Stenotic Lesions Research Articles

Long-term results of large common iliac artery aneurysms caused by Kawasaki disease in four patients.

Among Kawasaki disease patients with systemic artery aneurysms, the brachial and internal iliac arteries are the most commonly affected, and occlusions of both arteries are often found. However, the long-term fate of large common iliac artery aneurysms remains unknown, because their prevalence is very low. The long-term outcomes of common iliac artery aneurysms caused by Kawasaki disease in four patients (three females, one male) were investigated retrospectively based on their medical records and angiograms. Their ages ranged from 30 to 36 years-old. The onset age of Kawasaki disease ranged from 4 to 8 months, and the interval from the onset of Kawasaki disease to the latest angiogram ranged from 17 to 21 years. All patients had bilateral large coronary aneurysms and common iliac artery aneurysms with maximal diameters greater than 10 mm. Although all patients had multi-vessel coronary artery stenotic lesions and systemic artery aneurysms, they were asymptomatic. The three female patients underwent coronary artery bypass grafting, and the male patient underwent replacement of artificial vessels for large bilateral common iliac artery aneurysms at 3 years old of age. Over the long-term, common iliac artery aneurysms greater than 10 mm persisted as calcified aneurysms. However, they had no symptoms due to their common iliac artery aneurysms, and their ankle brachial pressure index was preserved, even if the stenosis of the common iliac artery developed as a late outcome, because the collateral arteries were well developed. The progression of stenosis of the common iliac artery after Kawasaki disease was slower.

"CIRCLE OF VIEUSSENS": A LIFE-SAVING CORONARY ARTERY ANOMALY IN A PATIENT WITH KAWASAKI DISEASE

"CIRCLE OF VIEUSSENS": A LIFE-SAVING CORONARY ARTERY ANOMALY IN A PATIENT WITH KAWASAKI DISEASE

S2353 Esophageal Hyperkeratosis Complicated by Recurrent Dysphagia

Introduction: Esophageal hyperkeratosis (EH) is a rare condition characterized by keratinization of the esophageal epithelium. The pathophysiology is poorly understood, and risk factors remain unclear. We present a case of severe long segment EH leading to severe esophageal stenosis. Case Description/Methods: A 70-year-old male with a long history of gastroesophageal reflux disorder (GERD) presented to the ED with acute food impaction. Prior to his presentation, he reported worsening dysphagia and ongoing heartburn for several months. He had been lost to follow-up and was not on any antacids at the time of presentation. Emergent upper endoscopy (EGD) was performed to remove the food impaction. Additional findings on EGD showed esophagitis, esophageal stenosis of 13cm in length (7mm in diameter), and white plaques. Esophageal biopsies were negative for eosinophils but confirmed candida and were suggestive of esophageal hyperkeratosis. Dilation was deferred until the esophagitis was treated with PPI and itraconazole. Repeat EGD one month later showed ongoing stenosis, healed esophagitis, as well as significantly thickened esophageal mucosa extending 13 cm proximally from the GE junction (Figure A, B). Balloon dilation of the stenotic lesion was performed. Repeat biopsies confirmed esophageal hyperkeratotic squamous epithelium with parakeratosis and no dysplasia (Figure C). Due to the severity of his stenosis, he subsequently underwent multiple EGDs with balloon dilations over the next several months to obtain a maximum esophageal lumen diameter of 19mm. Dilation of his esophagus was particularly difficult due to the length of hyperkeratosis, degree of stenosis, and loss of elasticity of his esophageal mucosa. Tearing of the tissue and bleeding were common even with small interval increases during each dilation session. In addition, healing of the tissue between sessions often led to a restricturing of his esophagus. He is currently symptom-free on pantoprazole 40mg twice a day, a soft diet, and undergoing surveillance endoscopies every 6 months with balloon dilations. Discussion: Esophageal hyperkeratosis is a rare disorder with thickening of the stratum corneum and occurs in 2% of esophageal biopsies. While the prevalence and pathophysiology are unclear, it is thought to be associated with GERD, vitamin A deficiency, zinc deficiency, and a low fiber/low residue diet. There is also some evidence to suggest it may be associated with an increased risk of squamous cell carcinoma.Figure 1.: 1: a and b) EGD of middle and lower esophagus showing irregular mucosa with furrowing and white exudate, pre-dilation. 1c) Magnification 400x. Histopathology demonstrates esophageal squamous mucosa with dyskeratosis and extensive hyperkeratosis (black arrow).

