Artigos de revistas: "Digital subtraction angioplasty"

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Frankhouse, Joseph H., Michael G. Ryan, George Papanicolaou, Albert E. Yellin e Fred A. Weaver. "Carbon Dioxide/Digital Subtraction Arteriography–Assisted Transluminal Angioplasty". Annals of Vascular Surgery 9, n.º 5 (setembro de 1995): 448–52. http://dx.doi.org/10.1007/bf02143858.

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Carlson, Eric B., Kenneth G. Morris, Tomoaki Hinohara e Anthony L. Sintetos. "Digital Subtraction Angiography in Angioplasty of Total Coronary Artery Occlusion". Chest 92, n.º 3 (setembro de 1987): 560–62. http://dx.doi.org/10.1378/chest.92.3.560.

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Caridi, J. G., S. W. Stavropoulos e I. F. Hawkins. "CO2 digital subtraction angiography for renal artery angioplasty in high-risk patients." American Journal of Roentgenology 173, n.º 6 (dezembro de 1999): 1551–56. http://dx.doi.org/10.2214/ajr.173.6.10584800.

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Adachi, Hidemitsu, Yohei Mineharu, Tatsuya Ishikawa, Hirotoshi Imamura, Shiro Yamamoto, Kenichi Todo, Hiroshi Yamagami e Nobuyuki Sakai. "Stenting for acute cerebral venous sinus thrombosis in the superior sagittal sinus". Interventional Neuroradiology 21, n.º 6 (22 de outubro de 2015): 719–23. http://dx.doi.org/10.1177/1591019915609120.

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Endovascular treatment for superior sagittal sinus (SSS) thrombosis is not always successful because of difficult access and long thrombus lesions. We report the first two cases of patients with acute cerebral venous sinus thrombosis at the SSS that was not recanalized by anticoagulation, mechanical thrombectomy, or thrombolysis, but was successfully treated by stent placement. Case 1 was a 37-year-old woman with bilateral subdural hematomas. Digital subtraction angiography showed obstruction of the sinus from the SSS to the right transverse sinus. Recanalization was achieved by selective thrombolysis using urokinase followed by balloon angioplasty, but re-occlusion occurred on the next day of treatment. Repeated endovascular treatment including balloon angioplasty, thrombus aspiration and thrombolysis using recombinant tissue plasminogen activator failed to achieve recanalization. We thus placed intracranial stents in the SSS, which did achieve recanalization. Case 2 was a 69-year-old woman with a small infarction in the left parietal lobe. Digital subtraction angiography showed sinus obliteration from the SSS to the bilateral transverse sinuses. Recanalization was not achieved by balloon angioplasty, thrombus aspiration and selective thrombolysis. We thus placed intracranial stents in the SSS, which did achieve recanalization. Postoperative course was uneventful in both cases and venous sinus patency was confirmed by venography >1.5 years after treatment. When conventional endovascular strategies have been unsuccessful, placement of intracranial stents, which can easily gain access to the distal part of the SSS as compared with carotid stents, may be a useful treatment option for the acute sinus thrombosis in this region.

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Terada, T., H. Yokote, Y. Kinoshita, M. Tsuura, O. Masuo, K. Nakai e T. Itakura. "Endovascular Treatment for Tandem Internal Carotid Stenosis". Interventional Neuroradiology 3, n.º 2_suppl (novembro de 1997): 208–11. http://dx.doi.org/10.1177/15910199970030s245.

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Three patients with tandem internal carotid stenoses were treated in one operation including carotid endarterectomy (CEA) for the proximal stenosis and percutaneous transluminal angioplasty (PTA) for the distal stenosis. We devised a Y-shaped shunt tube which we used for CEA, while a PTA balloon catheter was introduced via the tube to perform PTA guided by portable digital subtraction angiography (DSA). No cerebrovascular events occurred during follow-up. Our approach avoids the risk of a second procedure while effectively treating tandem stenoses.

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Cianci, Rosario, Alvaro Zaccaria, Silvia Lai, Giorgio Coen, Antonio Mander, Paolo Manfredini, Marco Minnetti, Gianfranco Clemenzia e Paolo Fiorani. "Color Doppler Ultrasound Guidance during Renal Angioplasty and Stenting". Journal of Endovascular Therapy 10, n.º 2 (abril de 2003): 357–60. http://dx.doi.org/10.1177/152660280301000230.

