Percutaneous Transluminal Intervention Research Articles

Rapid intervention team strategy improves intervention quality for patients undergoing hemodialysis with arteriovenous shunt dysfunction or failure.

Vascular access dysfunction is a great burden for hemodialysis patients. Early intervention of a dysfunctional arteriovenous shunt is associated with higher technical success and may improve midterm patency. This trial aimed to estimate the feasibility of a new system, the "rapid intervention team" (RIT) strategy. We recruited hemodialysis patients who visited our hospital because of arteriovenous shunt dysfunction or failure to undergo an RIT strategy from September 1, 2019 to December 31, 2022. In addition, we included a control group comprising patients who underwent percutaneous intervention for arteriovenous shunt dysfunction or failure before this strategy was implemented from February 1, 2017 to December 31, 2022. Case number, time to intervention, all-cause mortality, cumulative survival rate, and number of patients who required temporary dialysis catheter insertion and recreation were compared between the two groups. The primary endpoints were double-lumen insertion, a composite outcome involving permanent catheter insertion, and the need for recreation. The secondary endpoint was all-cause mortality. We enrolled 1054 patients, including 544 (51.6%) and 510 (48.4%) in the RIT and control groups, respectively. Even with the coronavirus disease of 2019 (COVID-19) pandemic, the number of cases significantly increased after the implementation of the RIT strategy (from 216 in 2019 to 828 in 2022, p for trend <0.001). The RIT group had a shortened time to intervention ( p for trend <0.001). The implementation of the RIT strategy was significantly associated with a reduced risk of insertion of a temporary double-lumen catheter and recreation of vascular access (1% vs 6% and 1% vs 28%, respectively; both p < 0.01). The cumulative survival rate was not significantly different between the RIT and control groups ( p = 0.16). The implementation of the RIT strategy improves the quantity and quality of percutaneous transluminal intervention for arteriovenous shunt dysfunction or failure in patients undergoing hemodialysis.

Percutaneous transluminal interventions of transplant renal artery stenosis: A case series study

Introductionand importance: Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplant that can lead to graft loss, when it is diagnosed early and treated appropriately it may prevent kidney damage and related systemic squeals. Case presentationThis case-series represents our center experience in managing TRAS using percutaneous transluminal angioplasty [either balloon angioplasty (PTA) or stent placement (PTAS)] in 11 patients. Clinical discussionAll treated patients experienced immediate total recovery of renal function and normalization of arterial blood pressure without any drug or reducing the number of drugs used; no complications related to the intervention were reported. ConclusionPTA or PTAS of TRAS can be considered safe and effective when it diagnosed and treated early.

Meso-Rex bypass for the management of extrahepatic portal vein obstruction in adults (with video)

BackgroundExtrahepatic portal vein obstruction (EHPVO) results in severe portal hypertension (PHT) leading to severely compromised quality of life. Often, pharmacological and endoscopic management is unable to solve this problem. Restoring hepatic portal flow using meso-Rex bypass (MRB) may solve it. This procedure, uncommon in adult patients, is considered the treatment of choice for EHPVO in children. MethodsFrom 1997 to 2018, 8 male and 6 female adults, with a median age of 51 years (range 22–66) underwent MRB procedure for EHPVO at the University Hospitals Saint-Luc in Brussels, Belgium. Symptoms of PHT were life altering in all but one patient and consisted of repetitive gastro-intestinal bleedings, sepsis due to portal biliopathy, and/or severe abdominal discomfort. The surgical technique consisted in interposition of a free venous graft or of a prosthetic graft between the superior mesenteric vein and the Rex recess of the left portal vein. ResultsMedian operative time was 500 min (range 300–730). Median follow-up duration was 22 months (range 2–169). One patient died due to hemorrhagic shock following percutaneous transluminal intervention for early graft thrombosis. Major morbidity, defined as Clavien-Dindo score ≥ III, was 35.7% (5/14). Shunt patency at last follow-up was 64.3% (9/14): 85.7% (6/7) of pure venous grafts and only 42.9% (3/7) of prosthetic graft. Symptom relief was achieved in 85.7% (12/14) who became asymptomatic after MRB. ConclusionsAdult EHPVO represents a difficult clinical condition that leads to severely compromised quality of life and possible life-threatening complications. In such patients, MRB represents the only and last resort to restore physiological portal vein flow. Although successful in a majority of patients, this procedure is associated with major morbidity and mortality and should be done in tertiary centers experienced with vascular liver surgery to get the best results.

