation. METHODS Between 2001 and 2015, 3048 patients with AF were treated with catheter ablation at our institution, of which 9 developed symptomatic PVS. A total of 11 PVS were treated. Pre-procedural imaging (CT, MR, transesophageal echocardiography, angiography) was performed in all patients. RESULTS Mean time from ablation to stenting was 18 months. Three patients had recurrent pneumonia and the remaining reduced functional capacity (NYHA 2). All patients were in functional capacity NYHA 1 (p < 0.05) after a mean follow-up of 64 (18-132) months. Three patients still had paroxysmal AF, of which two have undergone repeated ablation. CONCLUSIONS Symptomatic PVS after AF ablation can be successfully treated by stent implantation with durable results and good clinical outcome. AF ablation is still a feasible option after stent deployment.
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30
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Li X, Zhang J, Meng Y, Yang L, Wang F, Li B, Zhang X. Transplant renal artery stenosis caused by the stretch of an artey branch: a case report and literature review. BMC Nephrol 2018. [PMID: 29523086 PMCID: PMC5845193 DOI: 10.1186/s12882-018-0856-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 11/25/2022] Open
Abstract
Background Renal transplant is the preferred treatment option for these patients with end-stage renal disease. Transplant renal artery stenosis (TRAS) is one of the most common and serious vascular complications after renal transplantation, and most of the TRAS occurred in the anastomosis. The complication must be diagnosed and treated timely, otherwise the function of transplanted kidney may be losed. Case presentation A 46-year-old male with end-stage renal disease of unknown cause received a cadaveric renal transplant one year ago. Although three antihypertensive medications were administrated, his blood pressure gradually increased to 190/120 mmHg 3 weeks posttransplantation. Also the level of creatinine increased to 194 μmol/L.Color Doppler ultrasonography indicated a decreased resistance index (RI) in intrarenal arteries and increased blood flow of the transplant renal artery, therefore, a vascular complication of TRAS was suspected. Arteriography was performed and demonstrated TRAS caused by stretch of an artery branch, and the TRAS occurred in the distal site of the anastomosis instead of the anastomosis. Percutaneous transluminal bare stent implantation treatment was successfully performed. Satisfactory clinical efficacy with improvement in transplant renal function and renovascular hypertension was achieved after the interventional treatment. Conclusion To our knowledge this is the first reported case of TRAS caused by stretch of an artery branch. When refractory hypertension and allograft dysfunction are presented posttransplantation, TRAS should be suspected. Color Doppler ultrasonography as a non-invasive examination may provide some valuable information, three-dimention CT can be useful for further diagnosis, but is seldom necessary. Arteriography provides the definitive diagnosis of TRAS. Percutaneous transluminal stent implantation treatment of TRAS has high success rate with minimal invasion and complications. When an artery branch situated on the stenosis, a bare stent rather than covered stent is the preferred choice.
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Affiliation(s)
- Xiaohang Li
- Department of Hepatobiliary Surgery and Organ Transplant, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning Province, 110001, People's Republic of China
| | - Jialin Zhang
- Department of Hepatobiliary Surgery and Organ Transplant, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning Province, 110001, People's Republic of China.
| | - Yiman Meng
- Department of Hepatobiliary Surgery and Organ Transplant, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning Province, 110001, People's Republic of China
| | - Lei Yang
- Department of Hepatobiliary Surgery and Organ Transplant, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning Province, 110001, People's Republic of China
| | - Fengshan Wang
- Department of Hepatobiliary Surgery and Organ Transplant, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning Province, 110001, People's Republic of China
| | - Baifeng Li
- Department of Hepatobiliary Surgery and Organ Transplant, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning Province, 110001, People's Republic of China
| | - Xitong Zhang
- Department of Intervention, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning Province, 110001, People's Republic of China
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31
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Stegeman R, Breur JMPJ, Heuser J, Jansen NJG, de Vries WB, Vijlbrief DC, Molenschot MMC, Haas F, Krings GJ. Primary coronary stent implantation is a feasible bridging therapy to surgery in very low birth weight infants with critical aortic coarctation. Int J Cardiol 2018; 261:62-65. [PMID: 29550016 DOI: 10.1016/j.ijcard.2018.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/26/2018] [Accepted: 03/03/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical treatment of critical aortic coarctation (CoA) is difficult in very low birth weight (VLBW) infants ≤1500 g and preferably postponed until 3 kg with prostaglandins (PGE). OBJECTIVES To investigate the procedure and outcome of primary coronary stent implantation as bridging therapy to surgery in VLBW infants with CoA. METHODS Retrospective evaluation of primary CoA stenting in VLBW infants from 2010 to 2015. RESULTS Five VLBW infants with a median gestational age of 29 weeks (27-32) underwent primary CoA stenting. Indication was cardiac failure in 4 and severe hypertension in 1 patient. Age and weight at intervention were 14 days (range 12-16) and 1200 g (680-1380), respectively. Stent diameter ranged 3-5 mm. The femoral artery used for intervention was occluded in all infants without clinical compromise. Severe restenosis and aneurysm occurred in 1 VLBW infant and was successfully treated with covered coronary stents. Median age at surgical correction was 200 days (111-804) and weight 5500 g (4500-11,400). No reinterventions were required during a median postoperative follow-up of 2.8 years (0.1-5.0). Neurodevelopmental outcomes were normal and comparable between patients and siblings (4/5 gemelli). CONCLUSIONS Primary coronary stent implantation in VLBW infants with critical CoA is a feasible bridging therapy to surgery.
