Recanalization Techniques Research Articles

Technical review of a single-center experience of biliary recanalization for liver transplantation-related benign biliary stricture

PurposeTo review a single-center experience of percutaneous biliary recanalization for liver transplantation-related benign biliary stricture, particularly focusing on the technical aspect MethodTwenty-three recipients of liver transplantation (LT) with 27 benign biliary strictures underwent percutaneous recanalization using a step-by-step technique from June 2017 to March 2020. The step-by-step technique includes a hairy wire or an usual 0.035-inch wire passage, a coaxial system, supporting catheters of various shapes and wires, and an extraluminal passage. The success rate of percutaneous biliary recanalization, degree of stricture, interval between LT and biliary recanalization, procedure time, number of sessions, and recanalization techniques were analyzed. ResultsAmong the 27 lesions, 26 (96 %) were successfully recanalized using a percutaneous approach without major complications. Of the 27 lesions, 8 were complete obstructions and 19 were partial obstructions. Consequently, the average interval between LT and biliary recanalization was 28.8 ± 42.7 months (range, 2–192 months). The average procedure time was 50 ± 65 min (range, 8–345 min). The average number of sessions was 1.4 ± 1 (range, 1–6). The case distribution for the used recanalization techniques was as follows: twelve cases utilized step 1, 10 utilized step 2, 4 utilized step 3, and only 1 case utilized step 4. The complete obstruction group required a more advanced technique and spent more recanalization time than the partial obstruction group. ConclusionsThe step-by-step percutaneous biliary recanalization technique had a high success rate without major complications. According to the patient’s biliary anatomy appropriate selection of an angled 5-Fr support catheter and wire is essential in increasing the recanalization success rate.

Efficacy and safety of a mother-child technique for recanalization of chronic central venous occlusive disease in hemodialysis patients

ObjectiveThere is no optimal treatment for central vein occlusive disease that remains a major contributor to vascular access impairment. This study aimed to review the outcomes of percutaneous treatment with a mother-child technique in the treatment of symptomatic central venous stenosis (CVS) and central venous occlusion (CVO) in patients on hemodialysis. MethodsData were collected retrospectively and included all consecutive patients with CVS or CVO who were treated with percutaneous angioplasty and stenting. The occlusive lesions were crossed using the mother-child technique with an angiographic catheter-in-guiding catheter system. ResultsA total of 36 patients with symptomatic CVS and 45 patients with total CVO were included. The average age and gender composition were similar between the two groups. Patients with CVO had higher prevalence of diabetic nephropathy than CVS (24.4% vs 5.6%; P < .05). Lesion success, device success, and procedural success were achieved in 36 (100%), 1 (100%), and 36 (100%) patients in the CVS group and in 43 (95.6%), 11 (100%), and 43 (95.6%) patients in the CVO group, respectively. There were no severe complications or procedure-related deaths in either group. During follow-up (median, 6 months), the primary patency rates were 89.7% (CVS) and 81.0% (CVO) at 6 months and were 54.2% (CVS) and 47.1% (CVO) at 12 months. The assisted primary patency rates were 100% (CVS) and 91.2% (CVO) at 6 and 12 months. ConclusionsWith extra backup support of the mother-child technique, percutaneous treatment provides an effective and safe method for recanalization of chronic venous occlusion in patients on hemodialysis.

An Alternative Treatment of Stump Occlusion of the Superficial Femoral Artery with Percutaneous Direct Puncture Followed by Antegrade Recanalization

