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Guo H, Huang T, Dai Y, Fan Q, Zhang Y, He Y, Huang S, He X, Hu P, Chen G, Zhu W, Zhong Z, Liu D, Lu L, Zhang F. A Functional Stent Encapsulating Radionuclide in Temperature-Memory Spiral Tubes for Malignant Stenosis of Esophageal Cancer. Adv Mater 2023; 35:e2307141. [PMID: 37929924 DOI: 10.1002/adma.202307141] [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] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/22/2023] [Indexed: 11/07/2023]
Abstract
Stent implantation is a commonly used palliative treatment for alleviating stenosis in advanced esophageal cancer. However, tissue proliferation induced by stent implantation and continuous tumor growth can easily lead to restenosis. Therefore, functional stents are required to relieve stenosis while inhibiting tissue proliferation and tumor growth, thereby extending the patency. Currently, no ideal functional stents are available. Here, iodine-125 (125 I) nuclides are encapsulated into a nickel-titanium alloy (NiTi) tube to develop a novel temperature-memory spiral radionuclide stent (TSRS). It has the characteristics of temperature-memory, no cold regions at the end of the stent, and a uniform spatial dose distribution. Cell-viability experiments reveal that the TSRS can reduce the proliferation of fibroblasts and tumor cells. TSRS implantation is feasible and safe, has no significant systemic radiotoxicity, and can inhibit in-stent and edge stenosis caused by stent-induced tissue proliferation in healthy rabbits. Moreover, TSRS can improve malignant stenosis and luminal patency resulting from continuous tumor growth in a VX2 esophageal cancer model. As a functional stent, the TSRS combines the excellent properties of NiTi with brachytherapy of the 125 I nuclide and will make significant contributions to the treatment of malignant esophageal stenosis.
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Affiliation(s)
- Huanqing Guo
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Tao Huang
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Yi Dai
- Institute of Machinery Manufacturing Technology, China Academy of Engineering Physics, Mianyang, 621900, P. R. China
| | - Qichao Fan
- Institute of Machinery Manufacturing Technology, China Academy of Engineering Physics, Mianyang, 621900, P. R. China
| | - Yanling Zhang
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Yao He
- Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics, Mianyang, 621900, P. R. China
| | - Shuke Huang
- Institute of Machinery Manufacturing Technology, China Academy of Engineering Physics, Mianyang, 621900, P. R. China
| | - Xiaofeng He
- Vascular and Interventional Therapy Department, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P. R. China
| | - Pan Hu
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Guanyu Chen
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Wenliang Zhu
- Department of Minimally Invasive & Interventional Radiology, Guangxi Medical University Cancer Hospital, Nanning, 530021, P. R. China
| | - Zhihui Zhong
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Dengyao Liu
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
- Department of Interventional Radiology, Cancer Hospital Affiliated to Xinjiang Medical University, Urumqi, 830011, P. R. China
| | - Ligong Lu
- Zhuhai Interventional Medical Center, Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, 519000, P. R. China
| | - Fujun Zhang
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
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Wu M, Xun M, Chen Y. Adaptation of Vascular Smooth Muscle Cell to Degradable Metal Stent Implantation. ACS Biomater Sci Eng 2023. [PMID: 37364226 DOI: 10.1021/acsbiomaterials.3c00637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Iron-, magnesium-, or zinc-based metal vessel stents support vessel expansion at the period early after implantation and degrade away after vascular reconstruction, eliminating the side effects due to the long stay of stent implants in the body and the risks of restenosis and neoatherosclerosis. However, emerging evidence has indicated that their degradation alters the vascular microenvironment and induces adaptive responses of surrounding vessel cells, especially vascular smooth muscle cells (VSMCs). VSMCs are highly flexible cells that actively alter their phenotype in response to the stenting, similarly to what they do during all stages of atherosclerosis pathology, which significantly influences stent performance. This Review discusses how biodegradable metal stents modify vascular conditions and how VSMCs respond to various chemical, biological, and physical signals attributable to stent implantation. The focus is placed on the phenotypic adaptation of VSMCs and the clinical complications, which highlight the importance of VSMC transformation in future stent design.
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Affiliation(s)
- Meichun Wu
- Hengyang Medical School, University of South China, Hengyang, Hunan 410001, China
- School of Nursing, University of South China, Hengyang, Hunan 410001, China
| | - Min Xun
- Institute of Pharmacy and Pharmacology, School of Pharmaceutical Science, University of South China, Hengyang, Hunan 410001, China
| | - Yuping Chen
- Hengyang Medical School, University of South China, Hengyang, Hunan 410001, China
- Institute of Pharmacy and Pharmacology, School of Pharmaceutical Science, University of South China, Hengyang, Hunan 410001, China
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Liu H, Wang R, Zhang L, Shi J, Yao J. Clinical Observation of Uninterrupted Thrombolytic Therapy via Indwelling Catheter for Lower Limb Deep Vein Thrombosis. Int J Gen Med 2023; 16:2493-2501. [PMID: 37342406 PMCID: PMC10278963 DOI: 10.2147/ijgm.s416814] [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: 04/12/2023] [Accepted: 06/10/2023] [Indexed: 06/22/2023] Open
Abstract
Purpose Observe uninterrupted thrombolytic therapy via indwelling catheter for lower limb deep vein thrombosis. Methods We retrospectively studied data from 32 patients with lower extremity deep vein thrombosis who received comprehensive treatment, consisting of general treatment, inferior vena cava filter implantation, interventional thrombolysis, angioplasty, stenting, and post-operative monitoring. Results The efficacy and safety of the comprehensive treatment were observed for a follow-up period of 6-12 months. The treatment was 100% effective; patient results indicated no serious bleeding, acute pulmonary embolism, or death after surgery. Conclusion The combination of intravenous and healthy side femoral vein puncture and directed thrombolysis to treat acute lower limb deep vein thrombosis is safe, effective, and minimally invasive while still achieving a good therapeutic effect.
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Affiliation(s)
- Haoyuan Liu
- Department of Intervention, Hexi University Affiliated Zhangye People’s Hospital, Zhangye City, Gansu Province, 734000, People’s Republic of China
| | - Rurong Wang
- Department of Intervention, Hexi University Affiliated Zhangye People’s Hospital, Zhangye City, Gansu Province, 734000, People’s Republic of China
| | - Liang Zhang
- Department of Intervention, Hexi University Affiliated Zhangye People’s Hospital, Zhangye City, Gansu Province, 734000, People’s Republic of China
| | - Jingming Shi
- Department of Intervention, Hexi University Affiliated Zhangye People’s Hospital, Zhangye City, Gansu Province, 734000, People’s Republic of China
| | - Jiaxi Yao
- Institute of Urology, Hexi University, Zhangye City, Gansu Province, 734000, People’s Republic of China
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Yu L, Chan J, Cetta F, Taggart NW, Anderson JH. Transcatheter Treatment of Native Coarctation of the Aorta in a Child Using a Balloon-Expandable Endoprosthesis. JACC Case Rep 2023; 14:101830. [PMID: 37077872 PMCID: PMC10106998 DOI: 10.1016/j.jaccas.2023.101830] [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: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 04/21/2023]
Abstract
A 7-year-old child with native coarctation of the aorta was treated by transcatheter therapy using a 29-mm balloon-expandable stent. The procedure was successful and free of complications, and the patient was discharged home the same day. This stent has several features making it uniquely advantageous for treating this condition. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Liwei Yu
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph Chan
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Frank Cetta
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine/Division of Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathaniel W. Taggart
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine/Division of Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason H. Anderson
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine/Division of Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Address for correspondence: Dr Jason H. Anderson, Mayo Clinic Hospital, Saint Marys Campus, 4th Floor Mary Brigh Building, 1216 2nd Street SW, Rochester, Minnesota 55902, USA. @Dr_JHAnderson
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Leick J, Rheude T, Denne M, Cassese S, Kastrati A, Hauptmann F, Gehrig T, Kuna C, Lindner M, Lauterbach M, Werner N. Comparison of long-term outcome in patients with calcified stenosis treated with intravascular lithotripsy or with modified balloon angioplasty: a propensity score-adjusted study. Front Cardiovasc Med 2023; 10:1185422. [PMID: 37255702 PMCID: PMC10225498 DOI: 10.3389/fcvm.2023.1185422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/13/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023] Open
Abstract
Background The aim of this two-center, all-comers registry was to compare the effectiveness and safety of intravascular lithotripsy (IVL) to that of modified balloon angioplasty (MB). MB angioplasty using a cutting or scoring balloon is commonly used in patients with calcified coronary arteries. IVL is a new technology for lesion preparation. This is the first study to compare MB with IVL. Methods The cohort included all patients treated by MB angioplasty or IVL between 2019 and 2021. The primary endpoint was strategy success (<20% residual stenosis). The secondary endpoint was long-term safety outcomes [cardiac death, acute myocardial infarction (AMI), target lesion failure/revascularization (TVR)]. Quantitative coronary angiography (QCA) was performed in all patients. Primary and secondary endpoints were compared using inverse probability of treatment weighting (IPTW) for treatment effect estimation. Results A total of n = 86 patients were treated by IVL and n = 92 patients by MB angioplasty. The primary endpoint was reached in 152 patients (85.4%). Patients in the IVL group had less residual stenosis (5.8% vs. 22.8%; p = 0.001) in QCA. Weighted multivariable regression analysis revealed that IVL had a significant positive effect on reaching the primary endpoint of strategy success [odds ratio (OR) 24.58; 95% confidence interval (95% CI) 7.40-101.86; p = 0.001]. In addition, severe calcification was shown to result in a lower probability of achieving the primary endpoint (OR 0.08; 95% CI 0.02-0.24; p = 0.001). During the follow-up period (450 days) there was no difference in cardiovascular mortality rate [IVL (n = 5) 2.8% vs. MB (n = 3) 1.7%; p = 0.129]. Patients with unstable angina at the time of the index procedure had the highest probability of cardiovascular death [hazard ratio (HR) 7.136; 95% CI 1.248-40.802; p = 0.027]. No differences were found in long-term rates of AMI (IVL 1.7% vs. MB 2.8%; p = 0.399; IVL HR 2.73; 95% CI 0.4-17.0; p = 0.281) or TVR (IVL 5.6% vs. MB 9%; p = 0.186; IVL HR 0.78; 95% CI 0.277-2.166; p = 0.626). Conclusion IVL leads to a significantly better angiographic intervention outcome compared to MB angioplasty in our cohort. During long-term follow-up, no differences in cardiovascular mortality, rate of acute myocardial infarction, or target lesion failure/revascularization were observed.
