Balloon Embolectomy Catheter Research Articles

From Palm Leaves to Thermoplastic Polyurethanes-The History of Vascular Catheter Development and Use.

Vascular catheterization procedures are performed on millions of patients in the United States annually. Diagnostic and therapeutic, these procedures allow for the detection and treatment of diseased vessels. The use of catheters, however, is no new phenomenon. Ancient Egyptians, Greeks, and Romans constructed tubes from hollow reeds and palm leaves to be tunneled through the vasculature of cadavers to study cardiovascular system function, while eighteenth century English physiologist Stephen Hales used a brass pipe cannula to perform the first central vein catheterization on a horse. In 1963, American surgeon Thomas Fogarty developed a balloon embolectomy catheter, while in 1974, German cardiologist Andreas Grüntzig developed a more refined angioplasty catheter using polyvinyl chloride with improved rigidity. Vascular catheter material has since continued to evolve and is tailored to the specific needs of the procedure but would not have been possible without its rich and diverse history of development.

Managing thrombosis of arteriovenous fistula accompanied by aneurysm and single outflow of elbow perforating vein: a case report

BackgroundWe report a case of a patient who suffered thrombosis of a radial artery-cephalic vein fistula accompanied by aneurysm and a single outflow path of the elbow perforating vein. We performed open surgery combined with Fogarty balloon catheter embolectomy, anastomotic reconstruction and forearm median vein transposition.Case presentationThe patient presented with an arteriovenous fistula (AVF) after haemodialysis 5 years ago. In the process of dialysis, the fistula vein was punctured, resulting in aneurysm, high pressure and difficult haemostasis after needle extraction. AVF occlusion was observed on April 12, 2022. We performed a combined open surgery. First, a Fogarty balloon catheter was used to remove the thrombus, and the anastomosis was then reconstructed to restore AVF fistula patency. Finally, forearm median vein transposition was used to establish dual outflow. Postoperative haemodialysis was possible. There are various methods for removing the thrombus in AVF. Here, we report a case in which we performed open surgery combined with Fogarty balloon catheter embolectomy, anastomotic reconstruction and forearm median vein transposition to ensure fistula patency.ConclusionWe removed a complete reverse ‘Z’-shaped thrombus of the elbow perforating vein in a haemodialysis fistula. This report provides an effective strategy to manage a high-pressure fistula with single outflow of the elbow perforating vein.

Multimodal Recanalization for Subacute Symptomatic Internal Carotid Artery Occlusion Due to Atherosclerosis: Outcomes and Notes on Hybrid Techniques

Subacute internal carotid artery occlusion (ICAO) is associated with ipsilateral recurrent stroke, and successful recanalization of ICAO can improve cerebral blood perfusion (CBP) and prevent stroke. However, the optimal treatment remains controversial. We conducted a retrospective analysis of patients with subacute symptomatic ICAO due to atherosclerosis treated at our center. The hybrid surgical procedures included carotid endarterectomy, Fogarty balloon catheter embolectomy, aspiration thrombectomy, and percutaneous transluminal angioplasty/stenting. Recanalization rates, CBP improvement, stroke recurrence, and restenosis/reocclusion were investigated. Fourteen symptomatic atherosclerotic ICAO patients (type A, 4; type C, 10; men, 11; women, 3; average age, 68.1±7.9years) in the subacute phase were treated with a multimodal recanalization technique. Symptoms included mild cerebral infarction, transient ischemic attack (TIA), and amaurosis fugax. The average onset-to-treatment time was 18.1±4.8days. The successful recanalization (thrombolysis in cerebral ischemia grade 2 or 3) rate was 100%. The ipsilateral-to-contralateral mean transit time ratio was significantly lower at the 1-year follow-up than preoperatively (1.01±0.05 vs. 1.26±0.09, P<0.0001). There was one case of restenosis detected 1year after surgery and no cases of reocclusion. During the 28.3±10.0months of follow-up, only two cases of TIA occurred. The average modified Rankin Scale score and National Institute of Health Stroke Scale score were significantly lower at the most recent follow-up than before recanalization (1.21±0.89 vs. 1.86±0.66, P=0.0003; 1.36±1.55 vs. 2.00±1.88, P=0.0066). Multimodal recanalization techniques performed in a hybrid operation theater can safely achieve high recanalization rates in atherosclerotic ICAO patients in the subacute phase, which can be beneficial for recovering CBP and preventing stroke.