IntroductionThe purpose of the study was to evaluate the efficacy and safety of the “percutaneous direct puncture of occluded superficial femoral artery (SFA)” technique for recanalization of SFA, after failure of antegrade recanalization in patients with limited access to retrograde popliteal and crural arteries. Material and methodsBetween April 2014 and November 2017, 10 patients with CLI (Critical limb ischemia) underwent endovascular recanalization with direct percutaneous puncture of occluded SFA after failed antegrade recanalization. All patients had a long segment (39,9 ± 2.8 cm) occluded SFA without stump causing failed antegrade recanalization with a cannulated guidewire in the SFA origin. After unsuccessful attempts with the antegrade approach, the retrograde direct puncture technique of the occluded SFA was performed and followed by antegrade recanalization. Patients were followed up clinically with Doppler ultrasonography and according to the Rutherford scale at 1, 3, 6 and 12 months after discharge. ResultsTechnical success was achieved in 8/10 patients (80%).The mean follow-up period was 25,1 ± 9,6 months. One patient underwent major amputation, resulting in 90% limb salvage rate at 12 and 24 months. Amputation-free survival estimated by Kaplan-Meier analysis was 60% at 12 and 24 months. Primary patency rates were 62.5% at 12 and 24 months and secondary patency rates were 87.5% at 12 and 24 months. ConclusionTreatment of SFA occlusions without a stump in CLI patients via the percutaneous direct puncture of occluded SFA approach improved technical success and clinical recovery, especially in cases unsuitable for conventional antegrade and retrograde approaches.

Aspiration versus stentrieval technique as first passage for mechanical thrombectomy in acute ischemic stroke

Mechanical thrombectomy (MT) has become the standard care of treatment for eligible patients with large vessel occlusion (LVO) leading to acute ischemic stroke. In this study we review and compare the imaging and clinical outcome of three different techniques, including aspiration (ADAPT) and stentrieval (SR) techniques as first pass in acute ischemic stroke. This Study was conducted in Mashhad in 2018 and 2019. All patients with following criteria were included into study: acute ischemic stroke and large vessel occlusion. Success of MT and clinical outcomes were compared between ADAPT and SR techniques. 87 patients were included into study. Mean of age was 55.9 ± 13.0 years. There was no significant difference between two techniques for admission NIHSS, age, and time interval. As first passage, ADAPT technique was used in 59 patients (67.8%) and stentrieval in 28 (32.2%). Mean of passage was 2.5 ± 1.6 in ADAPT and 3.2 ± 1.6 in SR group. The difference was not significant (p = 0.085). Successful recanalization was achieved in 75.9% of ADAPT group and 76% of SR group (p = 0.991). Large significant ICH was seen in 15.3% of ADAPT group and 3.6% of SR group. Difference was not significant (p = 0.110). Good outcome (mRs 0-2) was reported in 38% of ADAPT group and 38.5% SR group with no significant difference between two groups (p = 0.976). Despite higher rate of ICH in ADAPT technique, ADAPT technique could be as effective as SR technique for successful recanalization as well as good outcome.

2121 A Combined Antegrade/retrograde Dilation Procedure With Gastroenterology and Interventional Radiology: A Case Report

INTRODUCTION: Endoscopic recanalization techniques for complete esophageal obstructions are not very well established. Dilatations of esophageal strictures causing complete obstruction by conventional bougienage techniques are not very successful. We present a case where complete esophageal stricture was treated with endoscopic recanalization by combine efforts of GI and IR team with endoscopy and guidewire by IR. CASE DESCRIPTION/METHODS: A 78-year-old male with a past medical history of HTN, HLD, DVT, prostate cancer, esophageal cancer s/p esophagectomy with gastric pull-up c/b anastomotic stricture s/p esophageal stent placement s/p removal in 1/2019 c/b recurrent stricture progressing to apparently complete obstruction. He had gastrostomy tube placed by interventional radiology. During endoscopy, one severe stenosis was found at the esophageal anastomosis with surrounding staples. A lumen was not visualized and Gentle probing using a Savary guidewire, fluoroscopic guidance or a Glot tip catheter did not help to visualize the lumen. Patient had a J tube which precludes retrograde approach. Procedure was aborted. Subsequently with IR guidance, a catheter with a metal wire was passed in retrograde fashion from gastrostomy site to the stenosed lumen. A puncture was carefully made and a guidewire was advanced out the mouth. Site of recanalization was dilated to 6 mm. Using the guidewire, an 18 mm × 10.3 cm WallFlex fully covered stent was loaded over it and passed into the esophagus. The stent was then deployed. Patient improved clinically. Subsequent Endoscopy showed mild tissue hyperplasia just proximal to the stent. Patient was followed up closely and still needed regular endoscopies and dilatations but is clinically stable and his dysphagia and quality of life has improved significantly. DISCUSSION: Patients with advanced malignancy and limited life expectancy who develop complete esophageal stricture and cannot tolerate surgical reconstruction benefit significantly from the endoscopic recanalization. New endoscopic techniques include rendezvous recanalization and CARD(combined antegrade‐retrograde dilation). In our case, combined efforts of GI and Interventional radiology helped to recanalize the complete obstruction of the esophagus by GI guided endoscopy and IR guided guidewire. Such novel techniques bring a significant improvement in the overall quality of life of patients with terminal diseases and high surgical risk.