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Affiliation(s)
- Raymond Stegeman
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands; Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands.
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
| | - Jörg Heuser
- Department of Paediatric Cardiology, Maxima Medical Center Veldhoven, De Run 4600, 5504, DB, Veldhoven, The Netherlands
| | - Nicolaas J G Jansen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
| | - Willem B de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
| | - Daniel C Vijlbrief
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
| | - Mirella M C Molenschot
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
| | - Felix Haas
- Department of Congenital Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
| | - Gregor J Krings
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
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Vallurupalli S, Garg A, Carlino M, Hakeem A, Uretsky BF. Full stent expansion of chronic total occlusion lesions requires prolonged inflation. Cardiovasc Revasc Med 2017; 19:403-406. [PMID: 29066341 DOI: 10.1016/j.carrev.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/03/2017] [Accepted: 09/05/2017] [Indexed: 11/30/2022]
Abstract
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been associated in some studies with higher target vessel revascularization (TVR) rates than non-CTO PCI. Optimal stent inflation time and its effect on TVR in CTO PCI is unknown. We investigated the time required for stent deployment using the previously described pressure optimized protocol (POP), which uses stent balloon pressure stability rather than an arbitrary inflation time as an end point for balloon deflation. We also compared TVR with CTO PCI vs non-CTO using the POP protocol in both groups. METHODS Patients with successful CTO PCI using POP between 2012 and 2015 were included. Patients having non-CTO PCI using POP and matched for stent diameter and length and temporal proximity constituted the control group to compare inflation time (n=83 each). TVR at 1year was compared between PCI during the time period using POP (CTO=83, non-CTO=263). RESULTS Stent inflation time to achieve optimal stent inflation using POP was longer in CTO vs non-CTO lesions (136±60 vs 108±51s, p=0.001). TVR at 365days was similar in CTO and non-CTO cohorts (2.4% vs 2.6%, p=0.9). CONCLUSION Stent expansion using POP in CTO lesions requires longer inflation duration but leads to similar TVR rates at 1year in CTO PCI compared with non-CTO PCI.
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Affiliation(s)
- Srikanth Vallurupalli
- Central Arkansas Veterans Health System, Little Rock, AR, USA; University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aatish Garg
- Central Arkansas Veterans Health System, Little Rock, AR, USA
| | | | - Abdul Hakeem
- Central Arkansas Veterans Health System, Little Rock, AR, USA; University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Barry F Uretsky
- Central Arkansas Veterans Health System, Little Rock, AR, USA; University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Han Y, Yang Q, Yang Z, Xia J, Su T, Yu J, Jin L, Qiao A. Computational Fluid Dynamics Simulation of Hemodynamic Alterations in Sigmoid Sinus Diverticulum and Ipsilateral Upstream Sinus Stenosis After Stent Implantation in Patients with Pulsatile Tinnitus. World Neurosurg. 2017;106:308-314. [PMID: 28698087 DOI: 10.1016/j.wneu.2017.06.168] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the relationships between upstream venous sinus stenosis and pulsatile tinnitus (PT), and to assess the correlation with diverticulum growth and the effectiveness of stent implantation. METHODS Patient-specific geometric models were constructed using computed tomography venography images from a patient with PT, with sigmoid sinus diverticulum, and with upstream transverse sinus stenosis, in whom stenting of the upstream sinus stenosis alone achieved complete remission of PT. Computational fluid dynamics simulation based on this patient-specific geometry was performed using commercially available finite element software (ANSYS-14) to qualitatively and quantitatively compare the flow velocity, flow rate, velocity vector, pressure, vorticity, and wall shear stress on the affected side transverse and sigmoid sinuses, before and after stent implantation. RESULTS Stenting improved the flow direction and magnitude. After stenting, the flow pattern became smoother and more regular. High-speed blood flow at the level of the diverticulum neck was confined to a smaller area, and its direction changed from approximately perpendicular to the diverticular dome to the distal side of the diverticular neck. The diverticulum showed obvious flow reduction, with decreases of 80.7%, 68.7%, 96.1%, and 91.3% in peak velocity, inflow rate, pressure gradient, and peak vorticity, respectively. The abnormally low wall shear stress at the dome of diverticulum was eliminated. CONCLUSIONS Our findings strongly support a major role of diverticulum stenosis before in PT development and suggest that such stenosis is a causative factor of diverticulum growth. They also confirm the effectiveness of stent implantation for the treatment of PT.