Effect of L-Arginine on the Thickness Iliac Arteries Wall Post Fogarty Balloon Embolectomy Catheter in Rabbit (Oryctolagus cuniculus)

The effect of the chronic administration of L-arginine on iliac arteries thickness after surgical embolectomy using Fogarty balloon catheter were examined. Sixteen New Zealand White male rabbits underwent unilateral iliac artery surgical embolectomy using Fogarty balloon catheter. Then the animals were divided into two group of control (P0) fed with standard rabbit diet and treatment (P1) standard rabbit diet added with L-arginine in their drinking water 4 for weeks. The iliac arteries were harvested for histological slide preparation with routine method, observed under the microscope attached with Nikon camera and measured using NIS-Element BR application in 8 zones. Data were collected and analyzed by independent T-test. The result of the vessel thickness was significantly decreased on the P1 (234.1± 18.1 µm) than P0 (411.6 ± 191.7 µm). Furthermore, the thickness of intimal was significantly decrease in P1 (140.9± 27.0 µm) compared with P0 (304.3± 215.7 µm). As a result, there was no significant different on the thickness of medial between P1 (93.2± 15.7 µm) and P0 (107.3± 101.5 µm). The results demonstrate that L-arginine decreased iliac artery wall thickness after surgical embolectomy with Fogarty balloon catheter in rabbit. Keywords: L-arginine ; nitric oxide ; Fogarty balloon catheter ; vascular smooth muscle cell proliferation.

The effect of anagliptin on intimal hyperplasia of rat carotid artery after balloon injury.

The present study evaluated the effect of anagliptin on intimal hyperplasia following carotid artery injury in Sprague-Dawley rats. Sprague-Dawley rats weighing 280–300 g were injured using a 2F Fogarty balloon embolectomy catheter. The rats were divided into injury-(saline) and anagliptin-(10 mg/kg/day) treated groups. vascular injuries were induced in the left carotid artery, followed by evaluation of neointima formation at 28 days. The right and left carotid arteries were harvested and evaluated with histological evaluation, and the plasma activity of glucagon-like peptide 1 receptor (GLP-1), stromal cell-derived factor (SDF)-1α, interleukin (IL)-6, IL-1β and tumor necrosis factor (TNF)-α were detected by ELISA analysis. Treatment with anagliptin decreased balloon injury-induced neointima formation, compared with the injury group (P<0.01). Body weight and food consumption did not alter following treatment with anagliptin. Anagliptin caused an increase in the serum active GLP-1 concentration, compared with the injury group. In addition, serum SDF-1α was significantly decreased by treatment with anagliptin (P<0.001). Anagliptin altered the serum activity of IL-6, IL-1β and TNF-α (P<0.01). The results of the present study demonstrated that anagliptin appeared to attenuate neointimal formation by inhibiting inflammatory cytokines and chemokines following balloon injury, and that treatment with a dipeptidyl peptidase 4 inhibitor may be useful for future preclinical studies and potentially for the inhibition of thrombosis formation following percutaneous coronary intervention.

TCTAP C-166 Successful Percutaneous Fogarty Balloon Catheter Embolectomy in a Centenarian Patient with Subacute Limb Ischemia

### Patient initials or identifier number I.T ### Relevant clinical history and physical exam A 100-year-old female, who had the history of atrial fibrillation, visited our hospital because of right lower-leg pain and pallor for several weeks. Enhanced computed tomography showed total occlusion

Analysis of associated diseases in patients with acute critical lower limb ischemia

Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number ofarterial thrombosis demanded more complex "inflow" and "outflow" ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.

