Lower Restenosis Rate Research Articles

Revitalizing Traditional Methods in Carotid Endarterectomy: A Comprehensive Review of Primary Closure Techniques

Objective: Carotid endarterectomy (CEA) remains essential in treating carotid artery disease, but recent interest has emerged in primary closure techniques. This study investigates the outcomes, efficacy, and safety of primary closure compared to conventional methods. Methods: A retrospective analysis of 130 patients who underwent CEA with primary closure at our clinic between January 2018 and April 2024 was conducted. All surgeries followed a standardized procedure under general anesthesia. Data on demographics, surgical time, cross-clamp time, mortality, morbidity, and hospital stay were collected. Follow-up evaluations were done at 1, 6, and 12 months post-surgery. Results: The study included 130 patients, 90 males (69%) and 40 females (31%), with an average age of 69.54±5.42 years. Restenosis occurred in five patients (3%) at 12 months, all asymptomatic. Three patients experienced transient ischemic attacks (TIA) postoperatively, which fully resolved within one month. Importantly, no early mortalities were recorded during the one-month follow-up period. Conclusion: Primary closure in CEA demonstrates promising outcomes, with low rates of restenosis and postoperative complications, along with no early mortality. These findings highlight primary closure as a potentially advantageous approach in CEA. Further research and prospective trials are necessary to validate and optimize this technique, ultimately improving patient outcomes in carotid artery disease management.

Midterm results of endovascular treatment of ateriovenous fistula stenosis at Dong Nai General Hospital

Introduction: AVF stenosis is a common complication, leading to impaired dialysis function, increased risk of occlusion and increased mortality. Endovascular intervention treatment of AVF stenosis is an important technique in the management of dialysis patients, particularly at local hospitals. Methods: This is a retrospective study performed at Dong Nai general hospital from 2022-2024. Results: The success rate of endovascular intervention to treat AVF stenosis at Dong Nai General Hospital is 91%, 3-month primary patency was 93.1% and 6-month primary patency was 86.2%. Drug-coated balloons (DCB) shows superior effectiveness compared to conventional balloons (PBA) with a lower restenosis rate. Conclusion: Endovascular intervention to treat AVF stenosis at Dong Nai General Hospital has good short term and midterm results. Drug-eluting balloons have a statistically significantly lower mid-term restenosis rate than conventional balloons. Implementing this technique at provincial hospitals helps reduce the burden on central hospitals and reduce medical costs for chronic kidney failure patients requiring hemodialysis.

Cerebrovascular implications of takayasu arteritis: a review.

Takayasu arteritis (TA) is a rare, chronic, inflammatory large-vessel vasculitis that affects the aorta and its main branches, including the cerebrovascular system. This review analyzes current knowledge and patient outcomes concerning the cerebrovascular implications of TA. A literature search, with publications from 1994 to 2024, identified pertinent studies through PubMed. An illustrative case report details a 19-year-old female with Type 1 TA, illustrating the complex decision required in the absence of surgical or endovascular options. Our results offer a demographic analysis of 1,698 TA patients, highlighting a female predominance of 89.99% and a mean symptom onset at 33 years. The clinical spectrum of cerebrovascular involvement presented varied symptoms, most notably dizziness, with significant incidences of ischemic events and bilateral stenosis primarily affecting the carotid and subclavian arteries. The most common type of TA was Type V, affecting 40% of patients studied. Endovascular treatment had a 95% initial success rate, with a 67% restenosis rate. Surgical treatment was successful in 84% of cases, but 21% had notable post-operative complications. Similar to the endovascular population, those treated with stand-alone conservative therapy saw a 93% initial remission rate with 52% having relapsed. Assessing the disease activity of TA is crucial when planning vascular intervention due to its significant impact on treatment outcomes. Despite its greater initial invasiveness, surgical interventions showed lower restenosis rates compared to either endovascular interventions or standalone conservative management. We emphasize advancements in TA management and the pressing need for continued research into diagnostic and treatment protocols for improved patient outcomes.