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Purpose: To investigate whether an imaging technique combining color Doppler ultrasonography and selective renal artery digital subtraction angiography reduces contrast requirements in patients with progressive renal insufficiency undergoing renal artery angioplasty and stenting. Methods: Eight patients (5 men; mean age 58 years) with renal artery stenosis and renal insufficiency underwent percutaneous transluminal angioplasty and stenting under color Doppler ultrasound guidance. Results: Color Doppler ultrasound imaging yielded the information necessary for verifying catheter position, stent placement and expansion, and hemodynamics after revascularization. The combined imaging technique considerably reduced contrast requirements to only 10 mL in each case. No worsening of renal function was seen in any patient. Conclusions: The combined imaging procedure uses low doses of contrast agent and is especially suited to patients with renal dysfunction undergoing percutaneous renal revascularization.

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Gruschwitz, Philipp, Viktor Hartung, Florian Kleefeldt, Dominik Peter, Sven Lichthardt, Henner Huflage, Jan-Peter Grunz et al. "Continuous extracorporeal femoral perfusion model for intravascular ultrasound, computed tomography and digital subtraction angiography". PLOS ONE 18, n.º 5 (23 de maio de 2023): e0285810. http://dx.doi.org/10.1371/journal.pone.0285810.

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Objectives We developed a novel human cadaveric perfusion model with continuous extracorporeal femoral perfusion suitable for performing intra-individual comparison studies, training of interventional procedures and preclinical testing of endovascular devices. Objective of this study was to introduce the techniques and evaluate the feasibility for realistic computed tomography angiography (CTA), digital subtraction angiography (DSA) including vascular interventions, and intravascular ultrasound (IVUS). Methods The establishment of the extracorporeal perfusion was attempted using one formalin-fixed and five fresh-frozen human cadavers. In all specimens, the common femoral and popliteal arteries were prepared, introducer sheaths inserted, and perfusion established by a peristaltic pump. Subsequently, we performed CTA and bilateral DSA in five cadavers and IVUS on both legs of four donors. Examination time without unintentional interruption was measured both with and without non-contrast planning CT. Percutaneous transluminal angioplasty and stenting was performed by two interventional radiologists on nine extremities (five donors) using a broad spectrum of different intravascular devices. Results The perfusion of the upper leg arteries was successfully established in all fresh-frozen but not in the formalin-fixed cadaver. The experimental setup generated a stable circulation in each procedure (ten upper legs) for a period of more than six hours. Images acquired with CT, DSA and IVUS offered a realistic impression and enabled the sufficient visualization of all examined vessel segments. Arterial cannulating, percutaneous transluminal angioplasty as well as stent deployment were feasible in a way that is comparable to a vascular intervention in vivo. The perfusion model allowed for introduction and testing of previously not used devices. Conclusions The continuous femoral perfusion model can be established with moderate effort, works stable, and is utilizable for medical imaging of the peripheral arterial system using CTA, DSA and IVUS. Therefore, it appears suitable for research studies, developing skills in interventional procedures and testing of new or unfamiliar vascular devices.

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Kitazume,, Hidemasa, Ichirou Kubo,, Toru Iwama,, Yoshio Ageishi, e Akio Suzuki,. "Left ventricular function during transient coronary occlusion: Digital subtraction left ventriculograms during coronary angioplasty". Clinical Cardiology 14, n.º 8 (agosto de 1991): 665–70. http://dx.doi.org/10.1002/clc.4960140808.

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Sanz, Mark L., G. B. John Mancini, Michael T. LeFree, Judith K. Mickelson, Mark R. Starling, Robert A. Vogel e Eric J. Topol. "Variability of quantitative digital subtraction coronary angiography before and after percutaneous transluminal coronary angioplasty". American Journal of Cardiology 60, n.º 1 (julho de 1987): 55–60. http://dx.doi.org/10.1016/0002-9149(87)90984-2.

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Zeller, Thomas, Christian Müller, Ulrich Frank, Karlheinz Bürgelin, Lutz Sinn, Barbara Horn, Peter C. Flügel e Helmut Roskamm. "Gadodiamide as an Alternative Contrast Agent during Angioplasty in Patients with Contraindications to Iodinated Media". Journal of Endovascular Therapy 9, n.º 5 (outubro de 2002): 625–32. http://dx.doi.org/10.1177/152660280200900514.

