Angioplasty Research Articles

Improvement in pain by using lidocaine combined with esketamine in elderly patients receiving local anaesthesia for percutaneous kyphoplasty: a randomized controlled study

BackgroundElderly patients often experience severe pain during percutaneous kyphoplasty under local anaesthesia. The aim of this work was to evaluate the effect of lidocaine combined with esketamine on pain improvement in elderly patients receiving local anaesthesia via percutaneous kyphoplasty.MethodsThis prospective, randomized comparative trial was conducted on 66 elderly patients, aged 60–80 years, with an American Society of Anaesthesiologists (ASA) grade of I-III, I‒III and a BMI of 18.5–25 kg/m2, who underwent single-level lumbar percutaneous kyphoplasty under local anaesthesia. Patients were divided into two equal groups (33 per group). Group LE received 200 mg of 1% lidocaine and 25 mg of esketamine (total volume of 20 ml), and Group L received 200 mg of 1% lidocaine (total volume of 20 ml). Patient characteristics, surgery, VAS scores, MAP, HR, MOAA/S scores, patient satisfaction and related adverse reactions were compared for the groups. The VAS scores during and after surgery were considered the primary outcome.ResultsThere were statistically significant differences in the VAS score between the two groups at the following time points: channel establishment by the puncture needle, balloon dilation, bone cement injection and postoperative period (P < 0.05). The VAS score decreased in the LE group, but the MAP and HR were more stable, and the difference was statistically significant (P < 0.05). The difference in the MOAA/S score between the two groups was statistically significant (P < 0.05), and the MOAA/S score in the LE group decreased. The patient satisfaction level in the LE group was 100% and 48.48% in the L group (P < 0.05). There were no related complications or adverse reactions in either group.ConclusionThe application of lidocaine combined with esketamine in local episcopal percutaneous vertebral kyphoplasty in elderly patients not only provides an effective analgesic effect but also improves surgical safety and patient comfort, which has important clinical value in promoting the optimization of surgical anaesthesia management in elderly patients.Trial registrationThe study was registered at Chictr.org.cn with the number ChiCTR2400083466 on 06/12/2023.

First experience of implantation of a new-generation bioresorbable stent in a young patient with coronary artery disease: a case report

Implantation of a drug-eluting stent into the area of hemodynamically significant coronary artery lesion is a generally accepted and widespread method of coronary artery disease (CAD) treatment. However, rigid metallic frame in artery is associated with disrupted vascular biomechanics and neointimal proliferation in response to foreign material. These processes can lead to restenosis and/or late thrombosis of the implanted stent and, as a consequence, to the recurrence of CAD symptoms, as well as to adverse cardiovascular events. One of the options for solving the above problems is the implantation of bioresorbable stents. This technique already has an evidence base and is increasingly being introduced into routine clinical practice in certain groups of patients. The article presents a case of successful balloon angioplasty and stenting of the right coronary artery with a new-generation bioresorbable stent in a young patient with CAD.

Clinical Characteristics of Patients with Takayasu Arteritis Undergoing Open or Endovascular Operations in China.

The operation rate for different involved arteries and the manifestation of vessel involvement of patients with Takayasu arteritis undergoing open or endovascular operations remain unclear. We aimed to investigate the clinical characteristics, vessel involvement, angiographic classification and operations information in a large cohort of patients with Takayasu arteritis undergoing open or endovascular operations at a single centre in China. From January 2017 to October 2022, a total of 153 consecutive patients undergoing open or endovascular operations were recruited from the Department of Vascular Surgery of Beijing Hospital. The demographic characteristics, clinical presentations, pattern of vascular involvement and operation information were collected and analysed. The majority of patients were female (128/153, 83.7%). The most common vascular finding was hypertension (66.7%). The subclavian (74.2%), carotid (70.1%) and renal (68.9%) arteries were the most commonly involved arteries. Type V (40.5%) was the most common angiographic classification pattern. A total of 296 open or endovascular operations were performed, including 73 percutaneous transluminal angioplasties (PTAs), 50 stent placements and 173 bypass graft operations. Patients with renal (83.3%) or carotid (65.2%) artery involvement had markedly higher rates of undergoing operations. The subclavian and carotid arteries, as well as the type V (40.5%) pattern, exhibited the highest frequency of involvement among patients with Takayasu arteritis who underwent open or endovascular operations. Variations in angiographic features can result in differences in clinical manifestations and significantly impact the possibility and modality of operations.

