Impact Of Percutaneous Transluminal Angioplasty Research Articles

Mid-term sustained relief from headaches after balloon angioplasty of the internal jugular veins in patients with multiple sclerosis.

ObjectivesMultiple sclerosis (MS) patients frequently suffer from headaches and fatigue, and many reports have linked headaches with intracranial and/or extracranial venous obstruction. We therefore designed a study involving MS patients diagnosed with obstructive disease of internal jugular veins (IJVs), with the aim of evaluating the impact of percutaneous transluminal angioplasty (PTA) on headache and fatigue indicators.Methods286 MS patients (175 relapsing remitting (RR), 75 secondary progressive (SP), and 36 primary progressive (PP)), diagnosed with obstructive disease of IJVs, underwent PTA of IJVs during the period 2011–2015. This included 113 headache positive patients (82 RR, 22 SP, and 9 PP) and 277 fatigue positive patients (167 RR, 74 SP, and 36 PP). Migraine Disability Assessment (MIDAS), and the Fatigue Severity Scale (FSS) were evaluated: before PTA; 3-months after PTA; and at final follow-up in 2017. Patients were evaluated with Doppler sonography of the IJVs at 1, 6 and 12 months after PTA and yearly thereafter. Non-parametric statistical analysis was performed using a combination of the Friedman test and Spearman correlation analysis.ResultsWith the exception of the PP patients there were significant reductions (all p < 0.001) in the MIDAS and FSS scores in the 3-month following PTA. The improvement in MIDAS score following PTA was maintained throughout the follow-up period in both the RR (p < 0.001; mean of 3.55 years) and SP (p = 0.002; mean of 3.52 years) MS cohorts. With FSS, significant improvement was only observed at 2017 follow-up in the RR patients (p < 0.001; mean of 3.37 years). In the headache-positive patients, post-PTA MIDAS score was significantly negatively correlated with the change in the blood flow score in the left (r = -0.238, p = 0.031) and right (r = -0.250, p = 0.023) IJVs in the RR patients and left IJV (r = -0.727, p = 0.026) in the PP patients. In the fatigue-positive cohort, post-PTA FSS score was also significantly negatively correlated with the change in blood flow in the right IJV in the PP patients (r = -0.423, p = 0.010). In addition, the pre and post-PTA FSS scores were significantly positively correlated in the fatigue-positive RR (r = 0.249, p = 0.001) and SP patients (r = 0.272, p = 0.019).ConclusionsThe intervention of PTA was associated with a large and sustained (>3 years) reduction in MIDAS score in both RR and SP MS patients. While a similar initial post-PTA reduction in FSS score was also observed, this was not maintained in the SP and PP patients, although it remained significant at follow-up (>3 years) in the RR MS patients. This suggests that venoplasty might be a useful intervention for treating patients with persistent headaches and selected concomitant obstructive disease of the IJVs.

Resolution of ischemic symptoms after percutaneous angioplasty for a symptomatic subclavian artery stenosis

A minor part of patients with subclavian or innominate artery occlusive disease (subclavian artery stenosis [SAS]) experience symptoms of vertebrobasilar insufficiency, upper extremity exertional ischemia (UEEI), or cardiac ischemia owing to subclavian-coronary steal (SCS) in some instances. The study aimed to assess the impact of percutaneous transluminal angioplasty (PTA) of symptomatic SAS on symptom resolution and to determine factors related with SAS recurrence. Symptom resolution and incidence of restenosis (RS) were evaluated for up to 15years in patients who had undergone successful PTA of SAS. The study group comprised 232 consecutive subjects after successful PTA of SAS (61.9± 8.4years old 53.4% men). The mean follow-up time was 101± 40months (range, 5-188 months). One month after PTA, 85.4% of the study participants were free from dizziness, 94.4% from imbalance, 97.1% from visual disturbances, 97.8% from syncope, 98.7% from UEEI, and 100% from SCS. RS was found in 37 patients (15.9%) in long-term observation. UEEI, dizziness, imbalance, and SCS were significantly more frequent in patients with SAS recurrence, as compared with patients with patent artery (65.9% vs 3.1% [P< .001] 63.4% vs 19.4% [P< .001]; 26.8% vs 9.4% [P= .005]; and 100% vs 15.4% [P= .018], respectively). Smaller stent diameter (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.79-0.96; P= .004), implantation of ≥2 stents for a lesion (OR, 1.15; 95% CI, 1.05-1.26; P= .003), concomitant stenosis in the carotid or vertebral artery (OR, 1.10; 95% CI, 1.01-1.21; P= .036), high-sensitivity C-reactive protein level (OR, 1.20; 95% CI, 1.09-1.31; P< .001), and high-density lipoprotein level (OR, 0.91; 95% CI, 0.82-0.98; P= .021) were associated independently with risk of RS, whereas recurrence of UEEI (relative risk, 1.71; 95% CI, 1.55-1.90; P< .001), dizziness (OR, 1.26; 95% CI, 1.14-1.39; P< .001), limb paresthesia (OR, 1.14; 95% CI, 1.04-1.25; P= .005), and angina in subjects after coronary artery bypass grafting (OR, 1.11; 95% CI, 1.01-1.21; P=.024) were associated with RS/SAS progression after PTA. Angioplasty of SAS leads to symptom resolution in most patients. UEEI, dizziness, and angina recurrence are predictors of RS or SAS progression; high-sensitivity C-reactive protein, smaller stent diameter, and number of implanted stents predict RS.