TCT-97 Subintimal Versus Intraplaque Recanalization of Coronary Chronic Total Occlusions Mid-Term Angiographic and Optical Coherence Tomography Findings from the ISAR-OCT-CTO Registry

There is ongoing controversy regarding outcomes of intraplaque versus subintimal recanalization of coronary chronic total occlusions (CTOs). No optical coherence tomography (OCT) studies have been conducted to specifically compare vessel healing following these recanalization techniques.

In-Hospital Outcome of Patients with Diabetes Mellitus after CTO Recanalization with Third-Generation Drug-Eluting Stents

Background: Percutaneous coronary intervention (PCI) of total chronic coronary occlusions (CTOs) still remains a major challenge in interventional cardiology. There is little knowledge in the literature about differences in CTO-PCI between diabetic and nondiabetic patients in the era of third-generation drug-eluting stents (DESs). In this study, we analyzed the impact of diabetes mellitus (DM) on procedural characteristics, complications, and acute outcomes in a cohort of 440 patients. Methods: Between 2012 and 2016, we recruited 440 consecutive patients, 116 of them with DM. All the patients underwent PCI for at least 1 CTO. Antegrade and retrograde CTO recanalization techniques were applied. Only third-generation DESs were used. We used t-tests and the Pearson chi-quadrat test to test the significant differences in the variables between the 2 groups. Results: The patients with DM were older than the nondiabetics (64.5 y vs. 61.1 y; P=0.003), and they suffered more frequently from a chronic kidney disease (7.1% vs. 2.4%; P=0.001). The nondiabetics less frequently had arterial hypertension (75.3% vs. 89.7%; P=0.001); however, they more often had a family liability for CAD (32.1% vs. 22.4%; P=0.050) and had a higher left ventricular ejection fraction (59.2% vs. 56.7%; P=0.011). The success rate was 85.2% in the patients without DM and 81.2% in the patients with DM (P=0.403). The existence of DM had no impact on the procedural success and complication rates. Conclusion: Our study on 440 patients shows that diabetics and nondiabetics have similar success and complication rates after the recanalization of CTOs using third-generation DESs. It is a feasible and safe procedure and can be recommended as an alternative treatment.

Alternative crossing technique for iliaco-femoro-popliteal CTOs with a catheter only