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Purpose: To evaluate gadodiamide as an alternative contrast agent for peripheral and renal angioplasty in patients with contraindications to iodinated contrast media. Methods: Seventeen patients (10 men; mean age 74 years, range 68–83) with contraindication to iodinated contrast media were given gadodiamide as the contrast agent during peripheral and renal intra-arterial digital subtraction angiography (DSA) and subsequent percutaneous interventions (balloon angioplasty, stent placement). Results: The mean volume of gadodiamide used was 136 ± 46 mL (range 60–200). No serious side effects were observed, especially no change in renal or thyroid function; no exanthema or other allergic reactions were noted. In patients without renal artery intervention, serum creatinine at discharge remained unchanged (2.57 ± 1.43 mg/dL to 2.40 ± 1.28 mg/dL, p=NS). In patients undergoing angioplasty/stenting of renal artery stenoses, serum creatinine decreased significantly from 3.53 ± 1.75 mg/dL to 2.36 ± 1.15 mg/dL (p<0.01). All but 1 intervention was successful. Using a simple scoring system, 2 judges blinded to the contrast agent graded the quality of the peripheral DSAs as “good,” whereas renal DSA images were only “sufficient.” Conclusions: For patients with contraindications to iodinated materials, gadodiamide may be a suitable alternative for renal or peripheral DSA followed by angioplasty.

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Kehagias, Elias, Christos V. Ioannou, Izolde Bouloukaki, Evangelia Papadaki, Nikolaos Galanakis, Nikolaos Kontopodis e Dimitrios Tsetis. "Feasibility of ischemic leg ulcer healing using percutaneous techniques: a real-life study". Acta Radiologica 61, n.º 3 (18 de julho de 2019): 353–60. http://dx.doi.org/10.1177/0284185119862955.

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Background Percutaneous transluminal angioplasty is established as the first-line vascular procedure in patients with lower extremity artery disease. Purpose We aimed to evaluate the technical and clinical effectiveness of percutaneous transluminal angioplasty in the management of ischemic foot ulcers. Material and Methods All consecutive patients presenting with a foot ulcer at the outpatient vascular surgery clinic of our hospital between June 2009 and June 2015 were evaluated using foot pulse assessment, ankle-brachial index, and duplex scanning. If non-invasive parameters suggested lower extremity artery disease, CT angiography and/or digital subtraction angiography were performed and a percutaneous transluminal angioplasty was carried out when feasible during the same session. All patients were followed until healing, amputation, death, or for at least two years. Short- and long-term clinical success was evaluated based on ulcer size and appearance. Patients with worsening ulcers after percutaneous transluminal angioplasty underwent bypass grafting or amputation. Results Percutaneous transluminal angioplasty was performed in 161 patients (100%) with stenoses > 50%, including cases lesions > 10 cm and/or multiple/calcified lesions, 144 of which completed the study. In 88 (61.2%) patients, percutaneous transluminal angioplasty was performed in the suprapopliteal axis exclusively, in 10 (6.8%) patients in the infrapopliteal axis only, and in 46 (31.9%) in both levels. Percutaneous transluminal angioplasty was technically successful in 141 (98%) patients. After 3.1 years, the rate of healing was 68%, limb salvage 88%, overall survival 69.5%, and amputation-free survival 64%. Conclusion Our data suggest that percutaneous transluminal angioplasty for ischemic foot ulceration treatment is in the majority of patients feasible, effective, and safe with high rates of healing and limb salvage.

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Culafic, Slobodan, Novak Lakicevic, Miodrag Mihajlovic, Dara Stefanovic e Milan Spaic. "Stenting for symptomatic high-grade basilar artery stenosis". Vojnosanitetski pregled 66, n.º 9 (2009): 744–48. http://dx.doi.org/10.2298/vsp0909744c.