Capture of Part of a Vessel Wall by a Coronary Orbital Atherectomy System

An 82-year-old man who had undergone coronary artery bypass grafting, aortic/mitral valve replacement, and tricuspid valvuloplasty was seen for exertional angina. On angiography, a severely stenotic lesion of the distal left internal thoracic artery (LITA) was noted, which was a bypass graft to the left anterior descending (LAD) artery (Fig. 1A, arrow). The LAD artery showed chronic total occlusion (CTO; Fig. 1B, arrow). We thought that if an angioplasty for the stenotic lesion in the LITA failed, then significant damage would occur in the LAD artery area.

Comorbidities in Patients before Surgical Myocardial Revascularization: Current State of the Problem. Part IІ

The first part of the article was dedicated to the problem of comorbidities in cardiac surgery patients with coronary artery disease (CAD), considered modern literary sources discussing endocrinopathies, connective tissue diseases, COVID-19-associated autoimmune processes, chronic kidney disease and diseases of the gastrointestinal tract.
 The aim. To continue the analysis of current literature data on comorbidities in patients hospitalized for surgical myocardial revascularization.
 Results. When assessing the preoperative status of a cardiac surgery patient with CAD, not only their cardiological status and the percentage of stenotic lesion of the coronary arteries are important, but also the presence of concomitant diseases and the degree of their compensation. According to the modern literary sources, 4-20.5% of patients undergoing coronary artery bypass grafting (CABG) have chronic pulmonary disease (COPD). In order to avoid bronchopulmonary complications in the postoperative period, high-quality preoperative diagnosis based on spirometric research is important. When verifying COPD, even of a moderate degree, a course of preventive therapy is required, and in the case of a severe course of COPD with a forced expiratory volume <50%, the involvement of a pulmonologist is necessary. Hemodynamically marked stenoses of brachiocephalic arteries are found in 6-12% of patients before CABG. According to European recommendations, ultrasound screening of carotid arteries is indicated for patients ≥70 years of age with multivessel lesions of the coronary arteries and a history of neurological disorders <6 months before planned cardiac surgery. Dementia is diagnosed in 9.6-20% of patients before CABG and is characterized by a higher rate of mortality and postoperative complications. It was established that the result of the cognitive function assessment using the Mini-Mental State Examination (MMSE) scale <24 is an independent risk factor for in-hospital mortality and postoperative delirium. Concomitant disease of peripheral arteries is diagnosed in 6.1-20.4% of patients before CABG and negatively affects both immediate and long-term results of myocardial revascularization.
 Conclusions. Timely verification and compensation of comorbidities is an important point in the perioperative management of cardiac surgery patients with CAD. The systemic nature of the atherosclerotic process leads to multifocal stenotic lesions of the arterial system, which requires from the heart team not only to determine the priority of surgical interventions, but also to choose the optimal method of myocardial revascularization, taking into account comorbidities.