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Affiliation(s)
- Jürgen Leick
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Centre, Technical University Munich, Munich, Germany
| | - Michael Denne
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Salvatore Cassese
- Department of Cardiovascular Diseases, German Heart Centre, Technical University Munich, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiovascular Diseases, German Heart Centre, Technical University Munich, Munich, Germany
| | - Felix Hauptmann
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Thomas Gehrig
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Constantin Kuna
- Department of Cardiovascular Diseases, German Heart Centre, Technical University Munich, Munich, Germany
| | - Michael Lindner
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Michael Lauterbach
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Nikos Werner
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
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Sandali O, El Sanharawi M, Tahiri Joutei Hassani R, Armia Balamoun A, Duliere C, Ezzouhairi SM, Sallam AB, Borderie V. Use of Digital Methods to Optimize Visualization during Surgical Gonioscopy. J Clin Med 2023; 12:jcm12082794. [PMID: 37109131 PMCID: PMC10146903 DOI: 10.3390/jcm12082794] [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: 02/24/2023] [Revised: 03/17/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
Purpose: The aim of this study was to evaluate the efficacy of digital visualization for enhancing the visualization of iridocorneal structures during surgical gonioscopy. Methods: This was a prospective, single-center study on a series of 26 cases of trabecular stent implantation performed by the same surgeon. Images were recorded during surgical gonioscopy, and before stent implantation, with standard colors and with the optimization of various settings, principally color saturation and temperature and the use of the cyan color filter. Subjective analyses were performed by two glaucoma surgeons, and objective contrast measurements were made on iridocorneal structure images. Results: The surgeons evaluating the images considered the optimized digital settings to produce enhanced tissue visibility for both trabecular meshwork pigmentation and Schlemm's canal in more than 65% of cases. The mean difference in the standard deviation of the pixel intensity values was 37.87 (±4.61) for the optimized filter images and 32.37 (±3.51) for the standard-color images (p < 0.001). The use of a cyan filter provided a good level of contrast for the visualization of trabecular meshwork pigmentation. Increasing the color temperature highlighted the red appearance of Schlemm's canal. Conclusions: We report here the utility of optimized digital settings including the cyan filter and a warmer color for enhancing the visualization of iridocorneal structures during surgical gonioscopy. These settings could be used in surgical practice to enhance the visualization of the trabecular meshwork and Schlemm's canal during minimally invasive glaucoma surgery.
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Affiliation(s)
- Otman Sandali
- Centre Hospitalier National d'Ophtalmologie des XV-XX, 28 Rue de Charenton, 75571 Paris, France
- Service de Chirurgie Ambulatoire, Hôpital Guillaume-de-Varye, 18230 Bourges, France
| | - Mohamed El Sanharawi
- Service d'Ophtalmologie, Centre Hospitalier de Châteaudun, 28200 Châteaudun, France
| | | | - Ashraf Armia Balamoun
- Watany Eye Hospital, Cairo 11775, Egypt
- Watany Research and Development Centre, Cairo 11775, Egypt
- Ashraf Armia Eye Clinic, Giza 12655, Egypt
| | | | | | - Ahmed B Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Vincent Borderie
- Centre Hospitalier National d'Ophtalmologie des XV-XX, 28 Rue de Charenton, 75571 Paris, France
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De Simone L, Chiellino S, Spaziani G, Porcedda G, Calabri GB, Berti S, Favilli S, Stefani L, Santoro G. Acute Coronary Syndrome Treated with Percutaneous Coronary Intervention in Hutchinson-Gilford Progeria. Children (Basel) 2023; 10:children10030526. [PMID: 36980084 PMCID: PMC10047036 DOI: 10.3390/children10030526] [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] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/02/2023] [Indexed: 03/30/2023]
Abstract
Hutchinson-Gilford progeria syndrome is an extremely rare genetic disease caused by a de novo mutation in the LMNA gene, leading to an accumulation of a form of Lamin A, called Progerin, which results in a typical phenotype and a marked decrease in life expectancy, due to early atherosclerosis and cardiovascular disease. We report the case of a fourteen-year-old Chinese boy with Hutchinson-Gilford progeria syndrome admitted to the emergency room because of precordial pain. Physical examination showed tachycardia 130 beats/min and arterial hypertension: 170/120 mmHg, normal respiratory rate, no neurological impairment; ECG evidenced sinus tachycardia, left ventricular hypertrophy, horizontal ST-segment depression in I, aVL, II, III, aVF leads, and V4-V6 and ST-segment elevation in aVR and V1 leads. Echocardiography highlighted preserved global left ventricular function with concentric hypertrophy, altered diastolic flow pattern, mitral valve insufficiency, and minimal aortic regurgitation. Blood tests evidenced an increase in high-sensitivity troponin T level (335 pg/mL). NSTEMI diagnosis was performed, and the patient was admitted to the intensive care unit. A coronary CT angiography showed a severe obstruction of the common trunk of the left coronary artery, for which an urgent percutaneous coronary intervention (PCI) was proposed. A selective coronary angiography imaged complete chronic occlusion of the left main coronary artery as well as severe stenosis at the origin of a very enlarged right coronary artery that vascularized the left coronary artery through collaterals. Afterwards, the right coronary artery was probed using an Amplatz right (AR1) guiding catheter, through which a large 3.5 mm drug-eluting coronary stent (Xience Sierra, Abbott, Abbott Park, IL, USA) was implanted. At the end of the procedure, no residual stenosis was imaged and improved vascularization of the left coronary artery distribution segments was observed. Dual antiplatelet therapy (DAPT) consisting of aspirin (75 mg daily) and clopidogrel (37.5 mg daily) and anti-hypertensive therapy were started. At the one-year follow-up, the patient had not reported any occurrence of anginal chest pain.
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Affiliation(s)
- Luciano De Simone
- Paediatric Cardiology, "Meyer" Children's Hospital, University of Florence, Viale Pieraccini, 24, 50139 Florence, Italy
| | - Serena Chiellino
- Paediatric Cardiology, "Meyer" Children's Hospital, University of Florence, Viale Pieraccini, 24, 50139 Florence, Italy
| | - Gaia Spaziani
- Paediatric Cardiology, "Meyer" Children's Hospital, University of Florence, Viale Pieraccini, 24, 50139 Florence, Italy
| | - Giulio Porcedda
- Paediatric Cardiology, "Meyer" Children's Hospital, University of Florence, Viale Pieraccini, 24, 50139 Florence, Italy
| | - Giovan Battista Calabri
- Paediatric Cardiology, "Meyer" Children's Hospital, University of Florence, Viale Pieraccini, 24, 50139 Florence, Italy
| | - Sergio Berti
- Interventional Cardiology, "Heart Hospital", National Research Council-Tuscany Foundation "G. Monasterio", 54100 Massa, Italy
| | - Silvia Favilli
- Paediatric Cardiology, "Meyer" Children's Hospital, University of Florence, Viale Pieraccini, 24, 50139 Florence, Italy
| | - Laura Stefani
- Sports Medicine Center, Clinical and Experimental Department, University of Florence, 50134 Florence, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, "Heart Hospital", National Research Council-Tuscany Foundation "G. Monasterio", 54100 Massa, Italy
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Fu X, Jiang W, Mu M, Wang G, Qi H, Chen Z, Zuo M, Gao F. Effect of percutaneous stenting strategy of unresectable malignant hilar biliary obstruction by three-dimensional reconstruction volumetry. Cancer Med 2023; 12:9506-9516. [PMID: 36808263 PMCID: PMC10166933 DOI: 10.1002/cam4.5720] [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: 10/14/2022] [Revised: 01/15/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
PURPOSE To explore clinical outcomes of percutaneous stent implantation using volumetric criteria for unresectable malignant hilar biliary obstruction (MHBO). Additionally, aimed to identify the predictors of patients' survival. METHODS Seventy-two patients who were initially diagnosed with MHBO between January 2013 to December 2019 in our center were retrospectively included. Patients were stratified according to the drainage achieved ≥50%, <50% of the total liver volume. Patients were divided into two groups: Group A (≥50% drainage), and Group B (<50% drainage). The main outcomes were evaluated in terms of relief of jaundice, effective drainage rate, and survival. Related factors that affect survival were analyzed. RESULTS 62.5% of the included patients reached effective biliary drainage. The successful drainage rate was significantly higher in Group B than in Group A (p < 0.001). The median overall survival (mOS) of included patients was 6.4 months. Patients who received drainage ≥50% of hepatic volume achieved longer mOS than those who received drainage <50% of hepatic volume (7.6 months vs. 3.9 months, respectively, p = 0. 011). Patients who received effective biliary drainage had longer mOS than those who received ineffective biliary drainage (10.8 months vs. 4.4 months, respectively, p < 0.001). Patients who received anticancer treatment had longer mOS than those who only received palliative therapy (8.7 months vs. 4.6 months, respectively, p = 0.014). In the multivariate analysis, KPS Score ≥ 80 (p = 0.037), ≥50% drainage achieved (p = 0.038), and effective biliary drainage (p = 0.036) were protective prognostic factors that affected patients' survival. CONCLUSION Drainage achieved ≥50% of the total liver volume by percutaneous transhepatic biliary stenting seemed to have a higher effective drainage rate in MHBO patients. Effective biliary drainage may create chances for these patients to receive anticancer therapies that seem to provide survival benefits.
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Affiliation(s)
- Xiaobo Fu
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Weiwei Jiang
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Maoyuan Mu
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guobao Wang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Han Qi
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zixiong Chen
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Mengxuan Zuo
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Fei Gao
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Yuan SL, Kim MH, Lee KM, Jin X, Song ZY, Park JS, Cho YR, Lim K, Yun SC. Sex differences between serum uric acid levels and cardiovascular outcomes in patients with coronary artery disease after stent implantation. Front Cardiovasc Med 2023; 10:1021277. [PMID: 36815018 PMCID: PMC9939523 DOI: 10.3389/fcvm.2023.1021277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/17/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023] Open
Abstract
Background The relationship between elevated serum uric acid (SUA) levels and cardiovascular outcomes after stent implantation remains uncertain. This study sought to evaluate the impact of SUA on 12-month cardiovascular outcomes after stent implantation. Methods We performed a retrospective study of patients who successfully underwent stent implantation and enrolled 3,222 patients with coronary artery disease (CAD) from a single center. SUA levels were measured before stent implantation. The patients were divided into six groups (<4, 4-4.9, 5-5.9, 6-6.9, 7-7.9 and ≥ 8 mg/dL) at SUA intervals of 1.0 mg/dL. The incidence of cardiovascular outcomes in the six groups was monitored for 1 year after stent implantation and the hazard ratios were estimated. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for cardiovascular outcomes were estimated using a Cox proportional hazard regression analysis. The primary endpoint was all-cause death. The secondary endpoint was a composite of all-cause death, myocardial infarction, target vessel revascularization, stent thrombosis and stroke. The follow-up duration was 12 months. Results Over the 12-month follow-up period, there were 101 all-cause deaths and 218 MACCE. After adjustment for several parameters, the group with SUA levels of more than or equal to 8 mg/dL had significantly higher hazard ratios in the incidence of all-cause death or MACCE. The group with <4.0 mg/dL had significantly higher hazard ratios in all-cause death only in male patients. In contrast, there were no significant differences observed for cardiovascular outcomes in female patients. Conclusions Our study identified a U-shaped association between SUA levels and cardiovascular outcomes during 12-month follow-up for males, but not for females. Further studies are warranted to clarify the sex differences between SUA levels and clinical outcomes.
