Occlusion Length Research Articles

Vessel wall MRI evaluation for the safety of endovascular recanalization of non-acute intracranial anterior circulation artery occlusions

BackgroundVessel wall MRI (VWMRI) can reveal the morphological features of intracranial artery occlusion (ICAO). This study aimed to investigate the imaging features of ICAO on VWMRI and explore their correlation...

Role of pre-procedure CCTA in predicting failed percutaneous coronary intervention for chronic total occlusions

PurposeThis study aimed to identify major lesion characteristics of chronic total occlusions (CTOs) that predict failed percutaneous coronary intervention (PCI) using pre-procedure coronary computed tomography angiography (CCTA) in combination with conventional coronary angiography (CCA). MethodsConsecutive patients with at least one CTO of the native coronary arteries received CCTA and CCA-guided PCI, with computed tomography performed before or during PCI. ResultsA total of 76 patients with CTO were included in this study. 76 patients were divided into successful and failed PCI groups based on their PCI outcome. There were 62 (81.58 %) patients in the successful PCI group and 14 (18.42 %) in the failed PCI group. The occlusion length ≥20 mm, ostial or bifurcation lesions, negative remodeling, microchannels, and good collateral vessels were the CCTA morphologic parameters associated with PCI outcome (P<0.05). In addition, the blunt stump, occlusion length ≥20 mm, and ostial or bifurcation lesions, were the CCA morphologic parameters associated with PCI outcome (P<0.05). The multivariate regression model showed that the three independent negative predictors: blunt stump on CCA (OR: 0.63; 95 % CI: 0.23–0.98; p =0.048), occlusion length ≥20 mm on CCTA (OR: 0.37; 95 % CI: 0.32–0.71; p <0.001) and negative remodeling on CCTA (OR: 0.26; 95 % CI: 0.28–0.44; p <0.001). ConclusionOur study demonstrated that combining CCTA and CCA morphologic characteristics could improve PCI outcome prediction in patients with CTO compared to CCTA morphologic features alone.

Incidence of Angiographic Deterioration Following Inframalleolar Angioplasty and Its Impact on Outcomes in Patients With Chronic Limb-Threatening Ischemia Requiring Repeat Intervention.

Clinical impact of inframalleolar (IM) angioplasty in patients with chronic limb-threatening ischemia (CLTI) is still controversial. This single-center, retrospective study included 168 patients with CLTI and tissue loss who underwent angioplasty for IM lesions. Angiographic follow up was performed at reintervention between April 2010 and December 2020. The outcome measure was the incidence of angiographic deterioration characterized by severe restenosis or occlusion of mildly stenotic lesions, occlusion of severely stenotic lesions, or extension of the occlusion length at reintervention. Angiographic deterioration was observed in 47.7% of patients, with the majority attributed to occlusion in severely stenotic lesions. Multivariate analysis revealed that a distal reference vessel diameter ≤1.0 mm in the initial angioplasty (hazard ratio 1.91 [95% confidence interval 1.20-3.04]; P=0.006) was significantly associated with angiographic deterioration of IM lesions at reintervention. Angiographic deterioration occurred in approximately half of the patients with CLTI who underwent IM angioplasty and reintervention.

Coronary computed tomographic angiography predicts crossing through chronic total occlusion within three guidewires

BackgroundCoronary computed tomography angiography (CCTA) is a valuable non-invasive method for the diagnosis and treatment of coronary artery disease, especially providing important clinical decision-making basis for percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). However, there is no data to discuss whether CCTA can predict the success rate of crossing through occlusive lesions within 3 guidewires. ObjectiveThe aim of this study was to establish a scoring model based on CCTA images to predict the success rate of CTO-PCI within 3 guidewires for grading treatment difficulty. MethodsData including 267 CTO lesions in 252 patients with pre-procedural CCTA were analyzed. Successfully crossing through the lesion within 3 guidewires was set as a new endpoint to eliminate operator bias and estimate surgical costs. The Guidewires of CTO (GW-CTO) score was determined by assigning an appropriate integer point for each independent predictor of this endpoint and summing all points accrued. Results72.3% reached the new endpoint. We identified 5 predictors. Including blunt proximal stump, both proximal and distal branches, occluded segmental curvature>45°, length of occlusion≥20 mm, and calcified plaque burden≥0.125. With the GW-CTO score rising from 0 to 5, the success rate dropped from 98.83% to 12.50%. The CTO-PCI difficulty was stratified into three grades: easy (0–1), intermediate (2–3), and difficult (4–5). The GW-CTO score yielded good predictive results, with an area under receiver-operator characteristic (ROC) curve of 0.87. ConclusionThis model is very novel and presents a new perspective to predict the probability of successfully passing through CTO lesions within 3 guidewires. This may help grade the difficulty of CTO-PCI and determining the cost efficiency.