432. A CASE OF ADVANCED ESOPHAGEAL CARCINOSARCOMA DIAGNOSED LATE DUE TO SEVERE STENOSIS AFTER CHEMORADIOTHERAPY

Abstract Radiochemotherapy (CRT) is one of the curative treatment options next to surgery in the treatment of esophageal squamous cell carcinoma. However, CRT may cause esophageal stenosis or obstruction during the healing process. Therefore, in such cases, follow up of early recurrence detection becomes an issue for those patients. We report a case of severe stenosis after CRT, in which recurrence could not detected until advanced cancer developed on the anal side of stenosis. The case is a 73-year-old male. He was diagnosed with upper thoracic esophageal cancer (T4N2M0StageIVa) and had undergone radical chemoradiotherapy 5 years ago. The treatment effect achieved a complete response, but the primary tumor site caused severe esophageal stenosis. Therefore, biannual CT follow up had been done instead of endoscopic follow up. During follow-up, CT revealed a new neoplastic lesion in the lower thoracic esophagus, and endoscopy inserted through a gastrostomy revealed a bulky tumor on the anorectal side of the stenotic lesion. Biopsy revealed carcinosarcoma and robot-assisted thoracoscopic esophagectomy was performed. Malignant neoplasms can be developed not only the same site of primary tumor after CRT. Especially in case of carcinosarcoma, detection would be delayed because of rapid growing. But when the severe esophageal stenosis occurred after CRT, the examination of anal side become difficult. Therefore, it is necessary to observe by frequent CT or PET examination, or endoscopy from gastrostomy for early detection of recurrence or newly malignant neoplasm.

Pure Endovascular versus Hybrid Approach for Management of Iliofemoral Arterial Disease: A Randomized Controlled Trial.

Common femoral artery (CFA) atherosclerotic lesions currently remain one of the last limitations for adoption of endovascular repair as the first-line treatment, easy surgical accessibility, and, last but not least, favorable long-term outcomes, still making CFA disease treatment part of the surgical domain. In the last 5 years, improvement of the endovascular equipment and technical skills of the operators have led to an increase in percutaneous CFA procedures. A single-center randomized prospective study of 36 symptomatic (Rutherford 2-4) CFA stenotic or occlusive lesions were included, and patients were randomized over two groups based on the management approach SUPERA versus hybrid technique. Patients had a mean age 60.8 ± 8.2 years. Thirty-two (88.9%) patients reported improvement of the clinical symptoms, 28 (87.5%) patients had intact pulse postoperatively, and 28 (87.5%) had patent vessels. Follow-up showed that none developed reocclusion or restenosis during the period of follow-up. Comparison of difference in peak systolic velocity ratio (PSVR) among study groups showed that the hybrid technique had more reduction of PSVR postintervention compared to the SUPERA group with a p -value of < 0.0001. Safety and feasibility of endovascular approach with the SUPERA stent to the CFA (no stent zone) has low incidence of postoperative morbidity and mortality in well experienced surgical hands.

The optimal management of ruptured basilar artery dissecting aneurysms: a case series and scoping review.

The natural history of ruptured basilar artery dissecting aneurysms (BADAs) remains unclear compared to that of ruptured vertebral artery dissecting aneurysms (VADAs). In this study, we investigated the natural history and optimal management of ruptured BADAs. We identified 17 patients with ruptured BADA among 4586 patients with aneurysmal subarachnoid hemorrhage (SAH) treated in seven participating hospitals. A scoping literature review was undertaken to investigate prognostic factors. Six patients among the profiled patients (35.3%) died, all with poor SAH grades (World Federation of Neurological Societies Grade IV and V). Rebleeding after admission was observed in three patients (17.6%) with poor SAH grades. Aggressive treatment and conservative management were initiated in seven and ten patients, respectively. Patients with good SAH grades had significantly higher favorable treatment outcomes than those with poor grades (83.3% vs. 9.1%, P = 0.005). Moreover, based on a scoping review of 158 cases with ruptured BADA, including the patients from our series, approximately 90% of patients with good SAH grades had favorable outcomes. A good SAH grade and no rebleeding after admission were favorable prognostic factors (P < 0.0001 and P = 0.002, respectively). The rebleeding rates were 20.2%, 13.3%, and 6.3% for dilated, pearl and string, and stenotic lesions, respectively. We concluded that the natural history of isolated ruptured BADAs may be better than that of VADAs. Although definitive treatment, if possible, is undoubtedly important, conservative management with careful radiological follow-up for morphological changes might be a viable option for patients in good clinical condition and with non-dilated lesions.