A Modified Epiglottis-Tongue Root Flap for Postoperative Laryngeal Stenosis in a Cancer Patient with a History of Radiotherapy

Introduction: Cricohyoidoepiglottopexy (CHEP) has emerged as a promising surgical technique for treating laryngeal stenosis, offering a low rate of restenosis and a high rate of successful decannulation. However, postoperative radiation therapy can complicate open surgery for some patients due to radiation-induced cellular and tissue damage. This damage can make adequate exposure or mobilization of the larynx challenging. Case Summary: A 71-year-old male, who had undergone a partial laryngectomy 3 years prior, developed laryngeal stenosis and difficulty plugging after 35 rounds of radiotherapy. Initially, CHEP was planned, but intraoperatively, it was found that traditional CHEP would result in excessive anastomotic tension. To prevent complications, we designed an epiglottis-tongue root flap for laryngeal function reconstruction. The patient experienced no restenosis and was successfully extubated. Discussion: By separating the preepiglottal space and mobilizing the base of the tongue to construct the epiglottis-tongue root flap, modified CHEP can achieve laryngeal function reconstruction in patients postradiotherapy. It is essential to conduct a comprehensive evaluation of the patient’s overall condition, degree of stenosis, tongue-to-tongue root status, and cervical tissue adhesion before surgery.

Management of airway complications following lung transplantation: first interventional bronchoscopy report from Türkiye.

Lung transplantation is the treatment of last resort for many chronic lung diseases. Airway complications (AC) following lung transplantation, such as bronchial stenosis, dehiscence, malacia, and fistula, account for frequent hospital admissions, additional treatment costs, decreased quality of life, and reduced survival rates. Beyond surgical and medical preventive efforts, interventional bronchoscopy (IB) can be used in the management of these complications. The aim of the study is to evaluate the efficacy of IB on the management of AC following lung transplantation. A retrospective analysis was done using the data of lung transplant patients with AC referred to the interventional pulmonology unit between December 2012 and December 2019. From a total of 116 lung transplants, the data of 14/116 (12%) patients and 14/220 (6.3%) anastomoses in the same lung transplant group with AC requiring IB were analyzed. In these 14 patients, the diseases leading to lung transplantation were interstitial lung diseases (ILD) (50.0%), bronchiectasis (28.6%), pulmonary arterial hypertension (PAH) (7.1%), chronic obstructive pulmonary disease (COPD) (7.1%), and COPD + bronchiectasis (7.1%). Airway stenosis was the most common airway complication, and it developed mostly in the right bronchial system.The 14 patients underwent 27 total sessions of IB with an average of 2-3 per patient. Airway patency was successfully achieved in 74.1% of the procedures. Mechanical dilatation with a balloon and/or a rigid tube was the most preferred procedure (81.5%). Permanent airway patency was achieved in eight (57.4%) patients. No early complications were encountered (0%). The late complication rate was 48.1%. The most frequent late complication was restenosis, which cannot be directly attributed to IB. IB is safe to perform on lung transplant patients with AC. It has low procedural complication rates and can be performed repeatedly. Because of the high rate of restenosis, interventional pulmonologists should find out treatment modalities with lower rates of restenosis.

Carotid endarterectomy has lower stroke risk than carotid artery stenting for patients with asymptomatic carotid stenosis and chronic kidney disease

