Case Of Restenosis Research Articles

Long-Term Outcomes of Stenting for Pulsatile Tinnitus Caused by Cerebral Venous Sinus Stenosis.

To investigate the long-term outcomes of stenting for isolated pulsatile tinnitus (PT) caused by cerebral venous sinus stenosis. Retrospective study. The First Medical Center, Chinese PLA General Hospital. Patients diagnosed to have isolated PT secondary to cerebral venous sinus stenosis at our institution between December 2009 and March 2023. Cerebral venous sinus stenting. Morphological features of the cerebral venous sinus, endovascular technique, and clinical outcomes. The study included 80 patients with a mean age of 39.4 ± 9.6 years and an average body mass index of 23.9 kg/m. The mean age at symptom onset was 35.1 ± 8.7 years. Seventy-five of the patients (93.8%) were women. PT was the primary symptom. All patients reported feeling anxious because PT had severely affected their day-to-day lives. The PT was right-sided in 52 cases (65%). All procedures were technically successful. The mean trans-stenotic pressure gradient decreased from 4.3 ± 3.3 mm Hg before stenting to 0.4 ± 0.9 mm Hg after stent placement. Twenty-one patients (26.3%) experienced poststenting headache. The mean follow-up duration was 80.5 ± 46.3 months, with 26 patients followed for over 120 months. PT resolved in all cases after stenting, and there were no recurrences. Follow-up radiographic examination of 23 patients (28.8%) at a mean of 71.2 ± 43.1 months identified only one case of restenosis. Long-term follow-up of these patients confirmed the efficacy and safety of stenting for isolated venous sinus stenosis-related PT.

Transcarotid artery revascularization for in-stent restenosis complicated by flow reversal occlusion

We report a case of symptomatic high grade in-stent restenosis of a prior placed transradial carotid artery stent. We performed a Transcarotid Artery Revascularization (TCAR) to treat this symptomatic restenosis. The TCAR was complicated by occlusion of our flow reversal system by a large atherosclerotic embolus. We performed a distal common carotid cutdown to retrieve the occlusive embolus and restored flow reversal. Completion neck and cerebral angiogram showed no filling defect, and our patient showed no neurologic deficit, and resolution of pre-operative symptoms.

Hyperacute Restenosis after Carotid Endarterectomy – A Rare Entity and Its Management

We report an interesting case of restenosis coming on in the early postoperative period after successful carotid endarterectomy at the site of endarterectomy. The patient was admitted and managed at Neurosurgery Department of Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai.

A case of restenosis of bile duct jejunal anastomosis 10 years after dilatation

A case of restenosis of bile duct jejunal anastomosis 10 years after dilatation

Safety and efficacy comparison between OACs plus single antiplatelet and dual antiplatelet therapy in patients with cerebral venous sinus stenosis poststenting

Background and purposeThe present strategies regarding poststent management for cerebral venous sinus stenosis (CVSS) are inconsistent. Herein, we compared the safety and efficacy of oral anticoagulants (OACs) plus single antiplatelet therapy and dual antiplatelet therapy for CVSS poststenting.MethodsA real-world observational study conducted from January 2009 through October 2019 enrolled patients who were diagnosed with CVSS and received stenting. Patients were divided into two groups according to the management they received poststenting. Group 1: OACs plus a single antiplatelet agent (clopidogrel 75 mg or aspirin 100 mg) and Group 2: dual antiplatelet therapy (clopidogrel 75 mg plus aspirin 100 mg). The safety (such as major or minor bleeding or venous thrombosis) and efficacy (the incidences of cerebral venous sinus restenosis, intrastent thrombosis, or stent displacement) of the two groups were compared.ResultsThere were a total of 110 eligible patients in the final analysis, including 79 females and 31 males with a mean age of 43.42 ± 13.23 years. No major bleeding or venous thrombosis occurred in either of the two groups. Two minor bleeding events occurred in group 2 (one with subcutaneous bleeding points in both lower limbs, another with submucosal bleeding in the mouth), whereas no bleeding events occurred in Group 1. In addition, at the 1-year follow-up, one case of intraluminal restenosis and two cases of in-stent thrombi occurred in Group 2, while none occurred in Group 1. Neither stenosis at stent-adjacent segments nor stent migration was detected in either group during the 1-year following stent placement.ConclusionOACs plus single antiplatelet therapy and dual antiplatelet therapy alone are both safe and efficacious management strategies after CVSS stent placement. The former may have more advantages than the latter for inhibiting intrastent thrombosis. However, further research by larger, multicenter clinical trials is needed.