Polymer Everolimus-Eluting Stent as Bailout Stenting for Below-the-Knee Artery Repair in Patients with Critical Limb-Threatening Ischemia: A Real-World National Registry.

Percutaneous old balloon angioplasty is still the preferred treatment for the treatment of below-the-knee (BTK) arteries in chronic limb-threatening ischemia (CLTI). In the case of a suboptimal angioplasty result, a bailout stenting is required. So far, few data are available to assess the outcomes of bailout stenting after BTK angioplasty. This study aims to investigate the 1-year efficacy and safety after implantation of a polymer everolimus-eluting stent (PEES) as bailout stenting for BTK repair in patients with CLTI in a real-world setting. This was a national multicenter prospective observational study. Patients with CLTI (Rutherford 4 to 6) BTK lesions (including P3) and requiring a bailout PEES due to dissection, thrombosis, or residual stenosis ≥30% after angioplasty were included. The freedom of a major adverse limb event at 12 months of the target limb was the primary endpoint. XIENCE assessed 106 limbs (CLTI, 96.2%; chronic total occlusion, 2.8%) in 106 patients (mean age 77.1 years; males, 71.7%; diabetes mellitus, 66.9%; chronic kidney failure, 36.8%) with CLTI undergoing PEES stenting as a bailout for BTK lesions. Bailout stenting was required after 75.5% and 26.4% of residual stenosis and dissection, respectively. The mean diameter and length of the PEES were 3 mm and 3.4 ± 0.5 cm, respectively. At 1 year, the freedom of a major adverse limb event was 79.6% (95% CI, 71.5%-88.7%), the major amputation rate was 6.2% (95% CI, 1.3%-11%), and the target revascularization rate was 14.9% (95% CI, 6.5%-22.5%). In CLTI patients with BTK lesions, PEES stenting showed safety and efficacy as bailout stenting for BTK arterial lesions. This confirms the need for PEES stenting in a real-world practice. The XIENCE study introduces the PEES as an effective bailout stenting option for patients with CLTI undergoing BTK revascularization, particularly for lesions under 4 cm. The study focuses on real-world cases where POBA alone is insufficient, demonstrating that PEES significantly improves outcomes by enhancing limb salvage and reducing the need for major amputations. For clinicians, this innovation offers a precise, size-adaptable solution, especially in cases where bailout stenting is required for short, focal lesions, improving both clinical and procedural results.

The Impact of COVID-19 Vaccination on Oxidative Stress and Cardiac Fibrosis Biomarkers in Patients with Acute Myocardial Infarction (STEMI), a Single-Center Experience Analysis

