1
|
Ulsaker H, Halvorsen H, Braaten AO, Dorenberg E, Rikken Lindberg B, Nordhus KC, Jakobsen Ø, Brekken R, Seternes A, Manstad-Hulaas F. Early and mid-term results after endovascular repair of thoracoabdominal aortic aneurysms using the off-the-shelf multibranched t-Branch device: a national multi-center study. SCAND CARDIOVASC J 2024; 58:2335906. [PMID: 38613333 DOI: 10.1080/14017431.2024.2335906] [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: 11/16/2023] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
Objective: The multibranched off-the-shelf Zenith® t-Branch (Cook Medical, Bloomington, IN) device is commonly chosen for endovascular repair of thoracoabdominal aortic aneurysms. The aim of this study was to report early and mid-term outcomes in all patients treated with the t-Branch in Norway; Design and Methods: A retrospective multicenter study with Norwegian centers performing complex endovascular aortic repair was undertaken. T-Branch patients from 2014 to 2020 were included. All postoperative computed tomography angiography images were reviewed, and demographic, anatomical, perioperative and follow-up data were analyzed; Results: Seventy patients were treated in a single-step (n = 55) or staged (n = 15) procedure. Symptomatic presentation was seen in 20 patients, six of which had a contained rupture. Technical success was 87% (n = 59), with failures caused by unsuccessful bridging of target vessels (n = 4), target vessel bleeding (n = 3), persisting type 1c endoleak (n = 1) and t-Branch malrotation (n = 1). 30-day mortality was 9% (n = 6) and was associated with high BMI (p = .038). The spinal cord ischemia rate was 21% (n = 15) and was associated with type II aneurysms (OR 5.4, 95% CI 1.1-26.7, p = .04), smoking (OR 6.0, 95% CI 1.3-27.6, p = .02) and intraoperative blood loss (OR 1.1, 95% CI 1.0-1.3, p = .01). Survival at one, two and three years was 84 ± 4%, 70 ± 6% and 67 ± 6%, respectively. Freedom from aortic-related reinterventions at one, two and three years was 80 ± 5%, 65 ± 7% and 50 ± 8%, respectively; Conclusion: The study showed low early mortality (9%) and satisfactory mid-term survival. Technical success was achieved in acceptable 87% of procedures. The rate of spinal cord ischemia was high, occurring in 21% of patients.
Collapse
Affiliation(s)
- Håvard Ulsaker
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy, St. Olavs Hospital, Trondheim, Norway
| | | | | | - Eric Dorenberg
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | | | - Øyvind Jakobsen
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North, Norway
| | - Reidar Brekken
- Norwegian National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy, St. Olavs Hospital, Trondheim, Norway
- Department of Health Research, SINTEF, Trondheim, Norway
| | - Arne Seternes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - Frode Manstad-Hulaas
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy, St. Olavs Hospital, Trondheim, Norway
- Department of Radiology, St. Olavs University Hospital, Trondheim, Norway
| |
Collapse
|
2
|
Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024. [PMID: 38743805 DOI: 10.1161/cir.0000000000001251] [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: 05/16/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
Collapse
|
3
|
Salsano G, Salsano A, Del Sette B, D’Alonzo A, Sassos D, Alexandre A, Pedicelli A, Di Iorio R, Colò F, Castellan L. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke. Open Med (Wars) 2024; 19:20240966. [PMID: 38756249 PMCID: PMC11097045 DOI: 10.1515/med-2024-0966] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction In the absence of clinical trials, the benefit of endovascular therapy (EVT) on the treatment of acute ischemic stroke (AIS) with primary distal and medium vessel occlusions (DMVO) is still not well defined. The aim of the study is to evaluate EVT with or without intravenous thrombolysis (EVT ± IVT) in primary DMVO stroke in comparison with a control cohort treated with IVT alone. Methods We analysed all consecutive AIS with proven primary DMVO. Primary endpoints were excellent outcome, functional independence at 3 months follow-up, and early neurologic improvement at 1 day after treatment. Results One hundred and fourteen patients with DMVO strokes were included between 2019 and 2023. Propensity-weighted analysis showed no significant differences in EVT ± IVT vs IVT for the excellent outcome (adjusted OR [aOR], 1.575; 95% CI, 0.706-3.513), functional independence (aOR, 2.024; 95% CI, 0.845-4.848), early neurological improvement (aOR, 2.218; 95% CI, 0.937-5.247), mortality (aOR, 0.498; 95% CI, 0.177-1.406), symptomatic intracranial haemorrhage (aOR, 0.493; 95% CI, 0.102-2.385), and subarachnoid haemorrhage (aOR, 0.560; 95% CI, 0.143-2.187). The type of revascularization did not influence the percentage of cerebral volume lost (adjusted linear regression estimate, -19.171, t value, 11.562; p = 0.104). Conclusions This study supports the hypothesis that patients with primary DMVO stroke treated with EVT (±IVT) or IVT alone have comparable outcomes.
Collapse
Affiliation(s)
- Giancarlo Salsano
- Department of Radiology and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Bruno Del Sette
- Department of Radiology and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessio D’Alonzo
- Department of Radiology and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Davide Sassos
- Clinica Neurologica IRCCS Azienda Ospedaliera Universitaria San Martino, IST, Genoa, Italy
| | - Andrea Alexandre
- UOSA Neuroradiology Unit, Department of Radiology, Radiotherapy and Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Pedicelli
- UOSA Neuroradiology Unit, Department of Radiology, Radiotherapy and Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Di Iorio
- Neurology Unit, Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Colò
- Department of Neurosciences, Catholic University School of Medicine, Rome, Italy
| | - Lucio Castellan
- Department of Radiology and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
4
|
Suzuki K, Takahara M, Tobita K, Hayakawa N, Mori S, Iwata Y, Horie K, Nakama T. Contemporary Therapy of Femoropopliteal In-Stent Restenosis / Occlusion, 36-month Follow up Study. Vasc Endovascular Surg 2024:15385744241253170. [PMID: 38739243 DOI: 10.1177/15385744241253170] [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: 05/14/2024]
Abstract
BACKGROUND Drug-eluting devices improved outcomes of endovascular therapy (EVT) for femoropopliteal lesions, but mainly for de novo lesions. Endovascular therapy for in-stent restenosis/occlusion (ISR/O) is challenging, and large trials and long-term data are not well reported. MATERIALS AND METHODS This study is a physician initiated, multicenter, and retrospective design. From 7 Japanese institutes, 3635 femoropopliteal cases were enrolled in the study. Among these, 346 cases of first ISR/O were studied. We defined drug-coated-balloon, drug-eluting stent, and covered stent as New devices. Balloon angioplasty and bare nitinol stent were included in the control group. RESULTS The propensity score matching extracted 112 pairs. At 12 months, the primary patency rate was 80.3% in the new device group and 52.7% in the control group, and there was a significant intergroup difference (P = .004). However, at 36 months, the rate was 43.3% vs 39.2%, with no significant difference (P = .090). No baseline characteristics had any significant interaction effect (all P > .05). CONCLUSIONS The New devices were more effective than the control group for ISR/O at 1 year, but caught up at 3 years.
Collapse
Affiliation(s)
- Kenji Suzuki
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Chiba, Japan
| | - Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama-shi Tobu Hospital, Yokohama, Japan
| | - Yo Iwata
- Department of Cardiology, Funabashi Municipal Medical Center, Chiba, Japan
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo-bay Urayasu Ichikawa Medical Center, Chiba, Japan
| |
Collapse
|
5
|
Chen L, Bian G, Zhu X, Duan X, Meng Y, Li L. Importance of computed tomography perfusion on assessing collateral circulation and prognosis of patients with acute anterior circulation large vessel occlusion after endovascular therapy. SLAS Technol 2024:100139. [PMID: 38734181 DOI: 10.1016/j.slast.2024.100139] [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: 01/24/2024] [Revised: 04/11/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
This study probed the importance of computed tomography perfusion (CTP) on assessing collateral circulation and prognosis in patients with acute anterior circulation large vessel occlusion (AAC-LVO) after endovascular therapy (EVT). Retrospective analysis was performed on the case data of 124 AAC-LVO patients who achieved EVT in the First People's Hospital of Lianyungang. All patients received computed tomography (CT) examination. Based on the multi-phase computed tomography angiography (mCTA) score, patients were separated into poor collateral circulation group and good collateral circulation group. Based on modified Rankin scale (mRS) score, patients were separated into good prognosis group and poor prognosis group. The receiver operating characteristic (ROC) curve was used to measure the efficacy of CTP parameters in predicting good collateral circulation or good prognosis. Correlation between CTP parameters with mCTA collateral and 90-day mRS circulation score was analyzed using the Spearman correlation analysis. The age and admission national Institutes of Health stroke scale (NIHSS) scores of the good collateral circulation group were lower than the poor collateral circulation group, and low perfusion area volume with Tmax > 6 s (VTmax>6s), infarct core area volume (VCBF<30%)and hypoperfusion intensity ratio (HIR) were also lower. The mCTA collateral cycle score was negatively related to VTmax>6 s, VCBF<30% and HIR. The area under the curve (AUC) values of VTmax>6 s and VCBF<30% and HIR for predicting good collateral circulation were 0.763, 0.884 and 0.842, respectively, which suggested that perfusion parameters VTmax>6 s, VCBF<30% and HIR could effectively indicate the status of patients' collateral circulation. Relative to the poor prognosis group, patients in the good prognosis group possessed lower admission NIHSS score, younger age, smaller final infarct volume, lower HIR, VCBF<30%, VTmax>6s, Alberta Stroke Program Early CT(ASPECT) score, and higher mCTA score. Spearman correlation analysis unveiled that ASPECT score, mCTA score and 90-day mRS were negatively correlated. The final infarct volume, perfusion parameters HIR and VCBF<30% were positively correlated with 90-day mRS. ROC analysis showed that all variates had good prognostic value for acute anterior circulation great vessel occlusion patients, while VCBF<30% and HIR had high diagnostic value for prognosis. To sum up, CTP can provide a comprehensive imaging assessment of the collateral circulation of patients with AAC-LVO and has a higher predictive value for the prognosis assessment of patients with EVT in terms of VCBF<30%, HIR score and mCTA collateral circulation score.
Collapse
Affiliation(s)
- Lei Chen
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Guangjun Bian
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Xiufang Zhu
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Xinxiu Duan
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Yue Meng
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Lei Li
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China.
| |
Collapse
|
6
|
Marios-Nikos P, Alex B, Jens F, Isabel F, Jan G, Mira K, Ronen L, Paolo M, Marc R, Jeffrey L S, Daniel S, Adriaan VE, Claus Z, Nikki R, Luzia B, Urs F. EnDovascular Therapy Plus Best Medical Treatment (BMT) Versus BMT Alone for MedIum distal VeSsel Occlusion sTroke (DISTAL): An international, multicentre, randomized-controlled, two-arm, assessor-blinded trial. Eur Stroke J 2024:23969873241250212. [PMID: 38702876 DOI: 10.1177/23969873241250212] [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: 05/06/2024] Open
Abstract
RATIONALE Whether endovascular therapy (EVT) in addition to best medical treatment (BMT) in people with acute ischemic stroke (AIS) due to a medium distal vessel occlusion (MDVO) is beneficial remains unclear. AIM To determine if people experiencing an AIS due to an isolated MDVO (defined as the co- or non-dominant M2 segment, the M3 or M4 segment of the middle cerebral artery, the A1, A2, or A3 segment of the anterior cerebral artery or the P1, P2 or P3 segment of the posterior cerebral artery) will have superior outcome if treated with EVT in addition to BMT compared to BMT alone. SAMPLE SIZE To randomize 526 participants 1:1 to EVT plus BMT or BMT alone. METHODS AND DESIGN A multicentre, international, prospective, randomized, open-label, blinded-endpoint (PROBE) superiority trial. OUTCOMES The primary efficacy endpoint is the distribution of disability levels on the modified Rankin Scale at 90 days. Secondary clinical efficacy outcomes include normalized change in National Institutes of Health Stroke Scale score from baseline to day 1, cognitive outcome at 90 days, and health-related quality of life at 90 days. Safety outcomes include all serious adverse events, symptomatic intracranial hemorrhage within 24 h, and all-cause mortality up to 90 days. Secondary imaging outcomes include successful reperfusion at end of EVT procedure and recanalization of target artery at 24 h. DISCUSSION DISTAL will inform physicians whether EVT in addition to BMT in people with AIS due to a MDVO is more efficacious than BMT alone.
Collapse
Affiliation(s)
| | - Brehm Alex
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Fiehler Jens
- Clinic of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Fragata Isabel
- Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
- NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Gralla Jan
- Clinic of Diagnostic and Interventional Neuroradiology, Inselspital Bern, Bern, Switzerland
| | - Katan Mira
- Clinic of Neurology, University Hospital Basel, Basel, Switzerland
| | - Leker Ronen
- Department of Neurology, Stroke Center, Hadassah Medical Center, Jerusalem, Israel
| | - Machi Paolo
- Clinic of Diagnostic and Interventional Neuroradiology, Hôpitaux universitaires de Genève, Genève, Switzerland
| | - Ribo Marc
- Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Saver Jeffrey L
- Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine of UCLA, Los Angeles, CA, USA
| | - Strbian Daniel
- Division of Emergency Neurology and Neurocritical care, HUS, Helsinki, Finland
| | - van Es Adriaan
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Zimmer Claus
- Clinic of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
| | - Rommers Nikki
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Balmer Luzia
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Fischer Urs
- Clinic of Diagnostic and Interventional Neuroradiology, Inselspital Bern, Bern, Switzerland
- Clinic of Neurology, Inselspital Bern, Bern, Switzerland
| |
Collapse
|
7
|
Liang Y, Yu Y, Liu J, Li X, Chen X, Zhou H, Guo ZN. Blood-brain barrier disruption and hemorrhagic transformation in acute stroke before endovascular reperfusion therapy. Front Neurol 2024; 15:1349369. [PMID: 38756220 PMCID: PMC11097340 DOI: 10.3389/fneur.2024.1349369] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/19/2024] [Indexed: 05/18/2024] Open
Abstract
Background and purpose Early blood-brain barrier (BBB) disruption in patients with acute ischemic stroke (AIS) can be detected on perfusion computed tomography (PCT) images before undergoing reperfusion therapy. In this study, we aimed to determine whether early disruption of the BBB predicts intracranial hemorrhage transformation (HT) in patients with AIS undergoing endovascular therapy and further identify factors influencing BBB disruption. Methods We retrospectively analyzed general clinical and imaging data derived from 159 consecutive patients with acute anterior circulation stroke who were admitted to the Department of Neurology of the First Hospital of Jilin University, and who underwent endovascular treatment between January 1, 2021, and March 31, 2023. We evaluated the relationship between BBB destruction and intracranial HT before endovascular reperfusion therapy and examined the risk factors for early BBB destruction. Results A total of 159 patients with assessable BBB leakage were included. The median (interquartile range, IQR) age was 63 (54-70) years, 108 (67.9%) patients were male, and the median baseline National Institutes of Health Stroke Scale (NHISS) score was 12 (10-15). Follow-up non-contrast computed tomography (NCCT) detected HT in 63 patients. After logistic regression modeling adjustment, we found that BBB leakage in the true leakage area was slightly more than 2-fold risk of HT (odds ratio [OR], 2.01; 95% confidence interval [CI] 1.02-3.92). Heart rate was also associated with HT (OR, 1.03, 95% CI, 1.00-1.05). High Blood-brain barrier permeability (BBBP) in the true leakage area was positively correlated with infarct core volume (OR, 1.03; 95% CI, 1.01-1.05). Conclusion Early BBB destruction before endovascular reperfusion therapy was associated with HT, whereas high BBBP correlated positively with infarct core volume.