P5489Old ladies paradox: trends in the inpatient care of coronary heart disease 2005–2016 in Germany

Abstract Objectives Coronary heart disease (CHD) and subsequent illnesses are the most common cause of death in industrialized countries and they continue to lead the cause of death statistics. In Germany, 2015 from all registered deaths 7.1% (n=65,686) are due to chronic CHD and 5.3% (n=49,210) due to acute myocardial infarction (AMI), but the proportion has fallen: Compared to 2003, when 10.9% (n=92,637) of the deceased of CHD and 7.5% of AMI (n=64,229). It is established that there are sex-differences in prevalence and in the age of the persons concerned. E.g. 2015 AMI infarction is cause of death in 57% (n=27,835) men and 43% (n=21,375) women from 49% men (n=36,049) and 51% women (n=37,127) in 2003. Aim of the study was, whether these differences in prevalence and diagnostic and interventional measurements in the hospital sector have shifted in recent years with the various entities of the acute coronary disease. Methods G-DRG Report-Browser 2005–2016 of the German DRG-Institute (InEK) and Federal Statistical Office data were used. Analysis was carried out with Microsoft Excel and Access (version 2016). Results Inpatient cases of main diagnosis AMI increased from 2005 from 206,104 cases to 219,156 cases in 2016 (+6.3%). Share of male increased from 62.5% to 66.6%. The NSTEMI share increased from 39.7% in 2005 to 66.2% in 2016; a total 145.202 cases (+77.2% to 2005). The increase was smaller in older women: 60–70y: +33.7%; 70–80y: +44.5%; 80–90y: +61.9%The NSTEMI increase in men was slightly higher than in women; proportion of men 2005: 64.2%, 2016; 65.1%. The STEMIs number shrank from 104,082 in 2005 to 70,521 (−34.0%) in 2016. The relative reduction was very high in older women: 60–70y: −45.2%; 70–80y: −55.3%; 80–90y: −54.1%. Share of men 2005: 60.1%, 2015; 70.0%. In 2008: 220,595 diagnostic-only coronarographies were conducted from a total of 690,745 coronarography measurements. These numbers increased to 485.496 (+120.1%) and 869.002 (+25.8%) in 2016. Share of the male decreased from 73.0% in 2008 to 65.6% in 2015. The increase for all coronarographies was highest in older women: 50–60y: +60.7% 60–70y: +39.4%; 70–80y: +72.5%; 80–90y: +168,4% The total number of percutaneous transluminal vascular interventions (PCI) increased from 2008 with 488,542 to 661,693 in 2016 (+35.4%). The relative increase in PCI was high in older women: 60–70y: +18.6%; 70–80y: +42.7%; 80–90y: +126.1%; &gt;90y: +314.1% Conclusions The number of cases of ACS is declining since 2005. There is a significant shift from STEMI to NSTEMI events over the observation period. In all forms of the ACS, the proportion of men in is increasing. The rate of coronary diagnostic and coronary intervention in men is disproportionately high in relation to disease rate. Paradoxically the share of examinations older women without further action increases strongly, despite their share in the disease was small and is still decreasing.

