Journal of Endovascular Therapy最新文献

N-butyl cyanoacrylate (NBCA) is commonly used in interventional radiology procedures for its efficacy in vessel occlusion, yet it poses risks of embolic material migration. We present a unique case of NBCA cast migration during deep circumflex iliac artery (DCIA) embolization, leading to occlusion of the dorsalis pedis and posterior tibial arteries, subsequently retrieved using a stent retriever device. A 68-year-old woman with a history of heart valve replacement presented with a large intramuscular hematoma. N-butyl cyanoacrylate embolization of DCIA resulted in cast migration, occluding distal arteries. Retrieval was attempted using a stent retriever device, successfully restoring arterial flow. N-butyl cyanoacrylate use necessitates attention to vascular anatomy and test injections to mitigate complications. Stent retriever devices, originally designed for acute stroke thrombectomy, offer a viable solution for embolic material retrieval in vascular interventions. This case highlights successful NBCA cast retrieval in lower extremity arterial occlusion using a stent retriever device. Prompt recognition and intervention are crucial in mitigating complications associated with NBCA use. Stent retriever devices present a valuable tool for NBCA cast retrieval, preserving arterial perfusion in affected areas.Clinical ImpactThis case highlights the innovative application of stent retriever devices for retrieving migrated NBCA casts, traditionally used for stroke management in peripheral arterial occlusions. This adaptation offers clinicians a new, effective tool for managing embolization complications, such as unintended material migration that can cause severe ischemia. Implementing this technique could change clinical practice by providing a reliable method to swiftly address and resolve potentially limb-threatening situations, thereby improving patient outcomes and procedural safety. This advancement in interventional radiology enhances clinicians' ability to handle complex embolic events with greater confidence and efficacy.

Background: Previous reports have shown comparable outcomes between drug-eluting stents (DESs) and drug-coated balloons (DCBs) for treating femoropopliteal artery (FPA) lesions; however, DCB outcomes include approximately 10% to 50% bailout stents. Therefore, comparing DESs and DCBs is not simple. The aim of this study was to compare the clinical outcomes of DESs and DCBs in patients with symptomatic FPA disease.

Materials and methods: Using the registries of 7 institutions, we retrospectively reviewed the records of 1356 patients who underwent endovascular therapy for FPA with DESs (n=333; Eluvia, 74.0%; Zilver PTX stent, 26.0%) or DCBs without bailout stents (n=1023; IN.PACT, 67.6%; Lutonix, 32.4%). The primary outcome was the 1-year primary patency comparison between DESs and DCBs, using propensity score matching. The severity of the dissection pattern after predilatation (none or grades A-C) was included as an explanatory variable for matching. Patients with grade D dissections were excluded from the main analysis and assessed independently.

Results: After matching, the 1-year primary patency between DESs and DCBs was similar (88.8% vs 85.2%, p=0.31). By contrast, perioperative complications were frequent with DES, compared with DCB (5.1% vs 2.2%, p=0.005), and the intravascular ultrasound-evaluated minimum luminal area was significantly larger with DES than with DCB (19 mm² vs 14 mm², p<0.001). In the supplemental analysis of lesions with grade D dissection, the 1-year primary patency was significantly higher with DES than with DCB (86.1% vs 55.1%, p=0.014).

Conclusion: In FPA lesions without severe dissection (ie, no dissection or grade A-C dissection), DESs and DCBs showed comparable 1-year primary patency in matched populations. However, DCBs did not perform well with severe dissection (ie, grade D or more).Clinical ImpactThe results of this study clearly define the appropriate boundaries for the "leaving nothing behind" strategy. Clinicians can now more clearly differentiate between the use of DES and DCB, based on the results of lesion preparation. Further prospective investigations with well-designed trials and larger populations are necessary to confirm these findings.

Purpose: The study investigated the association between cell-stent area and cerebrovascular events incidence in asymptomatic patients undergoing carotid artery stenting (CAS).

Materials and methods: This is an observational, retrospective, multicenter, cohort study. Between 2012 and 2022, all patients undergoing primary CAS for severe asymptomatic carotid artery stenosis were evaluated. Three groups were defined on the basis of the cell area (open cell, OC; closed cell, CC; double layer, DL). Periprocedural primary outcomes were 30-day stroke, mortality, myocardial infarction (MI), and major adverse event (MAE, stroke/mortality composite outcome) rates. Follow-up primary outcomes included overall survival, stroke-free survival (SFS), freedom from ipsilateral stroke (FFiS), and freedom from stroke-related mortality (FF-SRM). Data were analyzed at short-term (1 year) and mid-term (2.5 years) period.