Collapse
Affiliation(s)
- Yuchen Liang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Yang Yu
- Siemens Healthineers Ltd. CT Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Jiaxin Liu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Xuewei Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Xue Chen
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Hongwei Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Zhen-Ni Guo
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Changchun, China
- Department of Neurology, Neuroscience Research Center, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
8
|
Zhang M, Lotfollahzadeh S, Elzinad N, Yang X, Elsadawi M, Gower AC, Belghasem M, Shazly T, Kolachalama VB, Chitalia VC. Alleviating iatrogenic effects of paclitaxel via antiinflammatory treatment. Vasc Med 2024:1358863X241231942. [PMID: 38623630 DOI: 10.1177/1358863x241231942] [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: 04/17/2024]
Abstract
BACKGROUND Paclitaxel (PTX) is touted as an essential medicine due to its extensive use as a chemotherapeutic agent for various cancers and an antiproliferative agent for endovascular applications. Emerging studies in cardio-oncology implicate various vascular complications of chemotherapeutic agents. METHODS We evaluated the inflammatory response induced by the systemic administration of PTX. The investigation included RNAseq analysis of primary human endothelial cells (ECs) treated with PTX to identify transcriptional changes in pro-inflammatory mediators. Additionally, we used dexamethasone (DEX), a well-known antiinflammatory compound, to assess its effectiveness in counteracting these PTX-induced changes. Further, we studied the effects of PTX on monocyte chemoattractant protein-1 (MCP-1) levels in the media of ECs. The study also extended to in vivo analysis, where a group of mice was injected with PTX and subsequently harvested at different times to assess the immediate and delayed effects of PTX on inflammatory mediators in blood and aortic ECs. RESULTS Our RNAseq analysis revealed that PTX treatment led to significant transcriptional perturbations in pro-inflammatory mediators such as MCP-1 and CD137 within primary human ECs. These changes were effectively abrogated when DEX was administered. In vitro experiments showed a marked increase in MCP-1 levels in EC media following PTX treatment, which returned to baseline upon treatment with DEX. In vivo, we observed a threefold increase in MCP-1 levels in blood and aortic ECs 12 h post-PTX administration. Similar trends were noted for CD137 and other downstream mediators like tissue factor, vascular cell adhesion molecule 1, and E-selectin in aortic ECs. CONCLUSION Our findings illustrate that PTX exposure induces an upregulation of atherothrombotic mediators, which can be alleviated with concurrent administration of DEX. Considering these observations, further long-term investigations should focus on understanding the systemic implications associated with PTX-based therapies and explore the clinical relevance of DEX in mitigating such risks.
Collapse
Affiliation(s)
- Mengwei Zhang
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Saran Lotfollahzadeh
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Nagla Elzinad
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Xiaosheng Yang
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Murad Elsadawi
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Adam C Gower
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Clinical and Translational Science Institute, Boston University School of Medicine, Boston, MA, USA
| | - Mostafa Belghasem
- Department of Biomedical Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Tarek Shazly
- College of Engineering & Computing, University of South Carolina, Columbia, SC, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
| | - Vipul C Chitalia
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
| |
Collapse
|
9
|
Habibi MA, Rashidi F, Fallahi MS, Arshadi MR, Mehrtabar S, Ahmadi MR, Shafizadeh M, Majidi S. Woven endo bridge device for recurrent intracranial aneurysms: A systematic review and meta-analysis. Neuroradiol J 2024:19714009241247457. [PMID: 38613671 DOI: 10.1177/19714009241247457] [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: 04/15/2024] Open
Abstract
BACKGROUND Recurrent intracranial aneurysms present a significant clinical challenge, demanding innovative and effective treatment approaches. The Woven EndoBridge (WEB) device has emerged as a promising endovascular solution for managing these intricate cases. This study aims to assess the safety and efficacy of the WEB device in treating recurrent intracranial aneurysms. METHODS We conducted a comprehensive search across multiple databases, including PubMed, Scopus, Embase, and Web of Science, from inception to June 5, 2023. Eligible studies focused on evaluating WEB device performance and included a minimum of five patients with recurrent intracranial aneurysms. The complete and adequate occlusion rates, neck remnant rates, and periprocedural complication rates were pooled using SATA V.17. RESULTS Our analysis included five studies collectively enrolling 73 participants. Participant ages ranged from 52.9 to 65 years, with 64.4% being female. Aneurysms were wide-necked and predominantly located in the middle cerebral artery, basilar artery, and anterior cerebral artery. Previous treatments encompassed coiling, clipping, and the use of WEB devices. Our study found an overall adequate occlusion rate of 0.80 (95% CI 0.71-0.89), a complete occlusion rate of 0.39 (95% CI 0.28-0.50), and a neck remnant rate of 0.38 (95% CI 0.27-0.48). Periprocedural complications were reported at a rate of 0%, although heterogeneity was observed in this data. Notably, evidence of publication bias was identified in the reporting of periprocedural complication rates. CONCLUSION Our findings suggest that the WEB device is associated with favorable outcomes for treating recurrent wide-neck intracranial aneurysms.
Collapse
Affiliation(s)
- Mohammad Amin Habibi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Farhang Rashidi
- School of Medicine, Tehran University of Medical Sciences, Iran
| | | | - Mohammad Reza Arshadi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Iran
| | - Saba Mehrtabar
- Immunology Research Center, Tabriz University of Medical Sciences, Iran
| | | | - Milad Shafizadeh
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
10
|
Luo X, Yang B, Yuan J, An H, Xie D, Han Q, Zhou S, Yue C, Sang H, Qiu Z, Kong Z, Shi Z. Decompressive craniectomy for patients with malignant infarction of the middle cerebral artery: a pooled analysis of two randomized controlled trials. J Stroke Cerebrovasc Dis 2024:107719. [PMID: 38604351 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107719] [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: 11/09/2023] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Decompressive craniectomy (DC) reduces mortality without increasing the risk of very severe disability among patients with life-threatening massive cerebral infarction. However, its efficacy was demonstrated before the era of endovascular thrombectomy trials. It remains uncertain whether DC improves the prognosis of patients with malignant middle cerebral artery (MCA) infarction receiving endovascular therapy. METHODS We pooled data from two trials (DEVT and RESCUE BT studies in China) and patients with malignant MCA infarction were included to assess outcomes and heterogeneity of DC therapy effect. Patients with herniation were dichotomized into DC and conservative groups according to their treatment strategy. The primary outcome was the rate of mortality at 90 days. Secondary outcomes included disability level at 90 days as measured by the modified Rankin Scale score (mRS) and quality-of-life score. The associations of DC with clinical outcomes were performed using multivariable logistic regression. RESULTS Of 98 patients with herniation, 37 received DC surgery and 61 received conservative treatment. The median (interquartile range) was 70 (62-76) years and 40.8% of the patients were women. The mortality rate at 90 days was 59.5% in the DC group compared with 85.2% in the conservative group (adjusted odds ratio, 0.31 [95% confidence interval (CI), 0.10-0.94]; P=0.04). There were 21.6% of patients in the DC group and 6.6% in the conservative group who had a mRS score of 4 (moderately severe disability); and 10.8% and 4.9%, respectively, had a score of 5 (severe disability). The quality-of-life score was higher in the DC group (0.00 [0.00-0.14] vs 0.00 [0.00-0.00], P=0.004), but DC treatment was not associated with better quality-of-life score in multivariable analyses (adjusted β Coefficient, 0.02 [95% CI, -0.08-0.11]; p=0.75). CONCLUSIONS DC was associated with decreased mortality among patients with malignant MCA infarction who received endovascular therapy. The majority of survivors remained moderately severe disability and required improvement on quality of life. CLINICAL TRIAL REGISTRATION The DEVT trial: http://www.chictr.org. Identifier, ChiCTR-IOR-17013568. The RESCUE BT trial: URL: http://www.chictr.org. Identifier, ChiCTR-INR-17014167.
Collapse
Affiliation(s)
- Xiaojun Luo
- Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, China
| | - Bo Yang
- Department of Neurology, The First Affiliated Hospital of Henan Polytechnic University (Jiaozuo Second People's Hospital), Jiaozuo, China
| | - Junjie Yuan
- Department of Neurology, The 925th Hospital of The People's Liberation Army, Guiyang, China; Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Huijie An
- Department of Pharmacy, General Hospital of Southern Theatre Command, PLA, Guangzhou, China
| | - Dongjing Xie
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Qin Han
- Department of Neurology, The 903rd Hospital of The People's Liberation Army, Hangzhou, China
| | - Simin Zhou
- Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, Wuxi, China
| | - Chengsong Yue
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongfei Sang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhenyu Kong
- Department of Neurology, The First Affiliated Hospital of Henan Polytechnic University (Jiaozuo Second People's Hospital), Jiaozuo, China.
| | - Zhonghua Shi
- Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, 101 North Xinyuan Road, Wuxi, China.
| |
Collapse
|
11
|
Tan Q, Chen Z, Wu H, Wang H, Chen J, Lai K, Zhang F, Kang T, Zheng J. A Systematic Review and Meta-Analysis of Efficacy and Safety of Cilostazol Prescription in Patients With Femoropopliteal Peripheral Artery Disease After Endovascular Therapy. J Endovasc Ther 2024:15266028241241248. [PMID: 38590247 DOI: 10.1177/15266028241241248] [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: 04/10/2024]
Abstract
PURPOSE The purpose of this study is to assess the efficacy and safety of cilostazol prescription in patients with femoropopliteal peripheral artery disease (PAD) after endovascular therapy (EVT). MATERIALS AND METHODS We conducted a systematic review and meta-analysis of all studies reporting the outcomes of cilostazol after femoropopliteal EVT of PAD up to September 2022. Clinical outcomes of interest included primary patency, in-stent restenosis (ISR), vessel re-occlusion, freedom from target lesion revascularization (TLR), repeat revascularization, all-cause mortality, amputation, major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs), and bleeding complication. RESULTS A total of 4 randomized controlled trials (RCTs) and 8 observational studies containing a total of 4898 patients met the inclusion criteria and were included in this systematic review and meta-analysis. We found that the use of cilostazol was associated with higher primary patency after femoropopliteal artery EVT (odds ratio [OR]=1.67, 95% confidence interval [CI]=1.50-1.87, p<0.001, I2=33.2%), a lower risk of ISR (OR=0.43, 95% CI=0.29-0.63, p<0.001, I2=37.6%), repeat revascularization (OR=0.43, 95% CI=0.24-0.76, p<0.005, I2=27.4%), and vessel re-occlusion (OR=0.59, 95% CI=0.38-0.93, p<0.05, I2=0%). There was an increase in freedom from TLR rate (OR=2.19, 95% CI=1.58-3.05, p<0.001, I2=0%), as well as a reduction in the occurrence of MALEs (OR=0.50, 95% CI=0.29-0.85, p<0.05, I2=0%). However, there was no significant difference in amputation, MACEs, all-cause mortality, and major bleeding complications. Subgroup analysis showed that cilostazol treatment in patients with femoropopliteal drug-eluting stents (DES) implantation remained associated with higher primary patency and a lower risk of ISR. CONCLUSIONS After EVT of femoropopliteal artery lesions, additional oral cilostazol enhances primary patency, reduces the occurrences of ISR and vessel re-occlusion, diminishes the risks associated with MALEs, lowers the need for repeat revascularization, and increases freedom from TLR rates. However, it does not impact amputation, MACEs, all-cause mortality, or major bleeding complications. These findings suggest cilostazol as a potentially safe and effective adjunct therapy in patients with femoropopliteal PAD after EVT. CLINICAL IMPACT After undergoing endovascular therapy (EVT) for femoropopliteal artery lesions, the addition of cilostazol to antiplatelet therapy can significantly improve primary patency, reducing the incidence of in-stent restenosis, repeat revascularization, vessel re-occlusion, and major adverse limb events while increasing freedom from target lesion revascularization rate. The simultaneous use of drug-eluting stents in the femoropopliteal artery lesions, combined with cilostazol, potentially results in a synergistic anti-stenotic effect. This therapeutic approach does not appear to be associated with an increased risk of major bleeding events or all-cause mortality. These findings provide additional evidence supporting the treatment of anti-stenosis in patients with femoropopliteal artery lesions after EVT.
Collapse
Affiliation(s)
- Qiang Tan
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhilong Chen
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Huaping Wu
- Department of Cardiovascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Haifei Wang
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jingquan Chen
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Kun Lai
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Fuzhao Zhang
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tengyao Kang
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jianghua Zheng
- Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| |
Collapse
|
12
|
Deng Z, Zhong Y, Zou L, Bi G, Chen J, Dai X, Hu J, Xiong G, Deng L. Endovascular Repair Blunt Thoracic Aortic Injury in Adolescent: A Case Series. J Endovasc Ther 2024:15266028241245907. [PMID: 38590278 DOI: 10.1177/15266028241245907] [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: 04/10/2024]
Abstract
BACKGROUND Blunt traumatic aortic injury (BTAI) is a rare occurrence in adolescents, yet it is associated with a high mortality rate necessitating immediate treatment. Although endovascular repair has become the preferred treatment for such injuries in adults, its effectiveness in adolescents remains uncertain. CASE SUMMARY Blunt traumatic aortic injury typically presents with concomitant injuries to other organs and carries a high perioperative mortality rate with operative repair (OR). In this report, we describe the treatment of 3 clinical cases of BTAI in adolescents using thoracic endovascular aortic repair (TEVAR). These cases contribute pertinent evidence supporting the efficacy of intravascular repair for BTAI. CONCLUSION Operative repair (OR) remains the gold standard for treating BTAI in adolescents. Nevertheless, TEVAR therapy presents a viable alternative for patients with multiple injuries in whom anticoagulation is contraindicated. Further long-term observation is necessary to assess the lasting effects of TEVAR therapy. CLINICAL IMPACT This study has provided insights into endovascular repair for adolescent BTAT, offering clinicians significant reference material for choosing treatment strategies for adolescent BTAT. The study aims to demonstrate the safety and effectiveness of endovascular repair treatments in a series of clinical cases involving adolescent BTAI.