A17915 Long-term outcomes of percutaneous transluminal angioplasty/stenting of renovascular hypertension due to fibromuscular dysplasia over a seventeen-year period

Objectives: To evaluate the long-term outcomes of percutaneous transluminal intervention in patients with renovascular hypertension (RVHT) due to fibromuscular dysplasia (FMD). Methods: A retrospective analysis of 80 patients with RVHT due to FMD who underwent transcatheter therapy between January 2001 and December 2016 was performed. Blood pressure (BP) measurement, number of BP medications, and hypertension defined by a systolic blood pressure (SBP) >140 or diastolic blood pressure (DBP) >90 were recorded. Renal function was defined by estimated glomerular filtration rate (eGFR). Restenosis was defined by stenosis >50% and was determined by renal artery duplex and/or angiography. Freedom from event (restenosis, renal failure, recurrent hypertension) was performed using life table analysis. Results: Ninety-three procedures were performed on 80 patients with RVHT due to FMD. Forty-one patients (51.1%) were man, with mean age of 26.3 years old. Technical success was 96.9 %, as defined by < 30 % residual stenosis, with stent placement required in 11 patients (13.7%). There were no procedural complications. In the short term (1 month), the majority (92.5%) had an immediate clinical benefit. In the long term (mean, 67.5 months), Seven-eight (97.5%) patients were alive at follow-up. Freedom from recurrent or worsening hypertension (>140 SBP and >90 DBP) was (93.2%, 85.5%, and 77.6%) and freedom from reduced renal function (eGFR < 30 mL/minute) was (100.0%, 95.5%, and 84.3%) at 1, 5, and 10 years, respectively. Primary and assisted primary patency was (95.7%, 81.1%, and 70.5%) and (100.0%, 94.6%, and 82.8%) at 1, 5, and 10 years, respectively. Conclusion: Renal angioplasty for RVHT due to FMD is technically successful, safe, and durable. Most patients have long-term clinical benefit out to 10 years.

放射線性腸狭窄バイパス術の既往のある患者のpress through package誤飲による小腸穿孔に対して経皮的ドレナージ術および経皮経瘻孔的に治療した1例

症例は71歳の女性で，1999年に子宮頸癌に対して広汎子宮全摘+リンパ節廓清を行い術後は放射線治療も行った．その後腸閉塞を繰り返し，2009年に小腸－横行結腸側々バイパス術を施行した．2014年に右鼠径部痛を主訴に当院受診しCT上，バイパス吻合部より肛門側の小腸内にpress through package（以下，PTPと略記）を確認し，その周囲に膿瘍を認めた．放射線性腸炎により外科的にPTP除去は困難で，PTPは回腸末端から50 cm以上あり大腸内視鏡下での摘出も困難と判断し，穿刺ドレナージを行いドレーンを留置した．瘻孔形成を待ち経瘻孔的に内視鏡を挿入すると，PTPを除去できた．瘻孔の自然閉鎖を期待したが，小腸－横行結腸バイパスの機能不全が判明した．小腸－横行結腸バイパスの肛門側の小腸を切断し，口側を閉鎖して完全バイパスとし，肛門側を粘液瘻とした．経過は良好で術後20日目に退院となった．

Comparison of very long-term clinical and angiographic outcomes of bare metal stent implants between patients with and without type 2 diabetes

BackgroundData on a large patient population regarding very long-term outcomes after bare metal stent (BMS) implantation in diabetic patients are lacking. The aim of this study was to evaluate the very long-term (8–17 years) clinical and 6-month angiographic outcomes of BMS implantations in patients with and without type 2 diabetes. Methods and resultsA total of 2391 patients (579 with and 1812 without diabetes) who received BMS implantations between November 1995 and May 2004 were enrolled from the Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions (CAPTAIN) registry into this study. During a mean follow-up period of 152±53months, the diabetic patients had higher rates of all-cause mortality (28% vs. 15%, p<0.001), re-infarction (6% vs. 5%, p=0.284), target lesion revascularization (13% vs. 10%, p=0.049), and a lower cardiovascular event-free survival rate (42% vs. 56%, p<0.001) compared to the patients without diabetes. The diabetic patients also had a higher restenosis rate (26% vs. 18%, p<0.001) at 6-month angiographic follow-up. The multivariate analysis of risk factors for cardiac event-free survival included age (hazard ratio [HR]: 1.011; p=0.001), hypertension (HR: 1.168; p=0.011), diabetes mellitus (HR: 1.353; p<0.001), pre-existing coronary artery disease (HR: 1.341; p<0.001), and left ventricular ejection fraction (LVEF) (HR: 0.992; p=0.002) (Table 7). The Kaplan–Meier analysis showed a significant difference in cardiovascular event-free survival rate between the two groups (p<0.001). ConclusionThe clinical and angiographic outcomes of diabetic patients with BMS implantations were worse than those of patients without diabetes after a very long-term follow-up period.