The relationship between the classical cardiac biomarker and acute myocardial infarction (STEMI) in patients with COVID-19 is far from being elucidated. Furthermore, superoxide dismutase (SOD), a marker for oxidative stress, was associated with cardiac ischemia. Also, Galectin-3 is significant for defining the relationship between cardiac fibrosis and COVID-19. There are no studies on the effect of SARS-CoV-2 virus infection and vaccination on patients with STEMI and biomarkers above-mentioned. Aim: our single-center prospective study assesses the relationship between COVID-19 infection with/without vaccination and the value of SOD and Galectin-3 in STEMI patients. Material and methods: In total, 93 patients with STEMI and SARS-CoV-2 virus infection were included in the analysis, patients were divided in two groups based on COVID-19 vaccination status. Echocardiographic and laboratory investigations for cardiac ischemia, oxidative stress, and cardiac fibrosis biomarkers were investigated. Results: In total, 93 patients were included, the majority of which were male (72.0%), 45.2% (n = 42) were vaccinated against SARS-CoV-2; the mean age of vaccinated patients is 62 years, and 57% (n = 53) are smokers; blood pressure is found with a higher frequency in unvaccinated people (62.7%) compared to 28.6% in vaccinated people (p = 0.015), and 90.5% of the vaccinated people presented STEMI, compared with 96.1% of the unvaccinated ones. Revascularization with one stent was achieved in 47.6% of the vaccinated people and 72.5% for the unvaccinated people (p = 0.015). Galectin-3 was slightly more reduced in the vaccinated patients compared to the unvaccinated patients (0.73 vs. 0.99; p = 0.202), and the average level of Cu/ZnSOD was slightly more reduced in vaccinated patients compared to the unvaccinated patients (0.84 vs. 0.91; p = 0.740). Conclusions: Regarding patient’s SARS-CoV-2 infection functional status, the results from our single-center analysis did not find a statistically significant decrease in oxidative stress and cardiac fibrosis biomarkers along with cardiovascular complication following STEMI treated with percutaneous coronary angioplasty (PCI) in the case of patients with COVID-19 vaccination compared with patients who did not receive COVID-19 vaccine. Anyway, our data suggest that contemporary PCI techniques may offer an alternative revascularization strategy that enables complex CAD COVID-19 patients to be safely discharged from hospital.

Proctitis distal to colorectal anastomosis: a retrospective cohort study of an underreported complication after sigmoidectomy.

Proctitis distal to colorectal anastomosis is rare and infrequently reported. We evaluated the incidence, symptoms, treatment, and potential risk factors associated with this condition. We conducted a retrospective population-based cohort study in Västmanland County, Sweden. This investigation included all patients who underwent sigmoidectomy with colorectal anastomosis between 2008 and 2020. We excluded patients without an anastomosis and those with inflammatory bowel disease. Of the 546 patients identified, 233 fulfilled the inclusion criteria, of whom 26 (11.2%) developed proctitis distal to colorectal anastomosis. The most frequent symptoms included urgency (n=16, 61.5%), increased stool frequency (n=12, 46.2%), and anorectal pain (n=12, 46.2%). Endoscopic balloon dilation was performed in 20 cases (76.9%), with 10 requiring only a single therapeutic procedure. The median number of dilations was 3 (range, 1-8). Multivariable analysis revealed that surgery due to malignancy and emergency surgery were associated with elevated risk of proctitis. A subgroup analysis of patients who underwent surgery due to malignancy indicated that smoking (odds ratio, 3.9; 95% confidence interval, 1.1-14.0) and emergency surgery (odds ratio, 6.5; 95% confidence interval, 1.1-37.1) were also associated with increased proctitis risk. Proctitis distal to colorectal anastomosis is not uncommon following sigmoidectomy. Patients undergoing emergency surgery or surgery due to malignancy and who had a history of smoking displayed an increased risk of developing proctitis. Due to the paucity of symptoms observed, particularly in patients with a diverting stoma, routine endoscopic rectal examination should be performed during follow-up after sigmoidectomy.

Side branch preservation using tip detection-antegrade dissection reentry after failed subintimal tracking and reentry in chronic total occlusion: a case report

