Percutaneous Transluminal Angioplasty For Stenosis Research Articles

Improvement of Cerebrovascular Reserve by Percutaneous Transluminal Angioplasty for Symptomatic Middle Cerebral Artery Stenosis.

The purpose of this study was to investigate the efficacy of percutaneous transluminal angioplasty (PTA) for symptomatic middle cerebral artery stenosis by analyzing cerebral blood flow (CBF). Between January 2016 and December 2018, six patients with symptomatic middle cerebral artery stenosis underwent CBF analysis by single-photon emission computed tomography (SPECT) with acetazolamide challenge before and after PTA for stenosis. They were retrospectively reviewed, and the blood flow in the area of the affected middle cerebral artery before and after angioplasty was compared. The mean stenosis rate and length of lesion before angioplasty were 76.4 ± 5.4% and 6.5 ± 2.1 mm, respectively. Balloon angioplasty without stenting was performed on all patients. The mean residual stenosis rate just after angioplasty was 45.4 ± 9.3%. No periprocedual complications developed, and there were no notable cerebral ischemic events during the postprocedural follow-up period. One patient underwent repeat angioplasty for restenosis. Although there was only a mild decrease in blood flow at rest, the cerebrovascular reserve (CVR) in the area of the affected middle cerebral artery was markedly decreased before angioplasty (mean, 3.6 ± 4.3%). After angioplasty, the CVR was significantly improved (mean, 18.0 ± 4.7%, p <0.01). PTA for symptomatic middle cerebral artery stenosis can be safely performed using appropriate interventional techniques for select patients. Reduced CVR due to stenosis can be improved after angioplasty, which may reduce the risk of cerebral ischemic events.

Effectiveness and Influencing Factors of Percutaneous Transluminal Angioplasty for Stenosis of Transposed Brachiobasilic Arteriovenous Fistula

Effectiveness and Influencing Factors of Percutaneous Transluminal Angioplasty for Stenosis of Transposed Brachiobasilic Arteriovenous Fistula

Secondary interventions in patients with autologous arteriovenous fistulas strongly improve patency rates

Nowadays, as a result of more liberal selection criteria, dialysis-dependent patients have become substantially older, more likely to be female and diabetic, and have more comorbidity. The 1-year primary patency rates of arteriovenous fistulas (AVFs) are poor. To improve these results, several secondary interventions can be performed. The aim of this study was to evaluate the results after secondary interventions in patients with an upper extremity AVF. Between January 2000 and December 2008, all consecutive patients who underwent construction of an autologous upper extremity AVF were included. Patient characteristics were collected retrospectively from digital patient files and a prospectively recorded database on hemodialysis patients. Between January 2000 and December 2008, 736 hemodialysis access procedures were performed. A total of 347 autologous arteriovenous fistulas (AVFs) were created in 294 patients. The mean age was 62.1 ± 14.7 years, and the majority (66%) of the patients was male. Mean follow-up of all 347 fistulas was 21.9 ± 21.6 months. During follow-up, failure occurred in 209 (60%) of the AVFs. A total of 133 of these failures were followed by a secondary intervention, of which 78 (59%) were endovascular interventions. Twenty-nine patients developed a third failure, and 25 of these patients underwent another intervention, of which 22 were percutaneous transluminal angioplasty for stenosis. Fifteen patients developed a fourth failure, and all of them underwent an intervention. One patient had 11 interventions. The 1- and 2-year primary patency rates were 46% and 36.8%, respectively. The 1- and 2-year primary assisted patency rates were 74.6% and 71.2%, respectively. The 1- and 2-year secondary patency rates were 79.2% and 77.8%, respectively. The primary patency rate of AVFs is disappointing. However, due to mostly endovascular secondary interventions, 2-year primary assisted and secondary patency rates of more than 70% can be obtained.

Percutaneous Transluminal Angioplasty for Stenosis of the Posterior Cerebral Artery in Progressive Stroke -Case Report-

A 59-year-old male presented with repeated transient hemianopsia and hemiparesis on the left. Emergency magnetic resonance angiography showed stenosis of the right posterior cerebral artery (PCA). Endovascular recanalization with percutaneous transluminal angioplasty was performed immediately after the diagnosis. Patency of the PCA was successfully restored. The patient was discharged without neurological deficits. Progressive stroke in the PCA territory is rare. However, emergency endovascular recanalization is possible after prompt clinical diagnosis based on repeated diffusion-weighted magnetic resonance imaging and angiography after a 24-hour interval.