Left Main Coronary Artery Arising from the Right Coronary Sinus Presenting as Acute Coronary Syndrome

Coronary artery anomalies are extremely rare with a prevalence of 2.33% and they are extremely difficult to diagnose with the help of conventional tests. Once diagnosed, the associated life-threatening risks and complications that arise during surgical management are the dangers related to such anomalies. We present a case of a 45–year-old female, with chief complaints of chest pain radiating to back and left shoulder associated with palpitations for 7 days, a known case of systemic hypertension and diabetes mellitus type 2 for 7 years on regular medications. A series of investigations were conducted that included an electrocardiogram showing ischemic changes, a two-dimensional echocardiography that revealed globally dysfunctional left ventricle and an ejection fraction of 45%, and finally, a diagnostic coronary angiography leading to the diagnosis of the an abnormal origin of the left main coronary artery through the right coronary sinus associated with 80% stenotic lesion in the “left anterior descending artery” and 90% stenotic lesion in the “left circumflex artery”. The report concludes that anomalies arising from coronary arteries are extremely infrequent and difficult to diagnose. In addition, they can present with life-threatening complications during surgical management.

Multicentre experience with optimus balloon-expandable cobalt-chromium vascular stents in congenital heart disease interventions: Early outcomes and extended possibilities

Optimus™ and Optimus-CVS® (AndraTec, Germany) are balloon-expandable, cobalt-chrome, hybrid-cell designed stents with promising bare-metal and PTFE-covered specifications. We aim to evaluate Optimus stents in congenital heart disease (CHD) interventions. Retrospective multicentre review of CHD patients receiving Optimus stents. Stent mechanical behavior, clinical indications, and outcomes were assessed. A total of 132 stents (48.5% PTFE-covered, 53% XXL/15ZIG, 29.5% XL/12ZIG, 17.4% L/9-ZIG) were implanted (98.3% success rate) in 121 patients (59.5% males, 64.5% adults), median age 23.7 years (IQR, 15.5–40.7), and weight 63.5Kg (IQR, 49.5–77). Indications were right ventricular outflow tract standalone stenting or before revalvulation (66.1%), aortic coarctation treatment (14%), Fontan-circuit fenestration closure (9.9%), and miscellaneous (9.9%). 64 patients had covered stenting that was prophylactic in 45.3% of cases. In stenotic lesions (65/121, 53.7%), median percentage of achieved stent expansion was 91.3% (IQR, 82.3–96.8%), median vessel diameters increased from 13.8 mm (IQR, 9–17.3 mm) to 20.3 mm (IQR, 15.9–22.3 mm) ( P < 0.001), and percentage of vessel expansion was 39.4% (IQR, 18.6-84.3%). Median gradient across stenotic lesions decreased from 31 mmHg (IQR, 21–41) to 5 mmHg (IQR, 1–9) ( P < 0.001). In 20/28 (71.4%) patients, graft was dilated a median of 2 mm (IQR, 2–6 mm) above nominal diameter. Median stent shortening was 11% (IQR, 6.3%–15.1%) and was associated only with expansion diameter (OR: 0.58, 95% CI: 0.22–0.93). There was no stent embolization or dysfunction on follow-up, median 8 (IQR, 4–12) months. Optimus stents are effective tools for transcatheter treatment of simple and complex CHD. Optimus reliable mechanical behavior and particular covering design can promote widespread use.

Factors Predicting 150 and 200 Microgram Adenosine Requirement during Four Increasing Doses of Intracoronary Adenosine Bolus Fractional Flow Reserve Assessment.

Direct intracoronary adenosine bolus is an excellent alternative to intravenous adenosine fractional flow reserve (FFR) measurement. This study, during four increasing adenosine boluses (50, 100, 150, and 200 mcg), aimed to explore clinical and angiographic predictors of coronary stenotic lesions for which the significant ischemic FFR (FFR ≤ 0.8) occurred at 150 and 200 mcg adenosine doses. Data from 1055 coronary lesions that underwent FFR measurement at the Central Chest Institute of Thailand from August 2011 to July 2021 were included. Baseline clinical and angiographic characteristics were analyzed. The FFR ≤ 0.8 occurred at adenosine 150 and 200 mcg boluses in 47 coronary lesions, while the FFR ≤ 0.8 occurred at adenosine 50 and 100 mcg boluses in 186 coronary lesions. After univariable and multivariable logistic regression analyses, four characteristics, including male sex, younger age, non-smoking status, and FFR procedure of RCA, were predictors of the occurrence of FFR ≤ 0.8 at adenosine 150 and 200 mcg doses. Combining all four predictors as a predictive model resulted in an AuROC of 0.72 (95% CI: 0.68–0.76), an 86% negative predictive value. Comparing these four predictors, the FFR procedure of RCA gave the most predictive power, with the AuROC of 0.60 (95% CI: 0.56–0.63).