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Wu H, Yang Y, Zheng B, Chen K. Decreased PPAR-γ expression after internal carotid artery stenting is associated with vascular lesions induced by smooth muscle cell proliferation and systemic inflammation in a minipig model. Int J Clin Exp Pathol 2017; 10:7375-7383. [PMID: 31966579 PMCID: PMC6965304] [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] [Received: 11/10/2016] [Accepted: 11/26/2016] [Indexed: 06/10/2023]
Abstract
Vascular restenosis after stenting is known to be largely mediated by proliferation of vascular smooth muscle cells. Recently, peroxisome proliferator-activated receptor gamma (PPAR-γ) has been implicated as a regulator of cellular inflammatory responses, and the PPAR-γ agonist rosiglitazone (ROSI) has been shown to attenuate atherosclerosis formation. However, whether ROSI can inhibit neointimal formation by regulating the inflammatory response and inhibiting vascular smooth muscle hyperplasia after stenting-induced injury remains to be clarified. Accordingly, in this study, 10 minipigs were randomly divided into two groups: the stenting group (n = 5) and the ROSI group (n = 5). Morphometric analysis was conducted for the stented arteries. The protein expressions of PPAR-γ and smooth muscle 22-alpha (SM22α) were analyzed by immunohistochemistry and western blotting, and the serum interferon-γ and interleukin-10 levels were measured by enzyme-linked immunosorbent assay. Three months after implantation, morphometric analysis revealed that administration of ROSI (0.5 mg/kg/d, continuous administration for 90 days) resulted in significant reductions of luminal stenosis, the neointimal area, and neointimal thickness, as compared to the stenting groups. The expression of PPAR-γ and the PPAR-γ/SM22α ratio in the ROSI group were higher than in the stenting group. Furthermore, the serum interferon-γ and interleukin-10 levels were found to be increased and to reach peak levels at 4 h and 7 days after stenting, respectively, after which both declined. However, ROSI treatment resulted in decreased interferon-γ and increased interleukin-10 levels after stenting. In both groups, the cytokine levels returned to the baseline levels on day 56 after stenting. Taken together, these results suggest that ROSI can reduce neointimal formation after stenting by inhibiting the local and systemic inflammatory responses as well as vascular smooth muscle hyperplasia.
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Affiliation(s)
- Hongchen Wu
- Department of Neurology, Southwest Hospital, Third Military Medical UniversityChongqing, China
| | - Yuanrui Yang
- Department of Neurology, Southwest Hospital, Third Military Medical UniversityChongqing, China
- Department of Geriatrics, People’s Liberation Army General Hospital of Chengdu Military RegionChengdu, Sichuan Province, China
| | - Bo Zheng
- Department of Neurology, Southwest Hospital, Third Military Medical UniversityChongqing, China
| | - Kangning Chen
- Department of Neurology, Southwest Hospital, Third Military Medical UniversityChongqing, China
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Wang S, Wang Q, Liu H, Sun S, Sun X, Zhang Y, Wang Z, Cheng Z. Endovascular treatment of thoracic aortic pseudoaneurysm due to brucellosis: a rare case report. BMC Infect Dis 2017; 17:387. [PMID: 28576116 PMCID: PMC5457607 DOI: 10.1186/s12879-017-2485-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/22/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Arterial damage is a known complication of brucellosis, but the occurrence of a thoracic aortic pseudoaneurysm secondary to brucellosis has not been previously reported. CASE PRESENTATION A 65-year-old Chinese man presented with a pseudoaneurysm in the descending segment of the thoracic aorta that caused symptoms of chest pain and intermittent fever. He was diagnosed with a thoracic aortic pseudoaneurysm secondary to brucellosis based on a positive brucella serology test (standard-tube agglutination test) and imaging examination (computed tomography angiography). Anti-brucellosis treatment and covered stent graft implantation were attempted to eliminate the brucellosis and pseudoaneurysm, respectively, and were ultimately successful, with no symptoms after 6 months of follow-up. CONCLUSION Endovascular repair may be effective and safe for treating a thoracic aortic pseudoaneurysm resulting from brucellosis.