Collapse
Affiliation(s)
- Zhihe Deng
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Yaoyang Zhong
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Liping Zou
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Guoshan Bi
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Jie Chen
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Xianpeng Dai
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Jun Hu
- Department of Cardiac Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Guozuo Xiong
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Liming Deng
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| |
Collapse
|
13
|
Wang M, Li J, Zhang L, Li N, Li X, Wang P. The efficacy and safety of continuous intravenous tirofiban for acute ischemic stroke patients treated by endovascular therapy: a meta-analysis. Front Neurol 2024; 15:1286079. [PMID: 38633532 PMCID: PMC11021731 DOI: 10.3389/fneur.2024.1286079] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/26/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Tirofiban is a non-peptide selective glycoprotein IIb/IIIa receptor inhibitor with a short half-life. The research assesses the efficacy and safety of continuous intravenous tirofiban in patients with acute ischemic stroke (AIS) undergoing endovascular therapy (ET). Methods A systematic search of Pubmed, Embase, Web of Science, and Cochrane Library databases is conducted from inception until January 26, 2024. Eligible studies are included based on predefined selection criteria. Efficacy outcomes (favorable functional outcome and excellent functional outcome) and safety outcomes (symptomatic intracranial hemorrhage [sICH], any intracranial hemorrhage [ICH], and 90-day mortality) are calculated using odds ratios (OR) and 95% confidence intervals (CI). Results A total of 4,329 patients from 15 studies are included in the analysis. The results indicate a significant trend toward favorable functional outcomes in the tirofiban group (OR, 1.24; 95% CI, 1.09-1.42; p = 0.001). In terms of safety outcomes, tirofiban does not increase the risk of sICH (OR, 0.90; 95% CI, 0.71-1.13; p = 0.35) or any ICH (OR, 0.97; 95% CI, 0.70-1.34; p = 0.85), but it significantly decreases 90-day mortality (OR, 0.75; 95% CI, 0.64-0.88; p = 0.0006). A subgroup analysis suggests that continuous intravenous tirofiban demonstrates better efficacy (OR, 1.24; 95% CI, 1.09-1.42; p = 0.001) for patients with AIS undergoing rescue ET with even better results when used in combination with intra-arterial and intravenous administration (OR, 1.25; 95% CI, 1.07-1.451; p = 0.005). Conclusion Continuous intravenous tirofiban is effective and safe for patients with AIS undergoing rescue ET, particularly when combined with intra-arterial tirofiban. Systematic review registration PROSPERO, identifier CRD42023385695.
Collapse
Affiliation(s)
- Mengmeng Wang
- Clinical College, Shandong Second Medical University, Weifang, China
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, China
| | - Jing Li
- Clinical College, Shandong Second Medical University, Weifang, China
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, China
| | - Lingyu Zhang
- Clinical College, Shandong Second Medical University, Weifang, China
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, China
| | - Nana Li
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, China
| | - Xuemei Li
- Department of Neurology, School of Clinical Medicine, Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
| | - Pengfei Wang
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, China
| |
Collapse
|
14
|
Palena LM, Isernia G, Parlani G, Veroux P, Ficarelli I, Frascheri A, Pischedda A, Patrone L, Dionisi CP, Cianni R, Airoldi F, Landino P, Kleiban A, Filauri P, Passalacqua G, Antignani PL, De Rose E, Valls A, Biondi-Zoccai G, Manzi M. A multicenter prospective observational study appraising the effectiveness of the Supera stent after subintimal recanalization of femoro-popliteal artery occlusion: The SUPERSUB II study. Catheter Cardiovasc Interv 2024. [PMID: 38566517 DOI: 10.1002/ccd.31028] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/04/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Complex femoropopliteal artery disease represents a challenge. The Supera stent holds the promise of improving the results of endovascular therapy for complex femoropopliteal disease. AIMS We aimed at appraising the early and long-term effectiveness of the Supera stent after successful subintimal angioplasty (SuperSUB strategy) for complex femoropopliteal lesions. METHODS We conducted a multicenter, prospective, single-arm observational study including consecutive patients at participating centers in whom Supera was implanted after successful subintimal angioplasty for complex femoropopliteal lesions. RESULTS A total of 92 patients were included Femoropopliteal arteries were the most common target, and lesion length was 261 ± 102 mm. Most procedures were technically demanding, with antegrade femoral access in 35 (38%) and retrograde distal access in 55 (60%). Supera stent length was 281 ± 111 mm, with 4, 5, and 6 mm devices being most commonly used: 32 (35%), 35 (38%), and 23 (25%), respectively. Technical success was achieved in 100% of subjects, as was clinical success (per subject), whereas procedural success (per subject) was obtained in 98%. At 24 months, freedom from clinically driven target lesion revascularization was 93%, whereas primary patency was 87%. When compared with a similar historical cohort, Supera stent use appeared to be associated with a reduction in resources. CONCLUSION Use of Supera stent after successful subintimal recanalization of complex lower limb arterial lesions yields favorable procedural results, which are maintained over follow-up, and are associated also with a favorable resource use profile.
Collapse
Affiliation(s)
- Luis Mariano Palena
- Interventional Radiology Unit, Endovascular Interventions & Research, Foot & Ankle Clinic, Policlinico, Abano Terme, Italy
- Endovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giacomo Isernia
- Vascular Surgery Unit, A.O. Hospital Santa Maria della Misericordia, Perugia, Italy
| | - Gianbattista Parlani
- Vascular Surgery Unit, A.O. Hospital Santa Maria della Misericordia, Perugia, Italy
| | | | | | - Arian Frascheri
- Hemodynamics O.U., Hospital Sant'Antonio Abate, Erice, Italy
| | - Aldo Pischedda
- Interventional Radiology Unit, A.O.U. Sassari, Sassari, Italy
| | - Lorenzo Patrone
- Vascular and Interventional Radiology Unit, London North-West University NHS Trust-London, London, UK
| | | | - Roberto Cianni
- Interventional Radiology Unit, A.O. San Camillo Forlanini, Rome, Italy
| | - Flavio Airoldi
- Interventional Cadiovascolar Unit, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
| | - Pietro Landino
- Interventional Cardiology Unit, Casa di Cura Maddaloni, Maddaloni, Italy
| | - Andrès Kleiban
- Endovascular Areas, Instituto Medico Ceniclar, Rosario, Argentina
| | - Pietro Filauri
- Interventional Radiology Unit, Avezzano Hospital, Avezzano, Italy
| | | | | | | | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Cardiology Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Marco Manzi
- Interventional Radiology Unit, Endovascular Interventions & Research, Foot & Ankle Clinic, Policlinico, Abano Terme, Italy
| |
Collapse
|
15
|
Qu S, Wen R, Yan M, Qin J, Li J. Early endovascular approaches for treating acute mesenteric arterial occlusive disease in hemodialysis patients. Hemodial Int 2024; 28:241-246. [PMID: 38385856 DOI: 10.1111/hdi.13139] [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: 09/13/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Among hemodialysis patients, acute superior mesenteric artery (SMA) thrombosis a condition with a high mortality rate. Very few larger case series have been reported. METHOD We reviewed eight hemodialysis patients with diabetes mellitus and SMA thrombosis managed with endovascular therapy in our institution. Demographic, clinical, and radiological data were described. The patency of the SMA was assessed by computed tomography angiography (CTA) at one month after the endovascular procedure. At the last visit, clinical symptoms and check of mortality were recorded. RESULTS Multidetector CTA scan revealed severe stenosis of SMA in 6 patients and SMA occlusion in the other two patients. The severe stenosis of SMA were verified by angiography. Balloon angioplasty without stenting was performed to obtain satisfactory patency of SMA. Seven of eight patients achieved resolution of abdominal pain after the endovascular procedure. One patient died of suspected intestinal necrosis after 6 days of balloon angioplasty. All seven surviving patients did not experience a recurrence of symptoms with a median follow-up of 2 years. No significant residual stenotic or occlusive lesions were noted in follow-up CTA at one month after the endovascular procedure. CONCLUSION SMA thrombosis should be systematically suspected in hemodialysis patients experiencing abdominal pain. Prompt diagnosis of SMA thrombosis as soon as possible and early endovascular therapy are required to obtain a favorable prognosis in the hemodialysis patient with SMA thrombosis.
Collapse
Affiliation(s)
- Siyuan Qu
- Department of Rheumatology and Immunology, University of South China Affiliated Changsha Central Hospital, Hunan Province, China
| | - Rui Wen
- Department of Rheumatology and Immunology, University of South China Affiliated Changsha Central Hospital, Hunan Province, China
| | - Mingming Yan
- Department of Orthopaedic Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jiao Qin
- Department of Rheumatology and Immunology, University of South China Affiliated Changsha Central Hospital, Hunan Province, China
| | - Jiali Li
- Department of Rheumatology and Immunology, University of South China Affiliated Changsha Central Hospital, Hunan Province, China
| |
Collapse
|
16
|
Pimiento Figueroa J, Escobar Howard M, Escudero Pineda P, Orozco Arteaga S. Nasopharyngeal Migration of Coils Following Embolization of a Traumatic Pseudoaneurysm of the Internal Carotid Artery: A Case Report. Cureus 2024; 16:e58121. [PMID: 38738049 PMCID: PMC11088871 DOI: 10.7759/cureus.58121] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Post-traumatic pseudoaneurysms of the internal carotid are a rare but potentially fatal cause of epistaxis; they are associated with fractures of the base of the skull with involvement of the carotid canal. Endovascular management is the preferred therapeutic strategy, with optimal long-term results and low complication rates. Complications may include thromboembolic events, infarction of perforating arteries, and rupture of the pseudoaneurysm. We present a case of a 28-year-old male with a post-traumatic pseudoaneurysm of the internal carotid who was managed with endovascular therapy. A late complication was the extrusion of the embolization material into the nasal cavity and nasopharynx, which was safely and effectively treated through endovascular and endoscopic approaches.
Collapse
Affiliation(s)
| | | | - Pablo Escudero Pineda
- Interventional Neuroradiology, Servicios de Salud San Vicente Fundación, Medellín, COL
| | - Sebastian Orozco Arteaga
- Otolaryngology, Head and Neck Surgery, Hospital Universitario de San Vicente Fundación, Medellín, COL
- Otolaryngology, Head and Neck Surgery, Universidad de Antioquia, Medellín, COL
| |
Collapse
|
17
|
Iida O, Takahara M, Soga Y, Yamaoka T, Fujihara M, Kawasaki D, Ichihashi S, Sakata Y, Mano T, Higuchi Y. Three-year clinical course after fluoropolymer-based drug-eluting stent implantation for femoropopliteal lesions. Vasc Med 2024; 29:182-188. [PMID: 38457137 DOI: 10.1177/1358863x241228261] [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: 03/09/2024]
Abstract
BACKGROUND Although the 1-year clinical outcomes of fluoropolymer-based drug-eluting stents (FP-DES) were favorable for the treatment of real-world femoropopliteal lesions in symptomatic peripheral artery disease (PAD), their performance beyond 1 year remained unknown. The current study determined the 3-year clinical course of FP-DES implantation for real-world femoropopliteal lesions. METHODS This multicenter, prospective, observational study evaluated 1204 limbs (chronic limb-threatening ischemia, 34.8%; mean lesion length, 18.6 ± 9.9 cm, chronic total occlusion: 53.2%) of 1097 patients with PAD (age, 75 ± 9 years; diabetes mellitus, 60.8%) undergoing FP-DES implantation for femoropopliteal lesions. The primary outcome measure was 3-year restenosis. The secondary outcome measures included 3-year occlusive restenosis, stent thrombosis, target lesion revascularization (TLR), and aneurysmal degeneration. RESULTS The 3-year cumulative occurrence of restenosis was 27.3%, whereas that of occlusive restenosis, stent thrombosis, and TLR was 16.1%, 7.3%, and 19.6%, respectively. The annual occurrence of restenosis decreased by 12.0%, 9.5%, and 5.8% in the first, second, and third year, respectively (p < 0.001). Similarly, the rates of occlusive restenosis and stent thrombosis decreased (p < 0.001 and p = 0.007, respectively), whereas the rate of TLR remained unchanged for 3 years (p = 0.15). The incidence of aneurysmal degeneration at 3 years (15.7%) did not significantly differ from that at 1 and 2 years (p = 0.69 and 0.20, respectively). CONCLUSIONS This study highlights the favorable long-term clinical course of FP-DES in real-world practice, emphasizing the importance of monitoring for occlusive restenosis and stent thrombosis while considering the potential onset of aneurysmal degeneration.
Collapse
Affiliation(s)
- Osamu Iida
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Daizo Kawasaki
- Department of Cardiology, Morinomiya Hospital, Osaka, Japan
| | - Shigeo Ichihashi
- Division of Radiology, Nara Medical University, Kashihara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | | |
Collapse
|
18
|
Nakao S, Iida O, Takahara M, Okamoto S, Ishihara T, Tsujimura T, Hata Y, Toyoshima T, Higashino N, Mano T. Incidence of Acute Thrombotic Occlusion and Its Predictors After Contemporary Femoropopliteal Endovascular Therapy in Patients With Peripheral Artery Disease. J Endovasc Ther 2024; 31:263-273. [PMID: 36052430 DOI: 10.1177/15266028221120519] [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: 12/24/2022]
Abstract
PURPOSE This study investigated the incidence of acute thrombotic occlusion (ATO) and its predictors after contemporary femoropopliteal (FP) endovascular therapy (EVT) for peripheral artery disease. MATERIALS AND METHODS We retrospectively examined 763 limbs (chronic limb-threatening ischemia [CLTI]: 44%, involving popliteal lesion: 44%) in 644 patients (mean age: 75±9 years, male: 71%, hemodialysis: 34%) who successfully underwent EVT with contemporary FP devices (drug-coated stent: n=220, stent graft: n=158, drug-eluting stent: n=150, drug-coated balloon [DCB]: n=235) from June 2012 to July 2020. The outcome measure was ATO defined as acute onset of claudication and/or signs of CLTI in combination with angiographic evidence of occlusive thrombus formation within the treated segment. Cox proportional hazards regression models were used to identify baseline characteristics associated with the incidence of ATO after EVT treated with scaffold. To determine the impact of ATO occurrence and creatine phosphokinase (CPK) elevation on the subsequent composite outcome of mortality or major amputation, we developed the Cox model in which the trichotomous variable (free from ATO, ATO without CPK elevation, and ATO with CPK elevation) was a time-dependent covariate. RESULTS The 24-month incidence of ATO in the overall population was 4.3%±0.8% (DCB: 1.0%±0.7% vs scaffold: 5.8%±1.1%, p<0.01). Hemodialysis (hazard ratio [HR]: 2.63, p=0.02) and involving popliteal lesion (HR: 8.22, p<0.01) were independently associated with an increased risk of ATO in patients treated with scaffold. Both ATO without CPK elevation and ATO with CPK elevation were significantly associated with a composite outcome of mortality or major amputation comparing free from ATO, with an HR of 2.39 and 9.87, respectively (p=0.02 and p<0.01). CONCLUSION We found a substantial incidence of ATO after contemporary FP-EVT, particularly with scaffold. Hemodialysis and involving popliteal lesion were significantly associated with ATO risk in patients treated with scaffold. The occurrence of ATO, particularly with CPK elevation, was associated with an increased risk of a subsequent composite outcome of mortality or major amputation. The scaffold was safely used in patients without those risk factors of ATO, but a non-scaffolding strategy should be considered for patients with more risk factors. CLINICAL IMPACT The scaffold was safely used in patients without hemodialysis and involving popliteal lesion, but a non-scaffolding strategy should be considered for patients with those risk factors. The occurrence of ATO, particulary with CPK elevation, was of high risk of mortality or amputation.