Predictors of Long-Term Outcomes After Drug-Eluting Balloon Angioplasty for Bare-Metal Stent Restenosis

Clinical trials have investigated efficacy of drug-eluting balloon (DEB) angioplasty for bare-metal stent (BMS) in-stent restenosis (ISR). Few studies have investigated predictors of long-term outcomes following BMS-ISR treatment with DEB. From June 2011 to April 2015, 105 patients with 125 BMS-ISR lesions were enrolled from the Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions (CAPTAIN) registry. All these lesions were treated with DEB angioplasty as final therapy. The major adverse cardiac events (MACEs) were recurrent clinically driven target lesion revascularisation (TLR), myocardial infarction, and cardiac death after DEB angioplasty. After DEB angioplasty, the angiographic stenosis decreased from 84.8%±12.4% to 22.6%±10.4%. Over a mean follow-up duration of 21.7±13.4months, the rates of TLR at 1-12 months and 12-48 months were 4.8% and 4.2%, respectively. The rates of MACEs at 1-12 months and 12-48 months were 6.7% and 6.1%, respectively. Chronic haemodialysis, calcified lesion, chronic total occlusion lesion before stenting, stent with metal-to-artery ratio >16.5%, and residual stenosis >25% after DEB angioplasty were potential risk factors for MACEs in univariate analysis. After adjustment in multivariate analysis, independent predictors of long-term MACEs were identified as chronic haemodialysis, chronic total occlusion lesion before stenting, and residual stenosis >25% after DEB angioplasty. The long-term results of DEB angioplasty for BMS-ISR are acceptable in this real-world registry. Patient (chronic haemodialysis), lesion (chronic total occlusion) and angioplasty (residual stenosis percentage) related factors predicted long-term outcomes following BMS-ISR treatment with DEB angioplasty.

Treatment Evaluation of Flow-Limiting Stenoses of the Superficial Femoral and Popliteal Artery by Parametric Color-Coding Analysis of Digital Subtraction Angiography Series.

To evaluate the hemodynamic effect of percutaneous transluminal intervention (PTI) on stenosis of the superficial femoral (SFA) and popliteal arteries (PA) using time-density curves (TDCs) derived from digital subtraction angiography (DSA) series in correlation with ultrasound peak systolic velocity ratio (PSVR) and ankle brachial index (ABI). DSA series of SFA or PA of patients with symptomatic peripheral arterial occlusive disease was obtained with a flat-panel angiography system with intention-to-treat. In DSA series acquired before and after PTI, TDCs were analyzed proximal and distal of each stenosis using parametric color coding (PCC). For correlation, ABI and PSVR measurements pre- and post-PTI were recorded for all patients. In total, 25 stenoses of the SFA or PA were treated by PTI in 22 patients (17 male, 5 female, mean age 68 years). After treatment, peak-to-peak (PTP) times between TDCs proximal and distal to the treated vessel segment decreased statistically significantly (p=0.01) on average from PTP=1.9±1.7s to mean PTP=1±1s. ABI and PSVR also changed statistically significantly after treatment (pretreatment ABI=0.7±0.2, PSVR=4.2±1.9; post-ABI=0.9±0.2, PSVR=1.3±0.4, both p<0.05). Correlation parameters did not show a strong correlation between change in TDC and clinical parameters ABI and PSVR. Using PCC for analyzing contrast medium dynamics in DSA series is clinically useful for evaluating stenoses of the SFA and PA and for immediate treatment control after PTA. Case series, IV.

