Complication Of Angioplasty Research Articles

Distal Balloon Angioplasty of Cerebral Vasospasm Decreases the Risk of Delayed Cerebral Infarction.

Conventional angioplasty of cerebral vasospasm combines proximal balloon angioplasty (up to the first segment of cerebral arteries) with chemical angioplasty for distal arteries. Distal balloon angioplasty (up to the second segment of cerebral arteries) has been used in our center instead of chemical angioplasty since January 2015. We aimed to assess the effect of this new approach in patients with aneurysmal SAH. The occurrence, date, territory, and cause of any cerebral infarction were retrospectively determined and correlated to angioplasty procedures. Delayed cerebral infarction, new angioplasty in the territory of a previous angioplasty, angioplasty complications, 1-month mortality, and 6- to 12-month modified Rankin Scale ≤ 2 were compared between 2 periods (before-versus-after January 2015, from 2012 to 2017) with adjustment for age, sex, World Federation of Neurosurgical Societies score, and the modified Fisher grade. Three-hundred-ninety-two patients were analyzed (160 before versus 232 after January 2015). Distal balloon angioplasty was associated with the following: higher rates of angioplasty (43% versus 27%, P < .001) and intravenous milrinone (31% versus 9%, P < .001); lower rates of postangioplasty delayed cerebral infarction (2.2% versus 7.5%, P = .01) and new angioplasty (8% versus 19%, P = .003) independent of the rate of patients treated by angioplasty and milrinone; and the same rates of stroke related to angioplasty (3.6% versus 3.1%, P = .78), delayed cerebral infarction (7.7% versus 12.5%, P = .12), mortality (10% versus 11%, P = .81), and favorable outcome (79% versus 73%, P = .21). Our study suggests that distal balloon angioplasty is safe and decreases the risk of delayed cerebral infarction and the recurrence of vasospasm compared with conventional angioplasty. It fails to show a clinical benefit possibly because of confounding changes in adjuvant therapies of vasospasm during the study period.

PROSPECTIVE ANALYSIS OF LIPID SPECTRUM PARAMETERS AND VASCULAR INFLAMMATORY MARKERS AS A VARIANT OF A PERSONIFIED APPROACH TO PROGNOSIS OF UNDESIRABLE CORONARY EVENTS IN PATIENTS WITH CORONARY HEART DISEASE AFTER ANGIOPLASTY

The relevance of the study is due to the fact that the ambiguous role of biochemical mediators in the development of angioplasty complications with stenting and the lack of consensus on the timing of laboratory indicators determine to specify the approaches to the study of biochemical parameters that indicate the nature of the course of coronary heart disease (CHD) and the development of possible undesirable complications after percutaneous coronary intervention. This article aims to analyze the parameters of lipid spectrum and markers of vascular inflammatory reaction in patients with CHD, in groups with stable angina and unstable angina episode after angioplasty with stenting, to trace the dynamics of biochemical parameters and to reveal the predictors of undesirable coronary events. Patients with CHD with significant coronary artery stenosis (CKS, n=95) revealed after coronary angiography (CAG) at the point of maximum increase in the markers of the inflammatory response (3 months after angioplasty) are divided into 2 groups – patients with stable angina pectoris (AP, n=77) until the end of the study and patients with a developed post-revascularization episode of unstable angina (UA, n=18) after angioplasty with stenting. It was established that patients with UA at the initial stage have a significantly higher risk of developing coronary blood flow instability in the post-revascularization period due to initially elevated levels of homocysteine and rf-CRP. The results obtained are very important for the implementation of an optimal program for monitoring patients with coronary artery disease, improving measures to increase adherence to therapy at the outpatient stage of treatment.

Ultrasound-guided angioplasty of dialysis fistulas in renal transplant patients.

IntroductionPercutaneous endovascular angioplasty has become the treatment of choice for dialysis fistula stenosis. The ultrasound-guided endovascular procedure is used in patients with severe renal impairment and advanced renal transplant failure, when the need for nephrotoxic contrast administration in standard angioplasty may worsen renal function.AimTo evaluate endovascular angioplasty guided by ultrasound for dialysis fistula stenosis in renal transplant patients with severe graft insufficiency.Material and methodsWe compared ultrasound (US)-guided angioplasty, performed in patients after renal transplantation, with standard contrast angioplasty performed in dialysis patients. We treated 10 kidney allograft recipients (9 kidneys and 1 kidney-pancreas) with significantly compromised renal transplant function and significant stenosis in dialysis fistulas, as detected during US examination. Patients were qualified for percutaneous angioplasty under US guidance. The mean period from transplantation was 32.7 months (5–100 months). Results of their treatment were compared to the control group of 20 end-stage renal disease patients with dialysis fistula stenosis treated by angioplasty under standard contrast visualization.ResultsThe immediate effectiveness of the angioplasty was 100% in both groups. No early complications of angioplasty or problems with the guidewire crossing the stenosis were observed. Twelve months of primary patency was observed in 80% and 45% in the US-guided and control groups, respectively.ConclusionsThe US-guided endovascular procedure is an effective and safe method of treating dialysis fistula stenosis in patients with impaired renal transplant function.