Results: A total of 1096 CAS were considered (787 men, 71.8%, median age = 74 years). Technical success was achieved in 99.5% procedures. Periprocedural 30-day stroke rate was 1.5% (OC: 1.1%, CC: 2.3%, DL: 1%, p=0.27), mortality was 0.7% (OC: 1.1%, CC: 0.3%, DL: 0.5%, p=0.35), and no MI was recorded. The MAE rate was 2.1% (OC: 2%, CC: 2.6%, DL: 1.5%, p=0.66). Median follow-up was 46 months. At 1 and 2.5 years, estimated overall survival was 96.1% and 91% (p=0.41), SFS was 99.1% and 98.2% (p=0.007, CC stroke rates 2.9% and 4.2% at timepoints), FFiS was 99.4% and 99% (p=0.014, CC FFiS rates 1.7% and 2.6% at timepoints) and FF-SRM was 99.5% and 99% (p=0.28). During follow-up, no stroke events occurred in DL group. CC design showed higher rates of any (4.2%) and ipsilateral stroke (2.6%) within 2.5 years.

Conclusion: In asymptomatic patients undergoing CAS, the contemporary overall stroke incidence is 1.5%. No statistical differences were observed in terms of 30-day stroke incidence among groups. The closed free-cell area showed higher rates of any and ipsilateral stroke within 2.5 years. The DL stents may offer the best available performances in terms of mid-term stroke prevention.Clinical ImpactThe study analyzed the contemporary results of carotid artery stenting (CAS) focusing on the impact of cell-stent area on peri- and post-operative cerebrovascular events in a multicenter real-world experience. In asymptomatic patients undergoing CAS the contemporary overall stroke incidence is 1.5%. No statistical differences were observed in terms of 30-day stroke incidence among groups. The closed free-cell area showed higher rates of any and ipsilateral stroke within 2.5 years. DL stents may offer the best available performances in terms of mid-term stroke prevention.

Objective: The objective of this study was to analyze neointimal hyperplasia of the inferior vena cava (IVC) after Option filter implantation by DynaCT and to provide a reference for the safety of effective neointimal hyperplasia cutting after long retrieval window filter implantation in vivo.

Methods: Clinical data on 22 patients with Option filters were retrospectively analyzed. DynaCT was used to analyze the characteristics of neointimal hyperplasia after filter implantation, including the distribution of neointimal hyperplasia and the maximum thickness of the neointimal hyperplasia. Correlation analysis was performed between the measurement results and the number of times the inner membrane of the filter was cut during filter retrieval, and correlation analysis also was performed between the measurement results and the time of filter placement.

Results: As measured by DynaCT, the neointimal hyperplasia after filter placement was located around the barbs of the filter plug, and the maximum neointimal hyperplasia thickness was located in the 1 to 5 points of the IVC. There was a linear trend between neointimal hyperplasia thickness of the IVC and filter neointimal cutting times by the retrieval catheter after filter placement. Correlation analysis showed a correlation coefficient of r = 0.609 (P = 0.003), indicating a significant correlation between the two. There also was a linear trend between neointimal hyperplasia thickness and implantation time. Correlation analysis showed that the correlation coefficient was r = 0.36 (P = 0.102), and the correlation between the two was not significant.

Conclusion: Based on DynaCT, the characteristics of IVC neointimal hyperplasia after Option filter implantation were analyzed, and the cutting force and direction of neointimal hyperplasia could be controlled effectively and safely by changing the filter retrieval catheter.Clinical Impactwe can effectively and safely cut the hyperplastic intima by modifying the filter retrieval catheter to control the cutting force and direction and provide a reference for the safe and effective retrieval of the long-retrieval-time window filter after implantation in the body.

Purpose: Endovascular aortic repair (EVAR) is currently expanding its feasibility thanks to design innovations, but hostile proximal necks and narrow iliac arteries are still a constraint, as expressed by the Instructions for Use (IFU) of most devices. Our aim is to report the preliminary results of the E-Tegra endograft in infrarenal abdominal aortic aneurysms (AAAs) performed in 15 high-volume centers.