Percutaneous Transluminal Angioplasty of Stenosis at the Common Iliac Artery Origin Using a Single Balloon Technique

Percutaneous transluminal angioplasty (PTA), with or without stent placement, is an established technique for treating stenoses of the iliac arteries. The method of choice for PTA of lesions near or involving the common iliac artery origin has been a double-balloon technique; otherwise known as the ‘kissing balloon’ technique. It theoretically reduces the risk of contralateral common iliac compression or embolisation compared to a single balloon. We demonstrate a successful series of common iliac artery PTA using the single-balloon technique.

Stenting der Arteria femoralis aus angiologischer Sicht

ZusammenfassungDie perkutane transluminale Angioplastie ist eine gut etablierte, wirksame und sichere Behandlungsoption für Stenosen und kurzstreckige Verschlüsse im Bereich der Oberschenkelarterien. Die zusätzliche Einlage von Stents ist allerdings mit einer häufigen und relativ raschen Restenosierung durch Intimaproliferation vergesellschaftet. Aufgrund dieser Problematik ist die Stenteinlage besonderen Situationen vorbehalten, z. B. Auftreten einer PTA-induzierten Dissektion, elastisches Recoil, insbesondere bei exzentrischen Stenosen.Bei der Platzierung in Bewegungssegmenten im Bereich der Arteria femoralis communis oder der Arteria poplitea kann es zur Desintegration des Stents kommen. Eine Stenteinlage sollte deshalb vermieden werden. Die aktuelle zurückhaltende angiologische Beurteilung des Stentings in der Arteria femoralis könnte durch effektive Maßnahmen zur Eindämmung der intimalen Hyperplasie (z. B. Brachytherapie oder Sirolimusbeschichtete Stents) revidiert werden.

Percutaneous transluminal angioplasty for stenosis of the aorta due to aortic arteritis in children.

Percutaneous transluminal balloon angioplasty for stenosis of the aorta due to aortic arteritis was attempted on 45 lesions in 41 children (age range, 4-14 years; mean, 9.9+/-4.2 years) presenting with symptoms of hypertension, severe congestive heart failure, and lower limb claudication. Balloon dilatation was technically successful in 38 (92.7%) patients for 41 stenotic lesions (91.1%). The mean peak systolic pressure gradient (PSG) decreased from 71.7 +/- 23.9 mmHg to 23.2 +/- 17.5 mmHg (p < 0.001) and the diameter of the stenosed segment increased from 3.3 +/- 1.1 mm to 7.5 +/- 2.2 mm (p < 0.001) immediately after angioplasty. Patients with short-segment (<3 cm) stenosis had a lower residual gradient (17.9 +/- 11.1 mmHg vs 30.5 +/- 22.6 mmHg; p < 0.05) and a wider diameter of the aorta (8.8 +/- 1.1 mm vs 7.5 +/- 2.2 mm; p < 0.02) compared to patients with long-segment (>/=3 cm) stenosis. Four patients required stent implantation; 2 for flow-limiting dissection, 1 for failure to reduce PSG by >50%, and 1 for recurrent restenosis. There was marked hemodynamic and angiographic improvement in these 4 patients. Hemodynamic and angiographic restudy in 21 of the 41 patients at mean follow-up period of 6.2 +/- 4.2 months (range, 3-24 months) showed restenosis in 4 (19%) patients. Restenosis was more common in patients with long-segment stenosis than those with short-segment stenosis (30% vs 9.1%). Late restudy in 8 patients, done at 3-7 years after first restudy, showed no recurrence of aortic narrowing. On clinical follow-up of 38 patients for a mean of 58.8 +/- 36.0 months (range, 8-146 months) there was marked improvement in symptoms. Hypertension was cured in 11 (29%), improved in 24 (63%), and persisted in 3 (8%). Six patients with associated severe renal artery stenosis showed further improvement in hypertension after successful renal angioplasty. Severe congestive heart failure improved in 21 (95.4%) of 22 patients. Mean left ventricular ejection fraction improved from 0.32 +/- 0.08 to 0. 48 +/- 0.10 (p < 0.001) at a mean follow-up of 28.7 +/- 8.4 months in these patients. Hemodynamic restudy in 10 of these patients showed improvements in left ventricular end-diastolic pressure from a mean 37 +/- 9 mmHg (range, 25-55 mmHg) to 16.4 +/- 6.2 mmHg (range, 6-25 mmHg) (p < 0.001). Lower limb claudication improved in all 4 patients. Our results suggest that percutaneous transluminal balloon angioplasty in children is safe and highly effective in relieving stenosis of the aorta due to aortic arteritis, with marked clinical improvement, and should be the treatment of choice particularly for discrete stenosis.