Balloon Catheter Pulmonary Embolectomy Under Direct Visual Control Using a Choledochoscope

Acute massive pulmonary embolism has a high mortality rate despite advances in diagnosis and therapy. To salvage critically ill patients, complete clot extraction without arterial wall injury is essential. In this study, we performed balloon catheter embolectomy under direct visual control by using a flexible choledochoscope. For clear visualization, we introduced deep hypothermic circulatory arrest, and cold normal saline solution was flushed through the irrigation channel. From our experience, we believe that balloon catheter embolectomy with a choledochoscope allows easy access to the secondary and tertiary pulmonary branches and enables complete clot extraction.

U74389F, a 21-aminosteroid antioxidant, improves neoendothelial morphology, but not neointimal thickening after balloon catheter injuryThis article is one of a selection of papers published in a special issue on Advances in Cardiovascular Research.

U74389F is a compound in a family of 21-aminosteroids devoid of classical glucocorticoid action that inhibit lipid peroxidation. These compounds improve neurologic function and tissue survival after head or spinal cord injury. Dexamethasone inhibits development of intimal hyperplasia (IH) and improves attenuated nitric oxide (NO) production of the rabbit aorta subsequent to balloon catheter injury. We tested the hypothesis that U74389F is protective in a catheter-induced endothelial-denuded and arterial injury model. A 4-Fr Fogarty balloon (BALL) embolectomy catheter was passed through the thoracic aorta of New Zealand White rabbits treated with 15 mg/kg U74389F (LAZ) 2 days before and 1 week after injury. Animals were killed at 4 weeks after surgical intervention, and formation of IH was determined by calculating the intimal/medial ratio (I/M). The treatment groups of animals were injured untreated (BALL), injured treated (BALL/LAZ), uninjured treated (CONTROL/LAZ), and sham-operated treated (SHAM/LAZ). Scanning electron microscopy revealed that after injury lazaroid treatment produced an improvement of the neoendothelium (alignment in the direction of blood and fewer intercellular gaps) as compared with injured but untreated aortas. Relaxation to acetylcholine (NO formation) was impaired in aortic rings from catheterized animals; lazaroid treatment improved the relaxation to 10-6 mol/L acetylcholine but not to lower concentrations. I/M for SHAM/LAZ, BALL, and BALL/LAZ was 0.02 +/- 0.02, 21.6 +/- 1.6, and 17.2 +/- 2.5, respectively; BALL vs. BALL/LAZ, p < 0.06. An increased contractile response to 120 mmol/L KCl was observed after lazaroid treatment. This is the first report of lazaroid-mediated improvement in the neoendothelial morphology, improved neoendothelial NO generation, and augmented hypopolarizing contractile response, but no attenuation in the development of IH.

Curative effects of extrusive and Fogarty balloon catheter embolectomy in acute femoral vein thrombosis: experiment with rabbits

To compare the influence extrusive and Fogarty balloon catheter embolectomy on the patency rate of bloodstream and the damage of the wall of vein in acute femoral vein thrombosis. Eighty rabbits were randomly divided into 4 groups: Group A (n = 25) undergoing ligation of unilateral femoral to establish acute femoral vein thrombosis model and treated by extrusion of the hind leg muscles 24 h after the operation, Group B (n = 25) treated by Fogarty balloon catheter embolectomy 24 h after establishment of the thrombosis model, Group C (n = 25) undergoing sham operation, and Group D (n = 5) as normal controls.7, 14, and 28 days after the treatment digital subtraction angiography (DSA) was conducted to observe the patency rate of the vessel.1, 4, 7, 14, and 28 days after the treatment specimens of the thrombotic and corresponding sections of the veins were collected from the 4 groups (on days 1 and 7 for Group D) to undergo transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Quantitative reverse transcription and polymerase chain reaction was used to detect the level of tissue thromboplastin (TF). ELISA was used to detect the levels of thromboxane B(2), (TXB(2)) and 6-keto-prostaglandin F1alpha (PGF1alpha). Occlusion was seen in 3 femoral veins of Group B and one femoral vein of Group (P < 0.01), and the other veins were all patent. TEM and SEM showed that the endothelial cell injury was slight in Group A, and aggravated in Group B. TF mRNA expression could be seen 1 day after the treatment in Groups A, B, and C, and peaked on the day 7, and not found in Group D at any time points (all P < 0.01); and the TF mRNA levels at different time points of Group A were all significantly lower than those of Group B (all P < 0.01). The TXB(2) expression levels on days 1 and 7 of Groups A, B, and C were all significantly higher than those of Group D; especially those of Group B (all P < 0.01). The 6-keto-PGF(1)alpha levels on days 1 and 7 of Group D were both significantly higher than those of Groups A, B, and C (all P < 0.01). Compared with Fogarty balloon catheter embolectomy, extrusion embolectomy can discard the thrombus more thoroughly and guarantee the patency rate of bloodstream. Both extrusion embolectomy and Fogarty balloon catheter embolectomy, especially the latter, cause damage to the blood vessel endothelium.