BackgroundThe standard approach for crossing peripheral CTOs is to use a combination of hydrophilic guidewires and catheters. The path is either intraluminally or in most cases at least partially subintimal. This standard approach with a guidewire-tip as leading point (“wire first”) to cross CTOs has a success rate of about 80%. We hypothesize that a “catheter first” approach, using the catheter alone for the entire recanalization till re-entering the vessel is less traumatic and might lead to a longer intraluminal recanalization due to a softer leading point. Based on this assumption we analyzed the success and duration of this approach with a gradual step-up approach from catheter tip to guidewire front-end to guidewire back-end. To the best of our knowledge, no studies measuring the time of recanalization of lower extremity CTOs using conventional devices were published yet.ResultsData of 46 consecutive chronic total iliaco-femoro-popliteal occlusions in 43 symptomatic patients treated by percutaneous transluminal angioplasty were collected prospectively between May 1st 2014 and June 30th 2016 and evaluated retrospectively. Chronic occlusion was defined as clinical symptoms or imaging features lasting more than 1 month.Patient age and gender, diabetes status, localization of occlusion, occlusion length, duration of symptoms, severity of vessel calcification, and recanalization time were assessed.Technical success was defined as placement of a catheter beyond the distal end of the lesion into the true lumen, confirmed by contrast injection.All 46 CTOs were successfully recanalized. In 22 cases (47.8%) recanalization was successful with the catheter tip only without the use of a guide wire. In 17 cases (36.9%) the guide wire was used in addition to the catheter. Localization of occlusion did not have an effect on the recanalization technique (p = 0.915). The mean rank for length of occlusion was not significant for different recanalization techniques (p = 0.095). The success rate for the catheter only approach was lower for higher grades of calcification (p = 0.008). There was no correlation between time of recanalization and length of occlusion (Pearson’s r = 0.004; adjusted R square = − 0.024; p = 0.980), diabetes (p = 1.000), sex (p = 0.244), or grade of calcification (p = 0.621). Recanalization time is significantly right-skewed with most recanalizations being successful under 30 min.ConclusionThis “catheter first” approach is somewhat contradictory to the prevailing dogma of “wire first”. The concept to use the catheter to start a recanalization is well known, but to perform the entire recanalization including the re-entry seems possible and potentially less traumatic, likely leading to a longer intraluminal course. Our data shows that recanalization of occluded lower extremity arteries between the aortic bifurcation and the popliteal artery can be achieved in the majority of cases (84.7%) solely by using an angled angiographic catheter +/− glide wire.We suggest a “5 min – 15 min – 30 min” rule on how long to attempt each recanalization technique. More precisely, we suggest trying 5 min with the catheter alone, then 10 min with the soft end of the guidewire and then switching to the stiffer back-end of the guidewire for another 15 min.

Functional outcome after symtomatic internal carotid artery occlusion

Abstract Internal carotid artery occlusion accounts for 15-20% of ischemic strokes, caused by atherosclerosis or dissection. Clinical symptoms are variable, from asymptomatic cases to minor or severe strokes. Diagnosis in internal carotid artery (ICA) occlusion is based on imaging techniques. Prognosis after ICA occlusion depends on many factors: severity of neurologic deficit, spontaneous recanalization of the artery, and the occurrence of recurrent strokes. Patients with spontaneous recanalization of the occluded ICA tend to have a retained functional ability and favorable clinical outcomes. Medical treatment, recanalization techniques and intensive rehabilitation program are essential in improving functional outcome of patients with stroke produced by ICA occlusion. We present the case of a young patient diagnosed with ischemic stroke produced by internal carotid artery occlusion, with consecutive severe neurologic deficit, and an unfavorable functional outcome, as evaluated with the Modified Rankin Scale. Spontaneous recanalization of the occluded ICA was observed after 6 weeks, suggesting a carotid dissection. The patient was included in an intensive rehabilitation program, associated with best medical therapy, showing improvement of its functional status at 3 months follow up. Key words: ischemic stroke, carotid artery occlusion, carotid dissection, spontaneous recanalization, functional outcome,

TCTAP C-180 Direct Stent Puncture Technique for Intraluminal Stent Recanalization in the Superficial Femoral and Popliteal Arteries In-stent Occlusion

### Patient Initials or Identifier Number Mrs. L ### Relevant Clinical History and Physical Exam Mrs. L was 64-year-old lady. She has past medical history with T2DM, HTN, Hyperlipidemia, CKD stage 3, bilateral PAOD. She has received PTA with 3 Viabahn stent in left proximal SFA to popliteal

Lower extremity endovenous reconstruction for symptomatic occlusive disease in pediatric patients: techniques, clinical outcomes, and long-term stent patencies.