Abstract Background Techniques for treating difficult chronic total occlusions (CTO) have evolved with the discovery of the tip detection-antegrade dissection reentry (TDADR) guided by intravascular ultrasound (IVUS). This case demonstrates TDADR as a viable bailout in failed subintimal tracking and reentry (STAR) technique. Case Summary A 78-year-old man with stable angina on optimal medical therapy had exertional angina pectoris secondary to a residual CTO lesion of the left circumflex coronary (LCX) artery. PCI was performed for a mid-LCX CTO with a blunt proximal stump where the dissection plane expanded along the main vessel and side branch 2. Due to lack of promising collaterals for the retrograde approach, STAR successfully recanalized side branch 1. As main vessel failed to be recanalized, we proceeded with an AnteOwl IVUS-guided TDADR, intending guidewire penetration into the true lumen from the middle of the dissection plane at the main vessel, proximal to side branch 2 origin. Accurate wiring was achieved, and a guidewire was placed on side branch 2 for protection. After stent placement in the main vessel and kissing inflation, cutting balloon dilatation was performed to create reentries for the STAR-induced extended main vessel hematoma. The procedure resulted in complete revascularization of main vessel and side branches. At 12-month follow-up, no further angina was reported, and coronary computed tomography (CT) showed patent side branches with no significant in-stent restenosis. Discussion Imaging-based TDADR method was effective in our present case despite failed subintimal tracking and reentry technique. Limited IVUS and operator availability may become a barrier in implementing TDADR.

Inadvertent Detachment of Stent Retrievers: Report of 2 Cases.

Mechanical thrombectomy using a stent retriever is a widely-used technique for recanalizing occluded cerebral arteries in acute ischemic stroke. Although rare, inadvertent stent detachment has primarily been reported with earlier stent retriever designs. We present 2 cases of inadvertent stent detachment with the pRESET stent. In the first case, an elderly patient presented with right middle cerebral artery occlusion and experienced stent detachment during the second retrieval. Despite this, successful recanalization was achieved through balloon angioplasty. In the second case, an elderly patient experienced stent detachment after the third retrieval, and recanalization of the M1 segment was unsuccessful due to the inability to pass the microcatheter. The first patient had a modified Rankin scale (mRS) score of 3, while the second had a poor prognosis with an mRS score of 5. These cases highlight that inadvertent stent detachment can impact outcomes, and balloon angioplasty may serve as a useful salvage therapy.

The DILATE Study: A Prospective Cohort Study of Balloon Dilatation for Eustachian Tube Dysfunction in patients with no middle ear disease.

The DILATE Study: A Prospective Cohort Study of Balloon Dilatation for Eustachian Tube Dysfunction in patients with no middle ear disease.

A Snapshot on Clinical Trials on Zotarolimus DES: A Repurposing Drug against Myocardial Infarction

AbstractMyocardial infarction is the permanent death (necrosis) of heart muscle caused by a lack of oxygen for an extended period of time (ischemia). Since the very first percutaneous transluminal coronary angioplasty was done 40 years ago, the science of interventional cardiology has advanced dramatically. The above progression began with a balloon catheter attached to a fixed wire, advancing to bare-metal stents, first-generation drug-eluting stents (DES), second- and third-generation biodegradable polymer-based DES. Ultimately, bioabsorbable stents are still in development. Zotarolimus is a new pharmacologic therapy with a similar reprint address; for example, the antirestenosis agent sirolimus has recently been investigated as part of a stent platform combined with a biomimetic phosphorylcholine and BioLINX polymer for its biological activity, as well as its usefulness as an antiproliferative agent. Several clinical trials have been conducted to assess the safety and efficacy of the zotarolimus drug-eluting stent (Z-DES). Medtronic Medical Devices, a global leader in medical technology (United States), and Abbot Global Health Care and Research began clinical trials on the Z-DES in 2002 and will continue through 2021 (INDIA). Endeavor (E-Zes), Resolute (R-Zes), Resolute Integrity (I-Zes), and Resolute Onyx are the different forms of Z-DES that Medtronic has tested in clinical trials. In comparison to other DES, Z-DES was found to be safe in these clinical trials done across multiple nations and in a diverse demographic. This review helps understand the overall clinical trial of Z-DES.

Simulation analysis of different types of balloon dilatation catheters for the treatment of intracranial arterial stenosis.