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Background. Stenosis of brain vessels in 5-10% of cases causes ischemic disesase of the brain. Atherosclerosis is a cause of stenosis in 95% of cases. Patients with basilar artery stenosis and recurrent ischemic attacks are candidate for stroke in 50% of cases in the first two years. Case report. A 48-year old man presented with a 12-month history of transitory ischemic attacks, periodical loss of vision and balance disorder. Diagnostic cerebral angiography performed by MSCT revealed annular stenosis of basilar artery (85%). Digital subtraction angiography (DSA) confirmed dimensions, grade and localisation of stenosis. Endovascular stenting was performed in general anesthesia. The first step of procedure was preliminary balloon angioplasty and after that self- expandable stent (diameter of 3.0 mm, length of 12 mm) was placed. Check angiogram after stenting confirmed complete dilatation of basilar artery stenosis. Conclusion. Combination of balloon angioplasty and selfexpandable stenting made possible non-surgical treatment of simptomatic basilar artery stenosis.

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Senthilnathan T. T., Manoj Prabakar R., Subramaniyan S. R., Marunraj G., Saravanan B. e Satyanarayanan S. "Endovascular Versus Open Versus Hybrid Revascularisation In Infra Inguinal Disease – 2 Years Prospective Study in A Tertiary Care Center in South India". International Journal of Research in Pharmaceutical Sciences 11, SPL2 (20 de abril de 2020): 97–101. http://dx.doi.org/10.26452/ijrps.v11ispl2.2134.

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Our aim is to share the clinical experience of , open and combined hybrid in infra inguinal disease and compare the results. A prospective study of 150 patients undergoing infra inguinal procedures was done, a period ranging from October 2017 to June 2019 with 3 months follow up. A number of patients undergoing CT , Digital Subtraction (DSA) were recorded. A number of cases undergoing Angioplasty, Catheter Directed (CDT), Open Surgical Bypass were noted. Cases of acute limb ischemia were excluded and chronic cases included in our study, age 35-85 years, sex distribution male 134(89.3%) and female 16(10.7%) cases. Similarly, individual risk factors were stratified. Ct was done in 60 (40%) and DSA in 90 (60%) cases. Diagnostic variables : left occlusion 42 (28%), right occlusion 55(36.7%), left tibial occlusion 18 (12%) and right tibial occlusion 35(23.3%). Treatment procedure variables : CDT and Angioplasty 1(0.7%), angioplasty 87(58%), angioplasty and bypass 8(5.3%), bypass 35(23.3%), CDT 15 (10%), CDT and bypass 4(2.7%). The results of the analysis were compared and statistical significance P-value were calculated by chi-square tests, SPSS software. Statistic significance was seen for risk factors CAD (0.001), Smoking (0.008), Hypertension (0.000) on comparison to treatment procedures and for corresponding clinical diagnosis (0.002), investigation modality (0.000) and treatment procedures.

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Hosny, Ahmed Samir. "Evaluation of Carbon Dioxide Angiography in Management of Critical Lower Limb Ischemia with Infrapopliteal Arterial Disease". International Journal of Surgery & Surgical Techniques 5, n.º 1 (2021): 1–5. http://dx.doi.org/10.23880/ijsst-16000157.

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The aim of the study is to elaborate on the understanding of the application of the CO2 angiography in obtaining quality imaging of infrapopliteal diseased arteries by digital subtraction CO2 angiography, and angioplasty using the automated Angiodroid CO2 injector® (primary outcome). This is a retrospective observational non-randomized study that included 23 patients of critical LL ischemia having infrapopliteal disease alone or combined with the femoropopliteal disease along with typical renal impairment. Carbon dioxide digital subtraction angiography (CO2 DSA) was used for all the patients and the outcomes were subjected to the comparison by iodinated contrast by an operator. The study included 17 female and 6 male subjects. The age group of the patient was between 48 years and 78 years. The mean age was 61.8 ± 11.1 years. The quality of the images obtained from the CO2 DSA method adopted was categorized as: good images (9) 39%, Accepted (8) 34%, and bad (6) 26% images. No complication from CO2 injection occured for the patients, while leg pain was recorded in 4 patients during the CO2 injection (17.3%). The trial outcome elaborated and supported the safety of using CO2 angiography in the diagnosis and management of critical LL ischemia with infrapopliteal disease.

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Dimakakos, Kotsis, Doufas, Pafiti-Condi, Tsiligiris, Antoniou e Mourikis. "Resultate von Ballonangioplastie und Stenting nach Clips- und Nahtarteriestenosen: Eine experimentelle Studie". Vasa 29, n.º 1 (1 de fevereiro de 2000): 35–39. http://dx.doi.org/10.1024/0301-1526.29.1.35.