The predictors of complications in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.

The aims of this study were to (1) evaluate risk factors of complications of balloon pulmonary angioplasty (BPA) and (2) assess the mechanism of the complications. BPA represents a promising treatment option in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, the complication ratio differs across reports, and the causes remain controversial. All complications found by angiography and non-contrasted computerized tomography (CT) immediately after BPA were recorded. New emergences of a ground-glass pattern or consolidation in CT after BPA that were not recognized on CT images before BPA were counted as pulmonary bleeding. Lesion morphologies were classified into four types (web, ring, abrupt narrowing and occlusive lesions) according to selective pulmonary angiography. Thirty patients consented to analysis of the BPA-related images, and 879 lesions (112 sessions) were evaluated. One hundred and twenty-two (99.2%) of 123 complications were confirmed to be associated with BPA procedures at the local area. In the multivariate analysis, occlusive lesions were the sole independent predictor of procedure-related complications (adjusted odds ratio 5.83, 95%CI [1.94-17.47], p = 0.002). Hemodynamic parameters were not predictors of complications. CT images after BPA presented the predictive value for the occurrence of hemoptysis. Almost all complications were attributed to operators' procedures. Lesion morphology was the sole predictor of BPA-related complications, while hemodynamic parameters were not associated with the frequency of complications. CT scan images after BPA were useful to identify bleeding complications and to predict hemoptysis.

In-Hospital Costs and Costs of Complications of Chronic Total Occlusion Angioplasty: Insights From the OPEN-CTO Registry

ObjectivesThe aim of this study was to describe the costs of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and the association of complications during CTO PCI with costs and length of stay (LOS). BackgroundCTO PCI generally requires more procedural resources and carries higher risk for complications than PCI of non-CTO vessels. The costs of CTO PCI using the hybrid approach have not been described, and no studies have examined the impact of complications on in-hospital costs and LOS in this population. MethodsCosts were calculated for 964 patients in the 12-center OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry using prospectively collected resource utilization and billing data. Multivariate models were developed to estimate the incremental costs and LOS associated with complications. Attributable costs and LOS were calculated by multiplying the independent cost of each event by its frequency in the population. ResultsMean costs for the index hospitalization were $17,048 ± 9,904; 14.5% of patients experienced at least 1 complication. Patients with complications had higher mean hospital costs (by $8,603) and LOS (by 1.5 days) than patients without complications. Seven complications were independently associated with increased costs and 6 with LOS; clinically significant perforation and myocardial infarction had the greatest attributable cost per patient. Overall, complications accounted for $911 per patient in hospital costs (5.3% of the total costs) and 0.2 days of additional LOS. ConclusionsComplications have a significant impact on both LOS and in-hospital costs for patients undergoing CTO PCI. Methods to identify high-risk patients and develop strategies to prevent complications may reduce CTO PCI costs.

A Case Series of Two Traumatic Iatrogenic Radial Arteriovenous Fistulae as Complication of Transradial Coronary Angioplasty