Endovascular stent reconstruction is the standard of care for chronic venous occlusive disease in adults, but it has not been reported in pediatric patients. This study reports the technical success, complications, clinical outcomes, and stent patency of iliocaval stent reconstruction for chronic iliocaval thrombosis in pediatric patients. Fourteen patients, 13 (93%) male with a mean age of 16.4years (range: 8-20years), underwent iliocaval stent reconstruction for chronic iliocaval thrombosis. The mean number of prothrombotic risk factors was 2.5 (range: 0-4), including 7 (50%) patients with inferior vena cava atresia. At initial presentation, the Clinical, Etiology, Anatomy, and Pathophysiology classification (CEAP) score was C3 in 2 (14%) patients, C4 in 11 (79%) patients, and C6 in 1 (7.1%) patient. Time course of presenting symptoms included chronic (>4weeks) (n=7; 50%) and acute worsening of chronic symptoms (2-4weeks) (n=7; 50%). Aspects of recanalization and reconstruction, stenting technical success, complications, clinical outcomes and stent patency were recorded. Clinical success was defined as a 1-point decrease in the CEAP. Primary, primary-assisted, and secondary patency were defined by Cardiovascular and Interventional Radiological Society of Europe guidelines. Most procedures employed three access sites (range: 2-4). Intravascular ultrasound was employed in 11 (79%) procedures. Blunt and sharp recanalization techniques were used in 12 (86%) and 2 (14%) patients, respectively. Stenting technical success was 100%. Two (14%) minor adverse events occurred and mean post-procedure hospitalization was 2.8days (range: 1-8days). Clinical success rates at 2weeks, 6months and 12months were 85%, 82%, and 83%, respectively. At a mean final clinical follow-up of 88months (range: 16-231months), clinical success was 93%. Estimated 6- and 12-month primary stent patencies were 86% and 64%, respectively. Six- and 12-month primary-assisted and secondary stent patency rates were both 100%. Iliocaval stent reconstruction is an effective treatment for symptomatic chronic iliocaval thrombosis in pediatric patients with high rates of technical success, 6- and 12-month clinical success, and 6- and 12-month primary-assisted and secondary patency rates.

Prospective randomized study of coronary chronic total occlusion recanalization using the CHOICE score

Background. Today there is no clear recommendations regarding the choice of a technique for coronary chronic total occlusion recanalization.Aim. The article aims to evaluate the efficacy of choosing the coronary chronic total occlusion primary recanalization strategy according to the CHOICE score in comparison with primary antegrade recanalization.Methods. This prospective single-center study included 160 patients with chronic total occlusion. The patients were randomized into two groups: in the first, the recanalization strategy was selected on the basis of the previously developed CHOICE score, in the second, antegrade recanalization technique was used as the primary strategy.Results. In the group where the choice of primary recanalization strategy was based on the CHOICE score, technical and procedural success rates were 90% and 88.8% and were significantly higher compared to those in the primary antegrade recanalization group, 76.3% and 75%, respectively. The success rate of the primary recanalization strategy was also higher in the group where choice of the primary recanalization strategy was based on the score (80% vs. 58.8%). At the hospital stage, 2 complications were recorded, one in each group. Thus, a patient in the CHOICE score-based strategy group developed periprocedural myocardial infarction, while the primary antegrade recanalization group there was 1 case complicated by perforation of the coronary artery, which required pericardiocentesis. The average number of stents and contrast did not differ between groups. However, the intervention time was longer in the group with primary antegrade recanalization (47.6 ± 28.2 vs. 39.2 ± 23.4).Conclusion. Selecting the CHOICE score-based recanalization can significantly increase the probability of procedural success and reduce the intervention time. Received 17 October 2018. Revised 13 December 2018. Accepted 18 December 2018. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Exploration of thrombus histological composition and clinical effect in mechanical thrombectomy of acute ischemic stroke