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Affiliation(s)
- Song Lin Yuan
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea,*Correspondence: Moo Hyun Kim ✉
| | - Kwang Min Lee
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Xuan Jin
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Zhao Yan Song
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Jong-Sung Park
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Young-Rak Cho
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Kyunghee Lim
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Yan L, Song J, Yu Y, Hou Z, Fu W, Cui R, Wan M, Xu X, Lv M, Wang Y, Miao Z, Lou X, Ma N. Predictors of hyperperfusion syndrome after stent implantation in symptomatic intracranial atherosclerotic stenosis. Quant Imaging Med Surg 2023; 13:1048-1057. [PMID: 36819235 PMCID: PMC9929400 DOI: 10.21037/qims-22-682] [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: 06/27/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
Background Hyperperfusion syndrome (HPS) is a serious complication after stent implantation in symptomatic intracranial atherosclerotic stenosis (ICAS). This study aims to explore the predictive value of preprocedural computed tomography perfusion (CTP) for HPS after intracranial stenting. Methods In this retrospective case-control study we collected data from consecutive patients from June 2012 to September 2019 who underwent stent implantation due to severe symptomatic ICAS. Patients who underwent CTP before the procedure were enrolled. CTP was postprocessed using the automated RAPID software to assess the preoperative cerebral perfusion. According to the presence or absence of HPS, the patients were classified into two groups: the HPS group and the non-HPS group. The baseline data, lesion characteristics, and preoperative CTP parameters between the two groups were compared. The receiver operating characteristic (ROC) curve analysis was performed to determine the optimal predictor of HPS. Results Among the 170 eligible patients, 6 patients (3.53%) had HPS, including 3 who presented with intracranial hemorrhages (ICHs), 1 who had dysphoria, 1 who had delirium, and 1 who had a headache. There were no significant differences in baseline and lesion characteristics between the HPS and non-HPS groups. Compared with the non-HPS group, the HPS group had a significantly higher volume of time-to-maximum (Tmax) >4 s (429.5 vs. 93 mL; P=0.006) and Tmax >6 s (200 vs. 0 mL; P=0.003). The optimal volume threshold for maximizing sensitivity in predicting HPS was 65.5 mL with Tmax >4 s [area under the curve (AUC), 0.832; 95% confidence interval (CI): 0.650 to 1.000; P=0.006]. Conclusions Tmax >4 s volume may be a predictor of HPS after stent implantation in symptomatic ICAS. Further prospective studies should be conducted to confirm our conclusion.
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Affiliation(s)
- Long Yan
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jia Song
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;,China National Clinical Research Center for Neurological Diseases, Beijing, China;,Department of Neurology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou, China
| | - Ying Yu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;,China National Clinical Research Center for Neurological Diseases, Beijing, China;,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhikai Hou
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;,China National Clinical Research Center for Neurological Diseases, Beijing, China;,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weilun Fu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Rongrong Cui
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;,China National Clinical Research Center for Neurological Diseases, Beijing, China;,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Min Wan
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaotong Xu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China;,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xin Lou
- Department of Radiology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;,China National Clinical Research Center for Neurological Diseases, Beijing, China
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11
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Kasar T, Erkut O, Tanidir İC, Şahin M, Topkarci MA, Guzeltas A. Balloon-expandable stents for native coarctation of the aorta in children and adolescents. Medicine (Baltimore) 2022; 101:e32332. [PMID: 36595787 PMCID: PMC9794334 DOI: 10.1097/md.0000000000032332] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Although balloon-expandable stent implantation for native aortic coarctation is a preferred method in the adolescent age group, there are insufficient data about indications for and the efficacy of the procedure in a younger age group. The aim of this study was to compare and evaluate the data of young pediatric and adolescent patients who underwent balloon-expandable stent implantation because of native aortic coarctation. The retrospective analysis included the demographic characteristics and data related to the procedure and follow-up of patients who underwent stent implantation for native aortic coarctation between August 2010 and November 2017. Patients with re-coarctation were excluded from the study. The patients were separated into 2 groups as the adolescent group (Group I: 10-18 years) and the pediatric group (Group II: ≤ 9.9 years). Group-I comprised of 18 patients and Group-II, 32 patients. Covered stent was implanted to 32 (73%) patients and uncovered stent to 12 (27%) patients. The procedural success rate was 100%. Following stent implantation, peak systolic gradient decreased significantly in both groups (P < .0001) (Group-I: from 35.9 ± 16.6 mm Hg-2.2 ± 3.4 mm Hg, Group II: from 34 ± 13.3 mm Hg-3 ± 4.09 mm Hg). Complications developed in 3 patients, and all in Group I. Femoral hematoma developed in 1 patient, balloon rupture occurred during the procedure in 1 patient, and there was temporary loss of pulse in 1 patient. All the complications were treated successfully. All the patients were taking anti-hypertensive drugs before intervention and during the mean 23-month follow-up period (range, 2-84 months), hypertension recovered in 35 (80%) patients and drugs were terminated. Stent implantation for aortic coarctation in the pediatric age group may provide pleasing results, reducing the coarctation gradient, providing effective dilatation in the lesion area and eliminating hypertension.
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Affiliation(s)
- Taner Kasar
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
- * Correspondence: Taner kasar, Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istasyon Mah.Turgut Ozal Bulvari No:11 Kucukcekmece, Istanbul 34303, Turkey (e-mail: )
| | - Ozturk Erkut
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - İ. Cansaran Tanidir
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Murat Şahin
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - M. Akin Topkarci
- Department of Anesthesia, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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12
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Odemis E, Çelikyurt A. Treatment of 12-year-old girl with midaortic syndrome by using Cook Formula stent. Cardiol Young 2022; 32:1695-7. [PMID: 35301967 DOI: 10.1017/S1047951122000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Middle aortic syndrome is a severe form of aortic coarctation and mostly involves the thoracic and abdominal part of the aorta. Traditional surgical approach has some potential risks and repetitive operations. Percutaneous stent implantation is a feasible and safe method for the palliation of middle aortic syndrome in childhood. Herein, a child with middle aortic syndrome was presented who has been treated by transcatheter stent implantation.
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13
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Li X, Hu H, Guo D, Hu Y, Zhou H, Chen Y, Fang X. Imbalance of Pro- and Anti-inflammatory Cytokines Induced Different Types of Recurrent Atrial Arrhythmias after Drug Eluting Coronary Stent Implantation. Curr Vasc Pharmacol 2022; 20:447-456. [PMID: 36045517 DOI: 10.2174/1570161120666220831094507] [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: 03/07/2022] [Revised: 06/08/2022] [Accepted: 07/27/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Atrial arrhythmias are associated with an increased risk of stroke and death in the elderly. The risk and predictive factors of recurrent atrial arrhythmias in elderly patients after coronary stenting are not well known. OBJECTIVE This research sought to investigate the roles of pro- and anti-inflammatory cytokine imbalances in different types of recurrent atrial arrhythmias in elderly patients defined as individuals aged 65 years or older after sirolimus eluting stent (Cordis, Warren, New Jersey) implantation. METHODS We measured interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), interleukin-17 (IL-17), interleukin-13 (IL-13) and interleukin- 37 (IL-37) in elderly patients with recurrent atrial arrhythmias and assessed the impact of pro- and antiinflammatory cytokine imbalances on recurrent atrial arrhythmias in elderly patients after coronary stenting. RESULTS Levels of IL-1 β, IL-6, IL-8, and TNF-α were remarkably increased (p<0.001), and IL-10, IL- 17, IL-13, and IL-37 were remarkably lowered (p<0.001) in elderly patients with recurrent atrial arrhythmias after coronary stent implantation. Imbalance of pro- and anti-inflammatory cytokines induced recurrent atrial arrhythmias after coronary stenting. Pro- and anti-inflammatory cytokine imbalances may be used to identify elderly patients who have an increased risk of developing recurrent atrial arrhythmias after coronary stenting. CONCLUSION The imbalance of pro- and anti-inflammatory cytokines was associated with recurrent atrial arrhythmias in elderly patients after coronary stenting. Pro- and anti-inflammatory cytokines may be clinically useful biomarkers for predicting recurrent atrial arrhythmias in elderly patients after coronary stent implantation.
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Affiliation(s)
- Xia Li
- Xiamen Road Branch Hospital, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, China
| | - Haibo Hu
- Xiamen Road Branch Hospital, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, China
| | - Dianxuan Guo
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, China
| | - Youdong Hu
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, China
| | - Hualan Zhou
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, China
| | - Ying Chen
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, China
| | - Xiang Fang
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, China
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14
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高 华, 陈 文, 卢 晓, 童 军. [Balloon dilation with stent implantation for the treatment of Eustachian tube obstruction]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:715-718. [PMID: 36036075 PMCID: PMC10127627 DOI: 10.13201/j.issn.2096-7993.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/15/2021] [Indexed: 06/15/2023]
Abstract
When the Eustachian tube is dysfunctional, the external air cannot enter the middle ear, resulting in a negative pressure state in the middle ear, which can cause a series of pathological changes in the middle ear. In this paper, 13 patients with recurrence of otitis media after balloon dilatation of the Eustachian tube were treated with stenting in the Eustachian tube for Eustachian tube dysfunction with satisfactory results, and this method can provide a reference for the clinical treatment of Eustachian tube dysfunction.
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Affiliation(s)
- 华公 高
- 同济大学附属上海市第四人民医院耳鼻咽喉科(上海,200434)Department of Otolaryngology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, 200434, China
| | - 文文 陈
- 同济大学附属上海市第四人民医院耳鼻咽喉科(上海,200434)Department of Otolaryngology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, 200434, China
| | - 晓清 卢
- 同济大学附属上海市第四人民医院耳鼻咽喉科(上海,200434)Department of Otolaryngology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, 200434, China
| | - 军 童
- 同济大学附属上海市第四人民医院耳鼻咽喉科(上海,200434)Department of Otolaryngology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, 200434, China
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15
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Jiang G, Ding D, Zhang X, Niu S, Lyu B. Efficacy of one-stop endovascular intervention in treatment of left iliac vein compression syndrome complicated with deep venous thrombosis of lower limbs. Zhejiang Da Xue Xue Bao Yi Xue Ban 2022; 51:341-349. [PMID: 36161716 PMCID: PMC9511488 DOI: 10.3724/zdxbyxb-2022-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/20/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To evaluate the clinical effect and safety of one-stop endovascular intervention in treatment of left iliac vein compression syndrome (IVCS) complicated with deep venous thrombosis (DVT) of lower limbs. METHODS Clinical data of 26 patients with secondary DVT due to IVCS admitted in the Department of Vascular Surgery, Hebei General Hospital from January 2018 to December 2021 were retrospectively analyzed. All patients underwent one-stop endovascular intervention procedure, including ultrasound-guided deep venipuncture, Angiojet catheter aspiration, iliac vein balloon dilation, stent implantation and simultaneous filter retrieval. The operation time and catheter aspiration time were documented; the preoperative and postoperative left lower extremity deep vein venous patency, circumferences of bilateral limbs at 15 cm above the knee and 10 cm below the knee, and the levels of hemoglobin, creatinine, alanine aminotransferase (ALT), aspertate aminotransferase (AST), total bilirubin and indirect bilirubin were measured. The incidence of post-thrombotic syndrome (PTS) and iliac vein stent patency were recorded through follow-up. RESULTS The one-stop endovascular intervention was successfully performed in 26 patients, with the operation time of (171±35) min and the thrombolysis time of (263±89) s. After treatment, the left lower extremity deep vein venous patency, circumferences of bilateral limbs at 15 cm above the knee and 10 cm below the knee were decreased (all P<0.01); the hemoglobin level were decreased, the creatinine, ALT, AST, total bilirubin and indirect bilirubin levels were increased (all P<0.01). Patients were followed up for 1-12 months. Stent thrombosis occurred in 1 patient 7 months after procedure, and the symptoms were improved after conservative treatment; the stents were unobstructed in all patients, 1 patient had stent mural thrombosis, in whom the stent blood flow was not affected. No PTS was observed during the follow-up. CONCLUSIONS The one-stop endovascular interventional treatment of IVCS complicated with DVT of left lower limb is safe and effective. Attention should be paid to the changes of liver and kidney function caused by catheter aspiration during the treatment, and corresponding intervention should be given in time to avoid the occurrence of related complications.