BACKGROUND: Since the introduction of transradial access as a site for coronary angiogram or angioplasty, the rates of vascular complications have significantly improved. Because of this, the procedure has become increasingly preferred due to reduced morbidity rates and lower procedural cost. Complications—specifically, arteriovenous fistulae—have become rarer with the use of the transradial approach. This case series presents two cases of traumatic iatrogenic radial arteriovenous fistula as a complication of transradial coronary angioplasty, as well as their management. Case 1: A 59-year-old male who underwent coronary angioplasty due to left anterior descending coronary artery stenosis was noted to have a tender and pulsating mass proximal to the puncture site that started two weeks after the procedure. Bruit was noted on auscultation. A small fistula formation on the distal radial artery, draining to the connecting vein, was noted on ultrasound. Initial compression of the fistula was done for one week with no observable improvement, so the patient underwent surgical repair. Case 2: A 52-year-old female underwent successful coronary angioplasty. Successful hemostasis by compression of a transradial band (TR) over the access site was achieved post-percutaneous coronary intervention. Two weeks after the procedure, the patient complained of a palpable pulsatile mass on her right wrist. Duplex scan of the right forearm showed a small arteriovenous fistula connecting the radial artery to a deep branch of the radial vein. The fistula and swelling spontaneously resolved after compression with TR band for 48 hours. Conclusion: Traumatic iatrogenic radial arteriovenous fistula is a rare complication of a cardiac catheterization procedure using a transradial access approach. Conservative manual compression may be the initial treatment option, but surgical repair may be considered in the presence of hemorrhage, hemodynamic instability, painful limb ischemia, non-healing ulcers and functional impairment. Keywords: radial arteriovenous fistula, coronary angioplasty, transradial compression, surgical ligation.

Immediate and Intermediate Outcomes of Balloon Angioplasty in Neonatal Type Coarctation of Aorta in Sulaimani Cardiac Center

Background and objectives: Coarctation of aorta is the fourth most prevalent heart disease in infants requiring catheterization and surgery during the first year of life. Unfortunately, the initial clinical manifestations in infants are non-specific and mainly consist of tachypnea, poor feeding, and failure to thrive which result in delays in the correct diagnosis and therapeutic interventions. The aim of the study was to assess the immediate and intermediate outcome of balloon angioplasty in neonatal-type coarctation of aorta. Methods: It is a case series study of 13 young infants with neonatal coarctation of aorta their ages were between 10 days to 18 months and were admitted to intensive care unit of pediatric teaching hospital and Shar Hospital neonatal care unit in Sulaimani. Balloon angioplasty was done for them in Sulaimani cardiac center between February 2014 to October 2017. Results: Balloon angioplasty was done for 13 young infants with good results in 10/13 cases without any complication. There were significant mean pressure gradient changes before and after the procedure (48 ± 18.57mmHg and 28.15 ±16.12mmHg, respectively). The complications of balloon angioplasty were divided into immediate complications which occurred within 24h post angioplastic procedure and included peripheral cyanosis1case (7.7%), small aneurysm formation 1 case(7.7%), and intermediate complications which occurred within 6 month of the angioplasty showed repeated dilatation of coarctation in 1 case (7.7%), while in 10 cases (76.9%) there were no any complications. Conclusions: Balloon angioplasty is a safe and effective treatment option in infants with coarctation of aorta; however, timely diagnosis and improvement in angioplasty techniques are necessary to improve the outcome.

C-Arm computed tomography (CACT)-guided balloon pulmonary angioplasty (BPA): Evaluation of patient safety and peri- and post-procedural complications.

To assess the frequency and severity of complications of balloon pulmonary angioplasty (BPA) using C-arm computed tomography (CACT) guidance. 266 consecutive interventions in 67 patients (42 females, mean age 66 ± 13 years) were included. Selective CACT was acquired prior to the intervention for three-dimensional (3D) guidance and to select appropriate balloon size based on the measured vessel diameter. Complications during and after the procedure, the need for further interventions and the impact on patient safety and outcome were assessed and categorised according to the SIR Classification System to Complications by Outcome (Grade A-F). Overall, 237 interventions were conducted without any complications (89.1%). Minor complications not requiring additional treatment occurred during or after 25 procedures (9.4%), including recurring dry cough in four patients during a total of 11 interventions (4.1%) (Grade A), three focal dissections of the targeted pulmonary artery (1.1%), four cases of pulmonary haemorrhage (1.5%), one case of reperfusion oedema (0.4%) and six cases of post-interventional short-term hemoptysis (2.3%) (Grade B). Four cases of major complications requiring additional treatment were observed (1.5%): one case of pulmonary haemorrhage (0.4%) and two cases of post-interventional haemoptysis (0.8%), all resolved after medical therapy without requiring further intervention, and one case of atrial tachycardia induced during catheterisation, subsequently requiring pharmacological cardioversion (0.4%) (Grade C). No fatal or life-threatening peri- or post-interventional complications or mortality were observed (Grade D-F). BPA performed under CACT guidance appears to be a safe procedure with a low risk of severe complications. • CACT guidance of BPA is safe and successful. • CACT-guided BPA procedures have a low complication profile. • CACT guidance is a valuable tool to navigate BPA.

Renal artery stenosis of a solitary kidney with successful salvage of unusual complication of renal artery angioplasty

Renal artery stenosis of a solitary kidney with successful salvage of unusual complication of renal artery angioplasty

Treatment of coronary in-stent restenosis: a systematic review.