Medium Term Outcomes of Deep Venous Stenting in the Management of Venous Thoracic Outlet Syndrome

Venous thoracic outlet syndrome (vTOS) is a relatively rare condition associated with significant morbidity. Its management continues to evolve, with increasing use of endovascular adjuncts, such as percutaneous thrombectomy and angioplasty, in addition to first rib resection. The utility of stenting residual venous stenotic lesions is poorly defined within the literature. This study sought to review the medium term patency rates of upper limb deep venous stenting in the management of vTOS. A single centre, retrospective review of patients managed for vTOS with first rib resection followed by upper limb deep venous stenting between January 2012 and February 2021 was conducted. Post-procedural ultrasounds were reviewed to determine stent patency. Twenty-six patients were included, with 33 stents placed. The median duration of follow up was 50 months. On venous duplex ultrasound at three years post-operatively, primary patency rates were 66%, primary assisted patency rates were 88%, secondary patency rates were 91%, and total occlusion rates were 9%. After stent placement, 80% of patients remained asymptomatic with regard to compression symptoms. Upper limb deep venous stenting is an effective adjunct to surgical decompression in the management of vTOS. Stent medium term patency rates are promising; however, further studies with longer follow up and larger cohorts with multicentre results are required to confirm these early findings.

577 Infra-Inguinal Bypass Graft Surveillance Is an Opportunity to Optimise Statin and Antiplatelet Therapy to Reduce 12-Month Major Amputation and Mortality Rates

Abstract Aim Infra-inguinal bypass graft failure within the first two postoperative years can result from stenotic lesions within the conduit and near anastomosis. This study assesses graft surveillance uptake, patency, amputation, and death rates among infra-inguinal bypass surgery patients at 1, 6 and 12-months postoperatively. Method Patients undergoing infra-inguinal bypass at a single vascular centre between 1st January 2018 and 31st December 2019 were identified from the prospectively collected database. Primary outcomes at 1, 6 and 12-months postoperatively included: duplex-ultrasound (DUS) surveillance uptake, patency, major amputations, and death rates. Statistical analysis with SPSS® was performed using chi-squared tests and paired sample t-tests. Results Of the 91 patients included, 79.1% were men and median(IQR) age was 71(62–76). At 1, 6 and 12 months, DUS uptake was 74.2%, 77.5% and 73.3% respectively, primary-assisted patency rates were 88.2%, 78.8% and 65.3% respectively and secondary patency rates were 97.6%, 96.3% and 96.3% respectively. Major amputation rates at 1, 6 and 12 months were 5.4%, 8.6%, 8.6% respectively. Death rates at 1, 6 and 12 months were 3.2%, 5.4% and 10.8% respectively. Patients on statin therapy post-operatively had lower 12-month mortality than those not on statin therapy (7.7% vs 30.0%, p=.028). Major amputation rate at 12 months was lower among patients prescribed antiplatelet therapy (6.3% vs 40%, p=.008). Conclusions DUS graft surveillance is a vital opportunity to adequately optimise statin and antiplatelet therapy post-revascularisation to reduce 12-month major amputation and mortality rates.