Collapse
Affiliation(s)
- Sho Nakao
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | | | | | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Taku Toyoshima
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Naoko Higashino
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| |
Collapse
|
19
|
Lungu CN, Creteanu A, Mehedinti MC. Endovascular Drug Delivery. Life (Basel) 2024; 14:451. [PMID: 38672722 PMCID: PMC11051410 DOI: 10.3390/life14040451] [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: 02/06/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Drug-eluting stents (DES) and balloons revolutionize atherosclerosis treatment by targeting hyperplastic tissue responses through effective local drug delivery strategies. This review examines approved and emerging endovascular devices, discussing drug release mechanisms and their impacts on arterial drug distribution. It emphasizes the crucial role of drug delivery in modern cardiovascular care and highlights how device technologies influence vascular behavior based on lesion morphology. The future holds promise for lesion-specific treatments, particularly in the superficial femoral artery, with recent CE-marked devices showing encouraging results. Exciting strategies and new patents focus on local drug delivery to prevent restenosis, shaping the future of interventional outcomes. In summary, as we navigate the ever-evolving landscape of cardiovascular intervention, it becomes increasingly evident that the future lies in tailoring treatments to the specific characteristics of each lesion. By leveraging cutting-edge technologies and harnessing the potential of localized drug delivery, we stand poised to usher in a new era of precision medicine in vascular intervention.
Collapse
Affiliation(s)
- Claudiu N. Lungu
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
| | - Andreea Creteanu
- Department of Pharmaceutical Technology, University of Medicine and Pharmacy Grigore T Popa, 700115 Iași, Romania
| | - Mihaela C. Mehedinti
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
| |
Collapse
|
20
|
Iida O, Ohki T, Soga Y, Suematsu N, Nakama T, Yamaoka T, Tobita K, Ichihashi S. Five-year outcomes of the GORE VIABAHN Endoprosthesis for the treatment of complex femoropopliteal lesions from a Japanese postmarket surveillance study. Vasc Med 2024:1358863X241233528. [PMID: 38544413 DOI: 10.1177/1358863x241233528] [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: 04/05/2024]
Abstract
Introduction: The safety and effectiveness of the GORE VIABAHN Endoprosthesis for treatment of symptomatic patients with peripheral artery disease (PAD) and complex femoropopliteal (FP) lesions was assessed in a real-world Japanese practice setting. Methods: A prospective, multicenter, postmarket surveillance study was conducted from 2016 to 2017 at 64 sites in Japan. Symptomatic patients with PAD and FP lesions ⩾ 10 cm and reference vessel diameters ranging from 4.0 to 7.5 mm were eligible for enrollment. Outcome measures evaluated at 5 years were primary patency (PP), primary-assisted patency (PAP), secondary patency (SP), freedom from target lesion revascularization (fTLR), occurrence of device- or procedure-related serious adverse events (SAEs), and stent fractures. Results: A total of 321 patients were enrolled and were a mean age of 73.9 ± 8.7 years; 77.3% were men and 26.5% had chronic limb-threatening ischemia (CLTI). The mean lesion length was 23.6 ± 6.6 cm and the frequency with TASC II C/D lesions and chronic total occlusions was 86.6% and 70.4%, respectively. The Kaplan-Meier estimated PP, PAP, SP, and fTLR at 5 years was 62.4%, 74.1%, 82.3%, and 75.9%, respectively. The mean ankle-brachial index was 0.92 ± 0.15 and the mean improvement in Rutherford class was 2.3 ± 1.4, which was maintained through 5 years. The rate of cumulative device- or procedure-related SAEs through 5 years was 19.9% with only 9.3% of those occurring after the first year. No stent fractures were observed through 5 years by x-ray evaluation. Conclusion: The 5-year safety and efficacy outcomes of the endoprosthesis were clinically acceptable for treating complex FP lesions in a real-world cohort of Japanese patients with PAD. (ClinicalTrials.gov Identifier: NCT04706273).
Collapse
Affiliation(s)
- Osamu Iida
- Osaka Police Hospital Cardiovascular Division, Osaka, Japan
| | - Takao Ohki
- Department of Surgery, Jikei University Hospital, Tokyo, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Nobuhiro Suematsu
- Department of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Center, Chiba, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Kazuki Tobita
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shigeo Ichihashi
- Department of Radiology and IVR Center, Nara Medical University, Nara, Japan
| |
Collapse
|
21
|
Kikuchi S, Ohira S, Doita T, Kamada K, Kuriyama N, Tamaru Y, Tatsukawa T, Yoshida Y, Uchida D, Azuma N. Super-Elderly Case of Acute Lower Limb Ischemia Treated with Indigo Aspiration System in Japan. Ann Vasc Dis 2024; 17:63-68. [PMID: 38628935 PMCID: PMC11018105 DOI: 10.3400/avd.cr.23-00095] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/18/2023] [Indexed: 04/19/2024] Open
Abstract
The Indigo Aspiration System (Penumbra Ltd., Alameda, CA, USA), a catheter-based device intended for the endovascular removal of clots from peripheral arteries and veins, was launched in Japan to treat acute limb ischemia after the cessation of urokinase sales. The initial application of this system in Japan was on a 96-year-old male patient. He was diagnosed with acute lower limb ischemia, which was caused by an embolism from a left common iliac artery aneurysm. The treatment significantly enhanced the perfusion to his left foot. This case report elaborates on the patient's treatment experience and discusses the indications for using the device.
Collapse
Affiliation(s)
- Shinsuke Kikuchi
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Seima Ohira
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Tsutomu Doita
- Department of Cardiovascular Surgery, Osaka University, Suita, Osaka, Japan
| | - Keisuke Kamada
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Naoya Kuriyama
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yuya Tamaru
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takamitsu Tatsukawa
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yuri Yoshida
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Daiki Uchida
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| |
Collapse
|
22
|
Schöfthaler C, Troisi N, Torsello G, Jehn A, Lichtenberg M, Karcher JC, Stavroulakis K, D'Oria M, Saratzis A, Zayed H, Andrassy M, Korosoglou G. Safety and effectiveness of the phoenix atherectomy device for endovascular treatment of common femoral and popliteal arteries: Results of the EN-MOBILE trial. Vasc Med 2024:1358863X241231943. [PMID: 38493349 DOI: 10.1177/1358863x241231943] [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: 03/18/2024]
Abstract
Background: This study aimed to assess the peri- and postprocedural outcomes of atherectomy-assisted endovascular treatment of the common femoral (CFA) and popliteal arteries. Methods: Phoenix atherectomy was used for the treatment of 73 and 53 de novo CFA and popliteal artery lesions, respectively, in 122 consecutive patients. Safety endpoints encompassed perforation and peripheral embolization. Postprocedural endpoints included freedom from clinically driven target lesion revascularization (CD-TLR) and clinical success (an improvement of ⩾ 2 Rutherford category [RC]). In addition, 531 patients treated for popliteal artery stenosis or occlusion without atherectomy were used as a comparator group. Results: Procedural success (residual stenosis < 30% after treatment) was 99.2%. The need for bail-out stenting was 2 (2.7%) and 3 (5.7%) in CFA and popliteal artery lesions, respectively. Only one (1.4%) embolization occurred in the CFA, which was treated by catheter aspiration. No perforations occurred. After 1.50 (IQR = 1.17-2.20) years, CD-TLR occurred in seven (9.2%) and six (14.6%) patients with CFA and popliteal artery lesions, respectively, whereas clinical success was achieved in 62 (91.2%) and 31 (75.6%), respectively. Patients treated with atherectomy and DCB in the popliteal artery after matching for baseline RC, lesion calcification, length, and the presence of chronic total occlusion, exhibited higher freedom from CD-TLR compared to the nondebulking group (HR = 3.1; 95% CI = 1.1-8.5, p = 0.03). Conclusion: Atherectomy can be used safely and is associated with low rates of bail-out stenting in CFA and popliteal arteries. CD-TLR and clinical success rates are clinically acceptable. In addition, for the popliteal artery, atherectomy combined with DCB demonstrates lower CD-TLR rates compared to a DCB alone strategy. (German Clinical Trials Register: DRKS00016708).
Collapse
Affiliation(s)
- Christoph Schöfthaler
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Nicola Troisi
- Department of Translational Research and New Technologies in Medicine and Surgery, Vascular Surgery Unit, University of Pisa, Pisa, Italy
| | - Giovanni Torsello
- University Hospital Münster, Institute for Vascular Research, Franziskus Hospital, Münster, Germany
| | - Amila Jehn
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Jan C Karcher
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Mario D'Oria
- Cardiovascular Department, Division of Vascular and Endovascular Surgery, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Hany Zayed
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Martin Andrassy
- Department of Cardiology and Vascular Medicine, Fürst-Stirum Klinikum Bruchsal, Bruchsal, Germany
| | - Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| |
Collapse
|
23
|
Hu C, Chen L, Wu M, Ye Q, Zou J, Zhao B, Li X, Wu H. Efficacy and Safety of Covered Stents Versus Bare-Metal Stents for Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis. J Endovasc Ther 2024:15266028241237387. [PMID: 38491926 DOI: 10.1177/15266028241237387] [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: 03/18/2024]
Abstract
PURPOSE This study aimed to assess the efficacy and safety outcome of covered stents (CSs), as compared with bare-metal stents (BMSs), for the treatment of patients with aortoiliac occlusive disease (AIOD). MATERIALS AND METHODS A systematic literature search was conducted in PubMed, Embase, and Cochrane Library up to August 2023 to identify all studies comparing efficacy and safety outcomes of CSs versus BMSs for treating AIOD. Our outcome was primary patency, secondary patency, technical success, ankle-brachial index (ABI) variation, target lesion revascularization (TLR), limb salvage, complications, and long-term survival. Dichotomous outcomes were pooled as relative risks (RR) or hazard ratio with the 95% confidence interval (CI). Continuous outcomes were pooled as weighted mean differences and 95% CI. Model selection was based on the heterogeneity of the included studies. RESULTS There were 10 studies (2 randomized controlled trials, 8 retrospective cohort studies), comprising 1676 sample size. Compared with BMSs, CSs use was associated with better primary patency of patients with a Trans-Atlantic Inter-Society Consensus II (TASC) D lesion (RR, 1.15, 95% CI, 1.04 to 1.27, p=0.007), TLR (RR, 0.39, 95% CI, 0.27 to 0.56, p<0.001), technical success (RR, 1.01, 95% CI, 1.00 to 1.02, p=0.010), and long-term survival (RR, 1.06, 95% CI, 1.01 to 1.11, p=0.020). There is no difference between CSs and BMSs regarding primary patency of all patients, secondary patency, variation in ABI, limb salvage, and complications. CONCLUSIONS Compared with BMSs, CSs used in AIOD was associated with more favorable primary patency in patients with TASC D lesions, TLR, technical success rates, and patient long-term survival. These results provide evidence of the advantages of using CSs for AIOD treatment. Future studies focusing on long-term variations in ABI, primary patency of different degrees of calcification, vascular segments, and TASC classification are warranted. CLINICAL IMPACT Although several studies evaluated the clinical efficacy of CS in the context of AIOD treatment, the significance and consistency of these findings were not determined to date. We found that CS was used in AIOD associated with better technical success rate, long-term patient survival, lower target lesion revascularization, and higher primary patency of patients with a Trans-Atlantic Inter-Society Consensus II D lesion when compared with BMSs. Our study provides evidence supporting the superiority of CSs over BMSs in the treatment of AIOD, and furnishing clinicians with guidance for treatment decisions.
Collapse
Affiliation(s)
- Chenming Hu
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Lang Chen
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Min Wu
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Qianling Ye
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Jun Zou
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Bin Zhao
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Xiang Li
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Huaping Wu
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| |
Collapse
|
24
|
Fujioka K, Nishida Y, Eguchi Y, Fujita T, Uchiyama K, Fujimoto M. Endovascular Therapy for Vascular Graft Infection After Multiple Bypass Surgeries for Aorto-Iliac Occlusive Disease. Vasc Endovascular Surg 2024:15385744241240240. [PMID: 38491914 DOI: 10.1177/15385744241240240] [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: 03/18/2024]
Abstract
BACKGROUND Vascular graft infection is a very complex disease. Although complete excision of the infected grafts with extra-anatomic bypass or in situ reconstruction is a general treatment strategy, some concerns including reinfection in the new graft remain. CASE REPORT An 88 year-old man presented to the hospital with abdominal swelling and bleeding. The patient had undergone revascularization for aorto-iliac occlusive disease twice in the past. The first procedure had been performed 15 years previously, with right ilio-femoral bypass grafting for right iliac artery occlusion and stent implantation for left iliac artery stenosis. The second procedure had been performed 10 years previously, with aorta-to-left femoral and left-to-right femoro-femoral bypass grafting because the terminal aorta, the first ilio-femoral bypass graft, and the stent of the left iliac artery had been occluded. The patient was diagnosed with vascular graft infection, and endovascular therapy was selected as the revascularization method prior to graft excision. It was successfully performed using various devices and techniques, followed by graft excision without critical limb ischemia. CONCLUSION This case demonstrates that endovascular therapy prior to graft excision can be an alternative revascularization method for vascular graft infection after bypass surgery for aorto-iliac occlusive disease.