Coronary stent implantation has significantly improved percutaneous coronary intervention and enabled the management of early complications of plain balloon angioplasty. However, a new complication has accompanied these improvements: in-stent restenosis (ISR) arising from neointimal hyperplasia. ISR after coronary angioplasty is currently one of the main limitations of this method, leading to the recurrence of exertional angina pectoris or acute coronary syndromes. The clinical incidence of ISR after bare-metal stent (BMS) implantation is approximately 20%–35%. The use of drug-eluting stents (DES) has led to a further decrease in the occurrence of ISR to 5%–10%. Evidence resulting from controlled clinical studies suggests that DES and drug-eluting balloon catheters (DEB) provide the best clinical and angiographic results in the treatment of ISR. We undertook a systematic review of the pathophysiology, diagnostics and treatment options for BMS- and DES-ISR. We discuss recent randomised studies, comparing different DES or DEB used for BMS or DES-ISR treatment, as well as the use of new biovascular scafolds and the topic of scafold restenosis.

The role of endothelial nitric oxide in the anti-restenotic effects of liraglutide in a mouse model of restenosis

BackgroundPrevious animal studies have shown that glucagon-like peptide-1 receptor agonists (GLP-1RAs) suppress arterial restenosis, a major complication of angioplasty, presumably through their direct action on vascular smooth muscle cells. However, the contribution of vascular endothelial cells (VECs) to this process remains unknown. In addition, the potential interference caused by severe hyperglycemia and optimal treatment regimen remain to be determined.MethodsNine-week-old male C57BL6 (wild-type) and diabetic db/db mice were randomly divided into vehicle or liraglutide treatment groups (Day 1), and subject to femoral artery wire injuries (Day 3). The injured arteries were collected on Day 29 for morphometric analysis. Human umbilical vein endothelial cells (HUVECs) were used for in vitro experiments. One-way ANOVA, followed by Tukey’s test, was used for comparisons.ResultsIn wild-type mice, liraglutide treatment (5.7, 17, or 107 nmol/kg/day) dose-dependently reduced the neointimal area (20, 50, and 65%) without inducing systemic effects, and caused an associated decrease in the percentage of vascular proliferating cells. However, these effects were completely abolished by the nitric oxide synthase (NOS) inhibitor N-omega-nitro-l-arginine methyl ester. Next, we investigated the optimal treatment regimen. Early treatment (Days 1–14) was as effective in reducing the neointimal area and vascular cell proliferation as full treatment (Days 1–29), whereas delayed treatment (Days 15–29) was ineffective. In HUVECs, liraglutide treatment dose-dependently stimulated NO production, which was dependent on GLP-1R, cAMP, cAMP-dependent protein kinase, AMP-activated protein kinase (AMPK), and NOS. Subsequently, we investigated the role of liver kinase B (LKB)-1 in this process. Liraglutide increased the phosphorylation of LKB-1, and siRNA-induced LKB-1 knockdown abolished liraglutide-stimulated NO production. In severe hyperglycemic db/db mice, liraglutide treatment also suppressed neointimal hyperplasia, which was accompanied by reductions in vascular cell proliferation and density. Furthermore, liraglutide treatment suppressed hyperglycemia-enhanced vascular inflammation 7 days after arterial injury.ConclusionsWe demonstrate that endothelial cells are targets of liraglutide, and suppress restenosis via endothelial NO. Furthermore, the protective effects are maintained in severe hyperglycemia. Our findings provide an evidence base for a future clinical trial to determine whether treatment with GLP-1RAs represents potentially effective pharmacological therapy following angioplasty in patients with diabetes.

6000Lesion morphology, not hemodynamic parameters, is an independent predictor of complications of balloon pulmonary angioplasty

6000Lesion morphology, not hemodynamic parameters, is an independent predictor of complications of balloon pulmonary angioplasty

Intraprocedural Distal Embolization After Femoropopliteal Angioplasty: Is There a Role for Below-the-Knee Stents?