Materials and methods: The e-Tegra Italian endoGraft REgistry (TIGRE) is a prospectively maintained database of consecutive EVAR with the E-Tegra stent-graft across 15 participating centers between March 2021 and March 2023. The registry records baseline clinical data, anatomic measurements of the abdominal aorta, perioperative and postoperative outcomes, with a scheduled follow-up period of 3 years for all patients. This is a preliminary analysis of the first results updated to January 2024. The primary endpoints are technical and clinical success, perioperative mortality, freedom from endograft rupture, and aortic-related mortality. The secondary endpoints are freedom from reintervention, and any type of endoleak (EL). The results were analyzed in relation with the anatomic characteristics of the AAAs, namely, iliac axes tortuosity and proximal neck hostility.

Results: The registry included 147 consecutive EVAR (138 elective and 9 in emergent setting), 7 of which were associated with an iliac branch implantation. Ninety patients had at least 1 criterion of anatomical hostility, and 25 were treated outside the device IFU. Primary technical success was achieved in 146 cases (99.3%) and assisted success in 147 (100%), with no perioperative mortality. After a median follow-up period of 20 months, no aneurysm-related mortality occurred. Reinterventions were 5: 2 for type IB EL and 3 for type II ELs with aneurysm sac increase. Five more type II ELs with aneurysm sac stability are under observation. No differences in terms of reinterventions were noted between aneurysms with standard and hostile anatomy.

Conclusion: The E-Tegra endograft is safe and effective in treating AAAs with standard and hostile anatomy, with a low rate of complications and reinterventions, although longer-term outcomes and larger numbers are needed to compare its performances related to specific anatomic criteria.Clinical ImpactThis multi-center nationwide Registry reports a real-world experience of EVAR performed with the E-Tegra abdominal endograft across 15 high-volume Centers, providing early- and mid-term device-specific results, which will help vascular surgeons in endograft selection. In particular, this study focuses on clinical results obtained in treating aneurysms with hostile anatomy, analyzing the performances of the E-Tegra endograft in cases of hostile proximal necks and narrow or tortuous iliac axes.

Objective: Helical stents have been developed to treat peripheral arterial disease (PAD) in the superficial femoral artery (SFA), with the premise that their particular geometry could promote swirling flow in the blood. The aim of this work is to provide evidence on the existence of this swirling flow by quantifying its signatures.

Materials and methods: This study consists of in vitro and in vivo parts. For the in vitro part, 3 helical stent models of different helicity degrees and 1 straight model were fabricated, and the flow was assessed at the inlet and outlet of each model. For the in vivo part, only 1 patient, treated with the helical stent, was eligible to participate in the study. The stent implanted in the SFA of the patient was evaluated in 2 leg postures (straight and flexed), and flow was assessed in 12 locations along the SFA. The in vivo study was approved by an ethical board (NL80130.091.21) in the Netherlands. High-frame-rate ultrasound was used to acquire data from the regions of interest (ROIs), using microbubbles as contrast agents. After processing the data via a correlation-based algorithm (echo particle image velocimetry or echoPIV), the velocity vector field within each ROI was extracted and analyzed for parameters such as vector complexity and velocity profile skewedness.

Results: The results show that in the outlet of the helical stents, when compared with the inlet, the flow vector field is more complex and the velocity profile is more skewed. For the in vivo case, the outcomes demonstrate more complexity and higher variability in the sign of skewedness inside the stent when compared with the flow in the proximal to the stent.

Conclusions: Helical stents make the vector field of the flow more complex and the velocity profile more skewed, both of which are signatures of swirling flow. Further studies are needed to evaluate whether these features can benefit patients in terms of patency rates.Clinical ImpactThis study demonstrates that helical stent models alter the blood flow when compared with straight stent models. Particularly, the flow grows more complex and its velocity profile becomes more skewed, both of which hint at the existence of swirling flow inside the helical stent. These observations, alongside with population-based studies that are currently being carried out, may provide the evidence that helical stents have some advantages over straight stents for the patients.

Purpose: This study aimed to assess the safety and viability of combining branched stent graft with fenestrated thoracic endovascular aortic repair (TEVAR) in treating aortic arch lesions.