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Background: Comparative evaluation of balloon angioplasty following intravascular stenting after experimental stenoses caused by arterial reconstruction with vascular clips and conventional sutures. Materials and methods: A total of 24 arteriotomies were carried out at the carotid and common iliac arteries of pigs following a 10mm longitudinal arteriotomy and provocation of stenosis. Twelve of the arteries were reconstructed with vascular clips and 12 with conventional suture. Ultrasonography revealed stenosis fluctuating from 60–95% (PSV: 1.8–3.5 m/sec EDV: 1.3–1.47 m/sec PSV ratio > 3.5). After 8 weeks, following digital subtraction angiography, which revealed > 50% stenosis in all of the cases, balloon angioplasty followed by placement of intravascular stent was carried out. Results: All the angioplasties remained angiographically and macroscopically patent two months after without thrombus formation. Rupture during dilatation occurred in one of the sutured cases. Histologically no degenerative changes, necrosis or remarkable intimal thickness were observed in either method. Focal inflammatory reaction was seen in 2 sutured and in 1 clipped cases while intimal ulceration was observed in 2 sutured cases. All cases with clips presented an intact endothelial surface. Conclusion: Early experimental results suggested that arterial stenosis provoked by clipped reconstruction could be managed successfully by balloon angioplasty followed by placement of intravascular stent.

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Kim, Joong-Goo, Chul-Hoo Kang, Jay Chol Choi e Jong-Kook Rhim. "Unrecognized Ruptured Intracranial Aneurysm Presenting as Cerebral Vasospasm-Induced Ischemic Stroke: A Case Report". Neurointervention 16, n.º 2 (1 de julho de 2021): 180–84. http://dx.doi.org/10.5469/neuroint.2021.00017.

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A 44-year-old woman presented with acute confusion, apparently due to a clinically silent subarachnoid hemorrhage followed by vasospasm, which in turn led to an ischemic stroke. During the initial evaluation, an acute ischemic stroke in the left middle cerebral artery territory was observed. Magnetic resonance imaging revealed a late subacute hemorrhage in the left basal cistern. Digital subtraction angiography indicated the presence of a small saccular aneurysm that had recently ruptured, as well as vasospasm in the left circle of Willis. Balloon angioplasty and balloon-assisted coil embolization were performed for the vasospasm and saccular aneurysm, respectively. This case demonstrates that clinically silent subarachnoid hemorrhages resulting in ipsilateral vasospasm and infarction can occur as complications of a ruptured aneurysm.

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Woelfle, K. D., H. Bruijnen, J. Neu, P. Campbell, C. Wack e H. Loeprecht. "The Role of Intraoperative Digital Subtraction Angiography for Quality Control of Standard Carotid Endarterectomy Using Patch Angioplasty". Cardiovascular Surgery 10, n.º 2 (abril de 2002): 116–22. http://dx.doi.org/10.1177/096721090201000205.

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The absence of technical defects is considered to be of great importance during carotid endarterectomy (CEA). In this context, both safe surgical technique and intraoperative quality control may be a fundamental part of the operative procedure. We have therefore undertaken a prospective study to evaluate the possible benefits of completion angiography in standard CEA using patch angioplasty. The objectives were three-fold: (1) to identify the incidence of defects requiring prompt revision; (2) to assess the perioperative stroke rate as well as the number of residual stenosis after 6 weeks in angiographically controlled patients and (3) to compare these results with a control group. From 1 January to 30 September 1999 111 patients with 115 consecutive CEAs which had completion angiography (Group A) were prospectively entered into this study. The results in group A were compared with a series of again 111 patients (Group B) which had 116 CEAs without intraoperative quality control between January and September in the year before. Surgical technique was identical in both groups. In general, risk factors were distributed evenly among both group with the exception that in group A were significantly more high-grade ipsilateral ICA stenoses while group B had more patients with diabetes and ipsilateral CT-defects. In group A, angiographic irregularities prompted us to immediate re-exploration in five patients (dilatation of severe ICA spasm 1; re-exploration of distal ICA occlusion 1; reopening of occluded ECA 3). With a 30 day mortality of 0% each perioperative stroke rate was comparable with 3/115 in group A and 3/116 in group B ( P = 1.0). 2/3 patients with neurological deficits in group A had early postoperative carotid thrombosis — in spite of a normal completion study. Duplex examination after 6 weeks revealed one asymptomatic ICA occlusion in each group. The incidence of residual stenosis (≥50%) was not significantly different being 3.7% in group A and 3.2% in group B ( P= 0.85). When applying a safe and simple operative technique for CEA, the incidence of abnormalities warranting immediate correction appears to be a rare event and, therefore, the necessity for obligatory quality control may be questionable. On the other hand, completion DSA allows a simple documentation of the adequacy of the surgical procedure.