Ventilation Dependency after Cardiac Operation for Infective Endocarditis: Risk Factors and Focus on Preoperative Aortic Regurgitation

Introduction: The investigation was to elucidate predictors of ventilation dependency after cardiac operation for infective endocarditis. Methods: Patients with infective endocarditis undergoing cardiac operation were retrospectively investigated. Mechanical ventilation &gt;72 hours was defined as ventilation dependency after cardiac operation. Results: 896 patients with infective endocarditis who underwent cardiac operation were assigned to group of mechanical ventilation ≤72 h (n = 704) and &gt;72 h (n = 192). Multivariate analyses identified age, interval from symptoms to operation, vegetation size, aortic occlusion length, pump length, intensive care unit (ICU) retention length, serum creatinine before and 24 h after surgery, preoperative and postoperative left ventricular end diastolic dimension (LVEDD), preoperative aortic regurgitation and packed red blood cells to be associated with ventilation dependency after cardiac operation; ventilation dependency is significantly related to prolonged ICU stay (&gt;3 d), 1- and 5-year mortality after cardiac operation. All-time mortality (45.3% versus 5.6%, p &lt; 0.001) of mechanical ventilation &gt;72 h group was higher than that of mechanical ventilation ≤72 h group. A significant positive correlation exists between preoperative aortic regurgitation and ventilation dependency after cardiac operation. A value of preoperative aortic regurgitation &gt;5.25 cm2 was 100% sensitive and 64.6% specific for the diagnosis of ventilation dependency after cardiac operation. Conclusions: We found modifiable risk factors of ventilation dependency after cardiac operation including interval from symptoms to operation, vegetation size, aortic occlusion length, pump length, ICU retention length, serum creatinine before and 24 h after operation, preoperative and postoperative LVEDD, preoperative aortic regurgitation and packed red blood cells and optimization of pre-, peri-, and postoperative factors that can reduce incidence of ventilation dependency, contributing to better short- and long-term outcomes.

Success Rate of Drilling and Knuckle Wire Crossing Technique in Chronic total Occlusion of the Femoro-Popliteal Artery and Predicting Factors Related to it in Real-World Data

Objective: Crossing chronic total occlusion (CTO) in femoro-popliteal (FP) arteries is challenging. Hence, this study aimed to describe real-world data on the technical success rate of crossing FP CTO lesions, and analyze predicting factors for crossing failure. Material and Methods: This retrospective study, conducted at a single center, involved patients with peripheral arterial disease (PAD) and FP CTOs, categorized as Rutherford categories 3-6, having undergone endovascular recanalization from 2017 to 2022. Baseline characteristics and crossing success rates were described using frequencies, percentages, means, medians, standard deviations, and interquartile ranges. Factors associated with crossing failure were analyzed through logistic regression analysis, with statistical significance set at a p-value&lt;0.05.Results: Among the 181 patients analyzed, the majority exhibited minor tissue loss (63%) and severe disease (TASC II category D, GLASS grade 4). The predominant CTO crossing approach was based on plaque cap morphology (CTOP) classification type B (66.9%), with severe CTO calcification (PACSS type 4) in 23.8%. Median occlusion length was 16.1 cm; 85.6% successfully crossed the CTO and antegrade success was 57.5%. Factors associated with crossing failure included: CTOP types C or D, CTO at the P3-popliteal artery, severe CTO calcification, and dyslipidemia. Retrograde recanalization showed higher success rates in CTOP type D and longer occlusions.Conclusion: This study highlights the safety and effectiveness of the catheter-wire crossing technique for FP CTOs. CTOP classification, CTO location, severe calcification, and dyslipidemia predicted crossing failure. The retrograde approach works well in CTOP type D and longer CTOs, providing insights for improving success in clinical practice.