BackgroundPatients with chronic kidney disease (CKD) typically have systemic arterial calcification and can develop circumferential arteriosclerosis. In carotid stenosis, this circumferential calcification may render carotid artery stenting (CAS) unfavorable due to increased risk of incomplete stent expansion. This study aimed to investigate whether carotid endarterectomy (CEA) or CAS is the preferred treatment option for patients with CKD. MethodsPatients with CKD (eGFR<60 mL/min/1.73m2) who underwent CEA and CAS were identified in ACS-NSQIP targeted database from 2011-2021. Emergent cases were excluded. Symptomatic and asymptomatic patients were examined separately. Thirty-day outcomes included mortality, stroke, cardiac events, renal dysfunction, and re-stenosis were examined by multivariable logistic regression. Restenosis was likely due to incomplete stent expansion in CAS and residual plaque in CEA. ResultsIn symptomatic patients, there were 4,522 CEA and 301 CAS cases. In asymptomatic patients, there were 7,198 CEA and 411 CAS cases identified. In both symptomatic and asymptomatic patients, there was no difference in mortality or cardiac events between CEA and CAS. In symptomatic patients, CEA has lower renal complication (0.62% vs 2.33%, aOR=0.539, p=0.03) than CAS but there was no difference in stroke or restenosis. On the other hand, in asymptomatic patients, CEA was associated with lower stroke (1.38% vs 4.38%, aOR=0.372, p<.01) and re-stenosis (0.25% vs 1.95%, aOR=0.167, p<.01). ConclusionCEA should be preferred for managing symptomatic patients with CKD, as it is associated with 1.9 times lower renal complications compared to CAS. For asymptomatic patients with CKD, given that CEA has 2.7 times lower 30-day stroke rate and 6 times lower restenosis rate, CEA should also be the preferred approach for management.

A Meta Analysis of Endoscopic Surgical Management of Choanal Atresia with and without Stent

Abstract Background Congenital choanal atresia is a rare abnormality, affecting approximately 1 in 7000–8000 newborns, with a female predominance. In congenital choanal atresia, the widened vomer fuses with the atretic plate, resulting in an hourglass configuration of the nasopharynx and the choanal region. Materials and Methods This meta analysis included 17 studies all were published between 2016 and 2021. Two different techniques, endoscopic management with and without stents, this study demonstrated success with no stent approach and lower rate of re stenosis when compared to stent used approach, however there are some indications and benefits of using stents. Results For our knowledge this is the second systematic review and metaanalysis to report the pooled success of endoscopic repair of choanal atresia with and without the use of nasal stents. Analysis of 5 studies that included 142 patients who were not stented demonstrated that the weighted pooled proportion of successful surgery was higher and significantly different when compared with three studies that evaluated 57 patients who were stented 86% (79%, 92%) vs 61% (40%, 81%). From an analysis of nine comparative studies including 405 patients Overall odds ratio (95% CI) = 3.56 (2.10, 6.05) with unimportant heterogeneity across studies (I-squared = 37%, Cochrane Q p = 0.12) favoring no stenting over stenting. Conclusion Success rates for management without stents is higher than using stents. The use of nasal stents may be associated with more frequent and more severe complications. Perioperative adjuncts such as nasal stenting should be considered in the context of the individual patient and surgeon preference. If the surgeon decides to stent, a duration of 1 week or shorter may be associated with better surgical outcomes; however, the evidence is limited.

Primary versus patch closure after carotid endarterectomy: A retrospective study

&lt;b&gt;Purpose: &lt;/b&gt;The present study aimed to provide our experience with patch closure (PAC) and primary closure (PRC) after carotid endarterectomy (CEA).&lt;br /&gt; &lt;b&gt;Materials &amp;amp; methods: &lt;/b&gt;The present retrospective comparative study included 106 patients submitted to elective CEA. They comprised 50 patients in PRC group and 56 patients in PAC group. Patients were followed perioperatively, at three months and at one year for surgical complications, stroke, and restenosis.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;Postoperatively, no significant differences were found between the studied groups regarding rates of stroke (6.0% versus 3.6%, p=0.740), infection (0.0% versus 3.6%, p=0.520), hematoma (2.0% versus 1.8%, p=0.940), pseudoaneurysm (0.0% versus 3.6%, p=0.520), cranial nerve injury (2.0% versus 1.8%, p=0.940), and cardiac events (2.0% versus 1.8%, p=0.940). At three months, three patients in PRC group and four in PAC group were lost to follow up. No significant differences were found between the studied groups regarding rate of restenosis at three months (2.1% versus 0.0%, p=0.960). At one year, patients in PRC group experienced significantly higher rate of restenosis (14.9% versus 1.9%, p=0.046). None of the studied patients died.&lt;br /&gt; &lt;b&gt;Conclusions: &lt;/b&gt;CEA combined with patch angioplasty may be associated with lower restenosis rate.