Impact of Percutaneous Transluminal Angioplasty for Treatment of Cerebral Vasospasm on Subarachnoid Hemorrhage Patient Outcomes

Percutaneous transluminal angioplasty (PTA) has been introduced for treatment of symptomatic cerebral vasospasm in patients with subarachnoid hemorrhage (SAH). While angiographic improvement is consistently reported, clinical improvement following the procedure varies, and limited data is available regarding overall impact on outcome. The authors performed a retrospective analysis of all hospital admissions with aneurysmal SAH over a 6 year period. The length of stay, discharge outcomes (measured by modified Rankin scale [mRS] at discharge), and 1-year mortality among patients with SAH before (4 year period) and after (2 year period) institution of PTA for cerebral vasospasm were compared. Embolization for intracranial aneurysm was used as a therapeutic option throughout the study duration. The effect of institution of PTA for vasospasm after adjusting for age, clinical severity, and use of aneurysm embolization on both discharge outcomes and 1-year mortality in multivariate analysis was evaluated. A total of 146 patients with aneurysmal SAH were admitted during the study duration. There was no difference between the 89 patients admitted in pre-angioplasty period and 57 patients admitted in post-angioplasty period in regards to age, medical co-morbidities, and admission clinical severity of patients (measured by Hunt and Hess grade and Glasgow coma scale). A total of 18 (32%) patients underwent PTA with or without intra-arterial vasodilator treatment in the second period of the study. There was a non significant decrease in rates of severe disability and death (mRS 5-6) at discharge (45 vs. 33%, P = 0.09) and 1-year mortality (32 vs. 22%, P = 0.26) after introduction of PTA for cerebral vasospasm after adjusting for potential confounders. There was no significant difference between the two time periods in regards to length of stay. A non significant trend was noted with reduced rate of severe disability and mortality at discharge and 1-year mortality after the introduction of PTA for cerebral vasospasm associated with SAH without increasing the length of hospital stay.

Impact of Endovascular Treatment on Clinical Status and Health-Related Quality of Life

Investigating the impact of percutaneous transluminal angioplasty (PTA) on clinical status and health related quality of life in patients with claudication and critical limb ischaemia (CLI). 61 patients and 64 limbs underwent a primary PTA (30 claudication and 34 CLI cases). Clinical status was graded according to Ahn and Rutherford and ankle/brachial index (ABI). Quality of life was assessed using the Nottingham Health Profile (NHP) preoperatively, one month and one year after the procedure. Triplex scan evaluation of the treated arterial segment was carried out postoperatively and one year after the procedure. Claudication: 24/27 patients underwent one-year follow up, after which 20/24 had no claudication. In triplex evaluation 17 (63.0%) treated segments were open with 0-50% restenosis, 9 (33.3%) with 51-99% restenosis and one (3.7%) was occluded. CLI: 13/34 (38.2%) patients underwent one-year follow-up after which eight patients (61.5%) were asymptomatic and five (38.1%) had claudication. In triplex evaluation there was 0-50% restenosis in 6 (46.2%) segments treated with PTA and 51-99% restenosis in 7 (53.8%) segments. 21 (61.8%) patients did not conclude the one year follow up: 7 had died, 5 had undergone bypass surgery and 6 an amputation and 3 did not attend the follow-up up for unknown reasons. Quality of life: For CLI patients, improvement was observed in the domain of pain, which continued throughout the follow-up period. Among the claudicants, the domain of physical mobility was improved at one month's follow-up, but this effect disappeared during the following year and could not be seen at one the one- year follow-up. Technical success and one-year results in claudication are good, and the rate of complications is low. However, although PTA resulted in an immediate improvement in the quality of life, this effect was not seen in the long term. In critical limb ischemia there was a group of patients in whom PTA led to a significant benefit in terms of limb salvage and quality of life.