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Jehle, J., F. K. Schmiel, E. Schwammenthal, P. Spiller e F. Loogen. "Left ventricular function during exercise before and after percutaneous transluminal coronary angioplasty using intravenous digital subtraction angiocardiography". European Heart Journal 8, suppl G (2 de outubro de 1987): 29–32. http://dx.doi.org/10.1093/eurheartj/8.suppl_g.29.

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Norell, M. S., J. P. Lyons, A. H. Gershlick, J. E. Gardener, M. T. Rothman, C. A. Layton e R. Balcon. "Assessment of left ventricular performance during percutaneous transluminal coronary angioplasty: a study by intravenous digital subtraction ventriculography." Heart 59, n.º 4 (1 de abril de 1988): 419–28. http://dx.doi.org/10.1136/hrt.59.4.419.

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Woelfle, K. "The role of intraoperative digital subtraction angiography for quality control of standard carotid endarterectomy using patch angioplasty". Cardiovascular Surgery 10, n.º 2 (abril de 2002): 116–22. http://dx.doi.org/10.1016/s0967-2109(01)00131-4.

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Young, Robert W., Matthew T. Bender, Geoffrey P. Colby e Alexander L. Coon. "Multiple pipeline twists encountered during treatment of a symptomatic fusiform ICA aneurysm". BMJ Case Reports 12, n.º 7 (julho de 2019): e230036. http://dx.doi.org/10.1136/bcr-2019-230036.

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Pipeline embolisation device (PED) ‘twisting’ is an intra-operative complication that manifests with the appearance of a ‘figure-8’ in perpendicular planes on digital subtraction angiography. A twisted PED causes narrowing and/or complete occlusion of the vessel lumen and poses significant risks for thrombus formation and downstream ischaemia. Here, we present a case in which three unique PED implants become twisted during pipeline embolisation of a large fusiform internal carotid artery aneurysm. The twists were remediated by balloon angioplasty and a combination of techniques that allowed the PED to rotate and restore its original axis. Six-month and twelve-month follow-up angiography demonstrated complete aneurysm occlusion with preservation of the parent vessel, proving that proper remediation of PED twisting can still result in successful long-term outcomes.

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SERRUYS, PATRICK W., FELIX ZIJLSTRA, HANS H. C. REIBER, RENE KONING e JOS ROELANDT. "Assessment of Coronary Flow Reserve During Angioplasty Using A Doppler Tip Balloon Catheter. Comparison With Digital Subtraction Cineangiography". Journal of Interventional Cardiology 1, n.º 1 (março de 1988): 19–33. http://dx.doi.org/10.1111/j.1540-8183.1988.tb00386.x.

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Buchholz, Alexander Matthias, Leonhard Bruch e Karl-Ludwig Schulte. "Activation of circulating platelets in patients with peripheral arterial disease during digital subtraction angiography and percutaneous transluminal angioplasty". Thrombosis Research 109, n.º 1 (janeiro de 2003): 13–22. http://dx.doi.org/10.1016/s0049-3848(03)00113-0.

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Pfluger, T., G. K�ffer e D. Hahn. "Exact measurement of vascular lumina in digital subtraction arteriography (DSA) during stent implantations and percutaneous transluminal angioplasty (PTA)". European Radiology 2, n.º 3 (1992): 209–13. http://dx.doi.org/10.1007/bf00595832.