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.

Use of monopolar microelectrodes and radiofrequency in the treatment of arytenoid edema after partial horizontal laryngectomy and radiotherapy.

We evaluated the tissue reduction effects using monopolar microelectrodes (MME) coupled to a radiofrequency (RF) generator in arytenoid edema caused by postoperative radiotherapy in larynx. This is a retrospective transversal study, which included 15 patients with supraglottic laryngeal carcinoma. All the patients had undergone a partial horizontal laryngectomy and bilateral neck dissection followed by postoperative radiotherapy. The studied group of patients presented laryngeal stenosis defined by arytenoid edema as a complication, requiring permanent tracheostomy for mean of 12 months. The surgical procedure for treating the edema was the transoral approach of the larynx by microlaryngoscopy under general anesthesia; using 180° MME coupled to a 4-MHz RF generator delivering 15 W using coagulation mode. A total of 11 (73%) patients were decannulated. The median time for decannulation was 10 weeks. No complications were reported. After 2 years of follow-ups, no case of re-stenosis was found. MME coupled to RF is a very efficient method to treat arytenoid edema after adjuvant radiotherapy.

Successful double-layer metal stents rotational ablation under 2-dimensional and 3-dimensional optical coherence tomography guidance: a case report

BackgroundStent ablation with rotational atherectomy has been considered a bail-out strategy for the treatment of severe stent underexpansion. Only a few reports have yet shown rotational ablation for double-layer metal struts.Case presentationWe present a case of 80-year-old female patient presented to our hospital because of worsening effort angina. Coronary angiography revealed severe in-stent restenosis in the proximal left anterior descending artery. Optical coherence tomography (OCT) examinations found that severe stenosis occurred at the overlap region with 2-layer underexpanded stents and circumferential calcification beneath them. Under the guidance of 2-dimensional (2D) and 3-dimensional (3D) OCT, we successfully performed percutaneous coronary intervention (PCI) of this lesion after adequate stent ablation, high-pressure balloon dilatation, and subsequent everolimus-eluting stent implantation. The patient recovered well uneventfully and discharged from hospital 7 days later. No restenosis occurred after 12 months.ConclusionsWe report a very rare case of in-stent restenosis due to double-layer underexpanded stents. The entire percutaneous coronary intervention procedure was performed step by step under the guidance of high-resolution OCT. Our findings highlight the specific value of 2D and 3D OCT guidance in double-layer stents rotational ablation.

A Case of Recurrent Coronary Artery Restenosis Associated with Suspected Arteritis in a Young Woman

Approximately 5% of patients with Acute Myocardial Infarction (AMI) do not have atherosclerotic Coronary Artery Disease (CAD) but present other factors responsible for luminal narrowing. A 24-year-old woman presented with angina and AMI without any known risk factors and recurrent coronary restenosis in the 7 year-follow-up period. Thorough tests revealed no suggestive factors besides increased amounts of tumor necrosis factor-a and interleukins. A diagnosis of arteritis was suspected. Therefore, glucocorticoid and immunosuppressor administration was performed, and the patient’s condition was relieved. Severe coronary artery disease with smooth distal coronary vessels in a young female without apparent risk factors could suggest a non-atherosclerotic etiology.