The application of balloon dilation catheters in the management of intracranial arterial stenosis has been gradually increasing. However, studies on the feasibility and effectiveness of different types of balloons remain relatively scarce. In this study, catheter models of three different materials were designed to simulate balloon crimping,splitting, and dilatation processes. A compliant balloon produces large deformations with poor dilatation and a stress concentration phenomenon. During dilatation, the shear stress generated in the intima and lesion area by the semi-compliant balloon was smaller than that generated by the non-compliant balloon. These results demonstrate the feasibility of using semi-compatible balloons.

The Feasibility of Thrombolysis Followed with Ultrasound-Guided Percutaneous Transluminal Balloon Angioplasty in Acutely and Sub-Acutely Thrombosed Arteriovenous Fistulas.

Prompt resolution of arteriovenous fistula (AVF) thrombosis is essential to minimize the need for temporary dialysis catheters. Identifying the ideal timing for the management of thrombosed arteriovenous fistula (AVF) is an area that has not been thoroughly explored. Herein, we examined a local infusion of urokinase for thrombolysis followed by ultrasound-guided percutaneous transluminal balloon angioplasty (PTA) in acute and subacute AVF thromboses. This retrospective cohort research assessed thrombosed AVF in patients referred to the Second Xiangya Hospital. We included patients who underwent local thrombolysis followed by ultrasound-guided PTA treatment between January 1, 2018, and January 1, 2020. Results. We enrolled the records of 86 patients into the present study, including 44 patients with acute AVF thrombosis (group 1: thrombus age, < 72 hours) and 42 patients with subacute AVF thrombosis (group2: thrombus age, 72 hours to seven days). The thrombolytic success rate was 79.5% in group 1 and 42.9% in group 2 (P < .001). All patients underwent ultrasound-guided PTA to dissolve any residual thrombi regardless of thrombolytic success. Technical success after PTA procedures was achieved in 93.2% of patients in group 1 and 88.1% in group 2 (P = .417). Primary patency at six months was comparable between the two groups (67.5% vs. 64.8%, P = .564). We observed that thrombolytic effect does not affect PTA success rate, and six-month patency rate. Direct local infusion of urokinase to the affected area followed by ultrasound-guided PTA constitutes a minimally invasive and effective method for salvaging thrombosed AVF in contrast to abandoning the occluded fistula.

Atherectomy Followed by Drug-Coated Balloon Angioplasty Versus Surgery for Symptomatic Deep Femoral Artery Arteriosclerotic Disease.

Limited data are available regarding endovascular therapy of arteriosclerotic lesions of the deep femoral artery (DFA). In this study, we compare the outcomes of atherectomy combined with drug-coated balloon (DCB) angioplasty and open repair of DFA lesions. This is a multicenter retrospective registry of patients with peripheral artery occlusive disease Rutherford categories 2 to 5 treated by surgical profundaplasty (SP) or atherectomy followed by DCB for DFA lesions (symptomatic DFA). The primary endpoint was clinically driven target lesion revascularization (CD-TLR). Overall mortality, target limb reinterventions, major amputation, and major adverse limb events (MALEs) were additionally analyzed. A total of 373 patients treated for an arteriosclerotic lesion of the DFA between February 2015 and August 2021 were included, 301 treated by SP and 72 with atherectomy and DCB. The rates of chronic limb threatening ischemia (CLTI) were 42.2% and 22.2% (p<0.002) for the surgical and endovascular groups, respectively. A previous DFA intervention was more frequent in the endovascular group (30.6% vs 15.3%; p<0.003). Patients who had an open repair were more likely to have an occlusion of the profunda (34.9% vs 19.7%, p=0.014), severe calcified lesions (26.5% vs 5.6%, p=0.001), and lesions longer than 20 mm (95.7% vs 88.7%, p=0.024). After propensity score matching, no significant differences were found with regard to technical and hemodynamic success. At 24 months, no difference was found in terms of freedom from CD-TLR (95.7% vs 96.8%), freedom from all-cause mortality (94.2% vs 98.5%), freedom from MALE (90.4% vs 93.9%), and amputation-free survival (93.8% vs 97%). Following endovascular therapy, length of stay was significantly lower (p<0.001) and any reintervention on the index limb was more frequent (p=0.039). Patients with CLTI, occlusion of profunda, severe calcified lesions, and longer lesions are more frequently treated by open surgery, while reinterventions are more commonly treated by atherectomy and DCB. In patients with comparable clinical and lesion characteristics after matching, endovascular and surgical reconstruction of DFA lesions showed similar mid-term clinical outcomes. However, the risk of reintervention at the index limb is higher after endovascular treatment. Randomized studies are now warranted to compare both techniques in terms of medical and financial aspects. Atherectomy followed by DCB of symptomatic DFA is safe and effective. In patients with comparable clinical and lesion characteristics, outcomes are comparable with surgery. However, the risk of reintervention at the index limb is higher after endovascular treatment. Therefore, whenever possible an additional outflow vessel revascularization should be performed by the time of the primary intervention. Randomized studies are warranted to compare endovascular techniques and open surgery also under economic aspects.