Involvement of altered arginase activity, arginase I expression and NO production in accelerated intimal hyperplasia following cigarette smoke extract

In the present experiments, we tried to elucidate whether changes in arginase activity, protein expression of arginase-I and -II, and NO production are involved in accelerating the intimal hyperplasia following administration of cigarette smoke extract (CSE). The intimal hyperplasia was caused by removing endothelial cells with the aid of balloon embolectomy catheter in the right carotid artery of the male rabbit. The left carotid artery underwent sham operation and served as control. CSE was prepared by bubbling a stream of cigarette smoke into phosphate buffered saline. Rabbits were given subcutaneously with CSE once a day for 5 weeks from 1 week before to 4 weeks after the surgery. The specimens were assessed histologically and the intima/media ratio (%) was evaluated as an index of the intimal hyperplasia. The accelerated intimal hyperplasia with CSE was accompanied by the augmentation of the impaired cyclic GMP production, enhanced overall arginase activity and up-regulation of arginase-I. Pearson's correlation coefficient analyses revealed the close relationships among the arginase activities in endothelial cells and smooth muscle layer, the intimal/media ratio and cyclic GMP production. These results suggest that the enhanced arginase activity together with facilitated up-regulation of arginase-I with CSE, which was associated with the augmented impairment of NO production, shed a new light on the processes associated with accelerating the intimal hyperplasia in rabbit carotid arteries following CSE.

A Few Beats Ahead: Medical Device Pioneers

A Few Beats Ahead: Medical Device Pioneers

Neutralization of Interleukin-18 Inhibits Neointimal Formation in a Rat Model of Vascular Injury

Studies in humans and animal models suggest that interleukin-18 (IL-18) plays a crucial role in vascular pathologies. IL-18 is a predictor of cardiovascular death in angina and is involved in atherotic plaque destabilization. Higher IL-18 plasma levels also are associated with restenosis after coronary artery angioplasty performed in patients with acute myocardial infarction. We investigated the effective role of IL-18 in neointimal formation in a balloon-induced rat model of vascular injury. Endothelial denudation of the left carotid artery was performed by use of a balloon embolectomy catheter. Increased expression of IL-18 and IL-18Ralpha/beta mRNA was detectable in carotid arteries from days 2 to 14 after angioplasty. The active form of IL-18 was highly expressed in injured arteries. Strong immunoreactivity for IL-18 was detected in the medial smooth muscle cells at days 2 and 7 after balloon injury and in proliferating/migrating smooth muscle cells in neointima at day 14. Moreover, serum concentrations of IL-18 were significantly higher among rats subjected to vascular injury. Treatment with neutralizing rabbit anti-rat IL-18 immunoglobulin G significantly reduced neointimal formation (by 27%; P < 0.01), reduced the number of proliferating cells, and inhibited interferon-gamma, IL-6, and IL-8 mRNA expression and nuclear factor-kappaB activation in injured arteries. In addition, in vitro data show that IL-18 affects smooth muscle cell proliferation. These results identify a critical role for IL-18 in neointimal formation in a rat model of vascular injury and suggest a potential role for IL-18 neutralization in the reduction of neointimal development.