Collapse
Affiliation(s)
- Kensuke Fujioka
- Department of Cardiovascular Medicine, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Yuji Nishida
- Department of Thoracic and Cardiovascular Surgery, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Yuya Eguchi
- Department of Cardiovascular Medicine, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Takashi Fujita
- Department of Cardiovascular Medicine, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Katsuharu Uchiyama
- Department of Cardiovascular Medicine, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Manabu Fujimoto
- Department of Cardiovascular Medicine, Kouseiren Takaoka Hospital, Takaoka, Japan
| |
Collapse
|
25
|
Tsujimura T, Iida O, Takahara M, Tobita K, Kawasaki D, Fujihara M, Sasaki S, Yokoi H, Suzuki K, Mano T. Impact of Platelet Reactivity on 1-Year Clinical Outcomes After Endovascular Therapy for Femoropopliteal Lesions. Am J Cardiol 2024; 215:58-61. [PMID: 38266798 DOI: 10.1016/j.amjcard.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/20/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Affiliation(s)
| | - Osamu Iida
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Daizo Kawasaki
- Department of Cardiology, Morinomiya Hospital, Osaka, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Sinya Sasaki
- Department of Cardiology, Saka General Hospital, Shiogama, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Kenji Suzuki
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| |
Collapse
|
26
|
Wang M, Guo C, Yang J, Li J, Hu J, Peng Z, Guo M, Zhang L, Li F, Yang Q, Zi W, Wang P. The effectiveness and safety of human urinary kallidinogenase in acute ischemic stroke patients undergoing endovascular therapy. J Cereb Blood Flow Metab 2024:271678X241238033. [PMID: 38459953 DOI: 10.1177/0271678x241238033] [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: 03/11/2024]
Abstract
The effectiveness and safety of human urinary kallidinogenase (HUK) in acute ischemic stroke (AIS) patients undergoing endovascular therapy (EVT) due to large vessel occlusion (LVO) was unclear. A pooled analysis was performed using individual data from the DEVT and RESCUE BT trials. Patients were divided into two groups based on HUK treatment. The primary outcome was the 90-day modified Rankin Scale (mRS) score. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH) within 48 hours. A total of 1174 patients were included in the study. Of these, 150 (12.8%) patients received HUK. The adjusted common odds ratio (OR) of the mRS score was 1.458 (95% confidence interval [CI] = 1.072-1.983; p = 0.016) favoring HUK. The incidence of sICH (2.0% vs. 8.6%; adjusted OR: 0.198; 95% CI: 0.061-0.638; p = 0.007) and mortality (11.3% vs.18.5%; adjusted OR: 0.496; 95% CI: 0.286-0.862; p = 0.013) was lower in HUK group than non-HUK group. This association was consistent with propensity score-matching and the inverse probability of treatment weighting analysis. In conclusion, HUK was safe and associated with a preferable prognosis in AIS patients due to LVO in the anterior circulation.
Collapse
Affiliation(s)
- Mengmeng Wang
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Shandong Province, China
- Clinical College, Weifang Medical University, Weifang, China
| | - Changwei Guo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jing Li
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Shandong Province, China
- Clinical College, Weifang Medical University, Weifang, China
| | - Jinrong Hu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhouzhou Peng
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Meng Guo
- The Thirteenth People's Hospital of Chongqing, Chongqing, China
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingyu Zhang
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Shandong Province, China
- Clinical College, Weifang Medical University, Weifang, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Pengfei Wang
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Shandong Province, China
| |
Collapse
|
27
|
Yoon JT, Lee KM, Ryu J, Park JI. Rapidly growing distal choroidal artery aneurysm re-rupture following revascularization for hemorrhagic Moyamoya disease: A case report. Clin Case Rep 2024; 12:e8605. [PMID: 38455861 PMCID: PMC10918708 DOI: 10.1002/ccr3.8605] [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: 08/26/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
Intracranial hemorrhage is the leading cause of neurological deficits and poor prognosis in adult patients with Moyamoya disease (MMD). Intracranial hemorrhage is occasionally accompanied by MMD-associated aneurysm and requires additional treatment. To date, direct or indirect bypass surgery or endovascular treatment, such as coil embolization, has been adopted and has achieved successful outcomes. The rapid growth of MMD-associated aneurysms and rebleeding after direct bypass surgery via superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis has rarely been reported. We report a case of a rapidly growing fragile arterial pseudoaneurysm in a patient with MMD. A 45-year-old female was admitted with a headache and decreased mental status. Radiological evaluation, including distal subtraction angiography, revealed intraventricular hemorrhage with a left posterior choroidal artery pseudoaneurysm. Within 4 days after revascularization surgery via STA-MCA direct bypass, the size of the pseudoaneurysm rapidly increased and rebleeding occurred, requiring coil embolization. After endovascular therapy and a second STA-MCA bypass surgery, the patient recovered well and was discharged 8 days later. Follow-up radiological imaging revealed an obliterated pseudoaneurysm without rebleeding or complications. In this case, the rapid growth of an MMD-associated pseudoaneurysm was observed after revascularization surgery because of temporary hemodynamic instability. This report raises questions regarding the causes and management of unstable postbypass hemodynamics.
Collapse
Affiliation(s)
- Jeong Taek Yoon
- Department of Medicine, Graduate SchoolKyung Hee UniversitySeoulKorea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University HospitalKyung Hee University College of MedicineSeoulKorea
| | - Jiwook Ryu
- Department of Neurosurgery, Kyung Hee University HospitalKyung Hee University College of MedicineSeoulKorea
| | - Ju In Park
- Department of Neurosurgery, Kyung Hee University HospitalKyung Hee University College of MedicineSeoulKorea
| |
Collapse
|
28
|
Wang K, Wang Y, Shi W, Shen K, Tao K, Ling R, Huang Y, Fu X, Hu D. Diagnosis and treatment of diabetic foot ulcer complicated with lower extremity vasculopathy: Consensus recommendation from the Chinese Medical Association (CMA), Chinese Medical Doctor Association (CMDA). Diabetes Metab Res Rev 2024; 40:e3776. [PMID: 38402455 DOI: 10.1002/dmrr.3776] [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: 01/04/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 02/26/2024]
Abstract
Diabetic foot ulcer complicated with lower extremity vasculopathy is highly prevalent, slow healing and have a poor prognosis. The final progression leads to amputation, or may even be life-threatening, seriously affecting patients' quality of life. The treatment of lower extremity vasculopathy is the focus of clinical practice and is vital to improving the healing process of diabetic foot ulcers. Recently, a number of clinical trials on diabetic foot ulcers with lower extremity vasculopathy have been reported. A joint group of Chinese Medical Association (CMA) and Chinese Medical Doctor Association (CMDA) expert representatives reviewed and reached a consensus on the guidelines for the clinical diagnosis and treatment of this kind of disease. These guidelines are based on evidence from the literature and cover the pathogenesis of diabetic foot ulcers complicated with lower extremity vasculopathy and the application of new treatment approaches. These guidelines have been put forward to guide practitioners on the best approaches for screening, diagnosing and treating diabetic foot ulcers with lower extremity vasculopathy, with the aim of providing optimal, evidence-based management for medical personnel working with diabetic foot wound repair and treatment.
Collapse
Affiliation(s)
- Kejia Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yunchuan Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Wenlong Shi
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Kuo Shen
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Ke Tao
- Department of Wound Repair, Wound Repair and Regenerative Medicine Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yuesheng Huang
- Department of Wound Repair, Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen, China
| | - Xiaobing Fu
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department and 4th Medical Center, PLA General Hospital and PLA Medical College, Beijing, China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| |
Collapse
|
29
|
Alexander AY, Patel NP, Cloft HJ, Lanzino G, Brinjikji W. Clinical and radiological features of parasagittal dural arteriovenous fistulas: a report of 8 cases from a single institution. Neurosurg Focus 2024; 56:E16. [PMID: 38427987 DOI: 10.3171/2023.12.focus23792] [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: 11/01/2023] [Accepted: 12/27/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Dural arteriovenous fistulas (dAVFs) of the superior sagittal sinus (SSS) are uncommon and represent 5%-12% of all intracranial dAVFs. SSS dAVFs can be divided into two main subtypes. The first type involves direct arterialization of the SSS, whereas the second type consists of a parasagittal arteriovenous shunt draining into a cortical vein directly lateral to the SSS and has retrograde cortical venous drainage with only secondary involvement of the SSS. Descriptions of the latter type of SSS dAVF are limited. As such, the authors present a consecutive case series of parasagittal SSS dAVFs from their institution. They detail clinical presentation, treatment strategies, and clinical and radiographic outcomes. METHODS The authors retrospectively reviewed a prospectively collected database of dAVFs that were treated between 2017 and 2023. All dAVFs characterized by an arterialized parasagittal vein directly lateral to the SSS were included in this study. Baseline demographic, clinical, radiological, treatment, and outcome-specific variables of interest were abstracted. RESULTS One hundred fifty-four dAVFs were seen at the authors' institution over the 6-year period of interest. Eight (5.2%) were parasagittal dAVFs. At initial diagnostic imaging, 7 were Cognard grade III and 1 was grade IV. All patients initially underwent embolization of their dAVF. Three patients did not have complete obliteration of their dAVF after the first embolization. One patient underwent further treatment with repeat embolization, and 1 underwent microsurgical disconnection-both resulted in complete occlusion of the dAVF. Seven dAVFs were obliterated at final follow-up and 1 remained patent as the patient refused further treatment despite angiographic progression of dAVF. All symptomatic patients had resolution of their symptoms, and the average length of follow-up was 16.8 months. CONCLUSIONS Treatment of parasagittal dAVFs consists of occluding the proximal portion of the parasagittal arterialized draining vein. Endovascular therapy with liquid embolic agents is usually the first line of treatment. Surgical ligation is a valid option if the fistula cannot be successfully obliterated with embolization. Symptoms related to the SSS dAVF resolve after their obliteration.
Collapse
Affiliation(s)
- A Yohan Alexander
- Departments of1Neurologic Surgery and
- 2Medical School, University of Minnesota, Minneapolis, Minnesota
| | | | - Harry J Cloft
- Departments of1Neurologic Surgery and
- 3Radiology, Mayo Clinic, Rochester; and
| | - Giuseppe Lanzino
- Departments of1Neurologic Surgery and
- 3Radiology, Mayo Clinic, Rochester; and
| | - Waleed Brinjikji
- Departments of1Neurologic Surgery and
- 3Radiology, Mayo Clinic, Rochester; and
| |
Collapse
|
30
|
Zhang M, Che R, Xu J, Guo W, Chen X, Zhao W, Ren C, Jia M, Ji X. Long term for patients with futile endovascular reperfusion after stroke. CNS Neurosci Ther 2024; 30:e14588. [PMID: 38475869 PMCID: PMC10933383 DOI: 10.1111/cns.14588] [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: 05/28/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 03/14/2024] Open
Abstract
AIMS With the progress of thrombectomy technology, the vascular recanalization rate of patients with stroke has been continuously improved, but the proportion of futile recanalization (FR) is still quite a few. The long-term prognosis and survival of patients with FR and its influencing factors remain unclear. METHODS Consecutive patients who received endovascular treatment (EVT) for ischemic stroke were enrolled between 2013 and 2021 from a single-center prospectively registry study. We evaluated the long-term outcome of these patients by Kaplan-Meier survival analysis, and the multivariable logistic regression curve was performed to analyze influencing factors. RESULTS Among 458 patients with FR, 56.4% of patients survived at 1 year, and 50.4% at 2 years. In the multivariate regression analysis, age, premorbid modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), posterior circulation infarct, general anesthesia, symptomatic intracerebral hemorrhage (sICH), and decompressive craniectomy were found to be related to unfavorable outcomes in long-term. Age, premorbid mRS, NIHSS, general anesthesia, and sICH were predictors of long-term mortality. CONCLUSIONS Futile recanalization accounts for a large proportion of stroke patients after thrombectomy. This study on the long-term prognosis of such patients is beneficial to the formulation of treatment plans and the prediction of therapeutic effects.
Collapse
Affiliation(s)
- Mengke Zhang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Ruiwen Che
- Department of Neurology, Beijing ShiJiTan HospitalCapital Medical UniversityBeijingChina
| | - Jiali Xu
- Department of Rehabilitation Medicine, Beijing ShiJiTan HospitalCapital Medical UniversityBeijingChina
| | - Wenting Guo
- Department of NeurologyZhejiang Provincial People's HospitalZhejiangChina
| | - Xi Chen
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Wenbo Zhao
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Changhong Ren
- Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Milan Jia
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xunming Ji
- Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Xuanwu HospitalCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| |
Collapse
|
31
|
Yao M, Liang D, Zeng X, Xie X, Gao J, Huang L. Dynamic Changes and Clinical Significance of Plasma Galectin-3 in Patients with Acute Ischemic Stroke Undergoing Endovascular Therapy. J Inflamm Res 2024; 17:1377-1387. [PMID: 38444639 PMCID: PMC10913805 DOI: 10.2147/jir.s455401] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024] Open
Abstract
Purpose Galectin-3 is a key regulator of microglial proliferation and activation and may have dual and time-dependent effects on ischemic stroke. This study aimed to prospectively investigate the dynamic changes in Galectin-3 levels in patients with acute ischemic stroke receiving endovascular therapy and its clinical significance. Patients and Methods A total of 105 patients with acute ischemic stroke who underwent endovascular therapy were prospectively enrolled. Plasma Galectin-3 was quantitatively detected by an enzyme-linked immunosorbent assay before the operation and at 1 day, 3 days and 7 days after the operation. A linear mixed-effect model, Pearson correlation analysis and receiver operating characteristic (ROC) curve analysis were used to evaluate the dynamic changes in the plasma Galectin-3 concentration and its relationship with clinical outcomes. Results Increases in plasma Galectin-3 levels at 1 day and 3 days after surgery were associated with early neurological deterioration and death (both P <0.05). Increased Galectin-3 levels before surgery and at 1 day and 3 days after surgery were associated with poor prognosis (P <0.05). Pearson correlation analysis revealed that Galectin-3 levels before surgery (r =0.318, P =0.002), at 1 day (r =0.318, P =0.001), 3 days (r =0.429, P < 0.001) and 7 days after surgery (r =0.340, P =0.001) were positively correlated with NIHSS scores. The ROC curve results showed that Galectin-3 concentration had a certain predictive value for death at 1 day (AUC=0.707, P=0.013), 3 days (AUC=0.708, P=0.016) and 7 days after the operation (AUC=0.708, P=0.016), but this predictive value was lower than that of the NIHSS score. Conclusion In acute ischemic stroke patients receiving endovascular therapy, an increase in the plasma Galectin-3 levels were associated with death, poor prognosis, and early neurological deterioration. Galectin-3 levels were significantly correlated with the NIHSS score and had a certain predictive value for death.