Intraprocedural distal embolization is an accepted complication of femoropopliteal angioplasty. The purpose of this study is to assess the use of below-the-knee stents in the "bail-out" of conventional methods. We retrospectively reviewed 1485 of femoropopliteal angioplasties that were performed in our centre in a 4-year period and analysed 12 cases (<1%) where distal embolization that required further intervention occurred. In all cases lesions were chronic and 75% suffered from critical limb ischaemia. The target vessel was the SFA in all of the cases with a long (>10cm) occlusion in 50%. A three-vessel run-off was present in only 25%. Patients that received a stent as a limb salvage attempt were analysed. Outcome measures were technical success, clinical success and procedure-related complications. Multivariate regression analysis of the factors related to stenting was also performed. In 41% of the cases with distal embolization, recanalization with aspiration, thrombolysis or angioplasty offered a satisfactory result. In 59%, conventional methods were ineffective; a stent was deployed in 85%, whereas in 15% surgical embolectomy was required. Technical and clinical success of the stent cases was 100% without any procedure-related complications. There was significance (p<0.05) between critical limb ischaemia and stenting; single-vessel run-off has also shown a positive trend (p=0.88). Stents appear as a valid salvage option for infragenicular distal embolization when conventional methods fail; the likelihood of having to use a stent is higher for patients with critical limb ischaemia and a single-vessel run-off.

Endarterectomy versus stenting in patients with prior ipsilateral carotid artery stenting

ObjectiveIn-stent restenosis is a recognized complication of carotid angioplasty and stenting (CAS), and it is associated with an increased risk of stroke. Few case series have reported outcomes separately following carotid endarterectomy (CEA) and CAS for the treatment of in-stent restenosis. In this study, we perform an evaluation of redo-CAS vs CEA in a large contemporary cohort of patients who underwent prior ipsilateral CAS. MethodsWe studied all patients in the Vascular Quality Initiative (VQI) database, who underwent CEA or CAS between January 1, 2003, and April 30, 2016, after prior ipsilateral CAS. Univariate methods (χ2, t-test), Kaplan-Meier, logistic, and Cox regression analyses adjusting for patient characteristics were employed to evaluate stroke, death, myocardial infarction (MI), stroke/death, and stroke/death/MI within 30 days and up to 1 year following the procedure. ResultsThere were 645 carotid interventions (CEA, 134 [21%] and redo-CAS, 511 [79%]) performed in this cohort of patients with prior ipsilateral CAS. Postoperative stroke within 30 days comparing CEA vs CAS was 0% vs 0.3% (P = .61) for asymptomatic patients and 4.4% vs 3.5% (P = .79) for symptomatic patients for an overall stroke rate of 1.5% vs 1.4%. MI was 2.3% vs 1.2% (P = .35), 30-day mortality was 3.7% vs 0.9% (P = .02) following CEA vs CAS, whereas the composite of perioperative stroke/death was 4.5% vs 1.9% (P = .09). Freedom from stroke/death at 1 year was 91% for CEA and 92% for redo-CAS (P = .76). After risk adjustment, there was no significant difference in 30-day stroke (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.15-4.48; P = .82), mortality (OR, 2.21; 95% CI, 0.54-9.11; P = .27), or stroke/death (OR, 0.99; 95% CI, 0.26-3.84; P = .99) as well as 1-year stroke (hazard ratio [HR], 0.60; 95% CI, 0.13-2.85; P = .52), mortality (HR, 0.83; 95% CI, 0.42-1.65; P = .60), or stroke/death (HR, 0.80; 95% CI, 0.43-1.49; P = .48) comparing CEA with CAS. The significant predictors of perioperative stroke/death were older age, diabetes, active smoking, and preoperative American Society of Anesthesiologists class IV status (all P < .05). ConclusionsWe have reported adverse event rates for CEA and CAS after prior CAS and shown no significant difference in perioperative and 1-year outcomes between both groups. However, CEA is offered to patients who are more severely ill than redo-CAS, resulting in significantly higher absolute mortality. We recommend avoidance of CEA especially in asymptomatic patients with serious systemic disease. Tight management of diabetes and smoking cessation remain potent targets for outcomes improvement in redo-CAS patients.

Reperfusion Pulmonary Oedema as a Complication of Balloon Angioplasty of the Pulmonary Artery in Patients with Chronic Thromboembolic Pulmonary Hypertension

Reperfusion Pulmonary Oedema as a Complication of Balloon Angioplasty of the Pulmonary Artery in Patients with Chronic Thromboembolic Pulmonary Hypertension

Complications in Percutaneous Dialysis Interventions: How to Avoid Them, and How to Treat Them When They do Occur

Because of the increasing prevalence of end-stage renal disease, more percutaneous interventions are being performed. They serve an important role, allowing for restoration of access function, which is achieved with high level of technical success. However, complications are inevitable during any types of procedure, and percutaneous dialysis interventions are no exception. To provide safe and effective care these patients need, anyone performing endovascular dialysis interventions needs to understand the possible complications, how they can be avoided, and how they can be addressed if they are to occur. Topics in this article include complications seen while intervening on the thrombosed access, complications of angioplasty, potentially devastating complications of central venous interventions, and complications of dialysis catheter placement. Further, patients with end-stage renal disease are generally sicker than the average patient, usually afflicted by multiple comorbidities and are therefore more complicated from a medical perspective. This places them at higher risk for acute cardiopulmonary decompensation or arrest than any other interventional radiology patient subset. As result, we also briefly review general medical complications in this population.