Endovascular management of symptomatic stenosis of supra-aortic arteries in patients with Takayasu arteritis.

Endovascular management is used to treat Takayasu arteritis (TA) involving the supra-aortic branches. However, the long-term outcome of this treatment remains unclear. Here, technical safety, outcomes, and restenosis management of supra-aortic arteries in TA patients receiving endovascular treatment were evaluated. TA patients with symptomatic supra-aortic stenosis who underwent percutaneous angioplasty and stenting between 2008 and 2018 at our institute were enrolled in this study. Pre- and post-procedural magnetic resonance imaging (MRI) evaluations, including high-resolution vessel wall imaging (HR-VWI), were performed. Technical efficacy, peri-procedural complications, early post-procedural MRI results, and stent patency were examined. All six patients successfully received stent placement or percutaneous transluminal angioplasty in a total of 22 treated arteries without neurologic complications. During follow-up (mean, 56.3 ± 41.1 months), no recurrent stroke occurred, yet significant restenosis developed in 12 of 22 (54.5%) of the treated arteries. Three of the patients underwent HR-VWI before surgery. Concentric wall thickening and enhancement of the left common carotid artery was detected in one patient, indicating acute inflammation. Angioplasty with drug-eluting balloon (DEB) successfully treated a case of refractory restenosis. Among 10 early post-procedure MRI performed, only two asymptomatic new lesions were detected with diffusion-weighted imaging. Endovascular treatment of supra-aortic arteries of TA patients was safe and effective, yet was associated with a high restenosis rate. Thus, close follow-up is needed. HR-VWI is helpful for pre-procedural selection of patients for percutaneous angioplasty and stenting and drug-eluting balloon angioplasty appears to be a promising treatment for refractory in-stent restenosis.

Long-term Kinetic Papilledema Improvement After Venous Sinus Stenting in Idiopathic Intracranial Hypertension

The aim of this study was to assess the safety and effectiveness of lateral sinus stenosis (LSS) stenting in patients with idiopathic intracranial hypertension (IIH) who are refractory to medical treatment, particularly focusing on visual outcomes including papilledema. Retrospective study of consecutive patients with IIH refractory to medical treatment who underwent LSS stenting. Clinical features, visual fields and optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thicknesses were assessed before stenting, at 1 month poststenting and at last follow-up. Complications were also recorded. A total of 16women were included, with amean age of 39 ± 11years. All patients had papilledema while 15/16 (94%) had headaches. Mean visual acuity was 0.036 logMAR, range (+0.4 to +0.0 logMAR). The mean RNFL thickness prior to stenting was 121.7 µm (±34.7 µm) and mean GCL thickness was 80.2 µm (±8.9 µm). Mean follow-up was 19.7months (±11.8 months). After stenting, acetazolamide was discontinued in 15/16 (94%) patients. Papilledema improved in 14/16 (88%) of patients. The mean RNFL thickness was significantly decreased 1 month after stenting (96.3 ± 15.6 µm; p < 0.001) and at last visit (93.4 ± 15.3 µm; p < 0.001). The GCL thickness after LSS stenting was moderately decreased at the last visit examination: 80.2 ± 8.9 µm vs. 78.0 ± 10.7 µm; (p < 0.01). No stent-related complication occurred, while there was one case of restenosis. Improvement of papilledema appears to occur relatively rapidly after the LSS stenting. The results further support the role of LSS stenting in the treatment of IIH, especially with respect to visual symptoms.