Objective: To explore histological composition of thrombus and clinical effect in mechanical thrombectomy of acute ischemic stroke. Methods: From March 2017 to August 2017 at the Institutes of Biology and Medical Sciences of Soochow University, hematoxylin and eosin (HE) staining was used to quantitatively analyze the composition of thrombus in 58 cases with acute ischemic stroke. The differences in components of thrombus with different TOAST classifications were compared, meanwhile, clinical data such as surgical process and prognosis were also analyzed. Results: (1) Baseline data: the age of arteriosclerosis was significantly lower than that of cardiogenic (P<0.05). There was statistically significant differences in onset to admission between the two types of stroke of other undetermined etiology (SUE) and Cardioembolism (CE) (P<0.05). (2) Histological composition of thrombus: there were no significant differences in fibrin and red blood cells (RBC) between the two types of SUE and CE thrombus (P>0.05). There were more RBC in LAA thrombus and more fibrin in CE thrombus (P<0.05). (3) Intraoperative data: the time of admission to recanalization of type LAA was longer than that of type CE (P<0.05). (4) Prognosis: there was no significant difference in the good prognosis between the two types of SUE and CE (P>0.05). It is the same between the types of LAA and CE (P>0.05). Conclusions: LAA thrombus contains more RBC, and cardiogenic thrombus contains more fibrin. Cryptogenic thrombus has the same composition with cardioembolism. The results may help to choose appropriate recanalization technique in different TOAST stroke and have guiding significance for the secondary prevention of SUE stroke.

Stent Retriever Thrombectomy with Mindframe Capture LP in Isolated M2 Occlusions.

Mechanical thrombectomy is an effective recanalization technique in acute ischemic stroke patients with large vessel occlusions; however, it is unclear to what extent stent retriever thrombectomy may be applicable to occlusions of smaller peripheral cerebral vessels. The outcome of patients with isolated M2 occlusions treated with the Mindframe Capture low profile (LP) stent retriever was reviewed. Aretrospective review of prospectively collected data on all consecutive patients treated for isolated M2 occlusions between June 2013 and December 2017 using the Mindframe Capture LP was performed. Technical aspects of the recanalization procedure, recanalization rate, complication rate, and clinical outcome were analyzed. Mechanical thrombectomy with the Mindframe Capture LP was performed in 38patients (median age 79years) with an isolated M2 occlusion. The median National Institutes of Health Stroke Scale (NIHSS) score on admission was 7.5 (interquartile range, IQR 5-12) and successful reperfusion modified Thrombolysis in Cerebral Infarction (mTICI2b or 3) was achieved in 28patients (74%). Acompensated/adjusted modified Rankin Scale (mRS) 0-2 at 3months was observed in 65% when taking pre-stroke disability into account. Symptomatic intracranial hemorrhage (sICH) occurred in 1patient (2.6%). Asymptomatic intracranial hemorrhage (aICH) was noted in 8patients (21%) and asmall subarachnoid hemorrhage (SAH) in the immediate vicinity of the target vessel was apparent in 8patients (21%). The Mindframe Capture LP is atechnically effective thrombectomy device for the treatment of isolated M2 occlusions. The lower profile of the device is advantageous when targeting peripheral intracranial occlusions.

Radiofrequency Wire Recanalization of Chronically Occluded Venous Stents: A Retrospective, Single-Center Experience in 15 Patients.

Chronically occluded venous stents may be difficult to salvage, necessitating multiple approaches and adjunctive techniques. Radiofrequency wires have been used to cross chronic obstructions in a variety of settings. Herein, radiofrequency wire recanalization (RFWR) of chronically occluded venous stents is presented. Fifteen patients (8 males; 7 females) aged 23-74years (median 42years) underwent prior venous stenting in the setting of venous occlusions. Seven had an underlying coagulopathy, three had May-Thurner syndrome, three had provoked deep venous thrombosis, one had a dialysis fistula, and one had pacer leads in situ. All indwelling venous stents were chronically occluded and symptomatic. Out of 15 patients, 13 (87%) had iliocaval venous stents, while two (13%) had superior vena cava and/or upper extremity venous stents. After failing conventional and blunt recanalization techniques, RFWR was performed to traverse the chronic occlusions. Technical success and complications were recorded. Fifteen patients underwent 19 procedures. Twelve patients underwent one procedure, two patients had two procedures, and one patient had three procedures. RFWR alone was used in 12/19 (63%) procedures, while 7/19 (37%) required adjunctive sharp recanalization techniques. Technical success or crossing of the occlusion with flow restoration through the occluded segments was achieved in 17/19 (89%). One major and one minor complication occurred. Radiofrequency wire recanalization is an effective adjunct to revise chronically occluded venous stents, potentially increasing procedural success in challenging cases.