Predictors of late lumen enlargement after drug-coated balloon angioplasty for de novo coronary lesions.

Late lumen enlargement (LLE) - a positive remodelling phenomenon - after drug-coated balloon (DCB) angioplasty for stable coronary disease contributes to a lower restenosis rate. However, lesion characteristics promoting LLE remain unclear. This study aimed to investigate predictive lesion characteristics for LLE using serial optical frequency domain imaging (OFDI) following DCB angioplasty for de novo coronary artery lesions. This retrospective, single-centre observational study included patients with angina pectoris who underwent paclitaxel-coated balloon angioplasty without stenting under OFDI guidance as well as follow-up OFDI. OFDI endpoints were lumen volume, plaque phenotype, and procedure-associated dissection. LLE was defined as a ≥10% increase in the lumen volume of the treated lesion at follow-up. Between August 2016 and December 2019, among patients with successful DCB angioplasty, 108 lesions (83 patients) had available follow-up imaging after a median of 6.1 months. LLE was detected in 44 (40.7%) lesions. Fibrous/fibrocalcific and layered plaques had significantly larger lumen volumes at follow-up than immediately after the index procedure, whereas lipid plaques exhibited no significant difference. Medial dissection with an arc >90° revealed an increased lumen volume. Multivariate analysis showed that layered plaques (odds ratio [OR] 8.73, 95% confidence interval [CI]: 1.92-39.7; p=0.005) and medial dissection with an arc >90° (OR 4.65, 95% CI: 1.63-13.3; p=0.004) were independent LLE predictors. Layered plaques and extensive medial dissection after DCB angioplasty were associated with higher LLE occurrence in de novo coronary lesions. These findings may be clinically applicable to DCB therapeutic strategies based on plaque features.

Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis

BackgroundAcute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion (“tandem lesion”, TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventing restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the safety and 90-day outcome of patients receiving TL treatment under triple-APT, focused on stent-patency and possible disadvantageous comorbidities.MethodsPatients receiving TL treatment in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All patients received intravenous eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Duplex imaging was performed 24 h after treatment, at discharge and 90 days, and digital subtraction angiography was performed if restenosis was suspected.Results176 patients were included. Periprocedural complications occurred in 2.3% of the patients at no periprocedural death, and in-hospital death in 13.6%. Discharge mRS score was maintained or improved at the 90-day follow-up in 86%, 4.54% had an in-stent restenosis requiring treatment at 90 days. No recorded comorbidity considered disadvantageous for stent patency showed statistical significance, the duration of the endovascular procedure had no significant effect on outcome.ConclusionIn our data, TL treatment with triple APT resulted in a low restenosis rate, low rates of sICH and a comparably high number of patients with favorable outcome. Aggressive APT in the initial phase may therefore have the potential to prevent recurrent stroke better than restrained platelet inhibition. Comorbidities did not influence stent patency.

Self-expanding versus balloon expandable stent for intracranial arterial stenosis: A systematic review and meta-analysis.