P1840Mid-term results of bioprosthetic aortic valve replacement with the Trifecta valve: A word of caution

Abstract Background Structural valve deterioration (SVD) with associated bioprosthetic valve dysfunction remains an unsolved problem, exposing patients to the risk of aortic valve re-intervention after surgical aortic valve replacement (SAVR). Several strategies have been proposed to improve prosthesis design for optimal performance. The leaflets of the Trifecta valve are mounted on the outside of the prosthetic stent to achieve a larger orifice area. Although favourable early clinical outcomes have been reported, long-term durability still needs to be assessed. Purpose The aim of the current study was to assess the mid-term overall mortality and re-intervention rate in patients who received a Trifecta valve with a follow-up &gt;5 years. Methods Patients who underwent SAVR at our centre between 2011 and 2012 were identified in the internal, prospective database. All patients with implantation of a Trifecta valve in aortic position were included. Primary endpoints were freedom from overall mortality and from re-operation at latest follow-up (FU). Additionally, assessment of echocardiographic parameters at baseline and follow-up was performed. Results Seventy-six patients (age 77.3±9.5 years, BMI 28.6±5.8, 68% male) were included in the study. EuroScore II was 7.2% (± 7.7) while mean STS-Mortality score was 2.4±1.1%. Of all procedures, 53% were isolated aortic valve replacements, whereas concomitant procedures were performed in 47% of cases (37% CABG, 12% mitral surgery, 8% tricuspid surgery). Baseline echocardiographic assessment showed a mean pressure gradient (MPG) of 51±21 mmHG, a peak pressure gradient (PPG) of 78±36 mmHG and a peak velocity (Vmax) of 4.2±1.1 m/s. Thirty-day mortality was 7%. Freedom from overall mortality at 1 year and 5 years was 84% and 73%, respectively. Freedom from death and freedom from re-operation at latest FU (6.7±0.5 years) was 68% and 90%, respectively. In a composite endpoint analysis, freedom from death or re-intervention at latest follow up was 60%. A total of 7 patients underwent aortic valve re-interventions (re-replacements n=5, valve-in-valve n=2). Indications for re-interventions were SVD (n=5), NSVD (n=1, pannus ingrowth) and endocarditis (n=1). One case of re-stenosis occurred in a patient who was deemed not feasible for aortic valve re-intervention and died. Kaplan Meier analysis Conclusion(s) To our knowledge, this patient cohort presents with the lowest rate of freedom from re-operation (90%, 6.7±0.5 years) after SAVR with the Trifecta valve. A relatively high number of SVD and NSVD has been observed, which might be attributable to the specific leaflet mounting or the deformable valve frame of the first generation. Current results call for further investigation with prospective echocardiographic follow-up in this patient group. Acknowledgement/Funding None

Intracranial Atheromatosis Disease (ICAD) and Stent Supported Angioplasty

Objectives: Symptomatic intracranial atheromatous disease has an unfavorable prognosis. The endovascular treatment with percutaneous transluminal angioplasty (PTA) stent assisted must be held in accordance with the efficacy, safety, complications and the risk of restenosis in the long term. Materials and methods: A study conducted between 1996 and 2008, includes 28 patients with 30 cases of stenosis located in the internal carotid artery (11), basilar artery (14) and vertebral artery (5). All cases were symptomatic even under anticoagulation treatment and the stenosis grade &gt; 60% (average 83.5%). Results: There was a significant reduction in the degree of stenosis (less than 50%), with an average residual stenosis of 36.8%. There were two complications, with reperfusion bruising (6.6%). In the long term monitoring, we found a single case of restenosis and no patient had a transient or permanent ischemic stroke. Conclusion: The treatment of intracranial stenosis with stentassisted angioplasty is effective, with a low complication rate and restenosis in this series.

Allium Stents: A Novel Solution for the Management of Upper and Lower Urinary Tract Strictures.