Outcomes of endovascular interventional therapy for primary Budd‑Chiari syndrome caused by hepatic venous obstruction

To date, interventional therapy for patients with Budd-Chiari syndrome (BCS) due to hepatic vein obstruction (HVO) has not been standardized in China. In Western countries, BCS primarily occurs due to thrombosis and the majority of patients receive thrombolysis. In China, BCS is mostly caused by the membranous occlusion of the HV or IVC. The present retrospective study evaluated the efficacy of recanalization techniques in patients with primary BCS due to HVO. The data of 69 patients with BCS due to HVO, who underwent endovascular therapy at 2 centers in China between December 2010 and December 2012, were analyzed. All of the patients underwent balloon angioplasty. In addition, 14, 6 and 5 patients received thrombolysis, endovascular stent and thrombolysis + endovascular stent, respectively. The overall technical success rate was 95.7% (66/69), and was comparable among the treatments. The HV pressure after the treatments was significantly lower compared with that prior to the procedures (23.3±6.9 vs. 46.5±8.6 cmH2O; P<0.001). The mean follow-up duration was 75 months (range, 60–84 months). During the 5-year follow-up, 10 patients (15.2%) had developed a recurrence of BCS-associated symptoms, of which 7 were successfully treated. The cumulative survival rates at 12, 36 and 60 months after endovascular interventional therapy (balloon angioplasty or combined treatment) were 98.5, 98.5 and 93.9%, respectively. After treatment by endovascular therapy, the patients with BCS caused by HVO had high survival rates and low recurrence rates in the short- and mid-term.

Percutaneous Coronary Intervention of Chronic Total Occlusions: When and How to Treat.

Chronic coronary total occlusions (CTO) are diagnosed in up to 20% of patients with coronary artery disease and have a detrimental effect on patients' quality of life and long-term prognosis. The exponential developments in CTO percutaneous coronary intervention (PCI) equipment, recanalization techniques, and operator expertise have been merged into the hybrid approach that represents a percutaneous revascularization algorithm for treating CTOs and has led to technical success over 90% at experienced centers. Therefore, patient selection for CTO PCI should be focused on anticipated patient benefit in terms of health status and long-term prognosis rather than coronary anatomic complexity. TABLE OF CONTENTS: This review will provide an overview of the clinical presentation and characteristics of patients with a CTO and will discuss the essential needs toward judicious patient selection for percutaneous CTO revascularization according to contemporary knowledge. Furthermore, the current high standard revascularization techniques in dedicated CTO PCI will be discussed.

Interventional Treatment of Acute Portal Vein Thrombosis.

Acute portal vein thrombosis is a potentially fatal condition. In symptomatic patients not responding to systemic anticoagulation, interventional procedures have emerged as an alternative to surgery. This study sought to retrospectively evaluate initial results of interventional treatment of acute portal vein thrombosis (aPVT) using a transjugular interventional approach. Between 2014 and 2016, 11 patients were treated because of aPVT (male: 7; female: 4; mean age: 41.06 years). All patients presented a rapid onset of symptoms without collateralization of portal flow as assessed by a CT scan at the time of admittance. The patients showed thrombotic occlusion of the main portal vein (11/11), the lienal vein (10/11) and the superior mesenteric vein (10/11). Different techniques for recanalization were employed: catheter thromboaspiration (1/9), AngioJet device (7/9), local-lysis-only (1/9) and TIPSS (7/9). Local lysis was administered using a dual (4/9) or single (5/9) catheter technique. The mean follow-up was 24.32 months. In 9 patients transhepatic access was successful. Initially reduction of thrombus load and recanalization were achieved in all 9 cases with residual thrombi in PV (n = 3), SMV (n = 7), and IL (n = 5). In the collective undergoing interventional procedures (n = 9) rethrombosis and continuous abdominal pain were seen in one patient, and thrombus progression after successful recanalization was seen in another. Freedom from symptoms could be achieved in 6 patients. One patient developed peritoneal and pleural effusion, respiratory insufficiency and portosystemic collaterals. Both patients who could not undergo an interventional procedure developed a cavernous transformation of the portal vein. One of them also had continuous intermittent abdominal pain. Interventional percutaneous approaches are able to improve patient outcome in patients with aPVT. It appears to be of utmost importance to not only remove/reduce the thrombotic material but to establish sufficient inflow and outflow by TIPS and simultaneous multi-catheter thrombolysis. · Pharmacomechanic thrombectomy in combination with local thrombolysis is a feasible approach. · The transjugular transhepatic approach seems to be a safe procedure. · TIPSS and dual catheter lysis may support flow management. · Wolter K, Decker G, Kuetting D et al. Interventional Treatment of Acute Portal Vein Thrombosis. Fortschr Röntgenstr 2018; 190: 740 - 746.