Materials and methods: The cohort included patients presenting with aortic arch lesions who underwent treatment with a combination of branched stent graft and fenestrated TEVAR between July 2020 and November 2022. Technical success was defined as the precise deployment of the stent graft, maintenance of branch vessel patency, and the absence of type I endoleak. The secondary outcomes examined were complications and all-cause mortality.

Results: The study cohort comprised 21 patients (average age: 61.0±14.8 years) with aortic arch lesions from 3 tertiary care hospitals. The aortic arch lesions encompassed aortic dissection (N=8), aortic aneurysm (N=8), pseudoaneurysm (N=1), intramural hematoma (N=1), and penetrating aortic ulcer (N=3). The technical success rate achieved was 95.2% (20/21). Failure in one case was due to an intraoperative type I endoleak, which was rectified with an additional stent graft placement. The 30-day mortality rate was 4.8% (1/21). One patient suffered a stroke but responded well to medical intervention. The median hospital stay was 10.9±5.4 days. During the follow-up period, one death (4.8%) was associated with aortic complications. A type II endoleak was observed and managed with close monitoring. Two patients underwent re-interventions for retrograde type A dissection and stent migration, respectively. No occlusions were observed in the target branch arteries.

Conclusions: The combination of branched stent graft with fenestrated TEVAR emerges as a viable strategy for addressing specific lesions in the aortic arch.Clinical ImpactThis study demonstrates the feasibility of using branched stent grafts with fenestrated TEVAR for treating aortic arch lesions, achieving a technical success rate of 95.2%. Compared to traditional open surgery, this innovative, minimally invasive approach reduces perioperative mortality and complications, such as stroke and spinal cord ischemia. For clinicians, it offers a viable alternative for patients unfit for open repair, particularly in complex aortic arch cases. While the initial outcomes are promising, further research is needed to assess long-term durability and risks, including stent graft migration and late endoleak, ensuring the technique's safety and efficacy over time.

Background: We aimed to compare the technical success rates and long-term patency of endovascular repair, subclavian-carotid bypass (SCB), and subclavian-carotid transposition (SCT) for subclavian artery occlusion.

Methods: A retrospective analysis was conducted on 181 patients at Fuwai Hospital (2015-2024). Primary endpoint was the primary patency rate. Secondary endpoints included technical success, secondary patency and freedom from target lesion revascularization (TLR) rates. Kaplan-Meier analyses were applied.

Results: One hundred and eighty-one patients [median age: 60 years, interquartile range (IQR) 54.00-65.00; 76.2% male) underwent 192 procedures, with 111 endovascular repairs, 38 SCBs, and 43 SCTs. Indications included vertebrobasilar insufficiency (39.2%), arm ischemia (28.7%), both (29.3%), cardiac causes (2.2%), and combined arm and cardiac indications (0.6%). The endovascular group had a lower technical success rate than SCB and SCT (86.5% vs 97.4% vs 100.0%). SCT had the longest lesion-to-vertebral artery (VA) length among the 3 groups. Ostial occlusion was more frequent and lesion length was longer in failed cases compared to successful cases (33.3% vs 6.3%, 14.50 vs 22.00 mm). After a median follow-up of 44 months (IQR 22.00-70.00), SCT had the highest primary patency rate (100% at 1, 3, and 5 years) compared to endovascular repair (93.4%, 88.2%, 77.6%) and SCB (94.1%, 86.8%, 72.3%; p=0.12). Endovascular group had primary patency, secondary patency, and freedom from TLR rates comparable to open surgery (SCB and SCT). SCB had lower primary patency than SCT.

Conclusions: Endovascular repair offers good long-term patency but requires careful patient selection due to higher technical failure rates. SCT is recommended for patients at high risk of endovascular failure, while SCB remains suitable for multi-segment, distal occlusions or lesions with a short lesion-to-VA length.Clinical ImpactTo our knowledge, this is the largest study comparing outcomes of endovascular repair, subclavian-carotid bypass (SCB), and transposition (SCT) for SA occlusion. We found that endovascular repair provides midterm patency comparable to open surgery and may serve as the preferred option in carefully selected patients-contrary to prior reports, possibly due to optimized antiplatelet therapy. Technical failure was more frequent in cases with ostial involvement or longer lesion length. Although SCB showed inferior patency to SCT, it remains preferable for complex, distal lesions, or those with short lesion-to-vertebral artery (VA) length. Our anatomical analysis may offer guidance for individualized treatment selection.