Investigation on the safety and effect of percutaneous transluminal intervention in advance aged patients with angina recurrence after coronary artery bypass grafting

Objective To summarize the safety and clinical therapeutic effect of advanced aged coronary heart disease（CHD） patients with angina recurrence after coronary artery bypass grafting （CABG）.Methods The clinical data,arteriography and the interventional results of 9 aged patients with angina recurrence treated by CABG were retrospectively analyzed .Results There were 8 patients received intervention ,among them 5 patients received coronary artery intervention , another 3 patients received graft vessels intervention .During operation and hospitaliza-tion,angina recurrence,acute myocardial infarction,revascularization,complication and mortality were not observed in 8 patients who received intervention .All patients were followed up for 12 months,there were 3 patients had angina recurrence and cured by drugs , but had no acute myocardial infarction and revascularization .Conclusion The intervention for advanced aged patients after CABG is a safe and effective treatment .The advanced aged patients with angina recurrence need receive arteriography quickly and receive coronary artery interventional treatment or graft vessels interventional treatment . Key words: Coronary artery bypass,off-pump; Aged

Clinical and angiographic outcomes after intracoronary bare-metal stenting.

BackgroundData from a large patient population regarding very long-term outcomes after BMS implantation are inadequate. This study aimed to evaluate the very long-term (8–17 years) clinical and long-term (3–5 years) angiographic outcomes after intracoronary bare-metal stenting (BMS).Methods and ResultsFrom the Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions (CAPTAIN) registry, a total of 2391 patients with 2966 lesions treated with 3190 BMSs between November 1995 and May 2004 were evaluated. In total, 1898 patients with 2364 lesions, and 699 patients with 861 lesions underwent 6-month and 3- to 5- year angiographic follow-up, respectively. During a mean follow-up period of 149±51 months, 18.6% of the patients died (including 10.8% due to cardiac death), 6.1% developed reinfarction, 16.2% had target lesion revascularization (including 81% of the patients within the first year), 14.5% underwent new lesion stenting (including 72% of the patients after 3 years), 2.4% underwent coronary bypass surgery, and 1.6% had definite stent thrombosis. The overall cardiovascular event-free survival rate was 58.5%. The 6-month angiographic study indicated a 20% restenosis rate. The minimal luminal diameter increased from 0.65±0.44 mm to 3.02±0.46 mm immediately after stenting, decreased to 2.06±0.77 mm at the 6-month follow-up, and increased to 2.27±0.68 mm at the 3- to 5-year follow-up.ConclusionsThis study provides clinical and angiographic results from a large population of patients who underwent BMS implantations after a long-term follow-up period (149±51 months). The progression of coronary atherosclerosis developed over time, and presented with new lesion required stent implantation. The follow-up angiographic findings reconfirmed the late and sustained improvement in luminal diameter between 6 months and 3–5 years.

Acute and long‐term outcomes of drug‐eluting stent implantations in aorto‐ostial, left anterior descending artery‐ostial, and nonostial lesions

This study was designed to evaluate the acute and long-term clinical and angiographic outcomes of drug-eluting stent (DES) implantations in aorto-ostial, left anterior descending artery (LAD)-ostial and nonostial lesions. From the CAPTAIN (cardiovascular atherosclerosis and percutaneous transluminal interventions) registry, a total of 61 patients with 61 aorto-ostial, 173 patients with 173 LAD-ostial, and 1,954 patients with 2,391 nonostial lesions were treated with DES implantations. Compared to patients with LAD-ostial and nonostial lesions, those with aorto-ostial lesions had a larger late loss (0.43 ± 0.66, 0.42 ± 0.63, and 0.95 ± 0.93 mm, respectively, P = 0.001), higher loss index (0.18 ± 0.28, 0.18 ± 0.26, and 0.39 ± 0.38, respectively, P = 0.001), and restenosis rate (7%, 6%, and 25%, respectively, P < 0.001) at a 6-9 months angiographic follow-up. During the long-term follow-up period of 34 ± 26 months, the aorto-ostial group had a higher rate of target vessel failure (21.7% vs. 12.3% vs. 10.9%, respectively, P = 0.030) and a lower cardiovascular event-free survival rate, as determined by the Kaplan-Meier analysis, than the other two groups (P = 0.002). In spite of treatment with DES implantation, aorto-ostial stenosis is still associated with higher restenosis and lower cardiovascular event-free survival rates than LAD-ostial and nonostial lesions during a long-term follow-up; however, LAD-ostial stenoses are not associated with a higher risk than nonostial lesions.