Transluminal Stenting for Femoropopliteal Occlusive Disease: Analysis of Restenosis by Serial Arteriography

Our objective was to evaluate restenosis after stenting of femoropopliteal occlusions and the impact of percutaneous transluminal angioplasty (PTA) on recurrent stenosis. We used a retrospective analysis of contrast angiograms obtained during follow-up of stented limbs. Subjects included 27 claudicants (34 limbs) who had complete superficial femoral artery occlusion treated with PTA and Wallstents at the Veterans Adminstration Medical Center. During follow-up, 31 PTAs, three thrombolytic treatments, and one additional stenting were performed. Outcome was measured by contrast angiography. Primary patency at 1 and 3 years was 38% and 8% after stenting, and secondary patency (PTA required at least once in 21/34 limbs) was 89% and 55%, respectively. PTA performed during follow-up reduced within-stent restenosis on average from 48.3 +/- 13.6% to 22.8 +/- 18.0%. Recurrent stenosis after PTA measured 14.9 +/- 10.9 months later was 46.8 +/- 16.7%, showing little permanent impact of PTA on stenosis. Severe within-stent stenosis develops commonly after initial stenting of complete femoropopliteal occlusions. Supplemental PTA performed during follow-up provides immediate improvement in lumen diameter, but severe restenosis is still likely to recur.

Does Angioplasty Improve the Quality of Life for Claudicants?: A Prospective Study

This study aims to analyze the impact of percutaneous transluminal angioplasty (PTA) for claudication on patients' quality of life (QOL). The patients in this study included 108 claudicants, 74 men and 34 women, with a median age of 67 years (range 40-87 years), who were assessed prior to and at 1, 3, and 6 months following PTA. This is the first report to demonstrate that the previously well-documented improvements in the clinical indicators of lower-limb ischemia are accompanied by improvements in individual QOL domains and in overall global QOL. These findings are detectable within a month following PTA and last at least 6 months. The results of this study may go some way to provide proof of efficacy for the procedure and thus help justify the recently questioned widespread use of PTA in clinical practice.

Impact of angioplasty and arterial reconstructive surgery on the quality of life of claudicants. The Scottish Vascular Audit Group.

Claudicants usually die from concomitant conditions. Therefore, surgical interventions are aimed at improving quality of life, rather than survival. This study compared the impact of percutaneous transluminal angioplasty (PTA), arterial reconstruction and conservative management on quality of life. SF36 questionnaires were completed by 201 newly referred claudicants prior to treatment and six months later. Multiple regression was used to compare the quality of life scores following the three treatments after adjustment for baseline scores, age, sex, site of disease and disease severity. Follow-up data were available on 81% of the 195 patients alive. Nineteen (10%) of these had undergone PTA and 19 (10%) reconstruction. All aspects of quality of life deteriorated following conservative treatment. PTA and arterial reconstruction produced significant improvements in both pain and physical functioning after adjustment for case-mix. Although unlikely to improve survival, PTA and arterial reconstruction are associated with significant improvements in quality of life.

112. The impact of percutaneous transluminal angioplasty (PTA) on limb blood flow and quality of life in patients with intermittent claudication

112. The impact of percutaneous transluminal angioplasty (PTA) on limb blood flow and quality of life in patients with intermittent claudication

Percutaneous transluminal angioplasty in femoral artery occlusions: Primary and long-term results in 107 claudicant patients using femoral and popliteal catheterization techniques

To assess the impact of percutaneous transluminal angioplasty (PTA) of occluded femoral arteries, a prospective study of 107 claudicant patients was performed. A total of 117 limbs were treated and were followed for 1-36 months; the mean length of treated occlusions was 7.4 cm (range 2-25 cm). Eighty-nine recanalizations were performed using antegrade femoral and 28 using the retrograde popliteal catheterization technique. With logistic regression a short length of occlusion correlated favourably with early success. Including rePTAs and applying standardized criteria, survival analysis with the Kaplan-Meier method revealed a 3-year secondary patency rate of 55% for all the treated limbs. The following factors had negative influence on primary patency after successful recanalization; presence of soft thrombotic material in the recanalized artery segment and the presence of focal dissections after PTA. In univariate and multiple logistic regression analysis, male gender and a lesser extent of the atherosclerotic disease (assessed by the number of diseased vessels in the treated limb) correlated with a lower frequency of PTA procedure complications. There was no statistically significant difference in the complications, in the primary success or in the long-term results using either the femoral or popliteal route. However, the popliteal approach improved the early success of the originally antegrade access group by 6% and increased by about one-fifth the number of patients considered technically feasible for PTA in femoral artery occlusions. PTA can be used in femoral artery occlusions up to 10 cm long and it is especially suitable in femoral artery occlusions not exceeding 5 cm in length. PTA can be tried in femoral artery occlusions exceeding a length of 10 cm if operative treatment is not suitable.