Atherosclerotic Renal Arterial Stenosis with Multivascular Involvement in a Patient Presenting with Uncontrolled Hypertension and Cardiac Dysfunction

Renal artery stenosis (RAS) is the most common cause of secondary hypertension, with an incidence rate of 1–3% and atherosclerosis being the most common cause in 90% of the cases. The detection of atherosclerotic RAS may portend multivascular involvement; hence, a more comprehensive approach is essential. Clinical outcomes depend on renal condition and atherosclerotic burden with other coexisting cardiovascular diseases. A haemodynamically significant RAS can be considered with the onset of hypertensive crisis associated with worsening renal function and flash pulmonary oedema, known as Pickering syndrome. Despite the current controversy regarding the lack of randomised studies supporting the benefits of revascularisation over medical therapy, this may be considered in patients with RAS and Pickering syndrome. Reported here is the case of a 76-year-old woman with bilateral RAS who presented with persistent elevated blood pressure and heart failure symptoms. The patient underwent successful bilateral percutaneous transluminal renal angioplasty. Long-term monitoring requires maintaining adequate blood pressure control and renal function.

A case of esophageal squamous cell carcinoma with epidermization showing a unique morphology.

An 80-year-old woman with a history of endoscopic balloon dilation for esophageal stricture caused by accidental ingestion of caustic soda during infancy presented with dysphagia. Upper gastrointestinal endoscopy revealed a 10-cm-long, highly white, elevated lesion with a feathered appearance. This lesion was determined to be the cause of dysphagia and was completely resected via endoscopic submucosal dissection. Histopathological examination revealed a thick keratin layer on the surface of the stratified squamous epithelium, with a prominent granular layer underneath and some areas showing nuclear atypia. The lesion was diagnosed as a well-differentiated squamous cell carcinoma, pT1a-LPM, derived from epidermoid metaplasia. Cancer genome analysis revealed mutations in TP53 as well as amplification of MYC, FGFR1, chromosome 7, and chromosome 20q. This case suggests that epidermoid metaplasia caused by chronic irritation from an esophageal stricture may have been exacerbated by the dilation procedure.

Demographic characteristics, clinical manifestations, and treatment outcomes of May-Thurner Syndrome: a five-year retrospective analysis using computed tomography venography in a Chinese population