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Affiliation(s)
- Shuai Wang
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Qi Wang
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Han Liu
- Department of Respiration, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Siqiao Sun
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Xiwei Sun
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Yang Zhang
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Zhongying Wang
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Zhihua Cheng
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
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Boe BA, Zampi JD, Schumacher KR, Yu S, Armstrong AK. The Use and Outcomes of Small, Medium and Large Premounted Stents in Pediatric and Congenital Heart Disease. Pediatr Cardiol 2016; 37:1525-33. [PMID: 27567910 DOI: 10.1007/s00246-016-1466-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
We sought to describe the use and outcomes of small, medium and large premounted stents in patients with congenital heart disease, including incidence of and risk factors for re-intervention and development of in-stent stenosis. Premounted stents offer several advantages over traditional manually crimped bare-metal stents, especially in small patients. There are no data describing the medium-term effectiveness and outcomes of premounted stents in congenital heart disease. We performed a single-center retrospective review of all small, medium and large premounted stents implanted over an 8-year period. Premounted stents were implanted in 71 vessels within 59 patients with a 97 % success rate. Regardless of implantation site, premounted stent implantation resulted in significant improvements in vessel size and pressure gradient (p < 0.0001). Over a median follow-up duration of 3.1 years [interquartile range (IQR) 1.3-5.2], 25 patients (43 %) required re-intervention (18 catheter based, 3 surgical and 4 hybrid) at a median time of 1.4 years (IQR 0.9-3.0) from implant. Factors associated with re-intervention included age ≤1.9 years [hazard ratio (HR) 2.4, p = 0.03], weight ≤11.5 kg (HR 2.5, p = 0.03) and bare-metal premounted stents compared to covered premounted stents (HR 4.2, p = 0.001). In-stent stenosis was diagnosed in 42 % of premounted stents which underwent follow-up angiography. No identified characteristics were associated with in-stent stenosis, including "oversizing" the premounted stent. Small, medium and large premounted stents are effective in treating vascular stenosis in congenital heart disease. Frequent follow-up is required, especially in smaller patients with expected somatic growth, and to evaluate for in-stent stenosis which occurs in nearly half of premounted stents.
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Haraki T, Uemura R, Masuda SI, Kobayashi N, Lee T. A honeycomb-like structure in the left anterior descending coronary artery treated using a scoring device and drug-eluting stent implantation: a case report. J Med Case Rep 2016; 10:80. [PMID: 27036624 PMCID: PMC4818500 DOI: 10.1186/s13256-016-0874-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 02/14/2016] [Accepted: 03/17/2016] [Indexed: 11/21/2022] Open
Abstract
Background A honeycomb-like structure in the coronary artery is rarely diagnosed by intracoronary ultrasound or optical coherence tomography. Further, its structural mechanisms and response to interventional therapy remain unknown. Case presentation A 59-year-old Japanese man was referred to our hospital because of acute decompensated heart failure with rapid atrial fibrillation. After receiving anticoagulant therapy, a coronary angiogram revealed a braid-like appearance and an intracoronary ultrasound image confirmed a honeycomb-like structure in the mid left anterior descending coronary artery. We inserted two guide wires into different partitions. Although a balloon angioplasty with a scoring device could not completely fenestrate these partitions, a stent implant was able to completely compress the structure easily. Conclusions The honeycomb-like structure of the left anterior descending coronary artery in our patient was suspected to be because of recanalization of a cardiogenic embolism. This structure may have been composed of relatively hard tissues, but was easily compressed by a stent implantation.
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Affiliation(s)
- Tatsuo Haraki
- Department of Cardiology, Saitama Eastern Cardiovascular Hospital, Osawa 3187-1, Koshigaya, 343-0025, Saitama, Japan.
| | - Ryota Uemura
- Department of Cardiology, Saitama Eastern Cardiovascular Hospital, Osawa 3187-1, Koshigaya, 343-0025, Saitama, Japan
| | - Shin-ichiro Masuda
- Department of Cardiology, Saitama Eastern Cardiovascular Hospital, Osawa 3187-1, Koshigaya, 343-0025, Saitama, Japan
| | - Nobuhiko Kobayashi
- Department of Cardiology, Saitama Eastern Cardiovascular Hospital, Osawa 3187-1, Koshigaya, 343-0025, Saitama, Japan
| | - Takeshi Lee
- Department of Cardiology, Saitama Eastern Cardiovascular Hospital, Osawa 3187-1, Koshigaya, 343-0025, Saitama, Japan
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Törő K, Matlakovics B, Dudás I, Karlinger K, Kiss M, Molnár A, Nemeskéri A. The utility of the combination of the corrosion cast method and post mortem MSCT scans. Leg Med (Tokyo) 2014; 16:283-9. [PMID: 25034501 DOI: 10.1016/j.legalmed.2014.06.004] [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] [Received: 05/20/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
A careful post-mortem investigation is needed to determine the cause of death of patients bearing coronary stents and to describe complications of stent implantation. The main purpose of this study was to combine post mortem methods of CT angiography and corrosion cast preparation for the visualization of coronary stenoses, coronary stents, instent restenosis, and stent occlusion. Injection-corrosion method was combined with post-mortem MSCT angiography to characterize the pathomorphological changes after stent implantation in 6 male cadaver hearts. Multi-slice computed tomography was employed to visualize the coronary artery system. For image post processing, multiplanar reconstructions, maximal intensity projections and three dimensional reconstructions were used. This study was assessing the feasibility of post mortem MSCT for intracoronary stent evaluation. We described a method for characterization of the coronary side branch stenosis caused by stent implantation. Post mortem CT imaging proved to be a feasible and highly reproducible technique for the characterization of pathological changes in the coronary system.
