Balloon Catheter Dilation Research Articles

Rehabilitation for complicated dysphagia after synchronous head-and-neck and esophageal cancer surgery: A case report

Rationale: Surgical intervention for synchronous head-and-neck and esophageal cancers often results in complex dysphagia, significantly affecting postoperative quality of life. Swallowing dysfunction may become permanent or worsen, with potential impacts on noncancer-related mortality. Patient concerns: We report a rare case of multiple synchronous squamous cell carcinomas of the head and neck (tonsillar and epiglottic cancer) along with esophageal cancer, presenting for dysphagia rehabilitation following surgery. Diagnoses: Comprehensive evaluations—including magnetic resonance imaging, laryngoscopy, gastroscopy, and histopathology—led to diagnoses of left tonsil cancer (squamous cell carcinoma, T2N2bM0), epiglottic cancer (squamous cell carcinoma, T1N2bM0), and lower esophageal cancer (squamous cell carcinoma, T2N0M0). Postoperative videofluoroscopic swallowing study identified an anastomotic stricture at the level of the fifth cervical vertebra. Interventions: The patient underwent an 8-week rehabilitation program incorporating stretching exercises, swallowing behavior therapy, super-supraglottic swallow techniques, catheter balloon dilation, electrical stimulation, and respiratory therapy. Outcomes: Following rehabilitation, the patient was able to resume partial oral intake without aspiration, with significant improvement in anastomotic stricture and swallowing function. Lessons: This case of dysphagia underscores the anastomotic stenosis resulting from oncological surgical intervention. Dysphagia is a frequent complication in patients with synchronous head-and-neck and esophageal cancers. Comprehensive rehabilitation and assessment of swallowing function enabled safe oral intake postoperatively in this patient.

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.

Current state of research on acupuncture for the treatment of post-stroke dysphagia: a scoping review.

Post-stroke dysphagia (PSD) is a common complication of stroke. Acupuncture as one of the traditional therapies in traditional Chinese medicine (TCM), can change the excitability of cerebral cortical nerve cells, and promote the recovery of neurological and swallowing functions. Several clinical primary studies (including RCTs, cohort studies, etc.) and systematic reviews have demonstrated its efficacy and safety in patients with PSD. The positive effects of acupuncture on PSD are also mentioned in international clinical and treatment guidelines, while there is no synthesis of this evidence. This scoping review aims to summarize the evidence from clinical primary studies, reviews, systematic reviews, and guidelines on acupuncture for the treatment of PSD and explore the breadth of this evidence, provide an overview of the range and characteristics of existing evidence, research gaps, and future research priorities in treating PSD with acupuncture. PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, SinoMed, Wan Fang Data, and VIP databases were searched from inception until June 12, 2024. The relevant data were presented through bubble diagrams, line graphs, and structured tables along with descriptive statistics and analysis. This scoping review was conducted based on the PRISMA-ScR Checklist. A total of 1,130 studies were included. Most of the studies were conducted in China, with the number increasing over time. The studies included 254 reviews, 815 clinical studies (678 RCTs,107 nRCTs, 12 case reports, 14 cohort studies, and four case series), 51 systematic reviews, and 10 guidelines. Acupuncture interventions included manual acupuncture (MA), electroacupuncture (EA), and MA/EA combined with acupuncture-related methods (such as scalp acupuncture, auricular acupuncture, warm acupuncture, etc.). The most frequently used acupoint was RN23. Acupuncture is often applied in combination with other treatments, such as herbal medicine, Western medicine, rehabilitation training, swallowing training, or catheter balloon dilatation. Effective rates and WTS were the most frequently used outcomes. Most studies reported significant efficacy and only a few studies explicitly reported adverse events. Acupuncture received positive recommendations in nine guidelines for the treatment of PSD. As a convenient and safe traditional Chinese medicine therapy with its characteristics, acupuncture can improve different stages and types of dysphagia without causing serious adverse reactions. In the future, more standardized international cooperative clinical research is needed to identify the influence of different acupuncture intervention times on the curative effect and dose-effect relationship of acupuncture; standardize the clinical acupoint selection scheme of acupuncture; develop a COS with TCM characteristics to improve the quality of outcome reporting, This will enable different research data to be summarized and compared, reduce resource waste, and provide more high-quality evidence.