Acute and long-term outcomes of ostial stentings among bare-metal stents, sirolimus-eluting stents, and paclitaxel-eluting stents

The aim of this study is to evaluate the acute and long-term outcomes of ostial stentings among bare-metal stents (BMS), sirolimus-eluting stents, and paclitaxel-eluting stents. According to the CAPTAIN (Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions) registry, from November 1995 to June 2011, 420 patients with ostial lesions were treated using BMS implantations (243 patients with 247 lesions), CYPHER implantations (77 patients with 77 lesions), or TAXUS implantations (100 patients with 104 lesions). Compared with the CYPHER and TAXUS groups, the BMS group had larger late loss (0.29±0.53, 0.64±0.78, and 1.30±0.79 mm, respectively, P=0.006) and restenosis rate (6, 8, and 33%, respectively, P<0.001). During the long-term follow-up, the BMS group had higher target lesion revascularization than the CYPHER and TAXUS groups (17, 4, and 6%, respectively, P=0.002). The cardiac event-free survival rate, as determined by the Kaplan-Meier analysis, was also lower in the BMS group than in the CYPHER and TAXUS groups (55, 86, and 76%, respectively, P<0.001). Intracoronary stenting with drug-eluting stent for ostial lesions was associated with lower angiographic restenosis and late loss, and a more favorable long-term clinical outcome than BMS.

Commentary: Drug-Eluting Balloons for Carotid In-Stent Restenosis: Can This Technology Deliver the Goods?

Percutaneous transluminal treatment of coronary and peripheral artery diseases has revolutionized the field of interventional medicine. Over the years, progressive technological and pharmacological advances have improved clinical outcome and offered an effective alternative to surgical treatment of atherosclerotic disease in both coronary and peripheral districts. Relatively new to this field are drug-eluting balloons (DEBs), which represent an attractive and novel treatment modality that offers numerous theoretical advantages over standard angioplasty and stent technologies. Among these benefits are homogenous distribution of an antiproliferative drug to the vessel wall (not just to segments of the wall in direct contact with stent struts); immediate drug release without the use of a polymer that could trigger late thrombosis; no prolonged, direct drug contact with the arterial wall, allowing better reendothelization of the vessel if a bare metal stent (BMS) is used in conjunction; no foreign object left in the body, which is especially important in peripheral applications where stents may be used for suboptimal results; maintenance of original vessel anatomy and flexibility, important during superficial femoral artery revascularization especially; and finally, lower restenosis rates in some indications. Recently, data from randomized clinical trials (RCT) showed that this technology is a viable alternative for the treatment of coronary in-stent restenosis (ISR) and of de novo and restenotic lesions in the peripheral arteries. Furthermore, treatment of bifurcation lesions, de novo lesions in small vessels, long lesions, and cerebrovascular interventions have been proposed. In the setting of ISR, the first major impact of DEBs in the management of ISR was shown by the results of the Paccocath ISR I trial (Treatment of In-Stent Restenosis by Paclitaxel Coated PTCA Balloons) comparing the efficacy of the Paccocath drug-eluting balloon vs. an uncoated balloon. The 6-month angiographic results showed binary restenosis and major adverse cardiovascular event (MACE) rates of 5% and 4%, respectively, in the DEB group compared with 43% and 31%, respectively, in the uncoated balloon group (p1⁄40.002 and 0.02). During a follow-up of 5.461.2 years, the clinical event rate was significantly reduced in patients treated with the DEB (59.3% vs. 27.8% MACE, p1⁄40.009), which was mainly driven by the reduction in target lesion revascularization (TLR) from 38.9% to 9.3% (p1⁄40.004).