A new angiographic scoring for grading the difficulty of recanalization for symptomatic non-acute middle cerebral artery occlusions.

Endovascular recanalization is a feasible option for treating symptomatic non-acute middle cerebral artery occlusion (MCAO) patients. Hence, we aimed to establish a new angiographic scoring to grade the recanalization difficulty of MCAO to determine the suitable patients for endovascular treatment. We retrospectively analyzed a total of 113 consecutive recurrent symptomatic non-acute MCAO patients who underwent endovascular recanalization from July 2015 to August 2021 in four Chinese comprehensive stroke centers. All patients were reappraised using a new angiographic scoring based on the stump morphology, the MCA occlusion length, MCA bend, and the distal vascular bed of MCAO. We used the final results to establish the patients' outcomes. The total successful recanalization and perioperative complication rates were 83.2% (94/113) and 15.9% (18/113), respectively. No deaths occurred within 30 days. Moreover, 96.9, 90, 87.5, 52.6, and 50% of the patients achieved recanalization with scores of 0, 1, 2, 3, and 4 (p < 0.001), respectively. However, the perioperative complication rate showed the opposite trend. (3.1% vs. 7.5% vs. 6.3% vs. 52.6% vs. 50%; p < 0.001). The median time of successful microwire crossing of the occlusion lesion (TMO) in the score 0 group was shorter than the other groups (2 min, 9 min, 8.5 min, 14 min, and 20 min; p < 0.001). When a score of 2 was used as the optimal cut-off point, the sensitivity and specificity were 86.2 and 63.2%, respectively. The new angiographic scoring can effectively predict the successful recanalization rate, perioperative complication rate, and TMO of endovascular recanalization for non-acute MCAO. It can also be used as an effective clinical evaluation tool to determine the suitable non-acute MCAO patients for recanalization, especially with a score ≤ 2.

Role of Preprocedural Multi Detector Computed Tomography Angiography in Prediction of Complexity &amp; Outcome of Coronary Chronic Total Occlusion Percutaneous Coronary Intervention

Abstract Background Chronic Coronary Total Occlusion (CTO) is considered one of the most challenging obstructive coronary artery diseases that had been widely managed medically or referred for bypass surgeries due to their complex nature which remained an obstacle for the operators. Coronary CT- angiography was used to develop easy predictive tools for CTO percutaneous intervention. Objectives To evaluate the ability of the CCTA and CT-RECTOR score to predict time-efficient guidewire (GW) crossing through a chronic total occlusion. Patients and Methods The present study included 40 patients with CTO lesions. All were subjected to preoperative CTO assessment using CCTA and CCA before an attempt of PCI to a CTO in the period between January 2022 and May 2023. The study was held in Ain Shams University hospitals and National Heart Institute. Results We divided the patients into two groups according to GW crossing within 30 minutes. Group 1 included patients with successful GW crossing within 30 min, group 2 included patients with failed GW crossing within 30 min. We compared the two groups according to demographic data and we found that males are more common to have CTO lesions (87.5%) which were predominantly located in RCA (50% of total no. with 76.9% of them in failed group, p = 0.018). Our results showed that CTOs with occlusion length ≥ 20 mm or calcification increased in failed group, but was not statistically significant (84.6% in failed group (p = 0.161) and 46.3% in failed group (p = 0.432) respectively). In addition, there was a statistical significance between presence of blunt stump (76.9% in failed group vs 29.6% in successful group, p = 0.004), a previous failed CTO-PCI attempt (53.8% in failed group vs 14.8% in successful group p = 0.009), and using retrograde wiring techniques (p = 0.003) between the successful and failed groups. Indicating that these points were important predictors of procedural failure. We compared CTO characteristics between CCTA-derived CT-RECTOR score and CA-derived J-CTO score. with increased score points, the probability of PCI difficulty and GW crossing failure increased. CT-RECTOR score was found to have the better ability for prediction of GW crossing within 30 min and CTO-PCI difficulty (p = 0.028). Conclusion CT-RECTOR score was superior to J-CTO score in the assessment and prediction of GW crossing difficulty within 30 minutes and final procedural outcomes.