A novel balloon dilation catheter facilitating endoscopic papillary balloon dilation in patients with Roux-en-Y gastrectomy

Video 1Selective biliary cannulation was difficult, and the catheter tended to be cannulated into the pancreatic duct. We applied a double-wire technique to achieve biliary cannulation. Finally, selective biliary cannulation was achieved. Cholangiography revealed a small stone of approximately 5mm in the common bile duct (red arrow). Subsequently, endoscopic papillary balloon dilation (EPBD) was performed using a new EPBD catheter with a diameter of 8mm. This new EPBD catheter was inserted. We inflated this EPBD catheter slightly while observing both endoscopy and fluoroscopy monitors to confirm its dilation process. EPBD was easily and effectively performed without slipping in or out of the papilla. The orifice of the papilla was dilated. Stone extraction was completely achieved.

Simulation and Experimental Investigation of Balloon Folding and Inserting Performance for Angioplasty: A Comparison of Two Materials, Polyamide-12 and Pebax.

A balloon dilatation catheter is a vital tool in percutaneous transluminal angioplasty. Various factors, including the material used, influence the ability of different types of balloons to navigate through lesions during delivery. Thus far, numerical simulation studies comparing the impacts of different materials on the trackability of balloon catheters has been limited. This project seeks to unveil the underlying patterns more effectively by utilizing a highly realistic balloon-folding simulation method to compare the trackability of balloons made from different materials. Two materials, nylon-12 and Pebax, were examined for their insertion forces via a bench test and a numerical simulation. The simulation built a model identical to the bench test's groove and simulated the balloon's folding process prior to insertion to better replicate the experimental conditions. In the bench test, nylon-12 demonstrated the highest insertion force, peaking at 0.866 N, significantly outstripping the 0.156 N force exhibited by the Pebax balloon. In the simulation, nylon-12 experienced a higher level of stress after folding, while Pebax had demonstrated a higher effective strain and surface energy density. In terms of insertion force, nylon-12 was higher than Pebax in specific areas. nylon-12 exerts greater pressure on the vessel wall in curved pathways when compared to Pebax. The simulated insertion forces of nylon-12 align with the experimental results. However, when using the same friction coefficient, the difference in insertion forces between the two materials is minimal. The numerical simulation method used in this study can be used for relevant research. This method can assess the performance of balloons made from diverse materials navigating curved paths and can yield more precise and detailed data feedback compared to benchtop experiments.

A Novel Balloon Catheter Dilation Apparatus for the Treatment of Depressed Nasal Bone Fracture

The nasal bone fracture is the most common type of facial bone fracture. Closed reduction with metal reduction instrument is commonly conducted for the treatment of a depressed nasal bone fracture which often leads to iatrogenic injury. In this article, a new balloon catheter dilation apparatus for nasal bone fracture is hypothesized by the authors. This device aims to repair nasal bone fracture via dilated balloons under fractured nasal bone and used as nasal internal packing system after operation. Compared with the conventional approach, it is proposed that this balloon dilation apparatus could be a potential powerful, less invasive approach to treat depressed nasal bone fractures.

Diagnostic and therapeutic strategies for vascular complications after renal transplantation: a single-center experience in 2,304 renal transplantations.

Vascular complications after renal transplantation are one of the serious surgical complications, which can affect the transplantation outcome and even endanger life if not treated properly. We performed a retrospective analysis of the 2,304 renal transplantations procedures completed between the period of Jan., 2015 and Jan., 2022, which consisted of 1,658 male patients and 646 female patients. Among the above cases, there were 54 cases of vascular complications after renal transplantation, the incidence of vascular complications in our study was 2.34% (54/2,304), the most common vascular complication was transplanted renal artery stenosis (TRAS, n = 36), followed by external iliac artery dissection (n = 5), renal artery rupture (n = 4), renal vein thrombosis (n = 3), renal artery thrombosis (n = 2), renal artery dissection (n = 1), renal artery pseudoaneurysm (n = 1), and internal iliac artery pseudoaneurysm (n = 1), and renal artery kinking (n = 1). 40 patients were treated by percutaneous transluminal angioplasty (PTA), including 3 balloon catheter dilatation and 37 endovascular stentings, and 14 underwent open surgery. Eventually, 9 patients had graft nephrectomy, resulting in an overall treatment rate of 81.5%. Most vascular complications can be treated satisfactorily with PTA. However, the overall treatment of renal artery rupture, thrombosis, renal artery kinking, and other complications is poor, and the rate of transplanted renal loss is high.