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Affiliation(s)
- Klára Törő
- Semmelweis University Department of Forensic and Insurance Medicine, Hungary.
| | - Balázs Matlakovics
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
| | - Ibolyka Dudás
- Semmelweis University Department of Diagnostic Radiology and Oncotherapy, Hungary
| | - Kinga Karlinger
- Semmelweis University Department of Diagnostic Radiology and Oncotherapy, Hungary
| | - Mátyás Kiss
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
| | - Agnes Molnár
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
| | - Agnes Nemeskéri
- Semmelweis University Department of Human Morphology and Developmental Biology, Hungary
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Kunadian V, Dunford JR, Swarbrick D, Halaby R, Ajari O, Cochet M, Feeney K, Larkin E, Gonzalez GR, Govindavarjhulla A, Nethala D, Patel H, Guddeti RR, Khan F, Kumar S, Patel S, Saddala P, Serla VV, Zacarkim M, Yadav D, Gibson CM. Triple Antiplatelet Therapy and Combinations with Oral Anticoagulants After Stent Implantation. Interv Cardiol Clin 2013; 2:595-606. [PMID: 28582186 DOI: 10.1016/j.iccl.2013.05.007] [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: 06/07/2023]
Abstract
Triple oral anticoagulation or triple antiplatelet therapies may be administered for various reasons. They reduce cardiac complications following percutaneous coronary intervention and stroke or other thromboembolic phenomenon in conditions such as atrial fibrillation. There is an elevated risk of severe bleeding, so it is necessary to balance risk and benefits. Newer oral anticoagulants and antiplatelet drugs may be considered; the number of options is increasing. This article examines triple therapies and the efficacy and safety of combinations of traditional anticoagulant and antiplatelet drugs, and reviews clinical trial data on novel agents. Guidelines to inform clinical decision-making are presented.
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Affiliation(s)
- Vijay Kunadian
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Joseph Robert Dunford
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Daniel Swarbrick
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rim Halaby
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ogheneochuko Ajari
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Madeleine Cochet
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Kristin Feeney
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Emily Larkin
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Gonzalo Romero Gonzalez
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Aditya Govindavarjhulla
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Daniel Nethala
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Hardik Patel
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Raviteja Reddy Guddeti
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Farman Khan
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Shankar Kumar
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Sapan Patel
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Prashanth Saddala
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Vishnu Vardhan Serla
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Marcelo Zacarkim
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Divya Yadav
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - C Michael Gibson
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Matsui H, Yasukochi S, Takigiku K, Tazawa S. Urgent stenting via internal jugular vein for stabilization in critical neonates with total anomalous pulmonary venous connection and severe pulmonary venous obstruction. J Cardiol Cases 2013; 8:e51-e53. [PMID: 30546741 DOI: 10.1016/j.jccase.2013.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/08/2013] [Accepted: 03/26/2013] [Indexed: 11/17/2022] Open
Abstract
Reducing obstruction in the vertical vein is significant for stabilizing the condition in neonates with total anomalous pulmonary venous connection (TAPVC). Stent implantation into the vertical vein is an alternative treatment for rescue in critical patients with TAPVC and severe pulmonary congestion. We performed a stent implantation into the supra-cardiac vertical vein for rescue and stabilization of a critical newborn with TAPVC. The internal jugular vein was selected for sheath insertion under echo guidance in an urgent procedure, which took 11 min from venous puncture to stent implantation. The internal jugular approach is optimal for stent implantation in patients with supra-cardiac TAPVC in a critical condition. <Learning objective: Learning alternative methods are valuable for rescue and treatment against critical conditions with congenital heart disease in neonates. This report can provide useful and optimal technique for rescuing a critical patient with total anomalous venous connection with severe pulmonary venous obstruction.>.