Length and Proximal Extent of Occlusion Dictates Severity of Disease in a Mini-Swine Model of PAD

Length and Proximal Extent of Occlusion Dictates Severity of Disease in a Mini-Swine Model of PAD

Bioresorbable Scaffold Use in Coronary Chronic Total Occlusions: A Long-Term, Single-Center Follow-Up Study.

Background and Objectives: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is often associated with longer total stent length. Our aim was to evaluate the long-term safety and effectiveness of bioresorbable scaffold (BRS) implantation in CTO to avoid using a full metal jacket. Materials and Methods: We conducted a single-center prospective longitudinal case study including 34 patients who underwent PCI of CTO with at least one BRS and drug-eluting stent (DES) implantation (n = 27) or BRS-only at the Latvian Centre of Cardiology between 2016 and 2018. Quantitative coronary angiography (QCA) and intravascular ultrasound were performed during the index procedure and long-term follow-up. Results: Of 34 patients with a mean age of 60.6 ± 9.5 years, 76.5% were male. The most common CTO artery was the right coronary artery (73.5%, n = 25). The median length of occlusion was 23.0 mm (interquartile range (IQR) = 13.9-32.7), with a total mean BRS/DES length of 49.6 ± 20.4 mm. During the median follow-up of 5.6 years (IQR = 5.0-5.9), the primary endpoint of target vessel re-occlusion occurred in 5.9% (n = 2) of patients. Target lesion revascularization (TLR) was performed in 35.3% (n = 12) of patients, with a mean time to TLR of 62.5 (95% confidence interval (CI), 53.9-71.2) months. Through QCA, there was a statistically significant increase in median residual diameter stenosis (20.1-31.4%, p < 0.01) and residual length of stenosis (5.2-7.1%, p = 0.04) compared with the index procedure. Conclusions: Our study demonstrates that BRS is a safe and feasible option for PCI of CTO, allowing for the avoidance of long segment stenting and ensuring long-term patency of the coronary artery.

Revascularization techniques for complete portomesenteric venous occlusion in patients undergoing pancreatic resection

IntroductionPancreatic pathologies causing portomesenteric occlusion complicate extirpative pancreatic resection due to portomesenteric hypertension and collateral venous drainage. MethodsPatients with portomesenteric occlusion undergoing pancreatectomy were identified between 2007 and 2020 at Stanford University Hospital. Demographic and clinical data, technique and perioperative factors, and post-operative outcomes were analyzed. ResultsOf twenty-seven (27) patients undergoing venous revascularization during pancreatectomy, most (15) were for pancreatic neuroendocrine tumor. Occlusions occurred mostly at the portosplenic confluence (15). Median occlusion length was 4.0 cm [3.1–5.8]. Regarding revascularization strategy, mesocaval shunting was used in 11 patients, in-line venous revascularization with internal jugular conduit in three patients, traditional venous resection and reconstruction in 9 patients, and thrombectomy in two patients. Median cohort operative time and estimated blood loss were 522 min [433–638] and 1000 mL [700–2500], respectively. Median length of stay was 10 days [8–14.5] with overall readmission rate of 37%. Significant complications occurred in 44% of patients despite only one (4%) perioperative mortality. DiscussionDespite the technical complexity for managing portomesenteric occlusions, early revascularization strategies including mesocaval shunting or in-line venous revascularization are feasible and facilitate a safe pancreatic resection for surgically fit patients.

Predicting Successful Chronic Total Occlusion Crossing With Primary Antegrade Wiring Using Machine Learning