Objective This study aimed to analyze the demographic characteristics, symptoms, and treatment outcomes of patients diagnosed with May-Thurner syndrome (MTS) using computed tomography venography (CTV). Methods Medical records of patients diagnosed with MTS through CTV at Hebei General Hospital of China between April 1, 2017, and May 31, 2022, were reviewed. The data collected included: (1) gender, age, body mass index (BMI), and smoking and drinking habits; (2) time of onset and symptoms of MTS, as well as other accompanying symptoms; (3) additional diagnoses, length of hospital stay (days), treatment methods, treatment success, and the occurrence of post-treatment bleeding or recurrence. Descriptive statistics were used, with mean ± standard deviation and median values reported. The t-test/u-test and Chi-square test (including the exact probability method) were used to compare means and rates, respectively, with a significance level set at α = 0.05. Results Out of 402 patients (233 males, 169 females), 118 (29.4%) were diagnosed with MTS, with 47 (21.1%) males and 71 (39.7%) females. The incidence of MTS was significantly higher in females than males (χ2 proportion = 16.545, χ2 composition = 9.763, P < 0.05). The average ages of male and female MTS patients were 56.4 and 59.9 years, respectively, with mean BMIs of 27.05 and 27.09 kg/m2. Among male patients, 27.7% (13) were smokers, and 17.0% (8) consumed alcohol. Inferior vena cava (IVC) thrombosis was notable in 59.3% of MTS patients, with a significantly higher proportion in females (70.4%) than in males (42.6%) (χ2 = 9.102, P < 0.05). Lower limb swelling without pain was reported by 70.3% of patients, with 53.4% (44.7% male, 59.2% female) experiencing swelling on the left side only, which was significantly more common than swelling on the right side only or both sides (χ2 = 44.554, P < 0.05). Additionally, 12.7% of patients reported both swelling and pain, with left-side symptoms being more prevalent than right-side or both sides. The average ages at symptom onset were 51.3 ± 17.1 years in males and 57.1 ± 13.2 years in females. All treatments for MTS were successful without bleeding or recurrence. The most common treatment method was balloon dilation combined with stent placement (57.6%). Conclusion CTV is highly effective in detecting and facilitating the successful treatment of MTS. It should be fully utilized to promote early diagnosis and treatment of MTS. Female MTS patients need more medical resources for diagnosis and treatment.

ELLIS Study: Comparative Analysis of Excimer Laser Coronary Angioplasty and Intravascular Lithotripsy on Drug-Eluting Stent as Assessed by Scanning Electron Microscopy.

Stent underexpansion is a significant challenge in percutaneous coronary intervention, critically impacting patient outcomes. While excimer laser coronary angioplasty (ELCA) and intravascular lithotripsy (IVL) are increasingly used to address this issue, their full impact on the integrity of drug-eluting stents remains unclear, raising concerns about their safety and efficacy. This in vitro study assessed the effects of ELCA and IVL on the structural integrity of drug-eluting stents using scanning electron microscopy. Nine stents, 5 Onyx Frontier (with durable circumferential polymer coating) and 4 Cre8 (polymer-free), were implanted in a 3-dimensional coronary artery simulator following standardized protocols. After implantation, treatments with saline-ELCA, contrast-ELCA, IVL, and high-pressure balloon dilatation were applied. A comprehensive evaluation of the stent surface was performed at 60-fold magnification. Scanning electron microscopy analysis revealed significant differences in polymer damage between the techniques. High-pressure balloon dilatation and contrast-ELCA exhibited substantial polymer fragmentation and detachment compared with IVL, saline-ELCA, and conventional dilatation. High-pressure balloon dilatation demonstrated the highest incidence of polymer shaving and overcoating. No significant alterations were observed in polymer-free stents, regardless of the technique used. IVL and saline-ELCA applied immediately after stent implantation produce minimal polymer damage, whereas high-pressure balloon dilatation and contrast-ELCA cause significant damage to the polymer coating. The integrity of polymer-free drug-eluting stent appears stable regardless of the technique used. Further research is needed to validate these findings and explore their clinical implications.

Three-dimensional anisotropic unified continuum model for simulating the healing of damaged soft biological tissues.

