Restoration Of Vessel Patency Research Articles

Mechanical marvels: robots in carotid artery stenting - a systematic review of effectiveness in neuroendovascular interventions

Aim: Carotid artery disease, or carotid stenosis, is a critical medical condition carrying the risk of stroke and fatality. The underlying pathology involves the accumulation of atheromatous plaques, leading to luminal constriction and disrupted blood flow. Endovascular interventions, such as carotid artery stenting (CAS), aim to restore vessel patency. Robotic assistance in CAS surgeries is rapidly evolving globally, offering precision and fatigue-free capabilities. Despite growing interest, a dedicated systematic review on robotic applications in CAS is notably absent. Methods: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search strategy involving five databases. Data extraction encompassed study origin, patient demographics, procedural details, procedure times, complications, fluoroscopy, and radiation parameters. Results: Over 199 articles were identified from five databases. Seven studies meeting inclusion criteria were analyzed. The predominant robotic system, CorPath GRX, demonstrated advantages such as remote operation, precision, and compatibility with various catheter sizes. Magellan Robotic System, employed in one study, showcased remote-controlled capabilities. These studies involved a total of 44 patients undergoing carotid artery stenosis procedures with robotic assistance. Reported complications included access site conversion, Angio-Seal device failure, and residual stenosis. Mean operation time varied from 34 to 85 min. Conclusions: The integration of robotic assistance in carotid interventions, as demonstrated by the CorPath GRX and Magellan Robotic System, holds significant promise in improving the precision and safety of CAS procedures. However, the limited number of studies, the high risk of bias, and the need for further research and standardization highlight the evolving nature of this technology.

Analysis of the therapeutic effect of aspiration thrombectomy for early carotid stent thrombosis

Objective: To investigate the clinical characteristics and the efficacy of thrombus aspiration in patients with early intrastent thrombosis (EST) following carotid artery stenting (CAS). Methods: This study is a retrospective case series, collecting clinical data of five patients who developed EST after CAS in the Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University from January 2021 to September 2023.All patients were male, with an age of (64.0±11.9) years (range:48 to 77 years), accounting for 2.0% (5/244) of CAS procedures during the same period.Among them, three patients did not receive standard dual antiplatelet therapy before the procedure, and one had an inadequate ADP inhibition rate (45.6%).Four patients received XACT carotid stents, while one received a Wallstent carotid stent.All five patients showed significant residual stenosis ranging from 43% to 55% after CAS.Emergency thrombus aspiration was performed in all cases, and data regarding perioperative conditions, vascular patency, and clinical outcomes were collected. Results: The interval between CAS and the occurrence of EST ranged from 3 hours to 14 days.The main clinical symptoms included sudden onset of consciousness disorders and contralateral limb weakness.None of the patients received preoperative intravenous thrombolysis, and thrombus aspiration was performed during the procedure to restore vascular patency.Four cases underwent balloon angioplasty during the procedure, and two cases utilized overlapping stents.Two patients experienced intraoperative embolization of thrombus to the C2 segment.In one case, the embolized thrombus was retrieved using an intracranial thrombectomy stent, while in another case, it was aspirated using a guiding catheter.Postoperatively, all patients had a thrombolysis in cerebral infarction grade of 3, and symptoms improved in four cases.One patient showed no improvement in symptoms, and MRI revealed extensive new infarction in the right frontal and insular regions, adjacent to the right lateral ventricle.Regular follow-up examinations after discharge did not reveal restenosis or embolism within the stent.The follow-up period ranged from 7.6 to 21.2 months, with modified Rankin scale scores of 0 to 1 point in four cases and 2 points in one case, indicating good recovery in all patients. Conclusions: Acute intrastent thrombosis is a rare complication after carotid artery stenting.The combined use of percutaneous thrombus aspiration and endovascular techniques, such as balloon angioplasty and stent overlapping, can rapidly restore vessel patency with favorable outcomes.However, further large-scale clinical studies are needed to confirm the effectiveness of these treatments for acute intrastent thrombosis.