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16
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Fang Y, Lin M, Chen L, Yang C, Liu A. Association between LDL/HDL ratio and in-stent restenosis in patients with acute coronary syndrome after stent implantation. Biomark Med 2022; 16:673-680. [PMID: 35574807 DOI: 10.2217/bmm-2021-1089] [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: 11/21/2022] Open
Abstract
Background: The relationship between LDL/HDL ratio and in-stent restenosis in acute coronary syndrome is unknown. Methods: This observational study recruited 256 patients with acute coronary syndrome who were being followed up by angiography after stenting. The patients were divided into in-stent restenosis (59%) and non-in-stent restenosis (41%) groups. Three stepwise multivariate logistic regression models and area under the curve were conducted to determine the role of LDL/HDL ratio in predicting in-stent restenosis. Results: LDL/HDL ratio was significantly associated with risk of in-stent restenosis (odds ratio ≈ 2.00; p < 0.05 for all) in three models. A good predictive performance of LDL/HDL ratio on in-stent restenosis was found with an area under the curve of 0.74. Conclusion: LDL/HDL ratio was independently associated with the risk of in-stent restenosis in acute coronary syndrome.
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Affiliation(s)
- Yang Fang
- Department of Cardiology, Benxi Central Hospital, Benxi, Liaoning Province, 117000, China
| | - Min Lin
- Department of Cardiology, Benxi Central Hospital, Benxi, Liaoning Province, 117000, China
| | - Lei Chen
- Department of Cardiology, Benxi Central Hospital, Benxi, Liaoning Province, 117000, China
| | - Chunyan Yang
- Department of Cardiology, Benxi Central Hospital, Benxi, Liaoning Province, 117000, China
| | - Aijun Liu
- Department of Cardiology, Benxi Central Hospital, Benxi, Liaoning Province, 117000, China
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17
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Pawłowski T, Legutko J, Kochman J, Roleder T, Pręgowski J, Chmielak Z, Kubica J, Ochała A, Parma R, Grygier M, Dudek D, Wojakowski W, Bartuś S, Witkowski A, Gil R. Clinical use of intracoronary imaging modalities in Poland. Expert opinion of the Association of Cardiovascular Interventions of the Polish Cardiac Society. Kardiol Pol 2022; 80:509-519. [PMID: 35290660 DOI: 10.33963/kp.a2022.0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022]
Abstract
The article presents the most common, current indications for the use of intravascular invasive imag-ing diagnostic techniques, i.e. intravascular ultrasound and optical coherence tomography in Polish invasive cardiology centers. The application of the above-mentioned techniques in the diagnosis of stenosis of the left main coronary artery, optimization of stent implantation procedures, treatment of calcified lesions, and other clinically important issues are discussed.
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Affiliation(s)
- Tomasz Pawłowski
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Center of Postgraduate Medical Education, Warszawa, Poland.
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.,John Paul II Hospital, Kraków, Poland
| | - Janusz Kochman
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Tomasz Roleder
- Cardiology Department, Specialist Hospital in Wrocław, Research and Development Center, Wrocław, Poland
| | - Jerzy Pręgowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Zbigniew Chmielak
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Andrzej Ochała
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Radosław Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Marek Grygier
- Chair and 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology, Collegium Medicum, Jagiellonian University, Kraków, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology, Collegium Medicum, Jagiellonian University, Kraków, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Robert Gil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Center of Postgraduate Medical Education, Warszawa, Poland
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18
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Cherpak BV, Davydova YV, Kravchenko VI, Yaschuk NS, Siromakha SO, Lazoryshynets VV. Management of percutaneous treatment of aorta coarctation diagnosed during pregnancy. J Med Life 2022; 15:208-213. [PMID: 35419094 PMCID: PMC8999110 DOI: 10.25122/jml-2021-0363] [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: 10/25/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Management of coarctation of the aorta (CoA) during pregnancy is complicated by increased procedural risks to the pregnant woman and her fetus. The aim of this research was to analyze 10-years of experience of CoA treatment diagnosed during pregnancy. During 2010–2020 we performed percutaneous stents implantations (SI) in 4 women during 15–23 weeks of pregnancy and in 6 women 48 hours – 5 years after delivery. In all presented cases, successful CoA repair was achieved. There was a significant decrease of peak-to-peak invasive systolic pressure gradient across the CoA (60.0±31.2 and 11.8±7.3 mmHg, p=0.001) and mean noninvasive systolic arterial pressure (163.0±46.2 and 120.5±9.2 mmHg, p=0.01) after SI. All percutaneously treated women during pregnancy (n=4) delivered healthy full-term babies. At follow-up (from 2 months to 10 years), all 10 women are alive without significant Doppler gradient across CoA with no signs of aortic aneurysm formation. To the best of our knowledge, we presented the largest published cohort of CoA percutaneous treatment during pregnancy. We categorized our experience in managing aortic coarctation diagnosed during pregnancy in one algorithm. Our experience demonstrates that excellent maternal and neonatal pregnancy outcomes can be obtained in women after CoA percutaneous repair, diagnosed during pregnancy. An aortic stent implantation is effective and safe for both mother and fetus.
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Affiliation(s)
- Bogdan Volodymyrovych Cherpak
- Pediatric Cardiology and Cardiosurgery Department, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine,*Corresponding Author: Bogdan Volodymyrovych Cherpak, Pediatric Cardiology and Cardiosurgery Department, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine. E-mail:
| | - Yulia Volodymyrivna Davydova
- Obstetrics Department for Extragenital Pathology in Pregnant Women, Institute of Pediatrics, Obstetrics and Gynecology NAMS, Kyiv, Ukraine
| | - Vitalii Ivanovich Kravchenko
- Department of Surgical Treatment of Aortic Pathology, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine
| | - Natalia Sergiivna Yaschuk
- Pediatric Cardiology Intervention Department, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine
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19
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Takahashi Y, Hayakawa A, Sano R, Fukuda H, Kubo R, Tokue H, Okawa T, Kawamura M, Kominato Y. Usefulness of a tissue optical clearing technique for forensic autopsy. J Forensic Sci 2022; 67:1124-1131. [PMID: 35088897 DOI: 10.1111/1556-4029.14995] [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: 11/04/2021] [Revised: 12/23/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
Forensic pathologists are required to investigate lethal trauma or disease at autopsy. In addition to massive contusions of various organs, a number of small features with potentially fatal implications also need to be sought. Since such lesions may need microscopic examinations for detailed evaluation, it is important to select suitable anatomic locations for tissue sampling. For practical screening of small lesions, we have developed a tissue optical clearing (TOC) technique for forensic autopsy. The technique involves clearing with a non-toxic organic solvent, ethyl cinnamate, which renders excised organs transparent, while hemorrhages or blood-containing vessels remain opaque. Using this technique, tiny hemorrhages in the spinal cord were able to be identified by gross examination, allowing proper selection of locations for tissue sampling. Subsequent histopathological evaluation was successfully performed with no apparent artifacts related with the TOC procedure. In addition, a combination of TOC and targeted CT angiography allowed feasible examination of the arterial occlusive lesion in the superior mesenteric artery, and when combined with micro-CT scanning it was useful for evaluating the lumen of the coronary artery with stent implantation. The results obtained so far indicated that TOC could complement routine forensic autopsy procedures when detailed evaluation of small lesions is required.
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Affiliation(s)
- Yoichiro Takahashi
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Akira Hayakawa
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Rie Sano
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Haruki Fukuda
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Rieko Kubo
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology & Nuclear Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Takafumi Okawa
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Miki Kawamura
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
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20
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Lin Y, Zhu L, Li X, Ba H, He X, Li S. Stent implantation in severe aortic coarctation in a pediatric patient with Turner syndrome: Case report and literature review. Front Pediatr 2022; 10:1041728. [PMID: 36776680 PMCID: PMC9909388 DOI: 10.3389/fped.2022.1041728] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Turner syndrome is a rare systemic disease and a significant proportion of these patients experience aortic coarctation. Selection of optimal therapy for aortic coarctation in patients with Turner syndrome is difficult due to the pathologic change of the systemic vessel. CASE PRESENTATION We report one successful case of covered stent implantation for the treatment of severe native coarctation of the aorta in a 15-year-old patient with Turner syndrome weighing 36 kg. A covered stent was implanted in this patient. After the stent implantation, the peak systolic pressure gradient immediately decreased from 48 mmHg to 14 mmHg. The aortic diameter at the coarctation site increased from 3 mm to 10 mm after stenting. A femoral arterial complication occurred in this case, and we stabilized the situation finally. RESULTS During a follow-up of 3 years, no restenosis of aortic coarctation was observed and the patient no longer experienced hypertension. The dissection of the right femoral artery remained stable. CONCLUSION A covered stent implantation for severe aortic coarctation in patients with Turner syndrome could be safe and effective. However, caution should be taken when using the technique to prevent complications.
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Affiliation(s)
- Yuese Lin
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Ling Zhu
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Xuandi Li
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Hongjun Ba
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Xiufang He
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Shujuan Li
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
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Kamann S, Haase T, Stolzenburg N, Löchel M, Peters-Berg D, Schütt D, Schnorr J. Bare Metal Stents on Resveratrol-Coated Balloons in Porcine Coronary and Peripheral Arteries. Int J Mol Sci 2021; 22:13099. [PMID: 34884903 DOI: 10.3390/ijms222313099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 12/02/2022] Open
Abstract
Balloon angioplasty and stent implantation are standard techniques to reopen stenotic vessels. Often, balloons or stents coated with cytostatic drugs are used to prevent re-occlusion of the arteries. Resveratrol, which is known for its numerous beneficial effects on cardiovascular health, is used as an antioxidant additive on paclitaxel-coated balloon catheters. What is still unclear is whether resveratrol-only balloon coating in combination with a bare metal stent (BMS) also has positive effects on vascular healing. Here, we analyzed neointimal thickening, fibrin deposition, inflammation, vasa vasorum density, and reendothelialization after implantation of BMS via a resveratrol coated balloon approach in a porcine model. In general, resveratrol treatment did not result in significantly altered responses compared to the control group in peripheral arteries. In coronary arteries, an increase in vasa vasorum density became evident three days after resveratrol treatment compared to the control group and abolished up to day 7. Significant effects of the resveratrol treatment on the fibrin score or intima-media area were transient and restricted to either peripheral or coronary arteries. In conclusion, local single-dose resveratrol treatment via a resveratrol-only coated balloon and BMS approach did not lead to adverse systemic or local effects, but also no significant beneficial effects on vascular healing were detected in the current study.
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22
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Liu K, Liu X, Shi C, Liu S, Du H, Li Y, Wang N, Feng Z, Jiang H. Double plastic stent implantation for recurrent acute pancreatitis with incomplete pancreas divisum: a case report and literature review. J Int Med Res 2021; 49:3000605211060142. [PMID: 34842463 PMCID: PMC8647234 DOI: 10.1177/03000605211060142] [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] [Indexed: 11/17/2022] Open
Abstract
Pancreas divisum (PD) is a common pancreatic malformation caused by the failure of fusion between ventral and dorsal pancreatic ducts. There is a small branch of communication between the two systems in incomplete PD, and this variation has an incidence of 15%. A 43-year-old female patient presented to our department with recurrent abdominal pain. Magnetic resonance cholangiopancreatography (MRCP) showed that the ventral pancreatic duct was curved, with a local pouchlike dilatation. Endoscopic ultrasonography supported the diagnosis of incomplete PD and showed a thin branch of communication between ventral and dorsal pancreatic ducts. Endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy of the minor papilla with double plastic stent implantation were performed. One pancreatic plastic stent was inserted across the minor and major papilla over the guide wire, creating a U-shape. The other wire-guided plastic stent was inserted through the minor papilla into the dorsal pancreatic duct. The pancreatic fluid drained smoothly after stent placement. During the 6-month follow-up, the patient remained well, without recurrence of pancreatitis.