A Chemical Characterization Workflow for Nontargeted Analysis of Complex Extracts from Polymer Based Medical Device Using High Resolution LC/MS.

The chemical characterization of extractables and leachables (E&Ls) is an important aspect of biosafety and biocompatibility assessment in medical device industry. The advent of the body-contact use of medical devices in patient treatment has introduced a potential source for extractables and leachables as these medical devices are comprised of various polymeric materials. Several industry working groups, the FDA and USP, have recognized the guidance for chemical characterizations and nontargeted analysis of medical device extracts, such as ISO 10993-18:2020. The MS application of nontargeted analysis has played a critical role in understanding the E&Ls from medical device extracts. However, there have been very few reports about the MS based workflow with nontargeted analysis for medical device extracts and there is little guidance about the exact methodologies which should be used, even though there is an urgent need for a clearly defined process for the identification of medical device extracts. In this study, we demonstrated an analytical LC/MS (liquid chromatography/mass spectrometry) workflow using high resolution Exploris120 Orbitrap instrument for data acquisition and Compound Discoverer 3.3 intelligent software for data processing to profile the polymer related E&Ls from a balloon dilation catheter device extracted with 40% ethanol. An E&L ID workflow combining LC separation, data-informed MS acquisition strategy, MS information mining (including adduct ions, MS information from both electrospray ionization (ESI) (+) and ESI (-), in-source fragmentation, common fragment ions (CFIs), common neutral losses (CNLs), and in silico MS simulation was described with intelligent software processing and manual data interpretation. The workflow developed in this study was proven to be effective to provide a comprehensive profile of polymer related degradation products, polymer impurities and additives including surfactants, UV curing agent, antioxidants, and plasticizers for the device analyzed. The classification of E&L compounds using CFIs and CNLs was very effective to facilitate the identification of polymer related impurities and extract the polymer related impurities with common structures in a large data result set.

Factors Associated With Nasolacrimal Duct Probing Failure Among Children in the Intelligent Research in Sight Registry

Understanding the factors associated with nasolacrimal duct probing failure in young children may help inform practice patterns. To identify factors associated with repeated nasolacrimal duct probing in young children. This retrospective cohort study analyzed data from the Intelligent Research in Sight (IRIS) Registry for all children who underwent nasolacrimal duct probing before 4 years of age between January 1, 2013, and December 31, 2020. The Kaplan-Meier estimator was used to assess the cumulative incidence of a repeated procedure within 2 years of the initial procedure. Hazard ratios (HRs) derived from multivariable Cox proportional hazards regression models were used to evaluate the association between repeated probing and patient age, sex, race and ethnicity, geographic region, operative side, laterality of obstruction, type of initial procedure, and surgeon volume. This study included 19 357 children (9823 [50.7%] male; mean [SD] age, 1.40 [0.74] years) undergoing nasolacrimal duct probing. The cumulative incidence of repeated nasolacrimal duct probing was 7.2% (95% CI, 6.8%-7.5%) within 2 years of the initial procedure. Among 1333 repeated procedures, the second procedure involved silicone intubation in 669 (50.2%) and balloon catheter dilation in 256 (19.2%). Among 12 008 children aged 1 year or younger, office-based simple probing was associated with a slightly higher probability of reoperation compared with facility-based simple probing (9.5% [95% CI, 8.2%-10.8%] vs 7.1% [95% CI, 6.5%-7.7%]; P < .001). In the multivariable model, a greater risk of repeated probing was associated with bilateral obstruction (HR, 1.48; 95% CI, 1.32-1.65; P < .001) and office-based simple probing (HR, 1.33; 95% CI, 1.13-1.55; P < .001), and a lower risk was associated with primary balloon catheter dilation (HR, 0.69; 95% CI, 0.56-0.85; P < .001) and procedures performed by high-volume surgeons (HR, 0.84; 95% CI, 0.73-0.97; P = .02). Age, sex, race and ethnicity, geographic region, and operative side were not associated with reoperation risk in the multivariable model. In this cohort study, most children in the IRIS Registry undergoing nasolacrimal duct probing before 4 years of age did not require any additional intervention. Factors associated with lower risk of reoperation include surgeon experience, probing performed under anesthesia, and primary balloon catheter dilation.