Budd-Chiari Syndrome - classification, diagnostics, imaging and treatment

Introduction: Budd-Chiari syndrome is a rare condition which can be defined as hepatic venous outflow obstruction occurring at any level between the small hepatic veins and junction of the inferior vena cava and the right atrium. Symptoms may vary from mild or even asymptomatic for many years to fulminant hepatic failure. Imaging is the mainstay of diagnosis of BCS. Laboratory and ematological tests are invaluable in recognizing hematological and coagulation disorders that may be identified in up to 75% of the patients. The recommended therapeutic approach to BCS is based on a stepwise algorithm beginning with medical treatment, endovascular treatment to restore vessel patency, placement of transjugular portosystemic shunt (TIPS), and orthotopic liver transplantation as a last resort rescue treatment. The aim of the study: This study aims to gather current knowledge about clinical manifestations, diagnosis and treatment of Budd-Chiari syndrome. Materials and methods: This review was based on available data collected in the PubMed database and Google Scholar web search engine, using the keywords: ’Budd-Chiari syndrome’ ,’hepatic venous outflow obstruction’. Conclusions: The treatment of Budd-Chiari syndrome requires interdisciplinary cooperation, which has resulted in the increasing curability of this rare disease over the last years.

Techniques and Evidence for Percutaneous Coronary Intervention for Coronary Bifurcation Lesions: An Ongoing Journey

Techniques and Evidence for Percutaneous Coronary Intervention for Coronary Bifurcation Lesions: An Ongoing Journey

Improving treatment for acute ischemic stroke-Clot busting innovation in the pipeline.

Acute ischemic stroke is a consequence of disrupted blood flow to the brain, caused by thrombosis—the pathological formation of occlusive clots within blood vessels, which can embolize distally to downstream tissues and microvasculature. The highest priority of stroke treatment is the rapid removal of occlusive clots and restoration of tissue perfusion. Intravenous thrombolysis is the pharmacological standard-of-care for the dissolution of blood clots, wherein thrombolytic drugs are administered to restore vessel patency. While the introduction of recombinant tissue-plasminogen activator (rtPA) in 1996 demonstrated the benefit of acute thrombolysis for clot removal, this was countered by severe limitations in terms of patient eligibility, lytic efficacy, rethrombosis and safety implications. Development of safer and efficacious treatment strategies to improve clot lysis has not significantly progressed over many decades, due to the challenge of maintaining the necessary efficacy-safety balance for these therapies. As such, rtPA has remained the sole approved acute therapeutic for ischemic stroke for over 25 years. Attempts to improve thrombolysis with coadministration of adjunct antithrombotics has demonstrated benefit in coronary vessels, but remain contraindicated for stroke, given all currently approved antithrombotics adversely impact hemostasis, causing bleeding. This Perspective provides a brief history of stroke drug development, as well as an overview of several groups of emerging drugs which have the potential to improve thrombolytic strategies in the future. These include inhibitors of the platelet receptor glycoprotein VI and the signaling enzyme PI3-Kinase, novel anticoagulants derived from hematophagous creatures, and proteolysis-targeting chimeras.

3:45 PM Abstract No. 47 MicroStent: initial single-center experience at a vascular center of excellence