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Affiliation(s)
- Hikoro Matsui
- Department of Pediatric Cardiology, Nagano Children's Hospital, 3100 Toyoshina, Azumino, Nagano, 399-8288, Japan
| | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Nagano Children's Hospital, 3100 Toyoshina, Azumino, Nagano, 399-8288, Japan
| | - Kiyohiro Takigiku
- Department of Pediatric Cardiology, Nagano Children's Hospital, 3100 Toyoshina, Azumino, Nagano, 399-8288, Japan
| | - Seiichi Tazawa
- Department of Pediatric Cardiology, Nagano Children's Hospital, 3100 Toyoshina, Azumino, Nagano, 399-8288, Japan
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Münsterer A, Kasnar-Samprec J, Hörer J, Cleuziou J, Eicken A, Malcic I, Lange R, Schreiber C. Treatment of right ventricle to pulmonary artery conduit stenosis in infants with hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2013; 44:468-71; discussion 471. [PMID: 23471153 DOI: 10.1093/ejcts/ezt104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine the incidence of right ventricle-to-pulmonary artery (RV-PA) conduit stenosis after the Norwood I operation in patients with hypoplastic left heart syndrome (HLHS), and to determine whether the treatment strategy of RV-PA conduit stenosis has an influence on interstage and overall survival. METHODS Ninety-six patients had a Norwood operation with RV-PA conduit between 2002 and 2011. Details of reoperations/interventions due to conduit obstruction prior to bidirectional superior cavopulmonary anastomosis (BSCPA) were collected. RESULTS Overall pre-BSCPA mortality was 17%, early mortality after Norwood, 6%. Early angiography was performed in 34 patients due to desaturation at a median of 8 days after the Norwood operation. Fifteen patients (16%) were diagnosed with RV-PA conduit stenosis that required treatment. The location of the conduit stenosis was significantly different in the patients with non-ringed (proximal) and the patients with ring-enforced conduit (distal), P = 0.004. In 6 patients, a surgical revision of the conduit was performed; 3 of them died prior to BSCPA. Another 6 patients had a stent implantation and 3 were treated with balloon dilatation followed by a BSCPA in the subsequent 2 weeks. All patients who were treated interventionally for RV-PA conduit obstruction had a successful BSCPA. Patients who received a surgical RV-PA conduit revision had a significantly higher interstage (P = 0.044) and overall mortality (P = 0.011) than those who received a stent or balloon dilatation of the stenosis followed by an early BSCPA. CONCLUSIONS RV-PA conduit obstruction after Norwood I procedure in patients with HLHS can be safely and effectively treated by stent implantation, balloon dilatation and early BSCPA. Surgical revision of the RV-PA conduit can be reserved for patients in whom an interventional approach fails, and an early BSCPA is not an option.
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Affiliation(s)
- Andrea Münsterer
- Department of Cardiovascular Surgery, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany.
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Lee JH, Yun JK, Kim DW, Kang SD. Clinical and angiographic outcomes of wingspan stent placement for treatment of symptomatic intracranial stenosis: single center experience with 19 cases. J Cerebrovasc Endovasc Neurosurg 2012; 14:157-63. [PMID: 23210041 PMCID: PMC3491208 DOI: 10.7461/jcen.2012.14.3.157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 08/11/2012] [Revised: 08/17/2012] [Accepted: 08/22/2012] [Indexed: 11/24/2022] Open
Abstract
Objective The limitations of medical management of symptomatic intracranial arterial stenosis (ICS) have prompted development of new strategies, including endovascular treatment. However, stenting of symptomatic ICS remains investigational. Here, we have reported and analyzed a series of 19 endovascular procedures involving placement of a Wingspan stent. Methods We conducted a retrospective review of a series of ICS in which patients were treated with percutaneous transarterial balloon angioplasty and stent placement (PTAS). Patients included in the study were diagnosed as symptomatic ICS between May 2010 and September 2011. Results Nineteen patients (median age, 65 years; 12 males, seven women) were treated with the Wingspan stent system for symptomatic ICS ranging from 50% to 99%. The technical success rate was 100%. The location of ICS included the internal carotid (n = 5; 1 petrous, 3 cavernous, and 1 clinoid segments), vertebral (n = 1; V4 segment), basilar (n = 1), and middle cerebral (n = 12; 9 M1, 3 M2) arteries. There was no occurrence of procedure-related mortality. Periprocedural morbidity occurred in two cases (10.5%), including carotid-cavernous fistula (n = 1) and subarachnoid hemorrhage (n = 1). No ipsilateral stroke was recorded beyond 30 days during a mean follow-up period of 13.2 months (range 9-19 months). Restenosis (> 50%) was observed in one patient (6.3%), who was asymptomatic, on follow-up imaging. Conclusion Wingspan stent for symptomatic ICS can be performed with a high rate of technical success and acceptable periprocedural morbidity rates. Our initial experience indicates that this procedure represents a viable treatment option for this patient population.
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Affiliation(s)
- Jun Hyoung Lee
- Department of Neurosurgery, Institute of Wonkwang Medical Science, School of Medicine, Wonkwang University, Iksan, Korea
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Yang SP, Wang HY, Yuan ZP, Xu FY, Sun C, Yu LZ. Combined use of esophageal and pyloric stents for esophageal-gastric cancers: A case report. Shijie Huaren Xiaohua Zazhi 2012; 20:2327-2329. [DOI: 10.11569/wcjd.v20.i24.2327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Multiple primary cancers are malignant tumors which synchronously or heterochronously occur in the same or different organs with completely different histological types. About 70% of cases of multiple primary cancers take place in digestive organs, and gastrointestinal cancers can easily induce stenosis. Here we report a case of combined use of esophageal and pyloric stents for digestive strictures caused by esophageal-gastric cancers. Stent implantation can relieve stenosis for patients who have lost opportunities for surgery, improve the quality of life, and prolong survival time.