Paraoxonase-1 Is Not a Major Determinant of Stent Thrombosis in a Taiwanese Population

BackgroundClopidogrel is a prodrug that undergoes in vivo bioactivation to show its antiplatelet effects. Recent studies have shown that cytochrome P450 (CYP), ATP-binding cassette transporters (ABCB1), and paraoxonase-1 (PON1) play crucial roles in clopidogrel bioactivation. Here, we aim to determine the effects of genetic polymorphisms of CYP (CYP 2C19*2, CYP 2C19*3, and CYP 2C19*17), ABCB1 (ABCB1 3435C>T, ABCB1 129T>C, and ABCB1 2677G>T/A), and PON1 (PON1 Q192R, PON1 L55M, and PON1 108C>T) on the development of stent thrombosis (ST) in patients receiving clopidogrel after percutaneous coronary intervention (PCI).Methods and ResultsWe evaluated the incidence of ST (0.64%) in 4964 patients who were recruited in the CAPTAIN registry (Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions). The presence of genetic polymorphisms was assessed in 20 subjects who developed ST after aspirin and clopidogrel therapy and in 40 age- and sex-matched control subjects who did not develop ST, which was documented after 9 months of angiographic follow-up. ST was acute in 5 subjects, subacute in 7, late in 7, and very late in 1. The presence of CYP 2C19*2 allele was significantly associated with ST (adjusted odds ratio [ORadj]: 4.20, 95% confidence interval [CI], 1.263–9.544; P = 0.031). However, genetic variations in PON1 and ABCB1 showed no significant association with ST.ConclusionWe conclude that in a Taiwanese population, PON1 Q192R genotype is not associated with ST development after PCI. However, the presence of CYP 2C19*2 allele is a risk factor for ST development after PCI.

Short- and long-term outcomes of percutaneous transluminal angioplasty/stenting of renal fibromuscular dysplasia over a ten-year period

The purpose of this study was to evaluate short and long-term outcomes of percutaneous transluminal intervention in patients with symptomatic renal artery stenosis due to fibromuscular dysplasia (RAFMD) and/or the combination of RAFMD with aorto-ostial atherosclerotic disease. A retrospective analysis of all patients with renal artery RAFMD who underwent transcatheter therapy between January 1999 and December 2009 was performed. Blood pressure (BP) measurement, number of BP medications, and hypertension defined by a systolic BP >140 ± diastolic BP >90 were recorded. Renal function was defined by estimated glomerular filtration rate (eGFR). Restenosis was defined by stenosis >60% and was determined by renal artery duplex and/or angiography. Freedom from event (restenosis, renal failure, or recurrent hypertension) was performed using life table analysis. Forty-three procedures were performed on 35 patients with RAFMD. Thirty-two patients (91%) were women, with mean age of 61.9 years old. Technical success was 100% with adjunctive stent placement required in the FMD segment for dissection in 1 patient (2.3%) and in the non-FMD aorto-ostial atherosclerotic lesion in 4 patients (9.3%). Short-term outcomes: the majority (69%) had an immediate clinical benefit for hypertension, 6% were cured without BP medications, and 63% improved with less than or equal to preoperative BP medications. Postintervention, 17% remained at moderately reduced renal function (<60), whereas the percent above >60 mL/minute eGFR increased significantly (from 51% to 69%; P = .002). For the entire cohort, renal function (mean eGFR) significantly increased from 71.9 mL/minute + 5.8 to 80.8 mL/minute + 5.2 (P = .007). Long-term outcomes: freedom from recurrent or worsening hypertension (>140 systolic blood pressure [SBP] and >90 diastolic blood pressure [DBP]) was (93%, 75%, and 41%) and freedom from reduced renal function (eGFR <30 mL/minute) was (100%, 95%, and 64%) at 1, 5, and 8 years, respectively. Patients with reduced baseline renal function (<60 mL/minute) and combined atherosclerotic disease were more likely to experience long-term reduced renal function (eGFR <30 mL/minute; P = .003). Primary and assisted primary patency was (95%, 71%, and 50%) and (100%, 100%, and 100%) at 1, 5, and 9 years, respectively. Renal angioplasty is a safe and durable modality for treating RAFMD with favorable short and long-term clinical outcomes. Patients with combined atherosclerotic disease and FMD were older and were more likely to have declining renal function over time. Early intervention may be imperative to achieve possible cure of hypertension.