Safety and Efficacy of the Passeo-18 Lux Drug-Coated Balloon Catheter in Atherosclerotic Femoropopliteal Lesions: The Multicenter BIOLUX P-IV China Study

The purpose of this trial was to assess the safety and effectiveness of a paclitaxel-coated balloon catheter in Chinese patients with de novo or nonstented restenotic femoropopliteal atherosclerotic lesions. BIOLUX P-IV China is a prospective, independently adjudicated, multicenter, single-arm trial conducted in China. Patients with Rutherford class 2-4 were eligible, excluded were patients in which predilation resulted in severe (≥ grade D) flow-limiting dissection or residual stenosis > 70%. Follow-up assessments were conducted at 1, 6, and 12months. The primary safety end point was 30-day major adverse event rate and the primary effectiveness end point was primary patency at 12months. We enrolled 158 patients with 158 lesions. Mean age was 67.6±9.6years, diabetes was present in 53.8% (n=85), and previous peripheral intervention/surgeries in 17.1% (n=27). Lesions were 4.1±0.9mm in diameter and 74±50mm long with a mean diameter stenosis of 91±13%; 58.2% (n=92) were occluded (core laboratory analysis). Device success was achieved in all patients. The rate of major adverse events was 0.6% (95% confidence interval: 0.0; 3.5) at 30days, consisting of 1 target lesion revascularization. At 12months, binary restenosis was present in 18.7% (n=26) and target lesion revascularization was performed in 1.4% (n=2, all clinically driven), resulting in a primary patency of 80.0% (95% confidence interval: 72.4, 85.8); no major target limb amputation occurred. Clinical improvement at 12months, defined as improvement of at least 1 Rutherford class, was 95.3% (n=130). The median walking distance per 6-minute walk test was 279m at baseline and improved by 50m at 30days and by 60m at 12months; the visual analogue scale changed from 76.6±15.6 at baseline to 80.0±15.0 at 30days and 78.6±14.6 at 12months. Our results confirmed the clinical effectiveness and safety of a paclitaxel-coated peripheral balloon dilatation catheter for the treatment of de novo and nonstented restenotic lesion of the superficial femoral and proximal popliteal artery in Chinese patients (NCT02912715).

Multi-Modality Treatment of Supraglottic Stenosis Secondary to Laryngeal Pemphigus: Sharing Experience in UiTM

Supraglottic stenosis is a rare subsite of laryngotracheal stenosis. In the literature, the common causes of supraglottic stenosis are radiation therapy or autoimmune disease. We present an experience in dealing with supraglottic stenosis secondary to laryngeal pemphigus. This is a case of a 36-year-old lady with supraglottic stenosis secondary to laryngeal pemphigus. She presented to our clinic with shortness of breath and mild stridor mainly on exertion. An office-based procedure of trans-nasal scope-guided with serial intralesional steroid injections (SILSI) using single-use Olympus Injector Force Injection Needles Max 23G, was done which halted the progression of the disease. Eventually, balloon dilatation under jet ventilation was performed to widen the size of the stenosis and reduce the symptoms. Dilatation was performed using CRE PRO Wire-guided balloon dilatation catheter from size 8mm to 12mm with respective pressure applied for about 2 minutes without interruption of spontaneous breathing, oxygenation, or ventilation. Incision of stenosis segment with micro scissor was performed in between balloon dilatation and the procedure was completed with intralesional steroid injections. Upon follow-up, we noted clinical improvement of the stenosis as well as the patient’s health perception as measured by EQ-5D-5L. Patients with supraglottic stenosis usually need tracheostomy for breathing. This multimodality treatment might be required to treat supraglottic stenosis. Endoscopic treatment can result in favourable outcomes for the patient without needing a tracheostomy. International Journal of Human and Health Sciences Supplementary Issue: 2023 Page: S25

Low-frequency neuromuscular electrical stimulation as a treatment for anejaculation caused by iatrogenic injury of the abdominal aorta: a case study