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Kudat H, Ozcan M, Tükek T, Sözen AB, Akkaya V, Oguz F, Seyhun Y. Relationship between HLA molecules and late restenosis after coronary stent placement. J Saudi Heart Assoc 2012; 24:85-8. [PMID: 23960677 PMCID: PMC3727561 DOI: 10.1016/j.jsha.2011.10.001] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 10/05/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study is to confirm whether there is relation between the human leucocyte antigen (HLA) locus and restenosis after percutaneous coronary intervention (PCI) holds in our patient population and whether it can be useful as a prognostic factor. METHODS We examined the HLA phenotypes in 46 consecutive patients (39 men, 7 women, mean age of 57 ± 9 years) who had successful stent implantation in the coronary artery. Selective coronary arteriography was performed 6 months after coronary stenting to assess the presence of restenosis. The HLA phenotyping was performed for HLA-A,-B,-C antigens by Terasaki microlymphocytotoxicity technique and for HLA-DR alleles with PCR-SSP technique. RESULTS Restenosis(R+) was present in 12 (26.1%) patients (11 men, 1 woman, mean age of 57 ± 10 years). For HLA Class I antigens frequency of HLA-B62 and HLA-CW2 antigen was slightly higher in restenotic patients but did not reach statistical significance. For HLA-DR alleles restenotic patients had higher frequencies for HLA-DRB1(∗)01(R+ %25, R- %14.7), and HLA-DR11(R+ %41.7, R- %20.6), without reaching statistical significance and lower frequencies for DR7(R+ %0, R- %17.6) and D13(R+%8.3, R- %32.4) and HLA-DR53 (R+ %25, R- %35.3) without reaching statistical significance. CONCLUSION In conclusion, results show that there was no relationship between the development of restenosis and HLA-subtypes.
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Affiliation(s)
- Hasan Kudat
- Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, 34390 Istanbul
| | - Mustafa Ozcan
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Istanbul
| | - Tufan Tükek
- Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, 34390 Istanbul
| | - Ahmet Bilge Sözen
- Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, 34390 Istanbul
| | - Vakur Akkaya
- Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, 34390 Istanbul
| | - Fatma Oguz
- Department of Medical Biology, Istanbul Medical Faculty, Istanbul University, Istanbul
| | - Yalçın Seyhun
- Department of Medical Biology, Istanbul Medical Faculty, Istanbul University, Istanbul
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Oonishi T, Hayabuchi Y, Sakata M, Mori K, Kagami S. Stent placement in the ductus venosus of a neonate with total anomalous pulmonary venous return. J Echocardiogr 2012; 10:27-9. [PMID: 27277927 DOI: 10.1007/s12574-011-0102-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/08/2011] [Indexed: 10/14/2022]
Abstract
A newborn with right isomerism, infracardiac total anomalous pulmonary venous return (TAPVR), and obstruction of the ductus venosus underwent stent implantation in the ductus venosus at 4 h after birth. This procedure averted early pulmonary venous obstruction. Since gradual neointimal proliferation subsequently occurred within the stent, the patient underwent stent balloon dilatation at 35 days of age and underwent surgical repair of the TAPVR with a Blalock-Taussig shunt operation at 53 days of age. Finally, the patient was discharged without any complications. Transthoracic echocardiography is very useful to confirm subsequent minimal change within the stent.
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Affiliation(s)
- Tatsuya Oonishi
- Department of Pediatrics, School of Medicine, University of Tokushima, Kuramoto-cho-3, Tokushima, 770-8503, Japan.
| | - Yasunobu Hayabuchi
- Department of Pediatrics, School of Medicine, University of Tokushima, Kuramoto-cho-3, Tokushima, 770-8503, Japan
| | - Miho Sakata
- Department of Pediatrics, School of Medicine, University of Tokushima, Kuramoto-cho-3, Tokushima, 770-8503, Japan
| | - Kazuhiro Mori
- Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Shoji Kagami
- Department of Pediatrics, School of Medicine, University of Tokushima, Kuramoto-cho-3, Tokushima, 770-8503, Japan
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Cao B, Zhang WN, Bai NF, Wei LZ. Endoscopy-guided combined implantation of chemotherapeutic seeds and stents for malignant obstruction caused by advanced gastric cancer: an analysis of 16 cases. Shijie Huaren Xiaohua Zazhi 2011; 19:1184-1186. [DOI: 10.11569/wcjd.v19.i11.1184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of endoscopy-guided combined implantation of 5-fluorouracil (5-FU) seeds and stents in the treatment of malignant obstruction caused by advanced gastric cancer.