Collapse
Affiliation(s)
- Mingzheng Yao
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, People’s Republic of China
| | - Dan Liang
- Department of Neurology, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, People’s Republic of China
| | - Xiuli Zeng
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, People’s Republic of China
| | - Xiaomei Xie
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, People’s Republic of China
| | - Jiali Gao
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, People’s Republic of China
| | - Li’an Huang
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, People’s Republic of China
| |
Collapse
|
32
|
Warburton TM, Thomas SD, Holden A, Katib N, Varcoe RL. A Cost-Consequence Analysis Comparing Balloon-Expandable Covered Stents for the Management of Aortoiliac Occlusive Disease. J Endovasc Ther 2024:15266028241234001. [PMID: 38410837 DOI: 10.1177/15266028241234001] [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: 02/28/2024]
Abstract
PURPOSE To compare procedural and long-term costs associated with the use of Balloon-Expandable Covered Stents (BECS) in the management of Aortoiliac Occlusive Disease (AIOD). MATERIALS AND METHODS A cost-consequence model was developed to simulate the intra- and post-operative management of patients with AIOD from the perspective of private health-payers. The study assessed the costs of the LifeStream (BD, Franklin Lakes, New Jersey), iCAST/Advanta V12 (Getinge, Goteborg, Sweden), BeGraft Peripheral (Bentley, Hechingen, Germany), and Viabahn Balloon Expandable (VBX) (W.L. Gore, Flagstaff, Arizona) BECS devices. Device costs were identified from the Australian Prosthesis List, whereas clinical outcomes of BECS were estimated from a systematic review of the literature. Costs were calculated over 24 and 36 month time horizons and reported in US dollars. RESULTS Long-term, per-patient cost of each device at 24 and 36 months was $6253/$6634 for the LifeStream; $6359/$6869 for the iCAST/Advanta V12; $4806 (data available to 24 months) for the BeGraft Peripheral; and $4839/$5046 for the Viabahn VBX, respectively. Most of the cost difference was attributed to the number of stents required per treated limb and frequency of clinically-driven target lesion revascularization events. CONCLUSIONS Best-available clinical evidence and economic modeling demonstrates that the BeGraft Peripheral and Viabahn VBX were of similar cost and the least costly options at 24 months, whereas at 36 months, the lowest cost BECS option for the treatment of AIOD was the Viabahn VBX. CLINICAL IMPACT This analysis supports economically informed decision-making for health-payers managing systems that care for patients with AIOD. Stent length and avoiding reintervention were identified as key areas of cost-saving for future BECS development.
Collapse
Affiliation(s)
- Thomas M Warburton
- Department of Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Shannon D Thomas
- Department of Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Andrew Holden
- Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Nedal Katib
- Department of Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| |
Collapse
|
33
|
Davies MG, Hart JP. Endovascular management of acute and subacute venous thoracic outlet syndrome. Front Surg 2024; 11:1302568. [PMID: 38440414 PMCID: PMC10909919 DOI: 10.3389/fsurg.2024.1302568] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Approximately 3% of all patients presenting with Thoracic Outlet Syndrome have a venous etiology (vTOS), which is considered "effort thrombosis". These patients will present with symptomatic deep venous thrombosis or focal subclavian vein (SCV) stenosis. Endovascular management of vTOS occurs in several phases: diagnostic, preoperative therapeutic intervention before decompression, postoperative interventions after decompression, and delayed interventions in the follow-up after decompression. In the diagnostic phase, dynamic SCV venography can establish functional vTOS. Approximately 4,000 patients have been treated for vTOS and reported in the literature since 1970. Declotting of the SCV was followed by surgical decompression in 53% of patients, while in the remainder, surgical decompression alone (18%), endovascular intervention alone (15%), or conservative therapy with anticoagulation (15%) was performed. The initial intervention was predominantly catheter-directed thrombolysis, with <10% of cases undergoing concomitant balloon angioplasty. 93% of cases were successful. In the postoperative phase, balloon angioplasty was performed to correct residual intrinsic SCV disease after vTOS decompression in under 15% of cases. Stents were rarely deployed. Symptom relief was reported as 94 ± 12% (mean ± SD) and 90 ± 23%, respectively for declotting with decompression and declotting alone. In the delayed phase, balloon angioplasty was performed in under 15% of cases to re-establish patency.
Collapse
Affiliation(s)
- Mark G. Davies
- Department of Cardiovascular Outcomes, Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases, Houston, TX, United States
| | - Joseph P. Hart
- Division of Vascular and Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| |
Collapse
|
34
|
Horie K, Takahara M, Nakama T, Tobita K, Tanaka A, Shintani Y, Tsubakimoto Y, Yoshioka N, Hayakawa N, Sasaki S, Iwata Y, Ogata K, Takagi T, Doijiri T, Fujihara M. Multicenter Registry of Common Femoral Artery Disease Treated With Endovascular Revascularization Using Interwoven Nitinol Stents: An Observational Retrospective Study. J Endovasc Ther 2024:15266028241231472. [PMID: 38369732 DOI: 10.1177/15266028241231472] [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: 02/20/2024]
Abstract
PURPOSE Surgical thromboendarterectomy has been the gold standard treatment for common femoral artery (CFA) disease. However, endovascular therapy (EVT) is conducted in certain patients with CFA lesions because of multiple comorbidities. The interwoven nitinol stent (IWS) has been developed to prevent stent fracture. Thus, this study aimed to evaluate the feasibility of EVT using IWS for CFA lesions in clinical practice. MATERIALS AND METHODS This retrospective multicenter registry analyzed patients who had symptomatic lower-extremity artery disease due to CFA lesions and underwent EVT using IWS between 2019 and 2021. The primary endpoint was restenosis 2 years after EVT. RESULTS This study enrolled a total of 177 patients with 196 CFA lesions. The 2-year estimate of freedom from restenosis was 88.0%. The 2-year freedom rates from the target-lesion revascularization, major amputation, and all-cause death were 92.9%, 99.0%, and 75.2%, respectively. The clinical features significantly associated with restenosis risk were the reference vessel diameter (RVD, per 1.0 mm, hazard ratio [HR], 0.24 [0.08-0.70]; p=0.009), external iliac artery (EIA) involvement (HR=4.03 [1.56-10.4]; p=0.004), superficial femoral artery (SFA) involvement (HR=3.05 [1.00-9.25]; p=0.049), body mass index (BMI; per 1.0, HR=0.85 [0.73-0.99]; p=0.032), occlusion of deep femoral arteries (DFAs) at baseline (HR=7.89 [2.04-30.5]; p=0.003), and chronic limb-threatening ischemia (CLTI, HR=2.63 [1.02-6.78]; p=0.045). Their significant association was also confirmed by the random survival forest analysis. During a median follow-up of 12.0 months, guiding sheaths were inserted via CFAs implanted IWSs in 73 cases (37.2%), and no patients had cannulation-related complications, such as failed hemostasis, fracture of IWS, and stent occlusion. CONCLUSIONS Endovascular therapy using IWS in CFA lesions showed acceptable 2-year patency rates at 88.0% and might preserve the arterial access via the ipsilateral CFAs. Small RVD, involving EIA and SFA lesions, emaciation, occluded DFA, and CLTI are associated with poor 2-year patency rates following EVT, thus, IWS implantation in CFA lesions may be an option for patients unsuitable for surgical revascularization. CLINICAL IMPACT This retrospective multicenter registry enrolled 177 patients with 199 CFA lesions treated with EVT using interwoven nitinol stents, because surgical thromboendarterectomy was difficult due to their multiple comorbidities. The 2-year estimate of freedom from restenosis was acceptable at 88.0%. The 2-year freedom rate from major amputation was also high at 99.0%. Moreover, during a median follow-up of 12.0 months, guiding sheaths were inserted via CFAs implanted IWSs in 73 cases, and no patients had cannulation-related complications such as failed hemostasis, fracture of IWS, and stent occlusion.
Collapse
Affiliation(s)
- Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Akiko Tanaka
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Yoshiaki Shintani
- Department of Cardiology, Ageo Central General Hospital, Ageo, Japan
| | | | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Japan
| | - Shinya Sasaki
- Department of Cardiology, Saka General Hospital, Shiogama, Japan
| | - Yo Iwata
- Department of Cardiology, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Kenji Ogata
- Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Tomonari Takagi
- Cardiovascular Center, Takatsu General Hospital, Kawasaki, Japan
| | - Tatsuki Doijiri
- Department of Cardiology, Yamato Seiwa Hospital, Yamato, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan
| |
Collapse
|
35
|
Jia Y, Feng Y, Ma Y, Feng G, Xu N, Li M, Liu M, Fan Z, Wang T. Type of anesthesia for endovascular therapy in acute ischemic stroke: A literature review and meta-analysis. Int J Stroke 2024:17474930241228956. [PMID: 38234158 DOI: 10.1177/17474930241228956] [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: 01/19/2024]
Abstract
BACKGROUND Endovascular thrombectomy (EVT) has been proven as the standard treatment for acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO). However, the ideal anesthetic strategy during EVT still remains unclear. Therefore, this systematic review and meta-analysis aimed to determine the optimal anesthetic modality for patients with AIS undergoing EVT based on current randomized controlled trials (RCTs). METHODS The databases Medline (via PubMed), EMBASE, Web of Science, and the Cochrane Library were searched for RCTs comparing general anesthesia (GA) and conscious sedation (CS) in AIS patients undergoing EVT. The primary outcome was a favorable functional outcome at 90 days postintervention. Data analysis was conducted using the Review Manager software (RevMan V.5.3). RESULTS Eight RCTs involving 1199 patients were included. There was no significant difference between GA and CS group in the rate of functional independence (risk ratio (RR) = 1.10, 95% confidence interval (CI) = 0.96 to 1.25; p = 0.17; I2 = 30%). Compared with the CS group, the GA group attained a higher successful recanalization rate (RR = 1.14, 95% CI = 1.08 to 1.20; p < 0.00001; I2 = 17%). In addition, patients in the GA were associated with a higher rate of hypotension (RR = 1.87, 95% CI = 1.44 to 2.41; p < 0.00001; I2 = 66%) and a higher incidence of pneumonia (RR = 1.38, 95% CI = 1.05 to 1.8; p = 0.02; I2 = 37%). CONCLUSION For AIS patients receiving EVT, the choice of anesthetic modality did not influence the 3-month neurological outcome while GA is superior to CS in terms of successful reperfusion rate. Moreover, the patients in the GA group were at a higher risk of developing hypotension and pneumonia. Further studies are required to provide more sufficient evidence.
Collapse
Affiliation(s)
- Yitong Jia
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yao Feng
- Department of Neurology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanhui Ma
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guang Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Na Xu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Meng Li
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Miao Liu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhen Fan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
36
|
Paraskevas KI, Veith FJ. Surgery or Endovascular Therapy for Patients With Chronic Limb-Threatening Ischemia? What do BASIL-2 and BEST-CLI Tell Us. Angiology 2024:33197241233421. [PMID: 38336359 DOI: 10.1177/00033197241233421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Affiliation(s)
| | - Frank J Veith
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
37
|
Betz T, Pfister K, Schierling W, Sachsamanis G, Radunski J, Nolte Ernsting C, Stehr A. Treatment of symptomatic popliteal artery lesions: An obituary of the GORE® TIGRIS® vascular stent. Clin Hemorheol Microcirc 2024:CH231993. [PMID: 38339921 DOI: 10.3233/ch-231993] [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: 02/12/2024]
Abstract
BACKGROUND The popliteal artery is highly exposed to biomechanical stress, which is the primary factor associated with stent failure. However, information on the optimal endovascular treatment for the popliteal artery is lacking. OBJECTIVE To report the efficacy of the GORE® TIGRIS® Vascular Stent for the endovascular treatment of popliteal artery lesions. METHODS Retrospective analysis of all patients with symptoms of peripheral artery occlusive disease (PAD) and popliteal artery lesions who underwent implantation of a GORE® TIGRIS® Vascular Stent between August 2012 and August 2014 at a tertiary vascular centre. RESULTS Between August 2012 and August 2014, 48 patients (32 men, aged 75±8 years) were treated with a GORE® TIGRIS® Vascular Stent. The technical success rate was 100% . At 12 months, the primary and secondary patency rates were 74% and 85%, respectively. During follow-up, no stent fracture was observed. No major amputations were performed. CONCLUSIONS Our study showed that isolated popliteal artery lesions in patients with symptomatic PAD could easily be treated with the GORE® TIGRIS® Vascular Stent, as good short-term results were achieved at 12 months. Therefore, the discontinuation of this product removed a useful tool with a simple release mechanism from the endovascular armamentarium of vascular specialists.
Collapse
Affiliation(s)
- Thomas Betz
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Karin Pfister
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Wilma Schierling
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Georgios Sachsamanis
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Jörn Radunski
- Department of Vascular Surgery, Evangelical Hospital Mülheim, Mülheim/Ruhr, Germany
| | | | - Alexander Stehr
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
- Department of Vascular Surgery, Evangelical Hospital Mülheim, Mülheim/Ruhr, Germany
| |
Collapse
|
38
|
Wang P, Shan Y, Xiao B, Zhang X, Hou J, Cui N, Cao X, Cheng K. How to Omit the Potential Pitfalls in Distal Radial Access: Lessons From Cadaveric and CTA Analysis. J Endovasc Ther 2024:15266028241229062. [PMID: 38326308 DOI: 10.1177/15266028241229062] [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: 02/09/2024]
Abstract
OBJECTIVES To verify the anatomical basis, ideal puncture sites, and potential pitfalls of the distal radial artery (dRA) in the anatomical snuffbox region for distal radial access (dTRA). MATERIALS AND METHODS Overall, 26 formalin-fixed upper limbs and computed tomography angiography (CTA) of the upper limbs of 168 consecutive patients were studied. Cadaveric dissection and dRA 3D reconstruction were used to evaluate the dRA route for dTRA. The puncture sites, dRA diameter, and angle of the dRA and tendons of the extensor pollicis brevis were also measured in the patients and cadavers. RESULTS The cadaver dissection provided more insights than did the dRA 3D reconstruction. However, preoperative evaluation had better diagnostic accuracy (p=0.024). Puncture sites 1 and 3 had a high success rate (63.2% possible success rate, 191/302). The DISFAVOR theory was put forward, in which 8 types of potential pitfalls that may interrupt puncture procedure or lead to a surgical failure were observed, including occlusion, stenosis, tortuosity, arteriovenous fistula, angioma, different radial artery (RA) ramifications, radial veins, and cephalic veins. The mean diameter of dRA based on cadaver dissection and CTA was 2.53 (SD=0.73) and 2.63 (SD=0.69) mm, respectively. Furthermore, the minimum distance from the outer layer of dRA to the skin was 5.71 (SD=2.0) mm based on CTA. The angle between the dRA and tendons of extensor pollicis brevis (TEPB) based on cadaver dissection and CTA was 58.0° (SD=21.5°) and 51.8° (SD=16.6°), respectively. CONCLUSIONS Puncture sites 1 and 3 were more suitable for the dTRA, and we put forward the DISFAVOR theory to summarize the 8 types of potential pitfalls during the use of dTRA.