5-Fr sheathless transradial cardiac catheterization using conventional catheters and balloon assisted tracking; a new approach to downsizing.

While the uptake of transradial access site is growing, there are concerns about associated radial injury. We report a feasibility study of a technique that enables both 5Fr diagnostic and PCI cases to be undertaken without an arterial sheath using conventional diagnostic and guide catheters with a modified balloon assisted tracking (BAT) technique. We performed a prospective single center pilot study to assess the feasibility and effectiveness of sheathless radial artery access and BAT to perform coronary angiography and angioplasty using conventional 5 Fr diagnostic and guide catheters. We assessed for successful acquisition of good quality angiogram, completion of the angioplasty and access site complications. 5 Fr sheathless cardiac catheterization was undertaken in diagnostic (55%) and PCI cases (45%, all indications) in 60 consecutive patients (mean age 62.8±11.4years) using conventional catheters. The procedure was successfully performed via the radial artery using a sheathless technique with BAT in 93.3% of patients. All patients had a patent radial artery following removal of the Helix device and there were no recorded access site complications. Trans-radial cardiac catheterisation for diagnostic and PCI cases using 5F Sheathless catheters (whose outer diameter is smaller than a 3Fr introducer sheath) with BAT appears feasible and allows both cardiac catheterization for diagnostic and PCI indications to be undertaken safely using conventional catheters through the radial route, with high success rates.

Acute stent malfunction in a fibrocalcific lesion

Stent fracture is an emerging complication of coronary angioplasty as a result of the complex interplay between stent design, the stented segment, stent over-expansion, a long stent and tortuous and complex lesions including chronic totally occluded vessels and calcified lesions.Its temporal course may be acute as well as delayed, including totally asymptomatic restenosis, migration of the stent, vessel perforation, and stent thrombosis. Here, we report the case of a 60 year-old patient who had acute stent fracture of an Endeavour Resolute stent (zotarolimus-eluting stent 3 × 33 mm) in a fibrocalcific lesion causing vessel perforation which was successfully treated with restenting by another Endeavour Resolute stent (3 × 29 mm).

Usefulness of paclitaxel-releasing high-pressure balloon associated with cutting balloon angioplasty for treatment of outflow stenoses of failing hemodialysis arteriovenous shunts.

To evaluate the technical and clinical success, primary patency (PP) and complications of angioplasty performed with paclitaxel-coated balloon (PCBs) associated with cutting balloon and for the treatment of the outflow stenoses of failing hemodialysis arteriovenous shunt. From September 2014 to September 2015, 50 patients with 66 stenoses were registered. Vascular accesses were autogenous (n=20) and prosthetic (n=30). Stenosis were documented during follow-up with routine echo-color Doppler, clinical evaluation and in the remaining incidentally during fistulography. Angioplasty was performed with cutting balloon and afterward with PCB. The mean follow-up time was 8months (range 6-15months). Technical success, clinical success, primary patency and complications were registered. Technical success was 100%. Clinical success was 94.7%. Primary patency rate was 87.7%; in five patients, a significant re-stenosis (≥50%) was registered. A residual asymptomatic stenosis (<30%) was registered in four cases (7%). No major complications were registered. A short-term patency benefit may be obtained including PCB in angioplasty treatment of failing hemodialysis arteriovenous shunts.

A broken balloon catheter entrapped in coronary artery due to its rupture during angioplasty of a chronic total occlusion: a rare complication of angioplasty managed conservatively

We present a case of a 72-year-old patient who underwent percutaneous transluminal coronary angioplasty due to a chronic total occlusion of left anterior descending artery. The balloon catheter ruptured and entrapped in the chronic lesion and had broken while attempting to remove from the lesion. End portion of the balloon catheter retained in the lesion. We tried various extraction methods but were unsuccessful. Because of the patient’s high surgical risk, we left the broken part of balloon catheter in lesion and fixed it to the coronary wall by stenting.