Anejaculation is the inability to ejaculate during sexual activity, either in an antegrade or retrograde fashion. Both anejaculation following an iatrogenic injury of the abdominal aorta and the efficacy of low-frequency neuromuscular electrical stimulation (NMES) in treating anejaculation have been reported rarely. In this case report, we describe a patient who experienced anejaculation following an iatrogenic injury to the abdominal aorta and eventually regained normal ejaculation ability following treatment with NMES. The patient, a 23-year-old Chinese man, underwent laparoscopic varicocele ligation on both sides, during which he sustained a ruptured wound in the abdominal aorta from a 10-mm trocar. To stop the bleeding, he underwent abdominal aortic balloon catheter dilatation combined with covered stent implantation. However, 10 days after the endovascular interventions, the patient developed hemorrhagic shock and underwent emergency exploratory laparotomy and adventitial suture of the abdominal aorta. Despite normal erectile function since a week after the last surgery, the patient complained of aejaculation for a year during intercourse or masturbation. After receiving NMES treatment for over two months, the patient reported successful intravaginal ejaculation during intercourse, and the improvement persisted for a month after treatment. Altogether, these findings suggest that NMES could be a feasible, safe, and cost-effective treatment method for improving anejaculation and provides a novel option for patients with this condition.

Comprehensive outcomes after primary arterial switch operation.

To report the long-term outcomes of the arterial switch operation for transposition of the great arteries. The data of 35 patients who underwent an arterial switch operation between April 2006 and May 2021 were retrospectively examined; five had double-outlet right ventricles, three had side-by-side transposition, and 27 had d-transposition. The punch-out technique was the basic method for coronary transplantation; however, if coronary artery kinking after additional peeling was a concern, the trap-door technique was used. In aortic reconstruction, the caliber difference between the neoascending aorta and the native pulmonary artery was fixed using the pulmonary artery flap. In pulmonary reconstruction, the pulmonary artery was bilaterally exposed over the second branch. The median age at operation and follow-up duration were 10.0 (8.0-12.5) days and 72.9 (40.7-139.5) months, respectively. Thirty-four patients survived, and one was lost to follow-up ([coronary transplantation]: right coronary artery, punch-out = 31, trap-door = 2; left coronary artery, punch-out = 28, trap-door = 7; [aortic regurgitation]: no-slight = 27, mild = 6, moderate = 1; [pulmonary regurgitation]: no-slight = 22, mild = 11, moderate = 1). Slight coronary bending occurred in two patients; ischemia was not observed. Catheter stent placement was performed in one of three patients with stenosis at the pulmonary artery bifurcation. Catheter balloon dilation was performed in one patient with supravalvular pulmonary stenosis. There were no cases of coronary, aortic, or pulmonary artery reoperations. The 15-year cumulative reintervention avoidance rate was 91.0%. There were no deaths or reoperations during the long-term follow-up period, and arterial switch operation outcomes at our hospital were satisfactory.

Clinical Outcomes of a Non-Compliant Balloon Dilatation Catheter: MOZEC™ NC Study

The present study sought to assess the clinical outcomes of the Mozec™ Non-compliant (NC) Rx PTCA balloon dilatation catheter (BDC) (Meril Life Sciences Pvt. Ltd., Vapi, India) for dilatation of coronary lesions. This was a post-marketing, single-centre, single-arm, retrospective study. In total, 57 patients who had undergone post-dilatation with the Mozec™ NC Rx PTCA balloon dilatation catheter were evaluated. The primary endpoint was procedural success defined as (i) successful delivery of the investigational device to and across the target lesion; (ii) successful inflation, deflation, and withdrawal of the investigational device; (iii) absence of vessel perforation, flow-limiting vessel dissection, increase in thrombolysis in myocardial infarction (TIMI) flow from baseline, clinically significant arrhythmia requiring medical treatment; and (iv) achievement of final TIMI flow grade 3 after percutaneous coronary intervention of the target lesion after single or multiple attempts to cross the target lesion. Procedural success was achieved in 57 (100%) patients. There were no incidences of major adverse cardiac events (MACE)/target lesion failure (TLF). Mozec™ NC Rx PTCA balloon dilatation catheter has demonstrated favourable outcomes for the dilatation of routine and complex coronary lesions in a small cohort, as evidenced by its 100% procedural success rate and absence of MACE.

The efficacy and safety of catheter balloon dilatation in the treatment of dysphagia after stroke: A protocol for systematic review and meta-analysis.