Stents are widely use in endoscopic urological procedures. One of the most important indications is the treatment of urinary tract strictures. Allium™ Medical has introduced several types of stents for the treatment of different types of urinary tract strictures, based on anatomic location. All the stents are made of nitinol and coated with a co-polymer that reduces encrustations. These stents are self-expandable and have a large caliber and a high radial force. They have different shapes, designed especially for the treatment of each type of stricture. One of the most important features of Allium-manufactured stents is the ease of removal, due to their special unraveling feature. The company has introduced the Bulbar Urethral Stent (BUS) for treatment of bulbar urethral strictures; a rounded stent available in different lengths. Initial data on 64 patients with bulbar urethral stricture treated with the BUS showed a significant improvement in symptoms, with minimal complications and few adverse events. For treatment of prostate obstruction in patients unfit for surgery or unwilling to undergo a classical prostatic surgery, the Triangular Prostatic Stent (TPS) was introduced, which has a triangular shape that fits in the prostatic urethra. Its body has a high radial force attached to an anchor (which prevents migration) through a trans-sphincteric wire (which reduces incontinence rate). Initial data on 51 patients showed significant improvement in symptoms and in urinary peak flow rate, with a relatively small number of complications. The Round Posterior Stent (RPS) was designed for treatment of post radical prostatectomy bladder neck contracture. This short, round stent has an anchor, which is placed in the bladder neck. This stent being relatively new, the clinical data are still limited. Ureteral strictures can be treated with the Ureteral Stent (URS), which is round-shaped, available in different lengths, and has an anchor option (for very distal or very proximal strictures). We have previously published data on 107 URSs inserted in patients with ureteral stricture due to several etiologies, including patients who failed previous treatment. All patients were asymptomatic for a long period of follow-up after stent removal, with only one case of re-stenosis. In this paper, we review the urological “covered” stents produced by Allium Medical with the relevant clinical data available at the present time.

Carotid endarterectomy for in-stent restenosis: a case report and literature review

It is relatively difficult to treat restenosis when restenosis occurs following carotid artery stenting. Endarterectomy with simultaneous stent removal is an effective approach when restenosis occurs. The treatment method is still not well known. The present paper reports a case of restenosis after stenting that was treated with endarterectomy with a satisfactory treatment outcome. The patient, a 74-year-old male, underwent stenting 10 months before he was re-hospitalized. He seemed to recover well after stenting until one month before he was re-hospitalized, when he presented symptoms of cerebral ischemia. Imaging examination revealed that in-stent stenosis had reoccurred, with the stenosis degree ranging from 70–99%. He was given endarterectomy treatment, and intra-operative findings showed that the stent grew into a carotid artery plaque and protruded below the adventitia and that the stent lumen was not covered by carotid artery intima. The surgery completely and successfully removed the plaque and the stent, while the adventitia was completely preserved. Follow-up indicated that there was no stenosis in the carotid artery, and the prognosis was good. Relevant literature was also reviewed in this paper, and the authors suggested that carotid artery plaque and stent endarterectomy is beneficial. However, surgical treatment for in-stent stenosis remains a challenging option.

Comparison of the effect of urokinase and batroxobin in the treatment of acute cerebral infarction

Objective To compare the efficacy and safety of urokinase and batroxobin in the treatment of acute cerebral infarction(ACI). Methods According to the digital table, 88 patients with ACI were randomly divided into two groups.The observation group(44 cases) was given thrombolytic therapy, the control group(44 cases) was given alteplase treatment.The treatment effects and safety were compared between the two groups. Results The NIHSS scores before treatment, 24h, 1 week and 2 weeks after thrombolysis had no statistically significant differences between the two groups(all P>0.05). After treatment for 1 month, 29 cases(65.9%) of nerve function good prognosis in the observation group, 28 cases(63.6%) in the control group, there was no significant difference between the two groups(χ2=0.049, P=0.958). In the control group, 1 case of cerebral hemorrhage, and occlusion in 1 case, 1 case of other adverse reactions(hematuria), the incidence rate of complications and adverse reaction was 6.82%(3/44). In the observation group, 2 cases of hemorrhage(including 1 case of cerebral hemorrhage and 1 case of gastrointestinal bleeding), 1 case of reperfusion injury and restenosis, 2 cases of other adverse reactions(including hematuria and allergic rash, each in 1 case), the incidence rate of complications and adverse reaction was 13.64%(6/44). There was no statistically significant difference in the incidence rate of complications and adverse reaction between the two groups(χ2=0.495, P=0.597). Conclusion Urokinase and alteplase in the treatment of ACI have considerable effect in improving the symptoms of patients with neurologic impairment, alteplase is slightly in terms of security advantages, but the price is relatively expensive, urokinase in the treatment of ACI in primary hospital is still desirable. Key words: Cerebral infarction; Urokinase; Alteplase