There are limited data regarding the comparison of balloon expandable stents (BES) and self-expanding stents (SES) for the treatment of intracranial arterial stenosis. We conducted a systematic review to identify studies that compared SES and BES in patients with symptomaticintracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until from January 1, 2010 to September 28, 2023. Statistical pooling with random-effects meta-analysis was undertaken to compare the rates/severity ofpostprocedure stenosis, technical success, 30-day stroke and/or death, cumulative clinical endpoints, and restenosis rates. A total of 20 studies were included.The standardized mean difference (SMD) for postprocedure stenosis (%) was significantly lower (SMD: -0.52, 95% confidence interval [CI]: -0.79 to -0.24, p < .001, 10 studies involving 1515 patients) with BES. The odds for 30-day stroke and/or death were significantly lower (odds ratio [OR] 0.68, 95% CI: 0.50-0.94, p = .019, 15 studies involving 2431 patients), and cumulative clinical endpoints on follow-up were nonsignificantly lower (OR 0.64, 95% CI: 0.30-1.37, p = .250, 10 studies involving 947 patients) with BES. The odds for restenosis during follow-up were significantly lower (OR 0.50, 95% CI: 0.31-0.80, p = .004, 13 studies involving 1115 patients) with BES. Compared with SES, BES were associated with lower rates of postprocedure 30-day stroke and/or death with lower rates of restenosis during follow up andthe treatment of symptomatic intracranial arterial stenosis.

Accessory hepatic vein recanalization for Budd-Chiari syndrome: a systematic review and meta-analysis

BackgroundBudd-Chiari syndrome (BCS) results when the outflow of the hepatic vein (HV) is obstructed. BCS patients exhibiting an accessory HV (AHV) that is dilated but obstructed can achieve significant alleviation of liver congestion after undergoing AHV recanalization. This meta-analysis was developed to explore the clinical efficacy of AHV recanalization in patients with BCS.Materials and methodsPubMed, Embase, and Wanfang databases were searched for relevant studies published as of November 2022, and RevMan 5.3 and Stata 12.0 were used for pooled endpoint analyses.ResultsTwelve total studies were identified for analysis. Pooled primary clinical success, re-stenosis, 1- and 5-year primary patency, 1- and 5-year secondary patency, 1-year overall survival (OS), and 5-year OS rates of patients in these studies following AHV recanalization were 96%, 17%, 91%, 75%, 98%, 91%, 97%, and 96%, respectively. Patients also exhibited a significant reduction in AHV pressure after recanalization relative to preoperative levels (P < 0.00001). Endpoints exhibiting significant heterogeneity among these studies included, AHV pressure (I2 = 95%), 1-year primary patency (I2 = 51.2%), and 5-year primary patency (I2 = 62.4%). Relative to HV recanalization, AHV recanalization was related to a lower rate of re-stenosis (P = 0.002) and longer primary patency (P < 0.00001), but was not associated with any improvements in clinical success (P = 0.88) or OS (P = 0.29) relative to HV recanalization.ConclusionsThe present meta-analysis highlights AHV recanalization as an effective means of achieving positive long-term outcomes in patients affected by BCS, potentially achieving better long-term results than those associated with HV recanalization.

Safety and efficacy of enterprise stenting for symptomatic atherosclerotic severe posterior circulation stenosis

PurposeTo investigate the safety and efficacy of Enterprise stent angioplasty and risk factors for the prognoses in treating symptomatic severe posterior circulation atherosclerotic stenosis (SSPCAS).Materials and methodsPatients with SSPCAS who were treated with the Enterprise stent angioplasty were retrospectively enrolled. The clinical data, peri-procedural complications, postoperative residual stenosis, in-stent restenosis and recurrent stroke at follow-up were analyzed.Results262 patients with 275 stenotic lesions treated with the Enterprise stent angioplasty were enrolled. The stenosis degree was reduced from 86.3 ± 6.2% before to 19.3 ± 5.4% after stenting. Complications occurred in 14 (5.3%) patients. Clinical follow-up was performed in 245 (93.51%) patients for 16.5 ± 7.3 months. During 1 year follow-up, 7 patients (2.9%) had recurrent symptoms, including 4 patients with stenting in the intracranial vertebral artery and 3 in the basilar artery. Imaging follow-up was conducted in 223 (85.11%) patients. In-stent restenosis was present in 35 patients (15.7%), with the restenosis rate of 26.4% (n = 23) in the intracranial vertebral artery, which was significantly (P < 0.001) greater than in the basilar artery (8.8%). Six patients (17.1%) with in-stent restenosis were symptomatic. The stenotic length was the only significant (P = 0.026 and 0.024, respectively) independent risk factor for 1 year stroke or death events and in-stent restenosis.ConclusionThe Enterprise stent can be safely and efficaciously applied in the treatment of symptomatic severe posterior circulation atherosclerotic stenosis, with a relatively low rate of in-stent restenosis and recurrent stroke within 1 year. The stenotic length was the only significant independent risk factor for 1 year stroke or death events and in-stent restenosis.