Dysphagia is a serious complication after stroke, which has a significant influence on the health as well as life quality of global people. Patients with dysphagia tend to be a higher risk rate of an aspiration than general person. Catheter balloon dilatation is an additional therapy for treating dysphagia in recent years, which can improve the symptom of achalasia of cricopharyngeal muscle. This research will be used for confirming the efficacy and safety of the catheter balloon dilatation for resolving dysphagia. We intend to search literature related to the research in different databases, for instance, China National Knowledge Infrastructure, Wanfang Data, PubMed, Cochrane Library, and Embase up to January 2022. Literature selection, data collection, as well as assessment of bias risk, will be carried out by 2 independent researchers. Data analysis will be conducted by using Stata and review manager 5.4. The results will be submitted to a peer-reviewed journal. The research will verify whether or not catheter balloon dilatation can improve dysphagia by submitting high-quality data syntheses. CRD42022358433.

Effect of Cold Fluid Compensatory Swallowing Combined with Balloon Dilation on the Treatment of Poststroke Cricopharyngeal Achalasia: A Pilot Randomized Controlled Trial.

Objective This study is aimed at comparing the treatment efficacy between catheter balloon dilation combined with cold fluid compensatory swallowing training and catheter balloon dilation alone on poststroke cricopharyngeal achalasia (CPA). Methods We conducted a single-blind, randomized controlled trial (RCT). Poststroke patients with CPA were divided into two groups: the control group (treated with catheter balloon dilation) and the trial group (catheter balloon dilation combined with cold fluid compensatory swallowing). Videofluoroscopic swallowing study (VFSS) was performed, and functional oral intake scale (FOIS) was used to evaluate and compare the swallowing function of patients in the 2 groups before and after intervention. Posttreatment VAS pain scores and recovery time were also measured. Results VFSS and FOIS scores in the two groups were improved after treatment (P < 0.05). In the trial group, VFSS scores in the pharyngeal phase and aspiration degree were significantly higher compared with the control group (P < 0.05) but not in the oral phase (P > 0.05). The difference in FOIS scores and patients' recovery time from intervention to eating mushy food between the trial and control groups was significant (P < 0.05), but not the VAS scores (P > 0.05). Conclusion The catheter balloon dilation combined with cold fluid compensatory swallowing was superior to catheter balloon dilation alone in terms of relieving dysphagia and reducing aspiration in patients with CPA following stroke. Long-term efficacy should be followed up with more objective and quantitative indicators in future studies.

Coronary perforation incidence and temporal trends (COPIT): systematic review and meta-analysis

Abstract Background Despite advancements in Percutaneous Coronary Intervention (PCI) technology and techniques, iatrogenic coronary artery perforation (CAP) remains a dreaded potential complication within the cardiac catheterisation laboratory. Data detailing the incidence of coronary perforation during PCI has previously been obtained from relatively small datasets. A swell of large data published in recent times provides invaluable information regarding PCI related CAP. Purpose COPIT is a systematic review and meta-analysis targeted at detailing the incidence, outcomes, etiology and treatment modalities of PCI related CAP including evaluation of temporal trends since the inception of PCI to contemporary practice. Additionally, COPIT provides hypothesis generating data regarding predictors of CAP during PCI. Methods A prospective systematic review and meta-analysis using MEDLINE and EMBASE via the OVID interface (PROSPERO ID: CRD42020207881) was performed according to the PRISMA guidelines. Identified relevant studies were used in a pre-specified sensitivity analysis to detail incidence, outcomes, etiology, treatment modalities and risk factors of PCI complicated by CAP. Studies limited to PCI in high risk populations only such as CTO-PCI or rotational atherectomy only were excluded. Results 67 studies met eligibility criteria detailing 5,568,191 PCIs over a 38-year period (1982–2020). The pooled incidence of CAP was 0.39% (95% CI: 0.34–0.45%) with no change in incidence over that time. Approximately 1 in 5 perforations led to cardiac tamponade (21.1%). Ellis 3 perforations are increasing in frequency and account for 43% of all perforations. Mortality due to perforation occurs in 7.5% of all CAP (95% CI 6.7% - 8.4%) but has declined over the studied period. Meta-regression suggested that female gender, hypertension, chronic kidney disease and previous coronary bypass grafting were all associated with higher incidence of CAP. Coronary perforation was most frequently caused by distal wire exit (37%) followed by balloon dilation catheters (28%). Covered stents were used to treat 25% of perforations, with emergency cardiac surgery needed in 17%. Conclusion Coronary perforations occurs in approximately 1 in 250 all-comer PCI procedures. A tendency towards increase in coronary perforations is likely reflective of contemporary trends towards high pressure post-dilatation with 1:1 vessel sizing as well as an ageing population with increasingly complex, calcific coronary disease. However, reduction in CAP related mortality suggests earlier recognition and effective treatment with transcatheter techniques. Funding Acknowledgement Type of funding sources: None.