(1) Brief overview on the treatments used in critical limb ischemia (CLI) arteries below the knee (BTK) and the current treatment landscape limitations. (2) Guide the reader on the composition of the MicroStent (Micro Medical Solutions, Wilmington, MA) (MS), dedicated for below-the-knee vessels in CLI. (3) Discuss our single-center experience via retrospective analysis and case examples Based on the angiographosome concept, vascular specialists have aimed to revascularize BTK vessels to improve in line flow to aid wound healing and promote limb salvage in Rutherford class (RC) 4-6 patients. Traditional methods spanning from POBA and bare-metal stenting to newer paclitaxel impregnated devices and atherectomy have been the mainstay to restore vessel patency and flow. However, there has been no dedicated peripheral stent for vessels BTK prior to recent advancements. Off label use of coronary stents, such as the 4-mm Resolute Onyx (Medtronic, Dublin, Ireland) have been used to salvage perfusion BTK. MS aims to create an ‘instructions for use’ (IFU) BTK stent for CLI therapy. Here, we share our experience with MS, exploring parameters beyond initial feasibility trials. Single center retrospective analysis in RC 4-6 CLI patients revascularized with MS. The first phase of the study included 8 patients treated from April–November 2018. Ultrasound was obtained for primary patency and hemodynamically significant stenosis with standardized protocol performed by a single technician on prescheduled follow-up visits at 15 days, 30 days, 3 months, 6 months and 1 year. Our analysis examined (1) primary patency, (2) secondary patency (defined as 1 reintervention at target lesion), (3) change of 1 or more RC, (4) wound healing, (5) major amputation and cardiovascular events, and (6) death. The second phase of the study is under enrollment with further analysis to be performed with larger sample size prior to publication. Exploring the safety and efficacy of novel devices for tibiopedal disease is imperative to develop IFU and treatment algorithms in this complex disease. Here, we share our early experience with MS in BTK arteries and what impact it may have to further the fight against amputation and CLI mortality.

Central Venous Pathologies: Treatments and Economic Impact.

Chronic venous insufficiency (CVI) is responsible for significant costs to society in the form of medical and surgical treatment and, importantly, unmeasurable lost work productivity due to pain and disability. Symptomatic chronic central vein obstruction, a cause of CVI, is potentially treatable using open surgical and endovascular techniques to restore vessel patency. Although upper extremity central vein obstruction often requires an open surgical procedure for durable relief, endovascular stents have proven remarkably useful for iliofemoral disease. Containment of healthcare resources requires accurate diagnosis, durable treatment modalities, and appropriate patient selection so that therapy is targeted to those individuals most likely to benefit. In this regard, identification of appropriate lesions should be based on intravascular ultrasound and 3-dimensional imaging studies. Treatment with dedicated venous stents offers the potential for long-term symptomatic improvement and increased work productivity when used in a well-defined, anatomically appropriate population with significant, symptomatic CVI.

Bioresorbable Coronary Scaffolds: Current State of Evidence

Second-generation drug-eluting stents are currently considered the standard of care in patients undergoing treatment for coronary artery disease with percutaneous coronary intervention. Despite significant improvements in stenting technology and stent material over the past three decades, the concern that a permanent metallic prosthesis within the coronary vasculature can serve as a trigger for stent-related adverse events, mainly stent thrombosis and in-stent restenosis, still persists. In order to overcome the disadvantages of drug-eluting stents there has been a robust development in the field of bioresorbable coronary scaffolds (BRS). These devices aim to provide temporary scaffolding to restore vessel patency and, after serving its purpose, fully degrade and thus allow restoration of vasomotion along with luminal enlargement. The initial experience with bioresorbable scaffolds in low-risk patients presenting with simple lesions was satisfying and generated optimism among interventional cardiologists by promising better patient outcomes. However, the unrestricted use of these devices in patients presenting with a higher baseline risk and more complex lesions came at the cost of alarmingly high rates of adverse cardiac events, especially the late device thrombosis. Although its non-inferiority compared to metallic everolimus-eluting stents was formally met in the clinical trials, there was a clear trend towards an increased occurrence of myocardial infarction and device thrombosis during the first year after device implantation, which persisted even at long-term follow-up raising concern on the future of BRS. This review article discusses the development, design, clinical data, and future directions in the field of BRS.

Potent Thrombolytic Effect of N-Acetylcysteine on Arterial Thrombi.