Safe and effective profile of the VSTENT bioresorbable polymer sirolimus-eluting stent in the treatment of patients with de novo coronary artery lesions: a prospective, cohort, multicenter study.

The drug-eluting stent was a significant stride forward in the development of enhanced therapeutic therapy for coronary intervention, with three generations of increased advancement. VSTENT is a newly developed stent manufactured in Vietnam that aims to provide coronary artery patients with a safe, effective, and cost-efficient option. The purpose of this trial was to determine the efficacy and safety of a new bioresorbable polymer sirolimus-eluting stent called VSTENT. This is a prospective, cohort, multicenter research in 5 centers of Vietnam. A prespecified subgroup received intravascular ultrasound (IVUS) or optical coherence tomography (OCT) imaging. We determined procedure success and complications during index hospitalization. We monitored all participants for a year. Six-month and 12-month rates of major cardiovascular events were reported. All patients had coronary angiography after 6 months to detect late lumen loss (LLL). Prespecified patients also had IVUS or OCT performed. The rate of device success was 100% (95% CI: 98.3-100%; P<0.001). Major cardiovascular events were 4.7% (95% CI: 1.9-9.4%; P<0.001). The LLL over quantitative coronary angiography (QCA) was 0.08±0.19 mm (95% CI: 0.05-0.10; P<0.001) in the in-stent segment and 0.07±0.31 mm (95% CI: 0.03-0.11; P=0.002) in 5 mm within the two ends of the stent segment. The LLL recorded by IVUS and OCT at 6 months was 0.12±0.35 mm (95% CI: 0.01-0.22; P=0.028) and 0.15±0.24 mm (95% CI: 0.02-0.28; P=0.024), respectively. This study's device success rates were perfect. IVUS and OCT findings on LLL were favorable at 6-month follow-up. One-year follow-up showed low in-stent restenosis (ISR) and target lesion revascularization (TLR) rates, reflecting few significant cardiovascular events. VSTENT's safety and efficacy make it a promising percutaneous intervention option in developing nations.

Long-term follow-up after simultaneous arterial switch operation and aortic arch repair.

Taussig-Bing anomaly (TBA) and transposition of the great arteries (TGA) with hypoplastic or interrupted aortic arch (AA) are rare anomalies. Various operative techniques and a high incidence of reinterventions are described. The aim of this retrospective single-centre study was to evaluate operative data, mortality and reintervention rate with special regard to the AA. At the Children's Heart Center Linz, 50 patients with the above-mentioned diagnosis have been corrected by a simultaneous repair between 2001 and 2022. Thirty-seven children had TBA, 13 had TGA and 5 of them had an interrupted AA. The median age at operation was 7 [interquartile range (IQR) 5-9] days, weight 3.38 (IQR 2.9-3.8) kg and follow-up 9.3 (IQR 3.1-14.5) years. The AA reconstruction was performed without patch material in 49 cases. There was 1 in-hospital mortality in a TBA patient and 1 late mortality (7 years later, neuroblastoma). 14/49 patients needed at least 1 reoperation (28.6%, all TBA) and 3 further patients had catheter reintervention or radiofrequency ablation only (6.1%, 2 TBA). Seventy-five percent of these procedures affected the right heart/pulmonary arteries; there was 1 re-coarctation repair. The simultaneous correction of TBA and TGA with AA obstruction or interruption is a safe operation with very low mortality. The AA reconstruction with minimized use of patch material resulted in a low restenosis rate.