Percutaneous transluminal intervention and antiplatelet therapy following endovascular graft exclusion for Stanford B thoracic aortic dissection

ObjectiveTo evaluate the safety and feasibility of percutaneous coronary intervention and antiplatelet therapy in patients who have undergone endovascular graft exclusion. MethodsFrom January 2005 to July 2007, percutaneous transluminal intervention (PCI) was performed in 13 patients who had undergone endovascular graft exclusion for the treatment of either acute or chronic Stanford B aortic dissection. Anticoagulant and antiplatelet treatments were administered according to the standard protocol. Patients were followed up for a mean period of 11months. Clinical characteristics, false lumen thrombosis and angiographic data were collected. ResultsPCI was technically successful in all 13 patients and no severe complications, including death, paraplegia or renal failure occurred during hospitalization. Complete false lumen thrombosis was observed in all patients within 6months. There were no major complications such as death, dissection rupture, or aneurysm development during the follow-up period. ConclusionOur data suggested that PCI and standard antiplatelet therapy are feasible and safe in patients who have undergone endovascular stent graft exclusion for Stanford B aortic dissection.

Close to Transplant Renal Artery Stenosis and Percutaneous Transluminal Treatment

Purpose. To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in the management of arterial stenosis located close to the allograft anastomosis (close-TRAS). Materials and Methods. 31 patients with renal transplants were admitted to our institution because of persistent hypertension and impairment of transplant renal function and underwent angiography for vascular investigation. 27 were diagnosed suffering from transplant renal artery stenosis (TRAS), whereas 4 had severe iliac artery stenosis proximal to the transplant anastomosis (Prox-TRAS). 3 cases of TRAS coexisted with segmental renal arterial stenosis, whereas 3 other cases of TRAS were caused by kinking and focal stenosis in the middle of the transplanted renal artery. Results. Angioplasty and stenting were successfully applied to all patients with iliac artery stenosis as well as to those with TRAS and segmental artery stenosis. Two of three patients with kinking were well treated with angioplasty and stenting, whereas one treated only with angioplasty necessitated surgery. No major procedure-related complications appeared, and the result was decrease of the serum creatinine level and of the blood pressure. Conclusions. PTA is the appropriate initial treatment of TRAS and close-TRAS, with low morbidity and mortality rates, achieving improvement of graft function and amelioration of hypertension.

Achievement of Right Ventricular Pacing by Use of a Long Guiding Catheter in a Hemodialysis Patient Presenting Significant Tortuosity of Vasculature

Increased vascular calcification and tortuosity are rather common in end-stage renal failure patients who are on hemodialysis. It renders manipulation of catheters and performance of percutaneous transluminal interventions more difficult than expected. Such vascular alterations may be evident in large veins and pose significant difficulties in placement of pacing leads as shown in our case. To overcome such difficulties, we demonstrated in this patient case that long guiding catheters may be of particular value.

Drug-coated Balloons – Potential Coronary Vascular Applications

One of the most innovative fields in modern medical research is the percutaneous transluminal treatment of vascular disease. During the last few decades considerable advances have been made in intravascular interventions for the treatment of coronary and peripheral arterial disease. However, long-term outcome remains an area of concern in many applications. Restenosis is still a challenge in endovascular medicine and has thus been referred to as the Achilles’ heel of percutaneous intervention. Therefore, novel strategies have been developed to overcome this problem. These include drug-eluting stents and the more recently introduced non-stent-based local drug delivery systems, in particular the drug-coated balloon. The results of several pre-clinical and clinical studies indicate that short-term exposure of injured arteries to paclitaxel delivered from regular angioplasty balloons may be sufficient to reduce late lumen loss and restenosis rates during the critical period after angioplasty of diseased coronary and peripheral arteries. Although the number of published trials and patients treated is still limited, the available data seem to prove that restenosis inhibition by immediate drug release is feasible. This article reviews the potential applications of the drug-coated balloon in coronary vascular disease.