Durability Of Angioplasty Research Articles

Thrombectomy and Stenting Management in Basilar Artery Occlusion Associated with Acute Stroke Case Report: Important Role of Radiology for Diagnostic and Treatment

Occlusions of the basilar artery (BA), which are typically caused by thromboembolism and atherosclerosis, may account for as much as 27% of posterior circulation ischemic strokes. The symptoms of BA occlusion can range from temporary weakness or paraesthesia to near-complete paralysis, leading to a high risk of morbidity and mortality. CT and MRI are the imaging modalities of choice for identifying and locating the infarct area, ruling out any other lesions, and detecting vascular abnormalities. The combination of thrombectomy and stenting has been shown to increase the safety and durability of angioplasty without causing noticeably negative side effects, and it may be utilized as the first line of treatment for BA stenosis or occlusion in acute stroke.

Impact of Race on Infrainguinal Angioplasty and Stenting

Over the last decade, catheter-based interventions on lower extremity arteries have been used with increasing frequency. However, the effect of racial background on the outcome of lower extremity endovascular interventions for peripheral arterial disease is unknown. The purpose of this study was to determine the effect of patients' race on the durability of angioplasty and stenting performed on the superficial femoral and popliteal arteries. The records of all patients undergoing percutaneous intervention on the lower extremity arteries during a 14-year period were reviewed. During a 44-month period (2003-2007), all patients underwent primary stenting as part of a prospective study protocol. Indication for intervention, TransAtlantic InterSociety Consensus II classification, runoff anatomy, site of intervention, and the placement of stents were noted. Results were analyzed by race. Kaplan-Meier life survival curves were plotted and differences between groups tested by log-rank method. Cox proportional hazards regression model was used to perform the multivariate analysis. Between 1994 and 2007, a total of 374 percutaneous interventions were performed on the superficial femoral and popliteal arteries in 280 patients. Of these, 182 procedures were angioplasties and 192 included both angioplasty and stenting. The study group consisted of 60% Caucasians, 23% Hispanics, 12% African Americans, and 5% Asians. No difference in primary patency rates was noted between individuals belonging to different races. However, in those undergoing angioplasty alone, Caucasians had the highest rate of failure, followed by Hispanics, African Americans, and then Asians (p < 0.002). No difference in patency rates between races was seen in patients undergoing angioplasty with stenting. For the entire group, dyslipidemia, TransAtlantic InterSociety Consensus II C and D lesions, and angioplasty without stenting negatively affected primary patency. Race does not appear to influence the durability of catheter-based procedures performed on the superficial femoral and popliteal arteries. However, in patients who underwent angioplasty alone, it was noted that Caucasians had the highest rates of failure and Asians the lowest. However, this difference was no longer apparent when stents were used.

Et Tu, Bare Metal Stent?

When performing percutaneous coronary revascularization, physicians nearly always supplement balloon angioplasty with a stent.1 This decision is based on evidence that stent implantation enhances the procedural success and durability of angioplasty. Benefits of stenting, compared with balloon angioplasty, include a reduction in the incidence of lesion recurrence, manifested as reduced need for repeat revascularization and lower rates of periprocedural myocardial infarction (MI).2–5 The major shortcoming of bare metal stents (BMS) is that ≈20% of native vessel and 30% of saphenous vein graft patients develop angiographic restenosis from neointimal hyperplasia. About half of these patients will have clinical restenosis and require repeat revascularization. In contrast to the favorable results of stents in de novo lesions, stenting of in-stent restenotic lesions with BMS results in more restenosis. Before the drug-eluting stent (DES) era, of multiple therapies investigated, only intracoronary brachytherapy was effective in preventing recurrent in-stent restenosis.6,7 Article p 2391 Fortunately, the DES was developed to suppress neointimal hyperplasia, and several randomized, double-blind, clinical trials demonstrated the ability of DES to substantially reduce the incidence of in-stent restenosis.8–10 Within a short time after commercialization, DES nearly replaced BMS in the United States, and the number of patients requiring repeat revascularization fell substantially.1 As clinical restenosis became infrequent, another potential and untoward event related to stents became more exposed—namely, stent thrombosis. This disorder can cause abrupt coronary occlusion and frequently clinically manifests as acute MI or death. Although stent thrombosis was common during the early years of BMS use, improvements in the technique of stent implantation and the administration of both aspirin and a thienopyridine (dual antiplatelet therapy) reduced the incidence of acute stent thrombosis to clinically acceptable levels.11,12 More recently, …

Patient Sex and Success of Peripheral Percutaneous Transluminal Arterial Angioplasty

Female sex negatively affects the durability of percutaneous angioplasty of native arteries supplying the lower extremity. Outcome analysis of the results of percutaneous angioplasty of lower extremity arteries in a single vascular surgery practice. University-affiliated community hospital. All patients undergoing percutaneous intervention on lower extremity arteries during 10 years. Indication for intervention, anatomic site of intervention, placement of percutaneous stents, and length of lesion undergoing angioplasty were noted. Patient demographics and risk factors were identified. Results were analyzed by sex. Kaplan-Meier life tables were plotted and differences between groups tested by the log-rank method. A Cox proportional hazards regression model was used to perform the multivariate analysis. During 10 years, 351 angioplasties were performed in 248 patients, 173 in women and 178 in men. There was no difference between men and women in indication for intervention, length and type of lesion treated, or quality of distal runoff. Univariate survival analysis identified a difference in duration of patency between men and women (P = .047). However, multivariate analysis demonstrated no significant difference in duration of patency between men and women (P = .18). Iliac angioplasty and adequate distal runoff were positive predictors of long-term patency (P<.001 for both). There appears to be no significant difference in the durability of angioplasty between men and women. However, location of angioplasty and adequacy of distal runoff may be useful in determining when to use angioplasty.