The Modeling of Magnetic Detection of Iron Oxide Nanoparticles in the Stream of Patient-Specific Artery With Stenotic Lesion: The Effects of Vessel Geometry and Particle Concentration

Magnetic nanoparticles (MNPs) prepared as stable colloidal suspensions dispersed in water have attracted special interest for biological applications. MNPs of iron oxide synthesized by a laser target evaporation (LTE) technique are excellent candidates for biomedical purposes. Magnetic fluid flowing through the blood vessel creates magnetic fields which can be detected by magnetic field sensor. In this work, the finite element method modeling (FEM) was used for calculation of the flow of ferrofluid containing magnetic iron oxide MNPs through a real coronary artery reconstructed from the routine angiography examination of a patient. The main objective of the study is to validate the possibility of the application of magnetic field sensor for the blood vessel geometry evaluation. The contribution of the magnetic susceptibility of MNPs, blood vessel diameter, and particular geometry as well as the orientation of the magnetic field sensor working on the principle of giant magnetoimpedance (GMI) were comparatively analyzed.

Factors Determining Primary Coronary Slow Flow Phenomenon among Opium Users and Non-users: A Case Control Study in Northern Iran.

Coronary slow flow phenomenon (CSFP) represents a clinical entity with recurrent chest pain leading to living impairment. The present study aimed to investigate whether opium use correlates with primary CSFP. This study included Iranian patients with suspected coronary artery disease who underwent myocardial perfusion imaging. Coronary blood flow was measured quantitatively using the thrombolysis in myocardial infarction (TIMI) frame count and slow flow was defined as TIMI grade 2 standard deviations. Age and clinical conditions including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLP), history of chest pain, and opium use were recorded. First, the characteristics of the two groups were compared and then the main analyses were conducted to examine the relationship between CSFP and opium use. Data were analyzed using t test and chi-square test via SPSS 25.0. The significance level was set at P<0.05. This study was conducted on 44 male patients with documented CSFP who had no stenotic lesions and 134 control group male patients who had normal coronary arteries with normal flow. The mean age was similar in the two groups (54.25 vs.52.69, P=0.474). Two groups were significantly different in terms of history of chest pain (P=0.003), but there was no significant difference in HTN (P=0.084), DM (P=0.284), HLP (P=0.183), smoking (P=0.696), and opium use (P=0.107). This study indicated that opium use is not associated with primary CSFP.

Benign Esophageal Stricture

Benign esophageal strictures, characterized by fibrotic narrowing of the esophageal lumen, are frequently encountered in clinical practice. Benign esophageal strictures are associated with a multifactorial etiology and may occur across various age and population groups. Common causes of benign esophageal strictures include gastroesophageal reflux disease (peptic stricture), esophageal injury secondary to surgery (anastomotic strictures), radiotherapy, caustic agent ingestion, or endoscopic resection. Benign esophageal strictures are categorized into simple and complex types based on their size, area involved, surface features, extent of luminal narrowing, and margins. Esophageal strictures often present clinically with dysphagia and may lead to severe complications. Regardless of the underlying cause, therapy is aimed at relief of dysphagia and prevention of stricture recurrence. Benign esophageal strictures are commonly treated using endoscopic balloon or bougie dilation, followed by disease-specific approaches to treat underlying inflammation. However, based on the underlying cause, the risk of recurrence of benign esophageal strictures is 10~30%. Therapeutic options for refractory or recurrent esophageal strictures include endoscopic incisional therapy, esophageal stent placement, or intralesional injection of steroids or mitomycin C. The pathophysiology of esophageal strictures is complicated, and thorough understanding and patient cooperation are important for optimal management. Physicians should familiarize themselves with the various dilation strategies available and their application for management of specific types of stenotic lesions. In this article, we review the evaluation and management of patients with esophageal strictures.