Coronary perforation incidence, outcomes and temporal trends (COPIT): a systematic review and meta-analysis

Coronary perforation is a potentially life-threatening complication of percutaneous coronary intervention (PCI). We studied incidence, outcomes and temporal trends following PCI-related coronary artery perforation (CAP).MethodsProspective systematic review and meta-analysis including...

Laparoscopic antireflux surgery or PPIs in the management of reflux-related esophageal stricture

BackgroundGastroesophageal reflux disease (GERD) is often associated with esophageal stricture, particularly benign esophageal stricture. We aimed to evaluate the effects of balloon catheter dilation (BD) combined with laparoscopic fundoplication (LF) surgery and proton pump inhibitors (PPIs) in patients with reflux-induced esophageal strictures.MethodsWe retrospectively analyzed 116 patients with reflux-induced benign esophageal strictures who underwent balloon dilatation therapy combined with PPIs (BD-PPIs group, n = 58) and balloon dilatation combined with LF (BD-LF group, n = 58). Patients were followed up for 24 months. The outcomes of the patients were monitored, including clinical success, symptom improvement, adverse events, and the frequency of esophagitis.ResultsAt the latest follow-up, the rate of clinical success was higher in BD-LF group than in BD-PPIs group (80.4% vs. 57.7%, P = 0.011). The patients in the BD-PPIs group required more dilation sessions to achieve successful dilation, as compared to those in the BD-LF group (2.1 ± 1.2 vs. 0.7 ± 0.8, P < 0.001). The DeMeester score, number of reflux episodes for which pH was < 4, and lower esophageal sphincter pressure were significantly better in the BD-LF group than in the BD-PPIs group (all P < 0.001). The incidence of reflux esophagitis was higher in the BD-PPIs group than in the BD-LF group, at 24 months (58.8% vs. 18.2%, P = 0.003).ConclusionsBalloon dilatation with concomitant LF is effective and safe for esophageal stricture secondary to GERD. Moreover, antireflux surgery techniques, such as Nissen or Toupet procedure, should be added for reflux-induced benign esophageal stricture.

CT imaging features of paranasal sinuses in children with primary ciliary dyskinesia

Background Primary ciliary dyskinesia (PCD) causes impaired mucociliary clearance and results in chronic pulmonary and sinonasal symptoms. Objectives To study the CT imaging features of paranasal sinuses in children with PCD. Materials and methods 17 PCD patients ranged from 4 to 13 years, a mean age of 7.9 ± 3.3 years, were included in the final analysis. Patients with non-PCD chronic rhinosinusitis (CRS) who accepted maxillary balloon catheter dilation were included in the control group. Paranasal sinuses CT scans were scored according to the Lund–Mackay staging system. The correlation between age and Lund–Mackay score was analyzed. Results 100% (17/17) had rhinosinusitis, 52.9% (9/17) had lung consolidation, 64.7% (11/17) had atelectasis, 35.3% (6/17) had bronchiectasis, and 47.1% (8/17) had a history of neonatal respiratory distress. The mean Lund–Mackay score of PCD patients was 14.2 ± 3.1, that of non-PCD CRS patients was 14.6 ± 5.5, the difference was not significant (p = .79). There was a significant inverse correlation between age and Lund–Mackay score in PCD patients (r = −0.530, p = .029) but not in non-PCD CRS patients (r = −0.168, p = .519). Conclusion Radiographic severity of rhinosinusitis in PCD patients was similar to the control population but decreased with age. Significance First time to propose radiographic severity of rhinosinusitis in pediatric patients with PCD might decrease with age.