Percutaneous intentional intra-luminal-assisted recanalization (PILAR technique) of challenging chronic total occlusions using a high-frequency vibration device.

Recanalization of peripheral chronic total occlusions (CTO) is technically challenging especially in cases of in-stent and/or pre-stent and heavily calcified lesions. A high-frequency vibrational device (HFVD) was first used as a secondary-intention device in CTO recanalizations when they were refractory to a guidewire. The aim of this study was to assess the safety and efficacy of the HFVD as a first-line treatment for challenging CTOs and thus to define the percutaneous intentional intraluminal-assisted recanalization (PILAR) technique. Fifty-two patients were treated with the HFVD. Only challenging CTOs were included: 7 pre-stent, 7 in-stent, and 38 highly calcified CTOs. Technical success was defined as the ability to cross the CTO using the HFVD. Secondary outcome was defined as successful intraluminal crossing. Safety endpoints were procedure-related thromboembolism or perforation. Patients were followed up at 3 months and 1 year. The technical success rate for recanalization was 90%, of which 83% were intraluminal. The mean recanalized length was 91 ± 44 mm. One thromboembolic complication occurred, which was subsequently treated with thromboaspiration. Three-month and 1-year primary patency rates were 92% and 79%, respectively. HFVD-based PILAR is a safe and effective technique for in-stent or pre-stent CTO recanalization of long and calcified lesions. • Intraluminal recanalization is the preferred procedure in heavily calcified or pre-/in-stent CTO. • First-line use of assisted intraluminal recanalization for CTO defines the PILAR technique. • HFVD-based PILAR is safe and provides a high success rate for challenging CTO recanalization.

Rendezvous endoscopic recanalization for complete esophageal obstruction.

Complete esophageal obstruction after (chemo)radiation for head and neck cancers is rare. However, inability to swallow one's own saliva strongly inflicts upon quality of life. Techniques for endoscopic recanalization in complete obstruction are not well established. We assessed the efficacy and safety of rendezvous recanalization. We performed a retrospective review of all patients who underwent endoscopic recanalization of complete proximal esophageal obstruction after radiotherapy between January 2009 and June 2016. Technical success was defined as an ability to pass an endoscope across the recanalized lumen, clinical success by changes in the dysphagia score. Adverse events were recorded prospectively. 19 patients with complete obstruction (dysphagia IV°), all of whom had failed at least one trial of conventional dilatation, underwent recanalization by endoscopic rendezvous, a combined approach through a gastrostomy and perorally under fluoroscopic control. Conscious sedation was used in all patients. In 18/19 patients (94.7%), recanalization was technically successful. In 14/18 patients (77.8%), the post-intervention dysphagia score changed to ≤ II. Three patients had their PEG removed. Factors negatively associated with success were obstruction length of 50mm; and tumor recurrence for long-term success. No severe complications were recorded. Rendezvous recanalization for complete esophageal obstruction is a reliable and safe method to re-establish luminal patency. Differences between technical and clinical success rates highlight the importance of additional functional factors associated with dysphagia. Given the lack of therapeutic alternatives, rendezvous recanalization is a valid option to improve dysphagia.