Collapse
Affiliation(s)
- Ping Wang
- Department of Radiology and Intervention, China-Japan Union Hospital of Jilin University, Changchun, China
- Department of Anatomy, Tarim University School of Medicine, Alaer, China
| | - Yuezhan Shan
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Benshan Xiao
- Department of Intervention, Affiliated Hospital of Jinggangshan University, Jian, China
| | - Xiang Zhang
- Department of Anatomy, Kunming Medical University, Kunming, China
| | - Jianfei Hou
- Department of Anatomy, Tarim University School of Medicine, Alaer, China
| | - Ni Cui
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xianglong Cao
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Kailiang Cheng
- Department of Radiology and Intervention, China-Japan Union Hospital of Jilin University, Changchun, China
| |
Collapse
|
39
|
Li BH, Wang LR, Huang J, Yang S, Huang B, Jia LJ, Zhou S, Guo FQ, Wang JH, Yu NW. Predictive role of neutrophil-to-platelet ratio in futile recanalization of patients after endovascular therapy. Biomark Med 2024; 18:137-143. [PMID: 38375795 DOI: 10.2217/bmm-2023-0585] [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] [Indexed: 02/21/2024] Open
Abstract
Aim: To explore the association between the neutrophil-to-platelet ratio (NPR) and futile recanalization (FR) in patients with acute ischemic stroke due to large vascular occlusions after endovascular therapy (EVT). Methods: FR after EVT was defined as a poor 90-day prognosis (modified Rankin scale [mRS] score ≥3) despite successful reperfusion (modified thrombolysis in cerebral infarction grade 2b-3). Patients were divided into high NPR (>35; n = 115) and low NPR (≤35; n = 81) groups. Results: The FR rate was significantly higher in the high NPR group than low NPR group (81.74 vs 55.56%; p = 0.000). NPR was independently associated with FR (odds ratio: 2.107; 95% CI: 1.017-4.364; p = 0.045). Conclusion: High NPR was associated with the risk of FR in patients with acute ischemic stroke due to large vascular occlusions.
Collapse
Affiliation(s)
- Bing-Hu Li
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
- University of Electronic Science & Technology of China, Chengdu, 610054, China
| | - Li-Rong Wang
- University of Electronic Science & Technology of China, Chengdu, 610054, China
| | - Jie Huang
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
- University of Electronic Science & Technology of China, Chengdu, 610054, China
| | - Shu Yang
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
- University of Electronic Science & Technology of China, Chengdu, 610054, China
| | - Bin Huang
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
- University of Electronic Science & Technology of China, Chengdu, 610054, China
| | - Li-Jun Jia
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Sen Zhou
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Fu-Qiang Guo
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
- University of Electronic Science & Technology of China, Chengdu, 610054, China
| | - Jian-Hong Wang
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
- University of Electronic Science & Technology of China, Chengdu, 610054, China
| | - Neng-Wei Yu
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
- University of Electronic Science & Technology of China, Chengdu, 610054, China
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| |
Collapse
|
40
|
Wei R, Chen Z. Axillary artery pseudoaneurysm with concurrent distal thrombosis: a case report. J Surg Case Rep 2024; 2024:rjae061. [PMID: 38370591 PMCID: PMC10871766 DOI: 10.1093/jscr/rjae061] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
This report details a case of axillary artery pseudoaneurysm with concurrent distal thrombosis, manifesting as acute upper extremity ischemia. The condition was successfully treated with a hybrid surgical approach, employing a covered stent graft and Fogarty balloon thrombectomy. We review the relevant literature on the management of this rare but critical vascular condition.
Collapse
Affiliation(s)
- Runze Wei
- Department of Vascular Surgery, Northern Jiangsu People's Hospital, Yangzhou 225001, China
| | - Zhaolei Chen
- Department of Vascular Surgery, Northern Jiangsu People's Hospital, Yangzhou 225001, China
| |
Collapse
|
41
|
Hata Y, Iida O, Okamoto S, Ishihara T, Tsujimura T, Higashino N, Toyoshima T, Nakao S, Takahara M, Mano T. Japanese real-world population with chronic limb-threatening ischemia who meet the criteria of the BEST-CLI trial. Vasc Med 2024; 29:64-66. [PMID: 37906710 DOI: 10.1177/1358863x231205229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Yosuke Hata
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | - Shin Okamoto
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | | | | | | | - Taku Toyoshima
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | - Sho Nakao
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka Prefecture, Japan
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka Prefecture, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| |
Collapse
|
42
|
Shang T, Zhou HJ, Wang YS, Qiu C, Chen TC, Sun J, Lu T, Wu Z, Zhang H, Li Z, Li DL. Mid-term Results of the Treatment of Isolated Dissection of the Celiac Artery: A Comparative Analysis of Endovascular Versus Conservative Therapy. J Endovasc Ther 2024; 31:80-88. [PMID: 35852451 DOI: 10.1177/15266028221112254] [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: 11/16/2022]
Abstract
OBJECTIVES Endovascular treatment (EVT) is an alternative method used to treat isolated dissection of the celiac artery (IDCA). However, only a few mid-term results have been reported. This study aimed to analyze and compare the outcomes of endovascular and non-operative therapies for IDCA. METHODS Data from a cohort of consecutive IDCA patients enrolled in the study hospital between April 2012 and September 2020 were retrospectively reviewed. Demographic information, imaging features, treatment modalities, and follow-up results of celiac artery remodeling and adverse events were collected and analyzed. RESULTS A total of 87 patients were enrolled in the study. Stents were deployed in 68 patients, and non-operative treatment (blood pressure control and pain management) was continued in the remaining 19 patients who did not receive stenting; among these 19 patients, EVT failed in 6. The mean follow-up period was 37.3 (range, 10-85 months) and 44.0 (range, 9-80 months) months in the EVT and non-operative groups, respectively. During follow-up, the overall complete remodeling (absence of residual dissection with no false lumen or no intramural thrombus) rate was significantly higher in the EVT group than in the non-operative group (87.3% vs 7.1%, p<0.001). The incomplete remodeling (improved true lumen with malabsorption or partial thrombosis of the false lumen) rate was not significantly different between the EVT and non-operative groups (6.3% vs 14.3%; p=0.2984). Meanwhile, the adverse event-free survival rates were 89.0%, 67.0%, and 67.0% at 1, 3, and 5 years, respectively, in the EVT group compared with 39.7% and 29.8% at 1 and 3 years in the non-operative group (p<0.0001). CONCLUSIONS EVT for IDCA may be considered an effective management option with a favorable clinical success rate, an encouraging complete remodeling rate, and a satisfactory adverse event-free survival rate. However, further evaluation with a long-term follow-up is required. CLINICAL IMPACT Endovascular intervention for isolated dissection of the celiac artery has attracted inadequate attention. In this retrospective study with comparative analysis of endovascular versus conservative therapy for isolated dissection of the celiac artery patients, a better complete remodeling rate and a higher adverse event-free survival rate were observed in the endovascular treatment (EVT) group during follow-up, indicating that EVT could be an effective management option for isolated dissection of the celiac artery.
Collapse
Affiliation(s)
- Tao Shang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hua-Ji Zhou
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Vascular Surgery, Ping Hu People's Hospital, Jiaxing, China
| | - Yi-Shu Wang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian-Chi Chen
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Sun
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, China
| | - Tian Lu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dong-Lin Li
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
43
|
Ebaid NY, Mouffokes A, Yasen NS, Elrosasy AM, Philip KG, Assy MM, Alsowey AM. Diagnostic accuracy of dual-energy computed tomography in the diagnosis of neurological complications after endovascular treatment of acute ischaemic stroke: a systematic review and meta-analysis. Br J Radiol 2024; 97:73-92. [PMID: 38263833 PMCID: PMC11027317 DOI: 10.1093/bjr/tqad007] [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: 05/27/2023] [Revised: 09/28/2023] [Accepted: 10/22/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To investigate dual-energy computed tomography's (DECT) diagnostic performance in detecting neurological complications following endovascular therapy (EVT) of acute ischaemic stroke (AIS). METHODS We performed the literature search using Web of Science, Scopus, PubMed, EBSCO, and Science Direct databases for published related studies. The selected studies estimated the validity of DECT in the detection of neurological complications after EVT for AIS. Study quality assessment was performed utilizing the Quality of Diagnostic Accuracy Studies-2 Tool. Our meta-analysis calculated the pooled sensitivity, negative likelihood ratio, specificity, and positive likelihood ratio for each detected complication. The summary receiver operating characteristics (sROC) curve was utilized to estimate the area under the curve (AUC). RESULTS Of 22 studies, 21 were included in the quantitative synthesis. In the detection of intracerebral haemorrhage (ICH), DECT pooled overall sensitivity and specificity were 69.9% (95% CI, 44.5%-86.8%) and 100% (95% CI, 92.1%-100%); whereas, in the detection of ischaemia, they were 85.9% (95% CI, 80.4%-90%) and 90.7% (95% CI, 87%-93.5%), respectively. On the sROC curve, AUC values of 0.954 and 0.952 were recorded for the detection of ICH and ischaemia, respectively. CONCLUSIONS DECT demonstrated high accuracy and specificity in the detection of neurological complications post-endovascular treatment of AIS. However, further prospective studies with a standardized reference test and a larger sample size are recommended to support these findings. ADVANCES IN KNOWLEDGE DECT is a rapid and valid imaging tool for the prediction of ICH and cerebral ischaemia after the EVT of AIS.
Collapse
Affiliation(s)
- Noha Yahia Ebaid
- Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig 40511, Egypt
- Medical Research Group of Egypt, Cairo 11511, Egypt
| | - Adel Mouffokes
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Medicine, University of Oran 1 Ahmed Ben Bella, Oran 31020, Algeria
| | - Noha S Yasen
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Applied Medical Sciences, Misr University for Science and Technology, Cairo 11511, Egypt
| | - Amr M Elrosasy
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Medicine, Cairo University, Cairo 11511, Egypt
| | - Kerollos George Philip
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Medicine, Sohag University, Sohag 82511, Egypt
| | - Mostafa Mohamad Assy
- Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig 40511, Egypt
| | - Ahmed Mohamed Alsowey
- Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig 40511, Egypt
| |
Collapse
|
44
|
Zhu L, Liu W, Hu Z, Li Z, Duan Z, Guo Z, Huang F, Lv K, Liao J, Chen Z, Jiang H, Wang K, Wang H, Lei Y, Liao J, Li J, Wang M, Yuan H, Zi W, Wan Y, Wang P. Endovascular Therapy for Basilar Artery Occlusion in Sudden Onset to Maximal Deficit Ischemic Events. J Am Heart Assoc 2024; 13:e030713. [PMID: 38214309 PMCID: PMC10926788 DOI: 10.1161/jaha.123.030713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/22/2023] [Accepted: 10/17/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The presence of sudden onset to maximal deficit (SOTMD) in patients with acute basilar artery occlusion often results in more severe outcomes. However, the effect of endovascular therapy on SOTMD and whether the outcome is affected by onset-to-puncture time remain unclear. METHODS AND RESULTS This retrospective analysis was conducted using data from the prospective BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry). Consecutive patients with basilar artery occlusion receiving endovascular therapy were dichotomized into SOTMD and non-SOTMD cohorts. The primary outcomes included a favorable outcome (modified Rankin scale 0-3), recanalization, and mortality at 90 days. The outcomes of patients with SOTMD were analyzed using multivariable logistic regression. In the multivariate analysis, a favorable outcome was similar between the two cohorts (odds ratio [OR], 0.88 [95% CI, 0.58-1.34]; P=0.5), although the mortality of patients with SOTMD was higher than that of patients with non-SOTMD (OR, 1.67 [95% CI, 1.14-2.44]; P=0.008). The probability of mortality increased from 40.0% at 1 hour to 70.0% at 6 hours in the SOTMD cohort, and favorable outcomes of patients with non-SOTMD declined from 38.0% at 1 hour to 18.0% at 8 hours. CONCLUSIONS No significant difference was observed in favorable outcomes between the SOTMD and non-SOTMD groups, although mortality was higher in the SOTMD cohort. The patients with SOTMD had a stronger time dependence for endovascular therapy in terms of mortality, while the time dependency regarding favorable outcome in the NSOTMD group was even higher. REGISTRATION URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1800014759.
Collapse
Affiliation(s)
- Lina Zhu
- Department of NeurologyWeihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihaiChina
- Department of NeurologyWeifang Medical UniversityWeifangChina
| | - Wenhua Liu
- Department of NeurologyWuhan No. 1 HospitalWuhanChina
| | - Zhizhou Hu
- Department of NeurologyLongyan No. 1 HospitalLongyanChina
| | - Zhenguang Li
- Department of NeurologyWeihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihaiChina
| | - Zhenhui Duan
- Department of NeurologyWuhan No. 1 HospitalWuhanChina
| | - Zhangbao Guo
- Department of NeurologyWuhan No. 1 HospitalWuhanChina
| | - Fang Huang
- Department of NeurologyPeople’s Hospital of Yuxi CityYuxiChina
| | - Kefeng Lv
- Department of NeurologyDong Guan People’s HospitalDongguanChina
| | - Jiasheng Liao
- Department of NeurologySuining No.1 People’s HospitalSuiningChina
| | - Zhao Chen
- Department of NeurologyYaan Peoples’s HospitalYaanChina
| | - He Jiang
- Department of NeurologyThe First People’s Hospital of NeijiangNeijiangChina
| | - Kuiyun Wang
- Department of NeurologyThe Jintang First People’s HospitalChengduChina
| | - Hongjun Wang
- Department of NeurologyFengdu People’s HospitalChongqingChina
| | - Yang Lei
- Department of NeurologyWulong District People’s HospitalChongqingChina
| | - Jiachuan Liao
- Department of NeurologySantai County People’s Hospital of North Sichuan Medical CollegeMianyangChina
| | - Jing Li
- Department of NeurologyWeihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihaiChina
- Department of NeurologyWeifang Medical UniversityWeifangChina
| | - Mengmeng Wang
- Department of NeurologyWeihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihaiChina
- Department of NeurologyWeifang Medical UniversityWeifangChina
| | - Haicheng Yuan
- Department of NeurologyQingdao Central HospitalQingdaoShandongChina
| | - Wenjie Zi
- Department of NeurologyXinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University)ChongqingChina
| | - Yue Wan
- Department of NeurologyYangluo Branch of Hubei Zhongshan HospitalWuhanChina
| | - Pengfei Wang
- Department of NeurologyWeihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihaiChina
| |
Collapse
|
45
|
Frączek MJ, Krzyżewski RM, Kliś KM, Kwinta BM, Popiela TJ, Stachura K. Unruptured intracranial aneurysms: Why should we focus on small aneurysms? A comprehensive update of recent findings. Pol J Radiol 2024; 89:e13-e23. [PMID: 38371893 PMCID: PMC10867953 DOI: 10.5114/pjr.2024.134424] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/21/2023] [Indexed: 02/20/2024] Open
Abstract
Intracranial aneurysms (IAs) are a significant public health concern because they have the potential to cause deva-stating consequences, including death and disability. Despite advances in diagnostic and treatment modalities, the outcomes for patients with aneurysmal subarachnoid haemorrhage (aSAH) remain poor, with high rates of rebleeding, vasospasm, and cerebral ischaemia. IAs are a significant risk factor for aSAH, and it is estimated that up to 3% of the general population have IAs. Recent studies using novel imaging modalities have shown that the prevalence of IAs may be much higher, with 6.6% of adults aged 40-84 years having intradural saccular IAs ≥ 2 mm. The risk of rupture for IAs is difficult to predict, and the decision to treat them invasively is based on a balance between the estimated rupture risk and the procedural risks of the treatment. However, the mortality and morbidity rates among patients treated for IAs can be as high as 5%. There is a need for clear guidelines on the treatment of IAs, and this review aims to provide an update on recent findings in this area. To achieve this goal, the authors identified and summarized recent, high-impact studies on IAs. The review focuses on the diagnostic and treatment options for IAs, as well as the risks associated with these interventions. The authors also provide an overview of the natural history of IAs and discuss the challenges and uncertainties in managing these patients.