The soft biological tissues have the ability to heal and self-repair after damage or injury. During the healing process, damaged tissues are replaced by newly produced undamaged tissue to restore homeostasis. Computational modeling serves as an effective tool for simulating the healing process and understanding the underlying mechanisms. In previous work, we developed the first unified continuum damage model for the healing of soft biological tissues. However, the initial theory lacked generalizability to more realistic scenarios and applicability to biomechanical problems due to the simplicity of the isotropic constitutive model and two-dimensional simulations. Therefore, we further improve our approach by developing a three-dimensional anisotropic unified healing model to address more realistic challenges. By using the Holzapfel-Gasser-Ogden model as the hyperelastic term, the influence of the collagen fibers is considered and the reorientation of fibers in healing is simulated. Three numerical examples related to hypertension, aneurysm, and restenosis of the atherosclerotic artery after balloon angioplasty are presented to demonstrate the effectiveness of the proposed model. By comparing numerical solutions and reference solutions, we demonstrate the ability of the proposed model in simulating long-term tissue healing process and analyze the impact of anisotropic terms.

Endovascular treatment of aortic coarctation using covered balloon-expandable stents-a systematic review and meta-analysis.

Balloon dilation followed by balloon-expandable stent implantation is an effective treatment for improving hemodynamic status in patients with coarctation of the aorta (CoA). However, limited evidence exists regarding the safety and efficacy of covered balloon-expandable stents (CBSs) in a large cohort. In this meta-analysis, we aimed to evaluate the overall success rates, hemodynamic and anatomical benefits, complications, and mid-term results of CBSs in treating CoA. The PubMed, Embase, and Cochrane Library databases were systemically searched for studies reporting outcomes of CBSs in treating CoA. Single-group rate meta-analyses were performed to calculate estimated pooled procedural success rates, the incidence of complications, and re-coarctation rates. A meta-analysis using standardized mean differences was conducted to compare pre- and postoperative trans-coarctation pressure gradients (PGs), coarctation diameter, and overall changes in systolic blood pressure (SBP). Subgroup analyses were performed to identify potential sources of heterogeneity. The final analysis included 12 studies with a total of 411 patients. The estimated pooled procedural success rate was 100% [95% confidence interval (CI): 98%-100%, I2 = 0, P = 0.78]. Significant decreases in trans-coarctation PGs and SBP were observed. The pooled incidences of stent-related, aortic, and access site complications were 2% (95% CI: 0%-5%, I 2 = 30.4%, P = 0.15), 2% (95% CI: 0%-4%, I 2 = 0%, P = 0.76), and 3% (95% CI: 1%-7%, I 2 = 52.9%, P = 0.02), respectively. Subgroup analyses showed that implantation of BeGraft stents was related to a significantly higher incidence of access site complications. Covered balloon-expandable stent implantation in treating CoA is safe and effective with high procedural success rates, an acceptable incidence of complications, and a low incidence of re-coarctation. https://www.crd.york.ac.uk/PROSPERO/, PROSPERO (CRD42023430356).

Impact of urinary catheters including reusable catheters on quality of life and work productivity in persons with spinal cord lesion

While preventing renal damage and symptomatic urinary tract infection are of paramount importance to persons with a spinal cord lesion (SCL), patient-reported outcomes (PROs) are receiving much more attention than ever before. We performed a cross-sectional internet survey of 282 adult members of SCL patient advocacy groups and investigated, for the first time, the impact of different types of urinary catheter, including a Japanese reusable silicone catheter and a reusable intermittent balloon catheter, on PROs of persons with SCL. Intermittent self-catheterization (ISC) did not surpass continuous indwelling catheterization in terms of a disease-specific urinary quality of life. Urinary incontinence, regular ISC, and performing ISC away from home confronted these individuals. Work productivity and regular activities correlated fairly well with the disease-specific urinary quality of life. Bowel management problems affected all PROs evaluated. The absence of differences in PROs among the types of catheter used for ISC implies that Japanese reusable catheters have the potential to benefit selected persons with SCL. Further research is warranted to develop measures for maximizing work productivity by overcoming urinary as well as bowel problems.