Intraoperative streptokinase: a useful adjunct to balloon-catheter embolectomy.

Intraoperative thrombolysis was attempted in 31 acutely ischaemic legs after operative arteriography had demonstrated residual distal thrombus or occlusion following balloon-catheter thromboembolectomy. There were 30 patients, 16 men and 14 women, aged 43-82 (median 73) years. The indication for operation was severe ischaemia with sensorimotor loss in 25 limbs, failed percutaneous thrombolysis in three and acute graft occlusion in three. A total of 21 perfemoral, 11 perpopliteal and four graft embolectomies were initially performed. Following arteriography, 100,000 units streptokinase was infused down the isolated distal arterial tree over 30 min and arteriography repeated. Complete lysis was achieved in 11 legs (35 per cent) and partial lysis in 12 (39 per cent). Additional procedures required included six operative angioplasties and six bypass grafts. After operation pedal pulses were restored in 14 limbs (45 per cent), with a viable leg in 23 cases (74 per cent) at the time of patient discharge or death. There were five wound haematomas but no evidence of systemic fibrinolysis. Four amputations were required, none in the group undergoing successful lysis, and there were seven deaths, five from cardiac disease. Arteriography after balloon-catheter embolectomy is essential to detect residual thromboembolus and intraoperative streptokinase appears to be a safe and effective way of removing this.

Which balloon embolectomy catheter?

This study compared seven makes of balloon embolectomy catheter currently available, testing the most commonly used 4 Fr catheters. The volume of fluid and inflation pressure required to burst balloons of each type were measured. All balloons showed a similar shape of inflation curve, but compliance varied considerably, and the pressure required to burst different balloon types varied from 1060 to 1920 cmH2O. Two balloon types consistently fragmented when they burst in free space. On a specially designed mechanical rig balloon catheters were pulled through a 6 mm tube containing a fixed stenosis, with continuous measurement of traction force and intraballoon pressure. Traction force varied from 34 to 129 g (median 40 g) during passage along the tube, and from 254 to 463 g (median 350 g) during passage through the stenosis. The shear force imparted by the balloon to the tube wall was also calculated. This study provides comparative data which may help to guide surgeons in their choice of balloon embolectomy catheter.

Use of a Fogarty Embolectomy Catheter to Retrieve a Foreign Body during Redo Coronary Artery Bypass Surgery: Case Report.

Abstract We report the successful use of an embolectomy catheter to retrieve a metal bullet tip of a cardiotomy suction device that was lost during redo coronary artery surgery. The metal tip was lost somewhere in the vicinity of a tear created in the ascending aorta during repeat sternotomy. Initial attempts at retrieval using a Foley catheter were made but were unsuccessful. The foreign body was successfully retrieved by withdrawing an inflated Fogarty balloon embolectomy catheter. The patient went on to have coronary artery bypass grafting and made a sound recovery from the operation.

Inward Remodeling of the Rabbit Aorta Is Blocked by the Matrix Metalloproteinase Inhibitor Doxycycline

Constrictive arterial remodeling accounts for a significant proportion of lumen loss in atherosclerotic progression and postangioplasty stenosis. Recent research suggests that constrictive remodeling is mediated by turnover of the extracellular matrix. We hypothesized that remodeling could be attenuated by treatment with the safe, effective matrix metalloproteinase (MMP) inhibitor doxycycline. Female rabbit abdominal aortas were denuded using a 4-Fr balloon embolectomy catheter, and reinjured 3 weeks later. Treatment with 30 mg/kg/day doxycycline was begun the day before the second injury. At 6 weeks after injury, lumen area measured 13.1 ± 1.2 mm² in controls compared to 17.5 ± 1.6 mm² in doxycycline-treated rabbits (p = 0.05). At 4 days after injury, MMP-2 activity was increased compared to uninjured controls, but doxycycline treatment reduced MMP-2 activity. Doxycycline treatment also inhibited fibrillar collagen deposition in the intima by 87% as detected by polarized light microscopy. Doxycycline was an effective inhibitor of constrictive arterial remodeling in the rabbit aorta. Treatment reduced MMP activity and attenuated the deposition of extracellular matrix particularly in the intima.