Collapse
Affiliation(s)
- Maciej Jakub Frączek
- Department of Neurosurgery and Neurotraumatology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Roger Marek Krzyżewski
- Department of Neurosurgery and Neurotraumatology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Kornelia Maria Kliś
- Department of Neurosurgery and Neurotraumatology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Borys Maria Kwinta
- Department of Neurosurgery and Neurotraumatology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tadeusz Jan Popiela
- Chair of Radiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Stachura
- Department of Neurosurgery and Neurotraumatology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
46
|
Qi S, Shi M, Li C, Song K, Zhou J, Yue F, Zhang W, Wang S. Associations between NIHSS sub-item scores and prognosis and intracranial hemorrhage after endovascular therapy for acute anterior circulation ischemic stroke. Front Neurol 2024; 14:1320055. [PMID: 38259652 PMCID: PMC10800981 DOI: 10.3389/fneur.2023.1320055] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose The relationship between sub-item scores on the National Institutes of Health Stroke Scale (NIHSS) scores and prognosis and intracranial hemorrhage in patients with acute ischemic stroke undergoing endovascular treatment (EVT) has been insufficiently studied. The aim of this study was to investigate the correlation between NIHSS sub-item scores, prognosis, and intracranial hemorrhage. Methods This study included patients with acute anterior circulation ischemic stroke undergoing EVT between February 2019 and April 2022. The outcomes included functional independence, defined as a modified Rankin Scale (mRS) score ≤ 2 at 3 months after EVT, intracranial hemorrhage within 24 h after EVT, and mortality within 3 months. A multivariate regression analysis was performed, including NIHSS sub-item scores and other adjusted variables. Results A total of 568 patients were enrolled. Of the 568 patients, 239 (45%) achieved functional independence at 3 months after EVT. The median age in this group was 63 years (IQR 52-69) and 176 (73.6%) were male patients. Intracranial hemorrhage within 24 h after EVT occurred in 170 (30%) patients. The median age in this group was 65 years (IQR 56-71) and 105 (61.8%) were male patients. In a multivariate analysis adjusted for age, gender, and factors with a value of p of <0.05, the NIHSS limb movement sub-item score was strongly associated with prognosis at 3 months (OR 0.833, 95% CI 0.758-0.915) and intracranial hemorrhage within 24 h after EVT (OR 1.161, 95% CI 1.037-1.300). Conclusion Higher limb movement sub-item scores on the NIHSS were independently associated with a poorer prognosis at 3 months and a higher rate of intracranial hemorrhage within 24 h after EVT among patients with acute anterior circulation ischemic stroke.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Shouchun Wang
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
| |
Collapse
|
47
|
Freiherr Von Seckendorff A, Nomenjanahary MS, Labreuche J, Ollivier V, Di Meglio L, Dupont S, Hamdani M, Brikci-Nigassa N, Brun A, Boursin P, Piotin M, Mazighi M, Ho-Tin-Noé B, Desilles JP, Delbosc S. Periodontitis in ischemic stroke: impact of Porphyromonas gingivalis on thrombus composition and ischemic stroke outcomes. Res Pract Thromb Haemost 2024; 8:102313. [PMID: 38318152 PMCID: PMC10840352 DOI: 10.1016/j.rpth.2023.102313] [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: 06/08/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024] Open
Abstract
Background Periodontitis is associated with an increased risk of ischemic stroke, but the mechanisms underlying this association remain unclear. Objectives Our objective was to determine whether Porphyromonas gingivalis (Pg), a periodontal bacterium, could be detected within thrombus aspirates, modify thrombus composition, and endovascular therapy responses. Methods The presence of Pg gingipain in 175 consecutive thrombi from patients with large vessel occlusion stroke enrolled in the multicenter research cohort compoCLOT was investigated by immunostaining. Thrombus blood cell composition according to gingipain status was analyzed in a subset of 63 patients. Results Pg gingipain immunostaining was positive in 33.7% of thrombi (95% CI, 26.7%-40.8%). The percentage of near to complete reperfusion (modified Thrombolysis in Cerebral Infarction Score 2c/3) at the end of the procedure was lower in the Pgpos group than the Pgneg group (39.0% vs 57.8% respectively; adjusted odds ratio, 0.38; 95% CI, 0.19-0.77). At 3 months, 35.7% of patients in the Pgpos group had a favorable neurological outcome vs 49.5% in the Pgneg group (odds ratio, 0.65; 95% CI, 0.30-1.40). Quantitative analysis of a subset of 63 thrombi showed that neutrophil elastase content was significantly (P < .05) higher in Pgpos thrombi than in Pgneg thrombi. Conclusion Our results indicate that intrathrombus Pg gingipain is associated with increased neutrophil content and resistance to endovascular therapy.
Collapse
Affiliation(s)
- Aurélien Freiherr Von Seckendorff
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Mialitiana Solo Nomenjanahary
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Julien Labreuche
- Department of Biostatistics, Centre Hospitalier Universitaire Lille, Lille, France
| | - Véronique Ollivier
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Lucas Di Meglio
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Sebastien Dupont
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Mylène Hamdani
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Nahida Brikci-Nigassa
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Adrian Brun
- Laboratory of Orofacial Pathologies, Imaging and Biotherapies URP2496, Unité de Formation et de Recherche Odontologie, Faculté de Santé, Université Paris Cité, Montrouge, France
- Division of Periodontology, Department of Oral Medicine, Assisantance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | - Perrine Boursin
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
- Fédération Hospitalo-Universitaire Neurovasc, Department of Neurology, Hopital Lariboisière, Assisantance Publique Hôpitaux de Paris, Paris, France
- Department of Neurology, Hôpital Lariboisière, Assisantance Publique Hôpitaux de Paris Nord, Paris, France
| | - Benoit Ho-Tin-Noé
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
- Fédération Hospitalo-Universitaire Neurovasc, Department of Neurology, Hopital Lariboisière, Assisantance Publique Hôpitaux de Paris, Paris, France
| | - Sandrine Delbosc
- Institut National de la Santé et de la Recherche Médicale, Laboratory for Vascular Translational Research, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
| | - compoCLOT study group
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
- Department of Biostatistics, Centre Hospitalier Universitaire Lille, Lille, France
- Laboratory of Orofacial Pathologies, Imaging and Biotherapies URP2496, Unité de Formation et de Recherche Odontologie, Faculté de Santé, Université Paris Cité, Montrouge, France
- Division of Periodontology, Department of Oral Medicine, Assisantance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
- Fédération Hospitalo-Universitaire Neurovasc, Department of Neurology, Hopital Lariboisière, Assisantance Publique Hôpitaux de Paris, Paris, France
- Department of Neurology, Hôpital Lariboisière, Assisantance Publique Hôpitaux de Paris Nord, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Laboratory for Vascular Translational Research, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
| |
Collapse
|
48
|
Padmanaban V, Zhu J, Zhou S, Ansari SA, Howington JU, Sahlein DH, Tejada JG, Wilkinson DA, Simon SD, Cockroft KM, Church EW. Safety and efficacy of endovascular versus microsurgical treatment of unruptured wide-necked middle cerebral artery aneurysms: a propensity score-matched analysis of the NeuroVascular Quality Initiative Quality Outcomes Database Cerebral Aneurysm Registry. J Neurosurg 2023:1-9. [PMID: 38157538 DOI: 10.3171/2023.10.jns231659] [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: 07/19/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Unruptured, wide-necked middle cerebral artery (WN-MCA) aneurysms have traditionally been considered ideal candidates for microsurgery (MS), although endovascular treatment (EVT) has dramatically increased in popularity with the advent of novel devices such as intrasaccular flow disruptors. The purpose of this study was to evaluate the safety and efficacy of MS versus EVT for unruptured WN-MCA aneurysms. METHODS The NeuroVascular Quality Initiative Quality Outcomes Database (NVQI-QOD) Cerebral Aneurysm Registry, a multiinstitutional, prospectively collected procedural database, was queried for cases of unruptured WN-MCA aneurysms treated with MS or EVT between 2015 and 2022. A wide neck was defined as an aneurysm neck ≥ 4 mm or a dome/neck ratio ≤ 2. Demographics and aneurysm characteristics were queried. Propensity score matching (PSM) was utilized to match aneurysm size, number of aneurysms treated, patient age, and aneurysm status. Safety outcomes were evaluated including intraoperative and postoperative complication rates. Aneurysm occlusion status and clinical outcomes using the modified Rankin Scale (mRS) score at discharge and the last follow-up were also assessed. RESULTS Of 671 unruptured MCA aneurysms, 319 were wide necked. Thirty cases were excluded, as the aneurysm had been previously treated. Two hundred eighty-nine operations (203 EVT, 86 MS) in 282 patients satisfied inclusion criteria. After PSM, there were 86 operations in each group for analysis. The mean aneurysm width was 5.0 (EVT) versus 4.9 mm (MS; p = 0.285). Safety data showed similar intraoperative (7.0% EVT vs 3.5% MS, p = 0.496) and postoperative (4.7% vs 7%, p = 0.746) complication rates. The MS patients were more likely to have complete aneurysm occlusion at discharge (90.4% vs 58.8%, p < 0.001). In a limited subset of patients (52.9%) for whom outcome data were available, the EVT patients were more likely to have an mRS score 0 at discharge (50/59 [84.7%] vs 29/54 [53.7%], p < 0.0003] and at the last follow-up (36/55 [65.5%] vs 13/36 [36.1%], p = 0.006). CONCLUSIONS This study describes a large, modern cohort of propensity score-matched patients who underwent treatment of unruptured WN-MCA aneurysms. Safety data on intraoperative and postoperative complication rates were similar in both treatment groups. MS was more likely to result in complete aneurysm occlusion at discharge. In a subset of patients with available outcome data, EVT was associated with better functional outcomes at discharge and the last follow-up. Given the lack of complete follow-up data and rates of retreatment, these results should be interpreted cautiously.
Collapse
Affiliation(s)
| | | | | | - Sameer A Ansari
- 3Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jay U Howington
- 4Department of Neurosurgery, Neurosurgical & Spine Institute of Savannah, Savannah, Georgia
| | - Daniel H Sahlein
- 5Neuro-interventional Radiology, Goodman Campbell Brain and Spine, Indianapolis, Indiana; and
| | - Juan G Tejada
- 6Department of Radiology, Indiana University, Indianapolis, Indiana
| | | | | | - Kevin M Cockroft
- Departments of1Neurosurgery
- 2Public Health Sciences
- 7Radiology, and
| | - Ephraim W Church
- Departments of1Neurosurgery
- 7Radiology, and
- 8Neurology, Penn State Health, Hershey, Pennsylvania
| |
Collapse
|
49
|
Takimura H, Tajima E, Taniguchi R, Tsuzuki I, Makino K, Yamaguchi Y, Kawano M, Takimura Y, Nishio S, Nakano M, Tsukahara R. Early and Late Ruptured Aneurysm After Endovascular Therapy With Paclitaxel-Coated Balloon. JACC Cardiovasc Interv 2023; 16:3041-3044. [PMID: 37804291 DOI: 10.1016/j.jcin.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 10/09/2023]
Affiliation(s)
| | - Emi Tajima
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | | | - Ippei Tsuzuki
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | - Kenji Makino
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | | | - Mami Kawano
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | - Yukako Takimura
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | - Satoru Nishio
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | | | - Reiko Tsukahara
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| |
Collapse
|
50
|
Inui R, Koge J, Tanaka K, Yoshimoto T, Shiozawa M, Abe S, Ishiyama H, Imamura H, Nakahara J, Kataoka H, Ihara M, Toyoda K, Koga M. Detrimental effect of anemia after mechanical thrombectomy on functional outcome in patients with ischemic stroke. Front Neurol 2023; 14:1299891. [PMID: 38187149 PMCID: PMC10770243 DOI: 10.3389/fneur.2023.1299891] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Background Anemia can occur due to an aspiration maneuver of blood with thrombi during mechanical thrombectomy (MT) for stroke. However, the association between postoperative anemia and stroke outcomes is unknown. Methods In a registry-based hospital cohort, consecutive patients with acute ischemic stroke who underwent MT were retrospectively recruited. Patients were divided into the following three groups according to their hemoglobin (Hb) concentrations within 24 h after MT; no anemia (Hb concentrations ≥13 g/dL for men and ≥ 12 g/dL for women), mild anemia (Hb concentrations of 11-13 g/dL and 10-12 g/dL, respectively), and moderate-to-severe anemia (Hb concentrations <11 g/dL and < 10 g/dL, respectively). A 3-month modified Rankin Scale score of 0-2 indicated a favorable outcome. Results Of 470 patients, 166 were classified into the no anemia group, 168 into the mild anemia group, and 136 into the moderate-to-severe anemia group. Patients in the moderate-to-severe anemia group were older and more commonly had congestive heart failure than those in the other groups. Patients in the moderate-to-severe anemia group also had more device passes than those in the other groups (p < 0.001). However, no difference was observed in the rate of final extended thrombolysis in cerebral infarction ≥2b reperfusion or intracranial hemorrhage among the groups. A favorable outcome was less frequently achieved in the moderate-to-severe anemia group than in the no anemia group (adjusted odds ratio, 0.46; 95% confidence interval, 0.26-0.81) independent of the baseline Hb concentration. A restricted cubic spline model with three knots showed that the adjusted odds ratio for a favorable outcome was lower in patients with lower Hb concentrations within 24 h after MT. Conclusion Moderate-to-severe anemia within 24 h after MT is independently associated with a reduced likelihood of a favorable outcome. Clinical trial registration https://www.clinicaltrials.gov, NCT02251665.
Collapse
Affiliation(s)
- Ryoma Inui
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kanta Tanaka
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Soichiro Abe
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroyuki Ishiyama
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| |
Collapse
|