Platelet cross-linking during arterial thrombosis involves von Willebrand Factor (VWF) multimers. Therefore, proteolysis of VWF appears promising to disaggregate platelet-rich thrombi and restore vessel patency in acute thrombotic disorders such as ischemic stroke, acute coronary syndrome, or acute limb ischemia. N-Acetylcysteine (NAC, a clinically approved mucolytic drug) can reduce intrachain disulfide bonds in large polymeric proteins. In the present study, we postulated that NAC might cleave the VWF multimers inside occlusive thrombi, thereby leading to their dissolution and arterial recanalization. Experimental models of thrombotic stroke induced by either intra-arterial thrombin injection or ferric chloride application followed by measurement of cerebral blood flow using a combination of laser Doppler flowmetry and MRI were performed to uncover the effects of NAC on arterial thrombi. To investigate the effect of NAC on larger vessels, we also performed ferric chloride-induced carotid artery thrombosis. In vitro experiments were performed to study the molecular bases of NAC thrombolytic effect, including platelet aggregometry, platelet-rich thrombi lysis assays, thromboelastography (ROTEM), and high-shear VWF string formation using microfluidic devices. We also investigated the putative prohemorrhagic effect of NAC in a mouse model of intracranial hemorrhage induced by in situ collagenase type VII injection. We demonstrated that intravenous NAC administration promotes lysis of arterial thrombi that are resistant to conventional approaches such as recombinant tissue-type plasminogen activator, direct thrombin inhibitors, and antiplatelet treatments. Through in vitro and in vivo experiments, we provide evidence that the molecular target underlying the thrombolytic effects of NAC is principally the VWF that cross-link platelets in arterial thrombi. Coadministration of NAC and a nonpeptidic GpIIb/IIIa inhibitor further improved its thrombolytic efficacy, essentially by accelerating thrombus dissolution and preventing rethrombosis. Thus, in a new large-vessel thromboembolic stroke model in mice, this cotreatment significantly improved ischemic lesion size and neurological outcome. It is important to note that NAC did not worsen hemorrhagic stroke outcome, suggesting that it exerts thrombolytic effects without significantly impairing normal hemostasis. We provide evidence that NAC is an effective and safe alternative to currently available antithrombotic agents to restore vessel patency after arterial occlusion.

Budd-Chiari Syndrome.

Budd-Chiari syndrome (BCS) is a rare disease with an incidence of 0.1 to 10 per million inhabitants a year caused by impaired venous outflow from the liver mostly at the level of hepatic veins and inferior vena cava. Etiological factors include hypercoagulable conditions, myeloprolipherative diseases, anatomical variability of the inferior vena cava, and environmental conditions. Survival rates in treated patients range from 42 to 100% depending on the etiology and the presence of risk factors including parameters of Child-Pugh score, sodium and creatinine plasma levels, and the choice of treatment. Without treatment, 90% of patients die within 3 years, mostly due to complications of liver cirrhosis. BCS can be classified according to etiology (primary, secondary), clinical course (acute, chronic, acute or chronic lesion), and morphology (truncal, radicular, and venooclusive type). The diagnosis is established by demonstrating obstruction of the venous outflow and structural changes of the liver, portal venous system, or a secondary pathology by ultrasound, computed tomography, or magnetic resonance. Laboratory and hematological tests are an integral part of the comprehensive workup and are invaluable in recognizing hematological and coagulation disorders that may be identified in up to 75% of patients with BCS. The recommended therapeutic approach to BCS is based on a stepwise algorithm beginning with medical treatment (a consensus of expert opinion recommends anticoagulation in all patients), endovascular treatment to restore vessel patency (angioplasty, stenting, and local thrombolysis), placement of transjugular portosystemic shunt (TIPS), and orthotopic liver transplantation as a last resort rescue treatment.

Subintimal angioplasty for lower limb arterial chronic total occlusions.

Subintimal angioplasty for lower limb arterial chronic total occlusions.