Acute Embolic Occlusion of the Superior Mesenteric Artery: A Case Report and Discussion of Management

Introduction: We present a case of acute embolus to the superior mesenteric artery (SMA). Clinical Picture: A 70-year-old gentleman with atrial fibrillation complained of colicky abdominal pain with clinical signs of tenderness and mild guarding. Treatment and Outcome: Laparotomy revealed extensive bowel ischaemia but no overt infarction. The SMA was occluded by an embolus at the root of the mesentery and balloon catheter embolectomy was carried out at once. Bowel resection was deferred in order to allow clear demarcation of gangrene to avoid sacrificing unnecessary length. At second look laparotomy, 1.2 m of bowel from mid-jejunum to mid-ileum was resected, salvaging about 1 m of previously dusky small and large bowel. Conclusion: This case illustrates the importance of accurate history taking, the role of early intervention and the usefulness of a second look laparotomy in cases of mesenteric ischaemia to minimise the extent of bowel resection.

Novel NAD(P)H oxidase inhibitor suppresses angioplasty-induced superoxide and neointimal hyperplasia of rat carotid artery.

Neointimal proliferation occurring after vascular or endovascular procedures is a major complication leading to end-organ or limb ischemia. In experimental models, balloon injury has been shown to induce NAD(P)H oxidase to produce vascular superoxide anion (O2*-) production, which has been implicated in cell proliferation, but a direct link is still unclear. We postulated that inhibition of arterial NAD(P)H oxidase, resulting in decreased O2*-, would lessen the neointimal hyperplasia caused by balloon injury to the common carotid artery (CCA). Sprague-Dawley rats were implanted with osmotic minipumps containing either vehicle, a cell-permeant peptide that inhibits NAD(P)H oxidase (gp91ds-tat, 10 mg/kg per day), or a scrambled peptide control (scrmb-tat). Two days after pump implantation, the left CCA was injured using an intravascular balloon embolectomy catheter (2F Fogarty). Systolic blood pressure was monitored by tail cuff. Fourteen days after injury, CCAs were harvested and analyzed by digital morphometry. Rats in both groups remained normotensive, with no significant differences in systolic blood pressure. Reactive oxygen species measurements after injury indicated a significant reduction in vascular O2*- in rats infused with gp91ds-tat, and the neointima/media area and thickness ratios were significantly lower in their arteries compared with control. On the contrary, no significant change in overall CCA diameter was observed in any group. Our data indicate that in response to balloon injury of the rat carotid artery, NAD(P)H oxidase activity contributes to neointimal hyperplasia and is involved in vascular cell proliferation and migration during restenosis.

Fluoroscopically assisted thromboembolectomy: should it be routine?

The treatment of acute limb ischemia secondary to thromboembolic disease has become significantly more difficult because of the increased proportion of elderly patients presenting with complex patterns of atherosclerotic disease. The presence of multiple medical comorbidities also complicates operative and perioperative management in these patients. Neither the techniques nor catheter designs have changed significantly since the introduction of the balloon embolectomy catheter in 1963, which permitted extraction of clot from remote sites. The authors believe that the use of intraoperative fluoroscopy and the performance of fluoroscopically assisted thromboembolectomy (FATE) greatly improves the results of this treatment in many cases. FATE facilitates catheter passage through tortuous, diseased arteries, identifies residual thrombus and underlying lesions, reduces vessel damage caused by balloon overinflation, and decreases the risk of catheter-induced dissection or atherosclerotic plaque displacement. Intraoperative fluoroscopy helps determine the need for as well as guides adjunctive procedures such as angioplasty and stenting. Such procedures can be performed at the time of the thromboembolectomy simplifying and expediting treatment.