BackgroundThere is limited data on predicting successful chronic total occlusion crossing using primary antegrade wiring (AW). ObjectivesThe aim of this study was to develop and validate a machine learning (ML) prognostic model for successful chronic total occlusion crossing using primary AW. MethodsWe used data from 12,136 primary AW cases performed between 2012 and 2023 at 48 centers in the PROGRESS CTO registry (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; NCT02061436) to develop 5 ML models. Hyperparameter tuning was performed for the model with the best performance, and the SHAP (SHapley Additive exPlanations) explainer was implemented to estimate feature importance. ResultsPrimary AW was successful in 6,965 cases (57.4%). Extreme gradient boosting was the best performing ML model with an average area under the receiver-operating characteristic curve of 0.775 (± 0.010). After hyperparameter tuning, the average area under the receiver-operating characteristic curve of the extreme gradient boosting model was 0.782 in the training set and 0.780 in the testing set. Among the factors examined, occlusion length had the most significant impact on predicting successful primary AW crossing followed by blunt/no stump, presence of interventional collaterals, vessel diameter, and proximal cap ambiguity. In contrast, aorto-ostial lesion location had the least impact on the outcome. A web-based application for predicting successful primary AW wiring crossing is available online (PROGRESS-CTO website) (https://www.progresscto.org/predict-aw-success). ConclusionsWe developed an ML model with 14 features and high predictive capacity for successful primary AW in chronic total occlusion percutaneous coronary intervention.

Sex Related Differences in Perioperative Outcomes after Complex Endovascular Aortic Aneurysm Repair

Prior studies suggest female sex is associated with worse outcomes after complex endovascular aortic aneurysm repair (EVAR) due to anatomic differences. Therefore, we aimed to compare 30-day perioperative and long-term outcomes after complex EVAR by sex. A single-center retrospective review of consecutive elective and emergent complex EVAR with company-manufactured devices, laser fenestration, snorkel/periscope, or octopus technique was performed from 2012-2023. The primary outcome was a composite endpoint of any major adverse event (MAE), new-onset dialysis, or death within 30days. Secondary 30-day technical and long-term outcomes were also assessed. 293 patients (57 females, 19%), mean age 74years, underwent complex EVAR with commercially available Zenith fenestrated endovascular graft (71%), p-Branch (2%), laser fenestration (8%), snorkel/periscope (16%), or octopus (2%) techniques. Females had significantly different aneurysm-related anatomic characteristics compared to males, including smaller aneurysm diameters (58±7.2 vs. 64±13.2mm, P<0.001), more involved aneurysm extent (21.7% vs. 9.8% thoracoabdominal, P=0.04), increased renal artery calcification (43.9% vs. 27.1%, P=0.01), and smaller iliac (7.6±1.3 vs. 8.9±1.8mm, P<0.01). Operative outcomes were similar; however, females had a greater need for adjunctive access conduits (21.1% vs. 10.6%, P=0.04), lower technical success (91.2% vs. 98.3%, P=0.02), and longer median [interquartile range] length of stay (3.0 [4.0] vs. 2.0 [2.5] days, P<0.001). The composite 30-day outcome of any MAE, new dialysis, or death was not significantly different (15.8% females vs. 11.4% males, P=0.37). Technical endpoints including 30-day rates of target artery occlusion and type 1 or 3 endoleak were also similar between groups. At mean follow-up of nearly 3years, females had significantly lower rate of renal function decline (16.0% vs. 41.9%, P<0.001), but no differences were found in long-term all-cause mortality, aneurysm sac regression, reintervention, or total follow-up imaging studies between groups. Females undergoing complex EVAR had challenging anatomy with higher intraoperative target artery occlusion, conduit use, and longer length of stay. However, 30-day and long-term outcomes were similar, suggesting females can undergo complex EVAR with high technical success and comparable perioperative outcomes to males. Females appeared to have protection from long-term renal function decline, which will be important for future study.

Abstract 1154: Length And Proximal Extent Of Occlusion Dictates Severity Of Disease In A Mini-swine Model Of PAD