Three-Dimensional High-Definition Laparoscopic Treatment of Dunbar Syndrome (Celiac Axis Compression by Median Arcuate Ligament Hypertrophy) With Intra-Operative Laparoscopic Duplex Ultrasound Evaluation: Report of Two Cases

Introduction: Dunbar syndrome consists in a rare vascular disorder characterized by extrinsic compression of the celiac artery. This mechanic compression results in symptoms related to intermittent mesenteric ischemia. The goal of treatment is to release celiac artery compression and to restore vessel patency. Here we report two cases treated in our Surgical Department over the last four years. Case Report: A young female of 28 years-old, L.P., and 57-year-old men, E.G., both affected by recurrent post-prandial diffuse abdominal pain, diarrhea and weight loss came to our observation. A complete abdominal evaluation associated to radiologic exams made the diagnosis of CAC syndrome. Both patients were referred to a 3D laparoscopic surgical treatment of CACS with release of the median arcuate ligament. Vessels patency was checked intra-operatively using ecolaparoscopy. Conclusion: Median arcuate ligament section is the treatment of choice in Dunbar Syndrome, a rare vascular syndrome caused by extrinsic compression of the celiac trunk by a lower-inserted muscular bridge that connects the two crura of the diaphragm and crosses over the abdominal aorta. Minimally invasive 3D laparoscopic approach is ideal to treat Dunbar syndrome for the high definition and magnification of the 3D visualization. We perform an intraoperative laparoscopic duplex ultrasound investigation in the initial phase of the operation and at the conclusion of the procedure to assess the effectiveness of the treatment.

When and how to use BRS in bifurcations?

Bioresorbable coronary scaffolds (BRS) may offer potential advantages compared to metallic DES, aiming to restore vessel patency without implanting a permanent prosthesis, which may be especially important for bifurcation treatment. On the other hand, there are some inherent limitations, which may impact on the widespread use of BRS. In the current article we discuss the bench testing data and initial clinical results on BRS use in bifurcation lesions presented during European Bifurcation Club (EBC) meetings and review some of the limited number of published real-world registry results.

Paradigm Shifts in Atherosclerotic Renovascular Disease

Results of recent clinical trials and experimental studies indicate that whereas atherosclerotic renovascular disease can accelerate both systemic hypertension and tissue injury in the poststenotic kidney, restoring vessel patency alone is insufficient to recover kidney function for most subjects. Kidney injury in atherosclerotic renovascular disease reflects complex interactions among vascular rarefication, oxidative stress injury, and recruitment of inflammatory cellular elements that ultimately produce fibrosis. Classic paradigms for simply restoring blood flow are shifting to implementation of therapy targeting mitochondria and cell-based functions to allow regeneration of vascular, glomerular, and tubular structures sufficient to recover, or at least stabilize, renal function. These developments offer exciting possibilities of repair and regeneration of kidney tissue that may limit progressive CKD in atherosclerotic renovascular disease and may apply to other conditions in which inflammatory injury is a major common pathway.

Predictors and Outcomes Associated with Rescue Therapy in SWIFT

Introduction: In the Solitaire With the Intention For Thrombectomy (SWIFT) trial, rescue therapy was used when the Solitaire or Merci device was unable to restore vessel patency. Markers for nonrecanalization in acute stroke have been reported for intravenous tissue plasminogen activator; however, similar predictors are not known for endovascular therapy. We sought to identify predictors and outcomes associated with rescue therapy in the SWIFT trial. Methods: Rescue therapy included the use of an alternative device, agent, or maneuver following failure to recanalize with three retrieval attempts using the initial device. Clinical, angiographic, and demographic data was reviewed. Results: Among a total of 144 patients enrolled, 43 (29.9%) required rescue therapy. We used the same baseline demographics for patients with and without rescue therapy. Rescue therapy was used in a higher percentage of patients randomized to the Merci group compared with the Solitaire group (43 vs. 21%, p = 0.009). Patients with rescue therapy experienced a longer recanalization time (p < 0.001), a lower percentage of successful recanalization (p < 0.001), and a lower percentage of good outcome (p = 0.009). In multivariate analysis, patients randomized to the Merci group (OR 3.99, 95% CI 1.58, 10.10) and age >80 years (OR 3.51, 95% CI 1.06, 11.64) were predictors of rescue therapy. Conclusions: Merci treatment group and age were predictors of rescue therapy, while a trend toward an increased need of rescue therapy was observed with hypertension and proximal clot location. Rescue therapy was associated with fewer good outcomes. These findings may reflect targets for improvement in endovascular therapy.