O069 Infra-inguinal bypass graft surveillance is an opportunity to optimise statin and antiplatelet therapy to reduce 12-month major amputation and mortality rates

Abstract Introduction Infra-inguinal bypass graft failure within the first two postoperative years can result from stenotic lesions within the conduit and near anastomosis. This study assesses graft surveillance uptake, patency, amputation and death rates among infra-inguinal bypass surgery patients at 1, 6 and 12-months postoperatively. Methods Patients undergoing infra-inguinal bypass at a single vascular centre between 1st January 2018 and 31st December 2019 were identified from the prospectively collected database. Primary outcomes at 1, 6 and 12-months postoperatively included: duplex-ultrasound (DUS) surveillance uptake, patency, major amputations and death rates. Statistical analysis with SPSS® was performed using chi-squared tests and paired sample t-tests. Results Of the 91 patients included, 79.1% were men and median (IQR) age was 71(62–76). At 1, 6 and 12 months, DUS uptake was 74.2%, 77.5% and 73.3% respectively, primary-assisted patency rates were 88.2%, 78.8% and 65.3% respectively and secondary patency rates were 97.6%, 96.3% and 96.3% respectively. Major amputation rates at 1, 6 and 12 months were 5.4%, 8.6%, 8.6% respectively. Death rates at 1, 6 and 12 months were 3.2%, 5.4% and 10.8% respectively. Patients on statin therapy post-operatively had lower 12-month mortality than those not on statin therapy (7.7% vs 30.0%, p=.028). Major amputation rate at 12 months was lower among patients prescribed antiplatelet therapy (6.3% vs 40%, p=.008). Conclusion DUS graft surveillance is a vital opportunity to adequately optimise statin and antiplatelet therapy post-revascularisation to reduce 12-month major amputation and mortality rates. Take-home message Infra-inguinal bypass graft surveillance is an opportunity to optimise statin and antiplatelet therapy to reduce 12-month major amputation and mortality rates.

Intravascular ultrasound evaluation during iliofemoral venous stenting is associated with improved midterm patency outcomes

ObjectiveIntravascular ultrasound (IVUS) examination is increasingly used in the treatment of iliofemoral venous disease and provides more sensitive and specific detection of stenotic lesions when compared with traditional multiplanar venography alone. Correlations with deep venous stent patency, however, have not yet been investigated. The objective of the study was to evaluate the impact of the use of IVUS examination in addition to multiplanar venography on iliofemoral venous patency. MethodsConsecutive patients who underwent stenting for symptomatic thrombotic or nonthrombotic iliofemoral venous lesions (NIVLs) between 2014 and 2020 at a single institution were identified and divided into two groups based on whether IVUS examination was used before stent deployment in addition to multiplanar venography compared with venography alone. A retrospective review of demographic, operative, and follow-up data was performed. Thirty-day and 2-year stent patency were measured as primary end points. χ2 analysis, logistic regression models, and Kaplan-Meier survival analysis were used to determine outcomes. Technical details and outcomes were additionally examined among patients treated for acute deep venous thrombosis, post-thrombotic syndrome, or NIVLs separately on subgroup analysis. ResultsWe identified 150 patients (173 limbs, 23 bilateral) who underwent iliofemoral stenting during the study period at our institution (mean age: 48.8 ± 16.8 years, 61% female). Adjunctive IVUS utilization before stent deployment was reported in 69 of 173 (39.9%) treated limbs. IVUS examination was more likely to be used in patients who underwent stenting for NIVLs compared with thrombotic disease (41.0% vs 11.2%, P < .01). There was no difference in the number of stents deployed between IVUS and non-IVUS cohorts. However, IVUS examination was associated with the increased total length of the stent deployed (126 ± 56 vs 112 ± 48 mm, P = .04) and a higher rate of infrainguinal stent extension (17.4% vs 6.7%, P = .03). In addition, mean stent diameter was significantly higher when IVUS examination was performed before stent placement (16.3 ± 3.7 vs 15.2 ± 1.9 mm, P < .01). Both 30-day (98.5% vs 89.4%, P = .02) and 2-year (90.3% vs 78.7%, P = .03) primary patency were significantly higher in the IVUS cohort. Adjunctive IVUS use was found to significantly protect against stent reintervention at 2 years on adjusted Cox regression analysis (hazard ratio: 0.22, 95% confidence interval: 0.07-0.71, P = .01). ConclusionsAdjunctive IVUS utilization is associated with differences in stent diameter and length selections as well as landing segments in the treatment of thrombotic and nonthrombotic iliofemoral venous disease. IVUS examination before stent deployment significantly protects against 30-day and 2-year stent reintervention when compared with the use of multiplanar venography alone. These data provide stronger evidence for routine IVUS use in addition to venography before iliofemoral venous stenting.