A case of recurrent proximal edge restenosis after drug eluting stent implantation

A case of recurrent proximal edge restenosis after drug eluting stent implantation

Postinflammatory medial canal fibrosis: An institutional review and meta‐analysis of short‐ and long‐term outcomes

Few studies report outcomes of surgical management of postinflammatory medial canal fibrosis (PIMCF). The objectives were to compare short- and long-term outcomes after surgical repair of PIMCF at our institution and systematically aggregate published data for meta-analysis. Medical records for the case series; PubMed, Scopus, and OVID/Medline for the systematic review/meta-analysis. Patients undergoing surgical treatment of PIMCF were identified. Short-term (<2 years) and long-term (>2 years) postoperative outcomes were evaluated for the case series and aggregated for the meta-analysis. At our institution, 16 patients (21 ears) were identified. Compared to the preoperative air-bone gap (ABG) (27.7 ± 7.5 dB), mean postoperative short-term ABG (8.2 ± 7.5 dB) and long-term ABG (15.3 ± 11.3 dB) were significantly improved (P < 0.001 for both). Although short-term restenosis rate was low (0%) among long-term follow-up patients, 64% (9 of 14) experienced some degree of recurrent canal narrowing, including one case of complete restenosis (7%). Similarly, meta-analysis pooled preoperative ABG (29.3 ± 9.7 dB, 95% confidence interval [CI] 27.0-31.6) improved significantly during short-term (11.4 ± 8.0 dB, 95% CI 8.3-4.5, P < 0.0001) and long-term (14.3 ± 9.6 dB, 95% CI 11.6-16.9, P = 0.0004) follow-ups, with partial deterioration in hearing over time. Long-term complete restenosis rate (13.8%) was worse than short-term (8.0%), with no significant difference over time (P = 0.85). Postinflammatory medial canal fibrosis is a rare condition that can successfully be treated with surgery to restore patency of the external auditory canal. Patients who experience improved hearing early on, however, are at significant risk of restenosis and recurrence of their conductive hearing loss with time. N/A. Laryngoscope, 2016 127:488-495, 2017.

Bioresorbable Vascular Scaffolds in a Real-World Patient Population-Results From a Mid-Term Angiographic Follow-Up.

We aimed to investigate the safety and efficacy of bioresorbable vascular scaffolds (BVS) in daily use in a real-world patient population. Between March 2013 and September 2014, 224 patients (233 lesions) were treated with BVS at a tertiary care center. Patients underwent follow-up coronary angiography 3-6 months after implantation. Clinical presentations were stable angina in 101 patients (45.1%), unstable angina in 47 (21.0%), NSTEMI in 38 (17.0%), and STEMI in 38 (17.0%) patients. Twenty-two patients (27 lesions) had chronic total occlusion (CTO). Procedural success was achieved in all patients. Two patients died in the follow-up period due to BVS thrombosis (0.9%). In-hospital death occurred in further 3 patients (1.3%) due to other causes not related to the BVS implantation. Total BVS thrombosis was 3.1% (7 patients) and there was only 1 case of relevant restenosis on angiographic follow-up. The overall incidence of major adverse cardiac events was 11 (4.9%). Mid-term follow-up after implantation of BVS suggests a satisfactory safety profile and low restenosis rate in routine daily practice involving a large range of complex lesions.

A case of in-stent restenosis associated with neoatherosclerosis in two coronary arteries after stent implantation in long term

A case of in-stent restenosis associated with neoatherosclerosis in two coronary arteries after stent implantation in long term