High‐Nitrogen Nickel‐Free Stainless Steel: An Attractive Material with Potential for Biomedical Application

Metal materials such as stainless steel, cobalt‐based alloy, and NiTi alloy used in clinic contain a certain amount of nickel (Ni) for the structure stability. Nickel ions can gradually dissolve into the human body even with much slow corrosion rate, causing allergic, inflammation, local tissue proliferation, and other adverse reactions to some people. To avoid these adverse effects of nickel, a new high‐nitrogen nickel‐free stainless steel (HNNFSS) using nitrogen and manganese instead of nickel to stabilize the austenite structure is developed, which exhibits much better mechanical properties, good corrosion resistance, and biocompatibility. Compared with the conventional orthopedic metal implants, the adhesion strength of HNNFSS implant with the surrounding tissue in animal is found to be stronger with new bone formation, promoted by both alkaline phosphatase (ALP) and osteocalcin (OCN) expressions. The vascular stent made of HNNFSS shows lower restenosis rate compared with the traditional 316L stainless steel stent, which is attributed to the promotion of endothelial cell and inhibition of smooth muscle cells, and superior blood compatibility. In conclusion, results from large number of studies show that high‐nitrogen nickel‐free stainless steel as a new kind of high‐performance biomedical metallic material possesses great application potential.

Editor's Choice – Two Year Results of the Randomised DISCOVER Trial Comparing Covered Versus Bare Metal Stents in the Common Iliac Artery

It has been suggested that covered stents (CS) may lower restenosis rates compared with bare metal stents (BMS) after endovascular treatment of the common iliac artery. This trial aimed to provide additional evidence on the efficacy of CS vs. BMS in the common iliac artery. This multicentre, randomised, single blind controlled superiority trial compared balloon expandable CS and balloon expandable BMS for advanced atherosclerotic lesions in the common iliac artery; this was defined as a stenosis > 3 cm in length or occlusion. The primary end point was freedom from binary restenosis after two years of follow up. The study was conducted according to the principles of the Declaration of Helsinki (version: October 2008) and registered with the Dutch Trial register (NTR3381). One hundred and seventy-four limbs were included between 2012 and 2019 with 87 limbs in each group. Six patients crossed over from the BMS group to the CS group but were analysed according to an intention to treat principle. Freedom from binary restenosis after two years of follow up was 84.7% (95% CI 76.7 - 92.7%) in the BMS group and 89.1% (95% CI 82.4 - 95.8%) in the CS group (p= .40). Freedom from occlusion was 95.0% (95% CI 90.3 - 95.7%) in the BMS group and 96.4% (95% CI 92.5 - 100%) in the CS group (p= .66). Freedom from target lesion revascularisation was 91.1% (95% CI 84.8 - 97.3%) and 95.2% (95% CI 90.7 -99.7%), respectively (p= .31). Technical success, complications, haemodynamic success, and clinical success were also comparable between both groups. Per-protocol analysis did not affect the outcomes of the study. No difference was found between balloon expandable CS and BMS for treating advanced atherosclerotic lesions of the common iliac artery.

The Diagnostic Value of Circulating Biomarkers and Role of Drug-Coated Balloons for In-Stent Restenosis in Patients with Peripheral Arterial Disease.

Peripheral arterial disease (PAD) is an increasingly pathological condition that commonly affects the femoropopliteal arteries. The current fashionable treatment is percutaneous transluminal angioplasty (PTA), often with stenting. However, the in-stent restenosis (ISR) rate after the stenting of the femoropopliteal (FP) district remains high. Many techniques have been proposed for the treatment of femoropopliteal ISR, such as intravascular brachytherapy, laser atherectomy, second stenting and drug-coated balloons angioplasty (DCB). DCB showed a significantly lower rate of restenosis and target lesions revascularization (TLR) compared to conventional PTA. However, further studies and multi-center RCTs with dedicated long-term follow-up are needed to verify the true efficiency of this approach. Nowadays, the correlation between PAD and inflammation biomarkers is well known. Multiple studies have shown that proinflammatory markers (such as C-reactive proteins) and the high plasma levels of microRNA could predict the outcomes after stent placement. In particular, circulating microRNA-320a, microRNA-3937, microRNA-642a-3p and microRNA-572 appear to hold promise in diagnosing ISR in patients with PAD, but also as predictors of stent patency. This narrative review intends to summarize the current knowledge on the value of circulating biomarkers as predictors of ISR and to foster the scientific debate on the advantages of using DCB in the treatment of ISR in the FP district.