METHODS: A total of 16 patients with advanced gastric cancer and gastric outflow obstruction were enrolled into the study. During the endoscopy procedures, stents and 45-60 chemotherapeutic 5-FU seeds (an average dose of 100-200 mg) were implanted into the tumors.
RESULTS: A total of 26 procedures of 5-FU implantation and 18 procedures of stent implantation were performed. In terms of improvement in outflow obstruction, significant response, partial response and partial remission were achieved in 7, 5 and 3 patients, respectively, and the overall response rate was 93.75%.
CONCLUSION: Endoscopy-guided combined implantation of 5-FU seeds and stents is safe, reliable and effective in the management of malignant obstruction caused by advanced gastric cancer.
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Yunoki K, Naruko T, Itoh A, Furukawa A, Abe Y, Nakagawa E, Komatsu R, Haze K. Stenting of right coronary ostial occlusion due to thrombosed type A aortic dissection: One-year follow-up results. J Cardiol Cases 2010; 1:e166-e170. [PMID: 30524530 DOI: 10.1016/j.jccase.2009.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 12/10/2009] [Accepted: 12/14/2009] [Indexed: 11/17/2022] Open
Abstract
A 52-year-old man experienced acute chest pain and was transferred to our hospital. An electrocardiogram showed ST-segment elevation in leads II, III, aVf, and V1 through V3. The diagnosis at the emergency room was inferior acute myocardial infarction (AMI), and emergent coronary angiography (CAG) was performed. While CAG showed subtotal occlusion of the right coronary artery (RCA) ostium, aortic dissection was suspected due to staining of the contrast agent distal to the occluded site of RCA. Intravascular ultrasound showed compression of the RCA ostium due to aortic dissection. We performed bare metal stent implantation, and contrast-enhanced computed tomography (CT) after stenting showed a thrombosed type A aortic dissection. The patient received medical treatment along with repeated CT and echocardiographic examinations, and was discharged without any events one month after admission. CAG six months after stenting and 64-multislice CT angiography one year later showed a patent RCA. Contrast-enhanced CT at six months showed complete resorption of the ascending aortic intramural hematoma, and 64-multislice CT at one year showed a descending aortic intramural hematoma. The patient is doing well one year after the onset. This is a rare case of successful medical treatment for acute type A aortic dissection complicated with AMI.
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Affiliation(s)
- Kei Yunoki
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Akira Itoh
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Atsuko Furukawa
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Eiichiro Nakagawa
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Ryushi Komatsu
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Kazuo Haze
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
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Higaki T, Yamamoto E, Nakano T, Ohta M, Takata H, Murao K, Chisaka T, Moritani T, Nagashima M, Shikata F, Ishii E. Successful stenting of the ductus venosus in 2 neonates with asplenia syndrome complicated by infracardiac type total anomalous pulmonary venous connection. J Cardiol Cases 2009; 1:e129-e132. [PMID: 30615751 DOI: 10.1016/j.jccase.2009.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 10/26/2009] [Accepted: 10/28/2009] [Indexed: 10/20/2022] Open
Abstract
In the neonatal period, the surgical mortality of palliation is extremely high for asplenia syndrome complicated by single ventricle combined with total anomalous pulmonary venous connection (TAPVC). Recently, stent implantation for the pulmonary venous drainage route soon after birth has been used instead of surgery to prevent pulmonary venous occlusion and to maintain stable hemodynamics in the neonatal period or in early infancy. Here, we successfully implanted stents in the ductus venosus (DV) in 2 neonates with asplenia syndrome complicated by infracardiac type TAPVC. The first patient was a 3-day-old male neonate with severe cyanosis. Immediately after TAPVC was diagnosed, we implanted a stent in the DV. The second patient was a 0-day-old female neonate. She was diagnosed as TAPVC by fetal echocardiogram. After the scheduled delivery, a stent was successfully implanted. We believe that stent implantation in the DV in the neonatal period is effective and less invasive than surgery in patients with infracardiac type TAPVC.
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Affiliation(s)
- Takashi Higaki
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan.,Department of Pediatric Cardiology, Stroke & Cardiovascular Center, Ehime University Hospital, Ehime, Japan
| | - Eiichi Yamamoto
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan.,Department of Pediatric Cardiology, Stroke & Cardiovascular Center, Ehime University Hospital, Ehime, Japan
| | - Takeshi Nakano
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masaaki Ohta
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hidemi Takata
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kikuko Murao
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Toshiyuki Chisaka
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tomozo Moritani
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Mitsugi Nagashima
- Department of Cardiovascular Surgery, Stroke & Cardiovascular Center, Ehime University Hospital, Ehime, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Stroke & Cardiovascular Center, Ehime University Hospital, Ehime, Japan
| | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
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