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Affiliation(s)
- Kunyi Liu
- Department of Gastroenterology, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, 71213Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xuechen Liu
- Department of Gastroenterology, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, 71213Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Chengyi Shi
- Department of Gastroenterology, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, 71213Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Siqi Liu
- Department of Gastroenterology, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, 71213Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Hongwei Du
- Department of Gastroenterology, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, 71213Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yan Li
- Department of Gastroenterology, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, 71213Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Na Wang
- Department of Gastroenterology, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, 71213Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhijie Feng
- Department of Gastroenterology, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, 71213Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Huiqing Jiang
- Department of Gastroenterology, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, 71213Second Hospital of Hebei Medical University, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Shi Y, Wang Y, Sun X, Tang Y, Jiang M, Bai Y, Liu S, Jiang W, Yuan H, Lu Y, Cai J. Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2021; 11:e044072. [PMID: 34187815 PMCID: PMC8245450 DOI: 10.1136/bmjopen-2020-044072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The survival benefit of using mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) is still controversial. It is necessary to explore the impact on clinical outcomes of MCS in patients with AMI undergoing stenting. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Cochrane Library, Medline, PubMed, Web of Science, ClinicalTrials.gov and Clinicaltrialsregister.eu databases were searched from database inception to February 2021. ELIGIBILITY CRITERIA Randomised clinical trials (RCTs) on MCS use in patients with AMI undergoing stent implantation were included. DATA EXTRACTION AND SYNTHESIS Data were extracted and summarised independently by two reviewers. Risk ratios (RRs) and 95% CIs were calculated for clinical outcomes according to random-effects model. RESULTS Twelve studies of 1497 patients with AMI were included, nine studies including 1382 patients compared MCS with non-MCS, and three studies including 115 patients compared percutaneous ventricular assist devices (pVADs) versus intra-aortic balloon pump (IABP). Compared with non-MCS, MCS was not associated with short-term (within 30 days) (RR=0.90; 95% CI 0.57 to 1.41; I2=46.8%) and long-term (at least 6 months) (RR=0.82; 95% CI 0.57 to 1.17; I2=37.6%) mortality reductions. In the subset of patients without cardiogenic shock (CS) compared with non-MCS, the patients with IABP treatment significantly had decreased long-term mortality (RR=0.49; 95% CI 0.27 to 0.90; I2=0), but without the short-term mortality reductions (RR=0.51; 95% CI 0.22 to 1.19; I2=17.9%). While in the patients with CS, the patients with MCS did not benefit from the short-term (RR=1.09; 95% CI 0.67 to 1.79; I2=46.6%) or long-term (RR=1.00; 95% CI 0.75 to 1.33; I2=22.1%) survival. Moreover, the application of pVADs increased risk of bleeding (RR=1.86; 95% CI 1.15 to 3.00; I2=15.3%) compared with IABP treatment (RR=1.86; 95% CI 1.15 to 3.00; I2=15.3%). CONCLUSIONS In all patients with AMI undergoing stent implantation, the MCS use does not reduce all-cause mortality. Patients without CS can benefit from MCS regarding long-term survival, while patients with CS seem not.
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Affiliation(s)
- Yunmin Shi
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yujie Wang
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuejing Sun
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Tang
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mengqing Jiang
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuanyuan Bai
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Suzhen Liu
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weihong Jiang
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Yuan
- Clinical Research Center, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao Lu
- Clinical Research Center, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jingjing Cai
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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24
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Sakellariou XM, Katsanos GI, Efstathopoulos AP, Sfairopoulos DG, Stamatis KV, Pappas SD, Kolettis TM, Nikas DN. Should Deferred Stenting Still Be Considered in ST-Elevation Myocardial Infarction with High Thrombus Burden? J Cardiovasc Dev Dis 2021; 8:jcdd8060059. [PMID: 34063837 PMCID: PMC8224060 DOI: 10.3390/jcdd8060059] [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: 04/27/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) may demonstrate distal microvascular embolization of thrombotic materials. We retrospectively examined 20 cases displaying extensive thrombus in the infarct-related artery (IRA), treated either with a two-step procedure, with interim tirofiban infusion, or immediate stent implantation. Distal embolization tended to be more common in the latter strategy, but, overall, the outcome was comparable. Thus, a two-staged procedure may be considered in selected cases of primary PCI associated with high thrombus burden.
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25
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Shi W, Yan L, Yang J, Yu M. Ethnic variance on long term clinical outcomes of concomitant use of proton pump inhibitors and clopidogrel in patients with stent implantation: A PRISMA-complaint systematic review with meta-analysis. Medicine (Baltimore) 2021; 100:e24366. [PMID: 33578533 PMCID: PMC7886473 DOI: 10.1097/md.0000000000024366] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pharmacokinetic and pharmacodynamic study showed a lower clopidogrel response when coprescribed with proton pump inhibitors (PPIs). Despite this, PPIs is necessary for patients treated with long term dual antiplatelet therapy (DAPT). Ethnic variance also played a different effect on clopidogrel response. Our study evaluated the effect of concomitant use of DAPT and PPIs and assessed whether ethnic variance exert different effect on clinical outcomes. METHODS We carefully searched EMBASE, PubMed/Medline databases, and the Cochrane library in April 2019. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) and individual endpoints reported. We also focused on bleeding events. Studies were excluded if the follow-up were <12 months and patients were not treated with clopidogrel after stent implantation. RESULTS A total of 18 studies were included in the systematic review (involving 79,670 patients). No randomized controlled trials (RCTs) were included. PPIs comedication were associated with increased MACCE (odds ratio [OR] = 1.38; 95% confidence interval [CI] = 1.28-1.49) while not associated with decreased bleeding risks, such as gastrointestinal bleeding (OR = 1.05; 95% CI = 0.53-2.11). PPIs comedication were associated with increased risk for all endpoints among Caucasian population while not with increased risk for MACE (OR = 1.20; 95% CI = 0.99-1.39), all-cause death (OR = 1.24; 95% CI = 0.74-2.06), cardiac-death (OR = 1.29; 95% CI = 0.64-2.57) among Asian population. CONCLUSION PPIs comedication were associated with adverse clinical outcomes, and ethnic variance may exert different effect on clinical outcomes. Subgroup analysis indicated that concomitant use of PPI might be suitable for Asian patients after stent implantation.
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Affiliation(s)
- Wence Shi
- State Key Laboratory of Cardiovascular Disease
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yan
- State Key Laboratory of Cardiovascular Disease
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingang Yang
- State Key Laboratory of Cardiovascular Disease
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyue Yu
- State Key Laboratory of Cardiovascular Disease
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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26
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Qian J, Zan J, Kuang L, Che L, Yu Y, Shen T, Tang J, Chen F, Liu X. A predictive nomogram of bleeding risk in patients with atrial fibrillation after drug-eluting stent implantation. Ann Transl Med 2021; 9:193. [PMID: 33708820 PMCID: PMC7940957 DOI: 10.21037/atm-20-3971] [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] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/02/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of anticoagulants and antiplatelet therapies is associated with a higher risk of bleeding in atrial fibrillation (AF) patients after percutaneous coronary intervention, especially after stent implantation. However, no accurate bleeding risk prediction tool has been developed for these patients. The aim of this study was thus to establish a bleeding risk prediction model (predictive nomogram) for patients with AF after stent implantation. METHODS Construction of the predictive nomogram was based on a retrospective study, which enrolled 943 AF patients who underwent drug-eluting stent implantation between May 2012 and September 2016. A range of factors, including demographics, comorbidities, medication strategies, arterial access, and laboratory tests, were collected as baseline data. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis were used to identify the key clinical features for construction of the predictive nomogram. The concordance index (C-index) and internal validation were used to evaluate the efficacy of the nomogram. RESULTS Of the 943 AF patients that underwent stent implantation, the occurrence of bleeding events was 8.2% (77 out of 943). Key predictors included the number of antiplatelet drugs, peptic ulcer, cerebral infarction, type 2 diabetes, thrombocytopenia, anemia, prior myocardial infarction, sex (male), use of anticoagulant drugs, liver dysfunction, hypertension, and acute myocardial infarction. These predictors were used to construct the nomogram. The C-index for the prediction of bleeding risk by the nomogram was 0.841 (95% CI: 0.79-0.89), which indicated good discrimination and calibration. The C-index of internal validation was 0.795, which demonstrated good efficacy of the model. CONCLUSIONS This study suggests that our novel nomogram can accurately predict bleeding risk in AF patients after stent implantation during hospitalization, thereby helping to avoid complications. The nomogram may also be helpful for the creation of individualized post-discharge medication strategies.
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Affiliation(s)
- Jun Qian
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiyong Zan
- Department of Gastroenterology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China
| | - Lijun Kuang
- Department of Ultrasound, Luwan Branch, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Che
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunan Yu
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ting Shen
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiani Tang
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fei Chen
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuebo Liu
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Moosmann J, Purbojo A, Eder S, Dittrich S. Case Report: Trans-axillary Artery Access for Rescue Stent Implantation in an Infant With Retrograde Non-passable Aortic Coarctation. Front Pediatr 2021; 9:625011. [PMID: 33898357 PMCID: PMC8060700 DOI: 10.3389/fped.2021.625011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/15/2021] [Indexed: 11/16/2022] Open
Abstract
Primary surgical repair remains the traditional treatment for patients with critical duct-dependent coarctation of the aorta (CoA). Initial surgical repair might not be possible or associated with higher risks if additional comorbidities arise in small infants and neonates. Balloon angioplasty (BA) has been described as a rescue strategy for these children. We describe the feasibility of a palliative BA and rescue stent implantation via an alternative antegrade right-axillary artery approach in an initially inoperable infant with pneumonia and respiratory failure and severe CoA, where the stenosis was not passable by traditional retrograde femoral access. This case adds new aspects to the therapy of critical CoA: Stent implantation provides a bridge to surgery in critically ill infants and does not preclude successful surgical repair. Further, if the classic retrograde approach is not possible, the right axillary artery access should be considered as an alternative to pass the stenosis.
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Affiliation(s)
- Julia Moosmann
- Department of Pediatric Cardiology, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Susanne Eder
- Department of Pediatric Cardiology, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany
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28
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Simakova MA, Karpova DV, Marukyan NV, Pishchulov KA, Mikhaylov ENM, Moiseeva OM. Dual-energy computed tomography-angiography in the evaluation and management of significant multiple pulmonary vein stenoses following atrial fibrillation ablation. Pulm Circ 2020; 10:2045894020969499. [PMID: 33335709 PMCID: PMC7724407 DOI: 10.1177/2045894020969499] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/05/2020] [Indexed: 11/15/2022] Open
Abstract
A 58-year-old male patient with multi-vessel pulmonary vein (PV) stenosis following atrial fibrillation ablation was referred to a specialized pulmonary hypertension clinic. Chest dual-energy computed tomography (CT)-angiography allowed precise diagnosis of two PVs occlusion and three PVs significant stenosis. Iodine maps showed perfusion deficiency and its value for each stenosis, determining the sequence of multiple PV interventions. We suggest iodine CT mapping is a useful tool in the definition of PV stenosis severity and planning staged angioplasty.
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Affiliation(s)
- Maria A Simakova
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Daria V Karpova
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Narek V Marukyan
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | | | - Evgeny N M Mikhaylov
- Almazov National Medical Research Centre, Saint-Petersburg, Russia.,Department of Bioengineering Systems, Saint-Petersburg Electrotechnical University "LETI", Saint Petersburg, Russia
| | - Olga M Moiseeva
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
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29
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Li K, Qi W, Liu B. [Surgical Treatments of Renal Artery Stenosis in Takayasu Arteritis]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2020; 42:691-695. [PMID: 33131526 DOI: 10.3881/j.issn.1000-503x.12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Refractory hypertension and renal insufficiency caused by Takayasu arteritis with renal arteries involved are difficult to treat with medicines.Instead,surgery is often recommended for refractory renovascular hypertension with renal artery stenosis of ≥70%.Although both open surgery and endovascular surgery have been applied,the preferred surgical strategy remains undetermined.This article reviews the clinical effectiveness,long-term patency,and complications of open surgery,percutaneous balloon angioplasty,and stenting in patients with Takayasu arteritis-associated renal artery stenosis.