Drug-Coated Balloon Versus Drug-Eluting Stent in Patients With Femoropopliteal Artery Disease: A Systematic Review and Meta-Analysis.

In this systematic review and meta-analysis, we aimed to compare drug-coated balloon (DCB) to drug-eluting stent (DES) in patients with femoropopliteal lesions in terms of restenosis, target lesion revascularization (TLR), and mortality. A comprehensive literature search was performed through PubMed, Scopus, and Embase databases. The intervention group was patients receiving percutaneous balloon angioplasty using the DCB. The control group was patients receiving percutaneous intervention using the DES. The primary outcome was restenosis, and the secondary outcomes were TLR and mortality. There were 4 studies comprising 812 patients (906 lesions) included in this systematic review and meta-analysis. The rate of restenosis was .19 [.13, .26] in DCB and .24 [.20, .28] in DES. There was a trend toward lower rate of restenosis (OR .73 [.52, 1.03], P = .074; I2: 46.3%) for DCB use compared to DES use. The rate of TLR was .11 [.08, .14] in DCB and .17 [.14, .21] in DES. TLR was lower (OR .61 [.41, .92], P = .017; I2: 1.2%) in the DCB group compared to the DES group. There were no significant differences in mortality (OR 1.38 [.78, 2.44], P = .268; I2: 0%) among the two groups. Meta-regression analysis showed that the rate of restenosis in DCB in this pooled analysis was affected by sex (reference: male, coefficient -.004, P = .009), smoking (coefficient: .003, P = .010), and total occlusion (coefficient: .008, P = .004). DCB use in patients with femoropopliteal lesion was associated with similar rate of restenosis, lower TLR, and similar mortality rate compared to DES use.

Abstract TMP62: Carotid Web Stenting Is Comparable To Atherosclerotic Stenting With Lower Procedural Risk

Introduction: Carotid Web (CaW) is an underrecognized etiology for ischemic stroke. This entity has been shown to be amenable to endovascular stenting, similar to carotid atherosclerotic stenosis (CAS). We aimed to assess procedural characteristics of stenting for CaW as compared to CAS. Methods: We retrospectively analyzed a cohort of patients at a single comprehensive stroke center from October 2014 to March 2021 who had undergone endovascular stent placement for symptomatic CAS or CaW. Patients who received other intervention (e.g. thrombectomy, aneurysm repair) on the same day as stent placement were excluded. Baseline patient characteristics, procedural data, periprocedural complications, and follow-up statistics were analyzed. Results: In total, 105 patients underwent stent placement status post ischemic stroke or transient ischemic attack; 79 patients had CAS and 26 patients had CaW. Patients with CAS were older on average (CAS 63 vs CAS 53.5 years, p &amp;lt; 0.001 ) and less likely to be female (OR 0.116; 95% CI 0.041 to 0.326, p &amp;lt;0.001). CAS patients were more likely to have vascular risk factors such as hypertension, hyperlipidemia, and Diabetes ( Table ). Radiation, need for angioplasty, and filter time were significantly lower in CaW procedures. No significant difference was found between the two pathologies in periprocedural complications such as hypotension, need for vasopressors, or bradycardia. However, post-procedural restenosis only occurred in CAS stents. Conclusion: Stenting for CaW is comparable to stenting for CAS in terms of vasovagal side effects, but associated with lower filter times, lower radiation dose, lower need for angioplasty, and lower rates of restenosis.