Influence of angioplasty and stenting on intracranial artery stenosis: preliminary results of high-resolution vessel wall imaging evaluation.

To investigate whether the imaging changes on high-resolution vessel wall imaging (HR-VWI) in patients before and after percutaneous transluminal angioplasty and stenting (PTAS) contribute to predicting the clinical outcome. The study included 24 severe intracranial artery stenosis (SICAS) patients undergoing PTAS with Wingspan Stent between 2018 and 2020 and had a 1-year follow-up. Three HR-VWI sessions (preprocedural, early [within 24 h], and delayed postprocedural [134.7 ± 27.1 days)]) in each subject were performed with 3-Tesla MRI. We evaluated periprocedural HR-VWI changes in patients with and without recurrent cerebral ischemic symptoms (RCIS) within 1-year follow-up. On CE-T1WI of the patients without RCIS, a significant decrease in enhanced area was observed on early postprocedural (0.04 ± 0.02 cm2, p = 0.001) and delayed postprocedural (0.04 ± 0.02 cm2; p = 0.001) HR-VWI compared to preprocedural (0.07 ± 0.02 cm2) HR-VWI. Patients with RCIS demonstrated no significant loss of enhanced area on CE-T1WI of early postprocedural HR-VWI (p = 0.180). Significant decreases in calibrated T1 signals were observed in both presence (1.77 ± 0.70 vs. 0.79 ± 0.52; p = 0.018) and absence (1.42 ± 0.62 vs. 0.83 ± 0.40; p = 0.001) of RCIS in early postprocedural HR-VWI. The preliminary results showed the presence of reduced contrast enhancement immediately after PTAS may indicate less recurrent stroke events within 1 year. Further studies are necessary to confirm the phenomena in a longer observation period. • Early postprocedural high-resolution vessel imaging (HR-VWI) within 24 h can effectively predict a 1-year outcome following intracranial stenting. • For stenotic lesions after stenting without reduced contrast enhancement on HR-VWI within 24 h may need closer clinical surveillance for potentially higher risk of stroke events within 1 year.

Myocardial deformation indices for detection of the functional significance of intermediate left anterior descending coronary artery stenosis: FFR guided study

This study aimed to investigate the diagnostic performance of non-invasive resting myocardial deformation indices in identifying functional significance of intermediate stenosis of the left anterior descending (LAD) artery. Patients with 50–70% LAD stenosis upon coronary angiography were enrolled and divided into group I with fractional flow reserve (FFR) > 0.8 and group II with FFR ≤ 0.8. Patients were subjected to conventional and speckle tracking echocardiography with measurement of myocardial deformation indices including regional peak longitudinal strain (PLS), global longitudinal strain (GLS), Post-systolic strain index (PSI), and time interval between Aortic valve closure (AVC) and PLS. The current study included 200 patients. Group II patients had significantly lower absolute mean values of regional (PLS) and (GLS) compared to group I (− 14.98 ± 5.05 and − 18.73 ± 3.92 vs. − 17.59 ± 3.62 and − 19.20 ± 2.61, p = 0.001 and 0.02, respectively). The FFR values of LAD correlated significantly and negatively with the time interval between AVC and regional PLS (r = − 0.201, p = 0.004) as well as PSI (r = − 0.257, p < 0.001). For identifying cases with FFR ≤ 0.8, the optimal cut-off value of the time interval between AVC and PLS was 76 ms with 77.8% sensitivity and 93.8% specificity. The best cut-off value of PSI was 13%, yielding 50% sensitivity and 87.5% specificity. In patients with intermediate 50–70% LAD coronary artery stenotic lesions, the PSI and the duration between AVC and regional PLS enabled the identification of functionally significant lesions with reasonable diagnostic accuracy.Trial registration ZU-IRB#3199-20-11-2015 Registered 20 November 2015, IRB_123@medicine.zu.edu.eg.