Subintimal angioplasty of tibial vessel occlusions in the treatment of critical limb ischaemia: mid-term results.

to evaluate the feasibility and preliminary results at 1 year of subintimal angioplasty of tibial occlusions in critical limb ischaemia (CLI). from December 1997 to December 1999, we intended to treat 36 patients and 40 limbs by subintimal angioplasty of occlusions of tibial vessels. Thirty-one had gangrene or ulceration and nine had rest pain. Twenty-seven occlusions were more than 10 cm, 10 were 5 to 10 cm and three were less than 5 cm in length. Three patients had an occluded previous ipsilateral bypass graft. All patients were followed 3 monthly for a median of 10 months by means of clinical and duplex examination. the technical success rate was 78% (31/40). Nine technical failures were treated by conventional surgery or angioplasty of another diseased tibial vessel. The clinical success rate was 68% (27/40). Four below-the-knee amputations were performed despite a patent recanalisation. Primary and secondary patency rates at 12 months were 56% (72% without technical failures). The 12-month limb salvage rate was 81% and survival rate was 78%. Three of five complications were treated by endovascular procedures. The length of occlusion (>10 cm) but not the location of distal re-entry, the type of vessel re-entry and the presence of diabetes are predictors of technical success and patency. subintimal angioplasty can be used to treat tibial occlusions in patients with CLI. Technical failure does not preclude conventional surgery and complications may often be treated by endovascular procedures. However, the durability of angioplasty is as yet uncertain.

Durability of angioplasty in treating severe leg ischaemia

Abstract Background Percutaneous transluminal angioplasty (PTA) has recently been accepted as a valuable therapeutic option in patients with severe limb ischaemia. However, despite the increasing use of this technique, there have been concerns that the long-term efficacy of PTA is inferior to that of surgical revascularization. This prospective study reports the outcome of an unselected cohort of patients who underwent balloon angioplasty for severe lower limb ischaemia in a single centre. Methods During 1997, 108 patients with 133 severely ischaemic legs were treated by PTA. The median age of the patients (49 per cent men) was 76 years. Symptoms were rest pain in 31 per cent, ischaemic ulceration in 56 per cent and gangrene in 13 per cent. The distribution of risk factors was typical: diabetes 32 per cent, ischaemic heart disease 18 per cent and stroke 16 per cent. Median (interquartile range) follow-up was 16 (12–19) months. There was a mean of 1·7 angioplasty sites per patient, distributed in the iliofemoral (14 per cent), superficial femoral (42 per cent), popliteal (18 per cent) and crural (26 per cent) arteries. PTA was performed luminally in 20 per cent of cases and subintimally in the remainder. Overall, 67 per cent of the lesions were complete occlusions with a median length of 20 (10–40) cm. Results Technical success was achieved in 104 limbs, with 29 failures. The outcome of patients with a failed angioplasty (29) was poor, with 14 requiring bypass surgery, 11 undergoing a major amputation and 32 per cent dying after the procedure. In contrast, patients having a technically successful angioplasty had a good outcome after a median follow-up of 16 (12–19) months. In this group there was a 30 per cent overall mortality rate during follow-up. However, 85 per cent of the patients had no symptoms of critical ischaemia and the limb salvage rate was 92 per cent. Conclusion PTA is an effective and durable procedure in patients with critical leg ischaemia, with results comparable to those of historical surgical controls. Technical failure of PTA is, however, associated with a dire outcome.

Elective stenting of symptomatic basilar artery stenosis.

Percutaneous angioplasty of the intracranial arteries still carries the risk of dissection, with acute closure and embolization. Stenting has been shown to improve the safety and durability of angioplasty in every circulatory bed in which it has been applied. However, stenting of the intracranial arteries has been limited by the availability of stents that can be reliably deployed intracranially. Twelve patients underwent elective stenting of the basilar artery after episodes of vertebrobasilar ischemia. In all patients, either medical therapy had failed or the patient had a contraindication for long-term anticoagulation. Information from independent neurological examinations, quantitative angiography, and clinical follow-up was collected. Differences between pretreatment and posttreatment degree of stenoses were subjected to 1-way ANOVA for repeated measures. There were 10 men and 2 women, all white, aged 40 to 82 years (mean age, 62.6 years). Stent placement was successful in all patients, leading to statistically significant changes in the degree of stenosis, from 71. 4% (range, 53% to 90%) to 10.3% (range, 0% to 36%) (P<0.0001). There were no deaths, stent thromboses, perforations, ruptures, or myocardial infarctions. Clinical follow-up was available for 0.5 to 16 months (mean, 5.9 months). One patient had nonspecific symptoms, and another had a transient ischemic attack. All other patients remained asymptomatic. Elective stenting of the basilar artery is feasible, with minimal risk to the patient. Its impact on long-term stroke prevention and its durability are unknown and will require further study.