Background: There is ongoing need for large animal models of peripheral artery disease (PAD) that replicate human disease. We present mild (MI), moderate (MD) and Severe (S) phenotypes of PAD in an Ossabaw mini-swine platform. Methods: Metabolic syndrome was induced in swine (N=16; age= 4 mo) with a high fat/fructose/sodium diet for 8 weeks. Ischemia induction (T0) consisted of: (1) open ligation and resection of R Superficial Femoral Artery (SFA) for MI(N=4); (2) endovascular coil occlusion of R External Iliac Artery (REIA), RSFA and popliteal artery for MD (N=9); and (3) coil occlusion of REIA, RSFA, and right internal iliac artery (RIIA) for S (N=4). At 4 weeks (T4) and 8 (T8), all swine underwent angiography via carotid access, and bilateral gastrocnemius biopsy. All swine had measurements of ankle brachial indices (ABIs), and calf muscle tissue oximetry (STO 2 ) measurements at T0, T4 and T8, along with weekly measurement of walking performance on a treadmill (WP). Results: At T4 and T8 R ABI were increasingly decreased from MI to MD to S (table 1). Mean STO 2 difference between R and L calf at T4 and T8 had no changes in MI, while the differences were larger in S compared to MD (table 1). WP was increasingly decreased from MI to MD to S (table 1). The artery that grew the most on angiography at T4 and T8 were R profunda artery (RPFA) in MI; RIIA in MD; and LIIA in S (table 1). In MI, R PFA had faster flow at T4 and T8 compared to L PFA. At T4, MD and S had similar delays of RPFA reconstitution, this improved at T8 in MD but did not in S (table 1). On histology, MI had no obvious myopathy, MD and S had moderate and severe myopathy respectively. All S subjects developed poorly-healing ischemic ulcers. Conclusion: Length and proximal extent of occlusion dictated the characteristics and severity of phenotypes in our Ossabaw swine model of PAD. This mirrors PAD in humans and can be used to develop therapies for different disease severities.

Length and Proximal Extent of Occlusion Dictates Severity of Disease in a Mini-Swine Model of Peripheral Artery Disease

Length and Proximal Extent of Occlusion Dictates Severity of Disease in a Mini-Swine Model of Peripheral Artery Disease

Incidence and predictors of restenosis following successful recanalization of non-acute internal carotid artery occlusion in 252 cases

BackgroundData concerning restenosis following successful recanalization of non-acute internal carotid artery occlusion (ICAO) are scarce. This study was conducted to identify the incidence and predictors of restenosis following successful recanalization...

The Characteristics of Primary Retrograde Approach Selection for Native Coronary Chronic Occlusion With Short Occlusion Length from the Japanese CTO-PCI Expert Registry

Although the coronary chronic total occlusion (CTO) crossing algorithm has been published, the characteristics associated with the first strategy selection for short-length lesions <20 mm is still debatable. This study aimed to determine the characteristics associated with primary retrograde approach (PRA) for native CTO with short occlusion length in percutaneous coronary intervention (PCI). Between January 2014 and December 2021, we examined data on 4,088 lesions in the Japanese CTO-PCI Expert Registry with occlusion lengths <20 mm. Then, the characteristics for short-length CTO, which was performed by way of the PRA, were assessed. PRA was performed in 785 patients (19.2%). The guidewire success rate was 93.6%, and the technical success rate was 91.3%. Previous coronary artery bypass grafting, chronic kidney disease, and 6 lesion/anatomic characteristics (i.e., blunt stump, distal runoff <1 mm, CTO lesion tortuosity, reattempt procedures, ostial location, and the presence of collateral channel grade 2) were associated with PRA (p <0.05). Moreover, hemodialysis was an independent factor of unsuccessful anterograde guidewire crossing, along with distal runoff <1 mm, the existence of calcification, and CTO lesion tortuosity (all p <0.05). In clinical settings, these independent factors for PRA in short-length CTO can help in selecting the CTO-PCI strategy.

Predictors of Crossing Failure in Femoropopliteal Lesions: The Importance of Length of the Lesion and Calcification

IntroductionEndovascular therapy is nowadays the first choice for most patients with peripheral artery disease. The most important cause of technical failure is failure to cross the lesion with a wire. In this retrospective study we explore possible risk factors of crossing failure. PatientsWe included all consecutive patients in whom the lesion could not be crossed in the period of the 1th January 2017 to 1th January 2022. The lesions of these patients were compared with patients in whom the lesion could be crossed (2:1). The following potential anatomical risk factors were compared: location of the lesion, occlusion length, lesion length, Peripheral Arterial Calcium Scoring Scale, Peripheral Academic Research Consortium, circumferential characterization classification and the TASC II classification. ResultsIn 71 patients the lesion could not be crossed, these patients were compared with 142 patients. There were significantly more patients with hypertension and hyperlipidemia in the group with crossing failure. The following factors were risk factors for crossing failure: occlusion length, lesion length, Peripheral Arterial Calcium Scoring Scale, Peripheral Academic Research Consortium and circumferential characterization classification. Discussions and conclusionAlthough conclusions should be carefully drawn from this retrospective study, calcification and length of the lesion are associated with crossing failure in the femoropopliteal segment. The Trans-Atlantic Inter-Society Consensus (TASC) II classification was the best predictor of crossing failure.