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Affiliation(s)
- Kang Li
- Department of Vascular Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Wanting Qi
- Department of Vascular Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Bao Liu
- Department of Vascular Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
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30
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Lu Q, Shen Y, Xia S, Chen B, Wang K. A Novel Universal Endovascular Robot for Peripheral Arterial Stent-Assisted Angioplasty: Initial Experimental Results. Vasc Endovascular Surg 2020; 54:598-604. [PMID: 32662355 DOI: 10.1177/1538574420940832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The bottleneck of the development of endovascular interventional robot is that it cannot fully adapt to commercialized endovascular devices, such as guidewires, catheters, and stents, and cannot complete the entire procedure of endovascular treatment, for instance, stent implantation. The purpose of this study is to evaluate whether the novel universal endovascular interventional robot can adapt to different commercialized endovascular devices and accomplish the entire procedure of endovascular treatment of peripheral vascular disease. METHODS AND MATERIAL The novel universal endovascular interventional robot consists of 2 components: a master surgeon console and a robotic platform with 4 manipulators. An adult pig was served as the experimental animal. Bilateral iliac artery stent implantation was performed on the pig by the endovascular interventional robot using commercialized guidewires, catheters, and stent delivery systems. RESULTS The novel universal endovascular interventional robot can adapt to commercialized endovascular devices, and most interventional procedures, such as insertion, withdrawal, and rotating, can be done through remote control. By coordinating multiple manipulators, complex actions such as superselection, crossing action, or implantation of self-expanding bare stent can be realized. The entire procedure took about 50 minutes, and the total exposure time of the surgeon was less than 1 minute. Postoperative angiography showed that the position of the stent grafts was accurate. The procedure was stable without any stent or surgical-related complications. CONCLUSION The novel universal endovascular interventional robot can realize peripheral arterial stent-assisted angioplasty with commercialized devices. Through the design improvement, the problem related to stent implantation is solved, and the remote operation is realized throughout the endovascular procedure.
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Affiliation(s)
- Qingsheng Lu
- Department of Vascular Surgery, 12520 Changhai Hospital, Shanghai, China
| | - Yu Shen
- Department of Vascular Surgery, 12520 Changhai Hospital, Shanghai, China
| | - Shibo Xia
- Department of Vascular Surgery, 12520 Changhai Hospital, Shanghai, China
| | - Bing Chen
- Department of Instrument Engineering, 12474Shanghai Jiao Tong University, Shanghai, China
| | - Kundong Wang
- Department of Instrument Engineering, 12474Shanghai Jiao Tong University, Shanghai, China
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Darocha S, Pietura R, Banaszkiewicz M, Pietrasik A, Kownacki Ł, Torbicki A, Kurzyna M. Balloon Pulmonary Angioplasty with Stent Implantation as a Treatment of Proximal Chronic Thromboembolic Pulmonary Hypertension. Diagnostics (Basel) 2020; 10:E363. [PMID: 32492944 DOI: 10.3390/diagnostics10060363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/17/2022] Open
Abstract
We present a case of a 67-year-old female with proximal chronic thromboembolic pulmonary hypertension (CTEPH), disqualified from pulmonary endarterectomy due to multiple comorbidities and high risk-to-benefit ratio as assessed by multidisciplinary CTEPH team. She was referred for balloon pulmonary angioplasty (BPA) and underwent three sessions with balloon catheters up to 8 mm diameter. During the second procedure, the elastic recoil phenomenon was observed in the treated post-thrombotic lesion of the right lower lobe artery, which made the balloon angioplasty ineffective. It was decided to implant a self-expanding stent for the prevention of restenosis. The procedure resulted in significant improvement of regional perfusion, as confirmed by control angiography. We feel that it contributed to the significant improvement of hemodynamic parameters and exercise capacity, as assessed three months after the last BPA procedure. In conclusion, pulmonary artery stenting may be an option in proximal CTEPH when elastic recoil phenomenon makes balloon angioplasty of a large vessel ineffective.
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Lee ML, Chang TM, Yang RC, Yang AD, Chen M. Systemic hypertension followed by insidious stroke in a 12-year-old boy with childhood neurofibromatosis type 1 presenting with renal and cerebral artery vasculopathy. Turk J Pediatr 2020; 61:629-634. [PMID: 31990487 DOI: 10.24953/turkjped.2019.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lee ML, Chang TM, Yang RC, Yang AD, Chen M. Systemic hypertension followed by insidious stroke in a 12-year-old boy with childhood neurofibromatosis type 1 presenting with renal and cerebral artery vasculopathy. Turk J Pediatr 2019; 61: 629-634. Neurofibromatosis type 1 (NF1)-associated vasculopathy is usually diagnosed decades after the clinical diagnosis of NF1. Childhood NF1-associated renal artery vasculopathy or moyamoya-like brain vasculopathy could be clinically silent for a long time. We report a 12-year-old boy who had systemic hypertension found incidentally at a routine check-up. Physical examination showed caféau- lait spots and strong radial pulses. Abdominal computerized tomography angiography showed severe right ostial renal artery stenosis. Genomic study showed a heterozygous mutation c.5902C > T (p.R1968*) and two heterozygous single nucleotide polymorphisms (NCBI: SNP rs18011052 and rs2905876) of NF1 gene. After endovascular revascularization for renovascular hypertension caused by renal artery stenosis, including percutaneous transluminal renal angioplasty and stent implantation, blood pressure dropped effectively from 205/143 mmHg to 130/90 mmHg. Supine renin level dropped from 87.2 pg/ mL to 47.9 pg/mL. Unfortunately, right hemiplegia, transient visual loss with blind spots (scotomas), and clumsiness of extremities emerged insidiously 3.5 months later. Brain magnetic resonance imaging and magnetic resonance angiography showed ischemic infarction involving the watershed area of the anterior and middle cerebral arteries, indicating presence of moyamoya-like brain vasculopathy. A dilemma is that a significant decrease of blood pressure after endovascular revascularization for renal artery stenosis may have potentially unmask the moyamoya-like brain vasculopathy in this patient. Vasculopathy could be heralding childhood NF1 in the young patients without full-fledged clinical features. Endovascular revascularization for renal artery stenosis could be a double-edge sword in childhood NF1 presenting with concomitant renal and cerebral artery vasculopathy.
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Affiliation(s)
| | - Tung-Ming Chang
- Department of Pediatric Neurology, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua
| | - Rei-Cheng Yang
- Department of Pediatric Neurology, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua
| | - Albert D Yang
- Departments of Medical Imaging, Changhua Christian Children's Hospital, Changhua
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Zartner PA, Schranz D, Mini N, Schneider MB, Schneider K. Acute treatment of critical vascular stenoses with a bioabsorbable magnesium scaffold in infants with CHDs. Cardiol Young 2020; 30:493-9. [PMID: 32079550 DOI: 10.1017/S1047951120000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Post-operative severe vascular stenosis and proliferating endothelial tissue lead to severe circulatory disorders and impair organ perfusion. Bioabsorbable magnesium scaffolds may help to overcome these obstructions without leaving obstructing stent material. We analyse their role in the treatment of vascular stenosis in infants. METHODS Since 2016, 15 magnesium scaffolds with a diameter of 3.5 mm were implanted in 9 patients aged 15 days to 7.6 years. Eight scaffolds were implanted in pulmonary venous restenoses, five in pulmonary arterial stenosis including one in-stent stenosis, one into a stenotic brachiocephalic artery, and one in a recurrent innominate vein thrombosis. RESULTS All patients clinically improved after the implantation of a scaffold. The magnesium scaffolds lost integrity after 30-48 days (mean 42 days). The innominate vein thrombosed early, while all other vessels remained open. Two patients died after 1.3 and 14 weeks not related to the scaffolds. Five patients needed further balloon dilations or stent implantations after the scaffold had fractured. At first recatheterisation after in mean 2.5 months, the mean minimum/maximum diameter in relation to the scaffold's original diameter was 89%/99% in the arterial implantations (n = 6) and 66%/77% in the pulmonary venous implantations. CONCLUSIONS The magnesium scaffolds can be used as a bridging solution to treat severe vascular stenosis in different locations. Restenosis can occur after degradation and make further interventions necessary, but neither vessel growth nor further interventions are hindered by stent material. Larger diameters may improve therapeutic options.
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Harada T, Inoue M, Uchida K, Ohashi H, Kusunoki M. Endovascular stenting for occluded superior vena cava in an infant with short bowel syndrome. Pediatr Int 2020; 62:244-246. [PMID: 32053857 DOI: 10.1111/ped.14092] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 11/06/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Tomoya Harada
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroyuki Ohashi
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
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Laubrie JD, Mousavi JS, Avril S. A new finite-element shell model for arterial growth and remodeling after stent implantation. Int J Numer Method Biomed Eng 2020; 36:e3282. [PMID: 31773919 DOI: 10.1002/cnm.3282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/05/2019] [Accepted: 10/27/2019] [Indexed: 06/10/2023]
Abstract
The goal of this paper is to study computationally how blood vessels adapt when they are exposed to a mechanobiological insult, namely, a sudden change of their biomechanical conditions such as proteolytic injuries or implantation. Adaptation occurs through growth and remodeling (G&R), consisting of mass production or removal of structural proteins, such as collagen, until restoring the initial homeostatic biomechanical conditions. In some circumstances, the initial conditions can never be recovered, and arteries evolve towards unstable pathological conditions, such as aneurysms, which are responsible for significant morbidity and mortality. Therefore, computational predictions of G&R under different circumstances can be helpful in understanding fundamentally how arterial pathologies progress. For that, we have developed a low-cost open-source finite-element 2D axisymmetric shell model (FEM) of the arterial wall. The constitutive equations for static equilibrium used to model the stress-strain behavior and the G&R response are expressed within the homogenized constrained mixture theory. The originality is to integrate the layer-specific behavior of both arterial layers (media and adventitia) into the model. Considering different mechanobiological insults, our results show that the resulting arterial dilatation is strongly correlated with the media thickness. The adaptation to stent implantation is particularly interesting. For large stent oversizing ratios, the artery cannot recover from the mechanobiological insult and dilates forever, whereas dilatation stabilizes after a transient period for more moderate oversizing ratios. We also show that stent implantation induces a different response in an aneurysm or in a healthy artery, the latter yielding more unstable G&R. Finally, our G&R model can efficiently predict, with very low computational cost, fundamental aspects of arterial adaptation induced by clinical procedures.