Management of atherosclerotic renovascular disease after Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL).

Many patients with occlusive atherosclerotic renovascular disease (ARVD) may be managed effectively with medical therapy for several years without endovascular stenting, as demonstrated by randomized, prospective trials including the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial and the Stent Placement and Blood Pressure and Lipid-Lowering for the Prevention of Progression of Renal Dysfunction Caused by Atherosclerotic Ostial Stenosis of the Renal Artery (STAR) and ASTRAL. These trials share the limitation of excluding subsets of patients with high-risk clinical presentations, including episodic pulmonary edema and rapidly progressing renal failure and hypertension. Although hemodynamically significant, ARVD can reduce renal blood flow and glomerular filtration rate; adaptive mechanisms preserve both cortical and medullary oxygenation over a wide range of vascular occlusion. Progression of ARVD to severe vascular compromise eventually produces cortical hypoxia, however, associated with active inflammatory cytokine release and cellular infiltration of the renal parenchyma. In such cases ARVD produces a loss of glomerular filtration rate that no longer is reversible simply by restoring vessel patency with technically successful renal revascularization. Each of these trials reported adverse renal functional outcomes ranging between 16 and 22% over periods of 2-5 years of follow-up. Blood pressure control and medication adjustment may become more difficult with declining renal function and may prevent the use of angiotensin receptor blocker and angiotensin-converting enzyme inhibitors. The objective of this review is to evaluate the current management of ARVD for clinical nephrologists in the context of recent randomized clinical trials and experimental research.

Stent Revascularization Restores Cortical Blood Flow and Reverses Tissue Hypoxia in Atherosclerotic Renal Artery Stenosis but Fails to Reverse Inflammatory Pathways or Glomerular Filtration Rate

Atherosclerotic renal artery stenosis (ARAS) is known to reduce renal blood flow, glomerular filtration rate (GFR) and amplify kidney hypoxia, but the relationships between these factors and tubulointerstitial injury in the poststenotic kidney are poorly understood. The purpose of this study was to examine the effect of renal revascularization in ARAS on renal tissue hypoxia and renal injury. Inpatient studies were performed in patients with ARAS (n=17; >60% occlusion) before and 3 months after stent revascularization, or in patients with essential hypertension (n=32), during fixed Na(+) intake and angiotensin converting enzyme/angiotensin receptors blockers Rx. Single kidney cortical, medullary perfusion, and renal blood flow were measured using multidetector computed tomography, and GFR by iothalamate clearance. Tissue deoxyhemoglobin levels (R(2)*) were measured by blood oxygen level-dependent MRI at 3T, as was fractional kidney hypoxia (percentage of axial area with R(2)*>30/s). In addition, we measured renal vein levels of neutrophil gelatinase-associated lipocalin, monocyte chemoattractant protein-1, and tumor necrosis factor-α. Pre-stent single kidney renal blood flow, perfusion, and GFR were reduced in the poststenotic kidney. Renal vein neutrophil gelatinase-associated lipocalin, tumor necrosis factor-α, monocyte chemoattractant protein-1, and fractional hypoxia were higher in untreated ARAS than in essential hypertension. After stent revascularization, fractional hypoxia fell (P<0.002) with increased cortical perfusion and blood flow, whereas GFR and neutrophil gelatinase-associated lipocalin, monocyte chemoattractant protein-1, and tumor necrosis factor-α remained unchanged. These data demonstrate that despite reversal of renal hypoxia and partial restoration of renal blood flow after revascularization, inflammatory cytokines and injury biomarkers remained elevated and GFR failed to recover in ARAS. Restoration of vessel patency alone failed to reverse tubulointerstitial damage and partly explains the limited clinical benefit of renal stenting. These results identify potential therapeutic targets for recovery of kidney function in renovascular disease.