Effects and safety of endovascular recanalization for non-acute symptomatic intracranial vertebral artery occlusion with different risks.

There is no consensus on the optimal treatment for non-acute symptomatic intracranial vertebral artery occlusion, and endovascular recanalization is a challenging procedure. We report our clinical experience of endovascular recanalization in patients with non-acute symptomatic intracranial vertebral artery occlusion to assess the feasibility and safety of endovascular recanalization and determine the candidate patients for this procedure. Ninety-two patients with non-acute symptomatic intracranial vertebral artery occlusion who underwent endovascular recanalization from January 2019 to December 2021 were retrospectively analyzed. we grouped all patients according to imaging examination findings, occlusion length, duration, nature, calcification, and angulation to evaluate the risk of endovascular recanalization. The overall success rate of endovascular recanalization was 83.7% (77/92), and the perioperative complication rate was 10.9% (10/92). Among the 3 classification groups, the recanalization success rate gradually decreased from the low-risk group to the high-risk group (low-risk: 100%, medium-risk: 93.3%, high-risk group: 27.8%, P = .047), while the overall perioperative complication rate showed the opposite trend (0%, 10.0%, 38.9%, respectively, P = .001); the proportion of patients with 90-day modified Rankin Scale scores of 0-2 decreased successively (100%, 83.3%, and 22.2%, respectively, P < .026); 77 patients with successful recanalization were followed; the rate of restenosis/reocclusion increased sequentially (0%, 17.9%, and 80%, respectively, P = .000). Patients in the low- and medium-risk groups showed a good clinical course after endovascular recanalization. Among 88 patients (four patients lost to follow-up), with a median clinical follow-up of 13 months (interquartile range ¼, 7-16), the rate of stroke or death after 30 days was 17.4% (16/92). Endovascular recanalization is safe and feasible for low- and medium-risk patients with non-acute symptomatic intracranial vertebral artery occlusion; it is also an alternative to conservative therapy for the patients.

Usage of rotational atherectomy and drug-coated balloon angioplasty for isolated popliteal artery lesions: two-year results of a retrospective study

Objectives In this study, perioperative properties and early and mid-term clinical outcomes of endovascular revascularization with a combined usage of rotational atherectomy (RA) and drug-coated balloon angioplasty (DCB) angioplasty for isolated popliteal artery lesion were reported. Methods A total of 28 patients with isolated popliteal artery stenosis who underwent combined RA and DCB angioplasty between December 2018 and September 2022 were analyzed retrospectively. Temren atherectomy system (Invamed, Ankara, Turkey) and Extender paclitaxel-coated drug-coated balloon catheter (Invamed, Ankara, Turkey) were used in all cases. The main outcome was primary patency; secondary outcomes were technical success, freedom from amputation, and mortality. Results The mean age of patients was 64.2 ± 9.1 years and the majority of the patients were male (n = 20; 71.4%). Types of the lesions were total occlusion in 24 limbs and critical stenosis in 4 limbs. The mean total occlusion length was 65.2 ± 14.2 mm. Flow-limiting dissection was seen in lesions of 2 patients (7.1%) and treated with prolonged balloon dilatation without bail-out stenting requirement. Technical success defined as an adequate vascular lumen (less than 30% stenosis) was achieved in 26 (92.8%) with a mean follow-up of 17.2 ± 8.2 months. The mean primary patency rates at 12 months and 24 months were 92.3% ± 3.2 and 81.2% ± 3.2, respectively. Complications included 1 distal embolization following RA, 2 flow-limiting dissections, and 3 puncture site hematomas. Conclusions Endovascular procedures using combined RA and DCB angioplasty seem to be effective alternative treatment modalities for the treatment of popliteal artery lesions with high rates of primary patency and freedom from TLR.