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Affiliation(s)
- Joan D Laubrie
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Étienne, France
| | - Jamaleddin S Mousavi
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Étienne, France
| | - Stéphane Avril
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Étienne, France
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Mori S, Nagata H, Sakamoto I, Oi K, Ohga S. Successful stent implantation for acute take-off left coronary artery stenosis. Pediatr Int 2019; 61:933-935. [PMID: 31569291 DOI: 10.1111/ped.13942] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/18/2019] [Accepted: 05/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sayo Mori
- Departments of, Department of, Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Kyushu, Japan
| | - Hazumu Nagata
- Departments of, Department of, Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Kyushu, Japan
| | - Ichiro Sakamoto
- Department of, Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Kyushu, Japan
| | - Keiji Oi
- Department of, Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Kyushu, Japan
| | - Shouichi Ohga
- Departments of, Department of, Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Kyushu, Japan
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Ooi YK, Ligon RA, Kelleman M, Vincent RN, Bauser-Heaton HD, Kim DW, Petit CJ. Thromboprophylaxis strategies for children with single-ventricle circulations (superior or total cavo-pulmonary connections) after stent implantation. Cardiol Young 2019; 29:877-84. [PMID: 31208476 DOI: 10.1017/S1047951119000969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To define optimal thromboprophylaxis strategy after stent implantation in superior or total cavopulmonary connections. BACKGROUND Stent thrombosis is a rare complication of intravascular stenting, with a perceived higher risk in single-ventricle patients. METHODS All patients who underwent stent implantation within superior or total cavopulmonary connections (caval vein, innominate vein, Fontan, or branch pulmonary arteries) were included. Cohort was divided into aspirin therapy alone versus advanced anticoagulation, including warfarin, enoxaparin, heparin, or clopidogrel. Primary endpoint was in-stent or downstream thrombus, and secondary endpoints included bleeding complications. RESULTS A total of 58 patients with single-ventricle circulation underwent 72 stent implantations. Of them 14 stents (19%) were implanted post-superior cavopulmonary connection and 58 (81%) post-total cavopulmonary connection. Indications for stenting included vessel/conduit stenosis (67%), external compression (18%), and thrombotic occlusion (15%). Advanced anticoagulation was prescribed for 32 (44%) patients and aspirin for 40 (56%) patients. Median follow up was 1.1 (25th-75th percentile, 0.5-2.6) years. Echocardiograms were available in 71 patients (99%), and advanced imaging in 44 patients (61%). Thrombosis was present in two patients on advanced anticoagulation (6.3%) and none noted in patients on aspirin (p = 0.187). Both patients with in-stent thrombus underwent initial stenting due to occlusive left pulmonary artery thrombus acutely post-superior cavopulmonary connection. There were seven (22%) significant bleeding complications for advanced anticoagulation and none for aspirin (p < 0.001). CONCLUSIONS Antithrombotic strategy does not appear to affect rates of in-stent thrombus in single-ventricle circulations. Aspirin alone may be sufficient for most patients undergoing stent implantation, while pre-existing thrombus may warrant advanced anticoagulation.
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Watanabe Y, Sakakura K, Kotoku H, Mashimo S, Nakata M, Nagata H, Chiba Y, Kojima M. Successful stent implantation in a rural area on a patient with superior vena cava syndrome through specialist intervention: a case report. J Rural Med 2019; 14:116-119. [PMID: 31191775 PMCID: PMC6545419 DOI: 10.2185/jrm.2990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/11/2018] [Indexed: 12/03/2022] Open
Abstract
Superior vena cava syndrome (SVCS), which is characterized by facial edema and congestion
of the head, upper extremities, and neck, is a life-threatening oncologic emergency.
Although a combination of chemotherapy and radiation therapy has been considered as the
standard treatment for SVCS, stent implantation to the superior vena cava (SVC) has been
recently developed to alleviate edema or dyspnea caused by SVCS. On the other hand, stent
implantation to the SVC requires skilled interventional cardiologists or radiologists. In
general, those specialists reside in university hospitals or large hospitals in an urban
area. In this case report, an 86-year-old man underwent stent implantation to a stenosed
SVC in a rural area. Because the patient refused the transfer to the core, urban hospital,
we invited a skilled interventional cardiologist from the core hospital and performed
stent implantation to the SVC in a small, rural hospital. It is generally difficult to
perform stent implantation for SVCS in a small hospital, because skilled operators in the
field of interventional cardiology or radiology do not usually perform operations in
smaller facilities. Our case indicates the importance of cooperation between rural
generalists and urban specialists.
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Affiliation(s)
- Yusuke Watanabe
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Honoka Kotoku
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Shota Mashimo
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Maiko Nakata
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Hiroyuki Nagata
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Yoshiro Chiba
- Department of Cardiology & Interventional Radiology, Mito Saiseikai General Hospital, Japan
| | - Masayuki Kojima
- Department of Surgery, Hitachiomiya Saiseikai Hospital, Japan
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Onishi H, Naganuma T, Hozawa K, Sato T, Ishiguro H, Tahara S, Kurita N, Nakamura S, Nakamura S. Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease. Vasc Endovascular Surg 2019; 53:284-291. [PMID: 30696371 DOI: 10.1177/1538574418824444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. MATERIAL AND METHODS We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. RESULTS There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). CONCLUSION Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.
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Affiliation(s)
- Hirokazu Onishi
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Koji Hozawa
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Tomohiko Sato
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Satoko Tahara
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Naoyuki Kurita
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Sunao Nakamura
- 1 Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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Kojima T, Imamura T, Osada Y, Muraji S, Nakano M, Oyanagi T, Yoshiba S, Kobayashi T, Sumitomo N. Efficacy of catheter interventions in the early and very early postoperative period after CHD operation. Cardiol Young 2018; 28:1426-30. [PMID: 30175700 DOI: 10.1017/S1047951118001452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Catheter interventions for residual lesions in the early postoperative period after CHD operations are still not established as a reliable treatment option. METHODS We retrospectively reviewed our institutional experience of cardiac catheterisations and catheter interventions performed in the early postoperative period. We classified our patients into two groups. The "hyper" acute phase group - operation to cardiac catheterisation of ⩽7 days - and acute phase group - operation to cardiac catheterisation from 7 to 30 days. RESULTS Of the 47 patients, catheter interventions were performed in 38 patients (81%). The success rate of the intervention was 96% in the acute phase group and 90% in the "hyper" acute phase group. The overall success rate was 95%. There were two self-limited complications in the acute phase group, but not in the "hyper" acute phase group. There were four cases of catheter interventions performed for a newly reconstructed aortic arch, and those procedures were also safe and effective. CONCLUSIONS Cardiac catheterisations and catheter interventions were safe and effective not only in the early postoperative period but also in the very early postoperative period. Catheter interventions for the left-sided heart in the early postoperative period were also safe and effective.
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Akagi K, Tanaka T, Baba S. Successful living donor liver transplantation after stent implantation in a patient with Alagille syndrome and severe bilateral pulmonary artery stenosis. Cardiol Young 2018; 28:1465-7. [PMID: 30160645 DOI: 10.1017/S1047951118001476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Severe pulmonary hypertension is a contraindication for liver transplantation owing to high mortality. However, decision-making regarding the treatment approach for patients with bilateral peripheral pulmonary artery stenosis, typically complicated by elevated main pulmonary artery and right ventricle pressures, can be challenging. Here, we report successful living donor liver transplantation after bilateral pulmonary artery stent implantation in a patient with Alagille syndrome, severe bilateral peripheral pulmonary artery stenosis, and extremely high main pulmonary artery and right ventricle pressures.
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Nakamura Y, Kataoka Y, Asaumi Y, Noguchi T, Yasuda S. Marking Technique for Identification of Optimal Stent Landing Site With Optical Coherence Tomographic Imaging. JACC Cardiovasc Interv 2018; 11:e79-80. [PMID: 29730368 DOI: 10.1016/j.jcin.2018.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 11/23/2022]
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Li F, Qiao G, Liang P, Liu J. A case report regarding general anesthesia management of a patient with pulmonary vein stenosis that underwent balloon dilatation and stent implantation. Medicine (Baltimore) 2018; 97:e0429. [PMID: 29702994 PMCID: PMC5944473 DOI: 10.1097/md.0000000000010429] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Pulmonary vein stenosis (PVS) is a rare cardiovascular deformity that can lead to high mortality if left untreated. Patients frequently experience multiple complications such as hemoptysis, pulmonary hypertension, bronchial venous rupture and cardiac insufficiency. Currently, pulmonary vein stenosis balloon dilatation (stent implantation) is the only treatment, and this can be performed under local or general anesthesia. However, a case report on the general anesthesia management of PVS has not been previously reported. In this case report, we discuss anesthetic considerations in patients with PVS, focusing specifically on perioperative airway and circulatory management as well as the risk evaluation, and the appropriate effective management of all potential complications intraoperatively. PATIENT CONCERNS A 58-year-old male patient was admitted because of coughing rusty sputum for during 2 years as well as experiencing dyspnea and chest distress after exertion or exercising. The difficulty breathing and chest distress had been going on for a year. This patient had undergone circumferential pulmonary vein isolation twice during the last 2 years. DIAGNOSES Based on the transthoracic echocardiography and computed tomography, this patient's diagnosis was considered as pulmonary vein stenosis, pulmonary hypertension (secondary), and pulmonary arteriovenous thrombosis. INTERVENTIONS We considered that such severe patients with PVS require respiratory and circulatory supports and perhaps emergency surgical interventions. Henceforth, we administered general anesthesia to the patient and had extracorporeal membrane oxygenation (ECMO) on standby. OUTCOMES The duration of the surgery was approximately 4 hours, the intraoperative vital signs were stable, no pericardial effusion was observed postoperatively, the blood flow in the pulmonary vein stent was smooth, and the patient was discharged 7 days later following rehabilitation. LESSONS This surgical procedure involving respiratory and circulatory supports requires the involvement of different medical personnel such as interventionists, anesthesiologists, and surgeons. Therefore, multidisciplinary cooperation under general anesthesia will undoubtedly benefit such patients.
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Affiliation(s)
- Fangzhou Li
- Department of Anesthesiology, West China Hospital, Sichuan University
| | - Guoyan Qiao
- Department of cadres medical care, ChengFei hospital, Chengdu, P.R. China
| | - Peng Liang
- Department of Anesthesiology, West China Hospital, Sichuan University
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University
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Sumarokov AB, Buryachkovskaya LI, Lomakin NV, Dotsenko YV, Uchitel IA, Timofeeva LA. [Duration of Dual Antiplatelet Therapy in Patients With Ischemic Heart Disease After Implantation of Endovascular Stents]. Kardiologiia 2018:41-52. [PMID: 29466171 DOI: 10.18087/cardio.2018.1.10081] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Optimal duration of dual antiplatelet therapy (DAPT) after stent implantation is uncertain. Some patients have an extended risk of thrombotic complications including that of very late stent thrombosis after cessation of recommended course of DAPT (6-12 months). On the other hand, there is a real risk of bleeding on DAPT. In this review, we present and discuss results of clinical trials of long-term DAPT and data of their meta-analyses. The review also contains consideration of some aspects of new AHA/ACC recommendations (2016) on duration of DAPT.