Endovascular Thrombectomy of a Renal Artery Chimney Stent-Graft Using the Solitaire Recanalization Device

The chimney graft technique is gaining popularity as an alternative endovascular treatment for juxtarenal aneurysms not suitable for standard or fenestrated endovascular aneurysm repair (EVAR).1–6 Despite excellent technical success,1,3–6 limited data are available regarding the long-term effectiveness of the technique, particularly in terms of chimney stent occlusion. This complication may have catastrophic consequences and represents a challenge for any endovascular approach, requiring in most the cases an open surgical bypass to restore vessel patency. Donas et al.1 used open thrombectomy to treat a renal chimney graft thrombosis. We encountered a symptomatic acute thrombosis of a renal chimney stent-graft, which we successfully treated with endovascular thrombectomy using a recanalization device that, in a recent article in the JEVT, proved useful in treating acute popliteal thrombosis.7

Abstract WMP3: Predictors And Outcomes Associated With Rescue Therapy In SWIFT

Introduction: In the Solitaire With the Intention For Thrombectomy (SWIFT) trial, rescue therapy was used when the Solitaire or Merci device was unable to restore vessel patency. Markers for non-recanalization in acute stroke have been reported for IV tPA, however similar predictors are not known for endovascular therapy. We sought to identify predictors and outcomes associated with rescue therapy in the SWIFT trial. Methods: Rescue therapy was defined per SWIFT study protocol, and included the use of an alternative device, agent, or maneuver following failure to recanalize with 3 retrieval attempts using the initial device. Clinical, angiographic, and demographic data was reviewed. Statistical analysis was performed using t-test or Wilcoxon methods and multivariate logistic regression analyses. Results: Among a total of 144 patients enrolled (31 roll-in phase Solitaire patients, and 113 randomized patients, 58 Solitaire, 55 Merci), 43 (29.9%) required rescue therapy. Baseline demographics for patients with and without rescue therapy were no different. Rescue therapy was used in a higher percentage of patients randomized to Merci than Solitaire (43% vs 21%, p = 0.009). Patients with rescue therapy experienced longer time to recanalization (p &lt; 0.001), a lower percentage of successful recanalization (p &lt; 0.001), and a lower percentage of good outcome (p = 0.009). In multivariate analysis, predictors of rescue therapy were those patients randomized to the Merci group (OR 3.99, 95% CI 1.58, 10.10) and patients over age 80 years (OR 3.51, 95% CI 1.06, 11.64). Non-significant trends toward an increased need for rescue therapy were observed in patients with hypertension (p = 0.09), and occlusions of the carotid terminus and M1 MCA compared with other locations (p = 0.10). No association was observed with rescue therapy and afib (p = 0.47) or IV tPA failure (p = 0.49), and rescue therapy was not associated with symptomatic ICH (p = 0.43). Conclusions: Predictors of rescue therapy included Merci treatment group and age, while trend toward an increased need of rescue therapy was observed with hypertension and proximal clot location. Rescue therapy was associated with fewer good outcomes. These findings may reflect targets for improvement in endovascular therapy.

Interventional Radiological Techniques and Current Devices in the Management of Iliofemoral Deep Vein Thrombosis

Iliofemoral Deep Vein Thrombosis (IF-DVT) is different from other types of lower extremity DVT because it has a much higher morbidity and causes more long-term damage. Early treatment with removal of thrombus and restoration of vessel patency gives symptomatic relief and reduces these complications. In this article, we present three cases of iliofemoral DVT treated successfully with pharmaco-mechanical thrombolysis using a variety of devices currently available. We demonstrate pre and post procedural imaging findings and discuss the current interventional radiological techniques and devices available for the treatment of iliofemoral deep vein thrombosis.