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Affiliation(s)
- A B Sumarokov
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex
| | - L I Buryachkovskaya
- Federal State Budgetary Institution, "Russian Cardiology Science and Production Center" of the Ministry of Health of the Russian Federation
| | - N V Lomakin
- Federal State Budgetary Institution "Central Clinical Hospital with Outpatient Clinic" at the Department of Presidential Affairs
| | - Y V Dotsenko
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex
| | - I A Uchitel
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex
| | - L A Timofeeva
- Central Clinical Hospital with Policlinic of the Presidential Administration of the Russian Federation
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Wadowski PP, Kopp CW, Koppensteiner R, Lang IM, Pultar J, Lee S, Weikert C, Panzer S, Gremmel T. Decreased platelet inhibition by P2Y12 receptor blockers in anaemia. Eur J Clin Invest 2018; 48. [PMID: 29171876 DOI: 10.1111/eci.12861] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/18/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anaemic patients undergoing angioplasty and stenting are at an increased risk of ischaemic events, which may be caused by an inadequate response to antiplatelet therapy with adenosine diphosphate (ADP) P2Y12 inhibitors. In the current study, we investigated the associations between anaemia and on-treatment platelet reactivity in clopidogrel-treated (group 1, n = 306) and prasugrel-/ticagrelor-treated (group 2, n = 109) patients undergoing elective and acute angioplasty with stent implantation, respectively. MATERIALS AND METHODS Monocyte-platelet aggregate (MPA) formation was determined by flow cytometry in both groups. On-treatment residual platelet reactivity in response to ADP was assessed by light transmission aggregometry (LTA) in both groups, and by the VerifyNow P2Y12 assay and the Impact-R in group 1. P-selectin expression was measured by flow cytometry in group 2. RESULTS In both groups, anaemia was associated with significantly higher MPA formation in response to ADP (both P ≤ .02). Moreover, by LTA maximal aggregation in response to ADP was significantly higher in patients with anaemia in both groups (both P < .05), and anaemic patients in group 1 had a significantly higher on-treatment platelet reactivity by the VerifyNow P2Y12 assay and the Impact-R than those without anaemia (both P < .001). In group 2, significantly higher platelet surface expression of P-selectin was seen in anaemia after stimulation with ADP (P = .02). CONCLUSION Anaemia is associated with decreased platelet inhibition by ADP P2Y12 receptor antagonists after elective and acute percutaneous interventions with stent implantation. However, due to inconsistencies between different platelet function tests additional data are needed to clarify the role of anaemia for platelet inhibition.
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Affiliation(s)
- Patricia P Wadowski
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christoph W Kopp
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Renate Koppensteiner
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Irene M Lang
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Joseph Pultar
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Silvia Lee
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Constantin Weikert
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Simon Panzer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Radak D, Djukic N, Tanaskovic S, Obradovic M, Cenic-Milosevic D, Isenovic ER. Should We be Concerned About the Inflammatory Response to Endovascular Procedures? Curr Vasc Pharmacol 2017; 15:230-237. [PMID: 28056759 DOI: 10.2174/1570161115666170105121900] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/12/2016] [Accepted: 12/30/2016] [Indexed: 12/12/2022]
Abstract
Endovascular surgery represents a minimally invasive procedure for the treatment of occlusive and aneurysmal arterial disease. However, it is followed by inflammatory response, with a rise in specific inflammatory biomarkers, such as C-reactive protein, serum amyloid A and fibrinogen. Shear stress during balloon inflation and vascular injury represents triggering events for the inflammatory process, stimulating the production of proinflammatory molecules and activation of circulating monocytes. The current literature indicates that stent implantation induces more prominent inflammatory reaction. Additionally, it has been shown that muscular arteries of femoropopliteal segment react to a greater extent to stent implantation, compared with elastic carotid or iliac arteries. The endovascular treatment of thoracic and abdominal aortic aneurysm is frequently followed with post-implantation inflammatory syndrome. Most recent findings point out that stent graft material plays a significant role in the inflammatory response, representing a challenge for clinicians. Future studies should consider the pathophysiology of the inflammatory response associated with endovascular procedures as well as predictors and risk factors including preventive strategies and therapeutic algorithms. Although the potential role of anti-inflammatory drugs after endovascular procedures has been observed, it needs to be validated in upcoming trials. The Neutrophil Lymphocyte Ratio, platelet count, Platelet-to-Lymphocyte Ratio and other biomarkers should be considered in future trials to assess the inflammatory response after endovascular procedures. Inflammatory markers may also become therapeutic targets.
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Affiliation(s)
- Djordje Radak
- Dedinje Cardiovascular Institute, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nenad Djukic
- Dedinje Cardiovascular Institute, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Tanaskovic
- Dedinje Cardiovascular Institute, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Obradovic
- Laboratory of Radiobiology and Molecular Genetics, Institute Vinca, University of Belgrade, Belgrade, Serbia
| | | | - Esma R Isenovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, P.O.Box 522, 11000 Belgrade, Serbia
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Chen K, Hou X, Zhou Z, Li G, Liu Q, Gui L, Hu J, Shi S. The efficacy and safety of endovascular recanalization of occluded large cerebral arteries during the subacute phase of cerebral infarction: a case series report. Stroke Vasc Neurol 2017; 2:124-131. [PMID: 28994833 PMCID: PMC5628384 DOI: 10.1136/svn-2017-000086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/28/2017] [Accepted: 06/01/2017] [Indexed: 11/20/2022] Open
Abstract
Background Intravenous tissue plasminogen activator with or without mechanical thrombectomy during the acute phase are approved therapies for ischaemic stroke. Due to the short treatment time window (<6 hours) and often treatment failure, these patients would still have an intracranial arterial occlusion (IAO). It is unclear whether these patients can benefit from subsequent interventional recanalizationof their occluded artery in the subacute phase. In this retrospective study, we have examined the efficacy and safety in patients who have received either percutaneous transluminal angioplasty (PTA) or percutaneous transluminal angioplasty and stenting (PTAS) for IAO in the subacute phase of their stroke. Methods Patients with subacute symptomatic ischaemic stroke caused by IAO were assessed to identify the responsible artery and low perfusion areas by CT angiography, MR angiography or digital subtraction angiography. In eligible patients, a PTA or PTAS was performed to reopen the occluded artery. Regular antithrombotic therapy, use of statins, control of risk factors and rehabilitation therapy were prescribed after the procedure. All patients had regular follow-up up to 12 months. Results PTA or PTAS was performed in 16 patients with cerebral infarction caused by IAO in the subacute phase. After the procedure, 12 cases were recanalized, two were partially recanalized and two failed to open. One patient with left C6 segment occlusion of the carotid artery had a central retinal artery embolism after PTAS. The perioperative adverse events were 6.25%. At 3 months, the distribution of modified Rankin scale scores was 0 (seven cases), 1 (three cases), 2 (five cases) and 3 (one case). Conclusion Selective PTA or PTAS could be performed in ischaemic stroke patients with a small infarct size and large area of hypoperfusion from an occluded large cerebral artery after the acute phase. It may improve neurological dysfunction and reduce the incidence of disability.
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Affiliation(s)
- Kangning Chen
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xianhua Hou
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zhenhua Zhou
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Guangjian Li
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Qu Liu
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Li Gui
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jun Hu
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Shugui Shi
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
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Kronlage M, Wassmann M, Vogel B, Müller OJ, Blessing E, Katus H, Erbel C. Short vs prolonged dual antiplatelet treatment upon endovascular stenting of peripheral arteries. Drug Des Devel Ther 2017; 11:2937-2945. [PMID: 29062225 PMCID: PMC5638576 DOI: 10.2147/dddt.s143226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Peripheral artery disease (PAD) is a highly prevalent disorder with a substantial economical burden. Dual antiplatelet treatment (DAPT) upon endovascular stenting to prevent acute thrombotic reocclusions is an universally accepted practice for postinterventional management of PAD patients. However, the optimal period of time for DAPT upon endovascular stenting is not known. METHODS In the current nonrandomized, retrospective monocentric study, we evaluated the duration of DAPT upon endovascular stenting. A total of 261 endovascular SFA and iliac stenting procedures were performed on 214 patients and these patients were subdivided into a short (4-6 weeks) or a prolonged (8-12 weeks) DAPT regime group. More than 65% of the patients included were male, approximately 35% were diabetic, and 61% had a history of smoking. Of all the patients, 90% exhibited a Rutherford stage 2-3, and approximately half of the patients had a moderate-to-severe calcified target lesion with a length of >13 cm. Major safety end points were defined as any bleeding, compartment syndrome, and ischemic events. In addition to this, patency, all-cause mortality, as well as amputation were followed up over a period of 12 months upon intervention. RESULTS Twelve months after endovascular stenting, primary patency in our cohort was comparable between the groups (83.94% short vs 79.8% long DAPT, P>0.05). Major bleeding occurred in 18 cases without any difference between the groups (P>0.05). In addition, during the 12-month follow-up, 6 (3.4%) patients in the short and 3 (3.5%) in the prolonged DAPT regime suffered a stroke/transient ischemic attack (P>0.05). In addition, there was no difference regarding mortality and amputation rate comparing short vs prolonged DAPT regime in a 12-month follow-up. CONCLUSION In the current cohort, prolonged DAPT after endovascular stenting had no beneficial effect on the outcome in a 12-month follow-up.
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Affiliation(s)
- Mariya Kronlage
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | - Maximilian Wassmann
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | - Britta Vogel
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | - Oliver J Müller
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
| | | | - Hugo Katus
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg.,DZHK German Center for Cardiovascular Research, Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Christian Erbel
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg
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Abstract
The treatment of severe coronary stenoses with stent implantation is very effective nevertheless, the underlying problem of atherosclerosis remains unsolved with the implantation of a stent. Therefore, besides lifestyle changes, the adequate medication therapy is of pivotal importance. In the majority of patients scheduled for or acutely undergoing catheterisation, beta-blockers form the basis of medication therapy. Members of the group, however, show significant differences in terms of pharmacodynamics. The third-generation beta-blocker and vasodilator carvedilol possesses complex adrenerg-blocking and Ca-channel blocking effects as well. In the background of the favourable effects, a further positive property is its anti-free-radical effect which most beta-blockers do not have. Therefore, as has been proven by several studies, it provides considerable benefits in hypertension, after myocardial infarction, in diabetes and also in the treatment of patients with cardiac failure. These positive effects have been markedly observed in interventional cardiology practice, as the majority of patients undergoing cardiac catheterisation have hypertension, diabetes or hyperlipidaemia. Its anti-free-radical effect is especially beneficial together with its smooth muscle proliferation-inhibitor effect which may favourably affect in-stent restenosis (ISR) as well. To summarise, due to its vasculoprotective effect, carvedilol is an ideal drug of choice following stent implantation in routine everyday practice. Orv Hetil. 2017; 158(37): 1453-1457.
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Affiliation(s)
- Attila Kónyi
- Klinikai Központ, Szívgyógyászati Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs, Ifjúság u. 13., 7623
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Li D, Li X, Yan X, Gu Y, Yang X, Meng F. Perioperative nursing of tracheal silicon stent implantation in infants: report on four cases. J Matern Fetal Neonatal Med 2017; 31:3328-3331. [PMID: 28805096 DOI: 10.1080/14767058.2017.1368073] [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: 10/19/2022]
Abstract
AIMS To report experience of perioperative nursing of tracheal silicon stent implantation in infants. METHODS Retrospective analysis on the cases of tracheal silicon stent implantation in infants in our hospital. RESULTS AND CONCLUSIONS Since middle of 2014, totally four tracheal silicon stent implantation were performed in our center. Of them, one case was recurrent tracheoesophageal fistula and the other three cases were traheomalacia. Parent's psychological support, infants' nutrition support and airway care were key responsibility for a nurse before implantation. During the procedure of stent implantation, it was responsible for a nurse to closely monitor the infants and to support operator. After the implantation, airway care and prevention of intra-airway bacterial colonization were important to avoid complications.
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Affiliation(s)
- Deli Li
- a Second Department of Pediatric Respiration , The First Hospital of Jilin University , Changchun , China
| | - Xiaoqing Li
- a Second Department of Pediatric Respiration , The First Hospital of Jilin University , Changchun , China
| | - Xiuli Yan
- b Department of Neurology , The First Hospital of Jilin University , Changchun , China
| | - Yue Gu
- c Department of Hepatopancreatobiliary Surgery , The First Hospital of Jilin University , Changchun , China
| | - Xueqin Yang
- d Department of Traditional Chinese Medicine , The First Hospital of Jilin University , Changchun , China
| | - Fanzheng Meng
- a Second Department of Pediatric Respiration , The First Hospital of Jilin University , Changchun , China
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