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Kuusik, Karl, Teele Kasepalu, Mihkel Zilmer, Jaan Eha, Kaido Paapstel, Kalle Kilk, Aune Rehema e Jaak Kals. "Effects of RIPC on the Metabolomical Profile during Lower Limb Digital Subtraction Angiography: A Randomized Controlled Trial". Metabolites 13, n.º 7 (18 de julho de 2023): 856. http://dx.doi.org/10.3390/metabo13070856.

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Remote ischemic preconditioning (RIPC) has demonstrated protective effects in patients with lower extremity arterial disease (LEAD) undergoing digital subtraction angiography (DSA) and/or percutaneous transluminal angioplasty (PTA). This study aimed to investigate the impact of RIPC on the metabolomical profile of LEAD patients undergoing these procedures and to elucidate its potential underlying mechanisms. A total of 100 LEAD patients were enrolled and randomly assigned to either the RIPC group (n = 46) or the sham group (n = 54). Blood samples were drawn before and 24 h after intervention. Targeted metabolomics analysis was performed using the AbsoluteIDQ p180 Kit, and changes in metabolite concentrations were compared between the groups. The RIPC group demonstrated significantly different dynamics in nine metabolites compared to the sham group, which generally showed a decrease in metabolite concentrations. The impacted metabolites included glutamate, taurine, the arginine-dimethyl-amide-to-arginine ratio, lysoPC a C24:0, lysoPC a C28:0, lysoPC a C26:1, PC aa C38:1, PC ae C30:2, and PC ae C44:3. RIPC exhibited a ‘stabilization’ effect, maintaining metabolite levels amidst ischemia-reperfusion injuries, suggesting its role in enhancing metabolic control. This may improve outcomes for LEAD patients. However, additional studies are needed to definitively establish causal relationships among these metabolic changes.

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Alurkar, A., L. Sudha P. Karanam, A. Atre, S. Nirhale, S. Nayak e S. Oak. "Ipsilateral Stroke with Uncrossed Pyramidal Tracts and Underlying Right Internal Carotid Artery Stenosis Treated with Percutaneous Transluminal Angioplasty and Stenting". Neuroradiology Journal 25, n.º 2 (abril de 2012): 237–42. http://dx.doi.org/10.1177/197140091202500215.

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We present a unique case of ipsilateral stroke in a 55-year-old right-handed hypertensive man with proven uncrossed pyramidal tract demonstrated by tractography. Diffusion-weighted imaging disclosed small acute ischemic infarcts in the right corona radiata with MR angiography showing narrowing of the right internal carotid artery. Significant carotid stenosis of right internal carotid artery (ICA) was detected on digital subtraction angiography as the underlying cause and subsequently treated with percutananeous transluminal angioplasty and stenting with good outcome. The presence of uncrossed pyramidal tract was confirmed by diffusion tensor imaging tractography. To our knowledge there are few reports of ipsilateral stroke with proven uncrossed pyramidal tracts described in the literature. This is the first documented report of ipsilateral stroke with uncrossed fibre tracts due to underlying critical stenosis of the ICA treated successfully with a good recovery.

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Kota, Prajna Bhargavi, Albert Abhinay Kota, Sunil Agarwal e Shyamkumar N. Keshava. "De novo arteriovenous malformations in post-thrombotic limbs". BMJ Case Reports 15, n.º 3 (março de 2022): e244576. http://dx.doi.org/10.1136/bcr-2021-244576.

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A 50-year-old woman presented with progressive, painful and disabling swelling of the left lower limb following a left ovarian cyst excision 2 years ago. She had gross oedema of the left lower limb with multiple pubic varices. Contrast-enhanced CT and digital subtraction imaging revealed diffuse arteriovenous malformation (AVM) with feeders from the left internal iliac artery and a short segment significant stenosis of the proximal left common iliac vein. She underwent angioplasty and stenting of the left iliac vein. Her symptoms dramatically improved following the procedure and her limb swelling regressed within 6 months. The occurrence of post-thrombotic AVMs has been long established in the dural and portal systems. This report deals with an analogous phenomenon following iatrogenic deep venous thrombosis of the left lower limb, its pathogenesis, natural history and a review of treatment options.

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Zhu, Peng-Cheng, Ling-Feng Shu, Qing-Hai Dai, Hong-Tu Tan, Jia-Bin Wang e Tao Wu. "Drug-coated balloon angioplasty for the treatment of intracranial arterial stenosis in a young stroke patient: A case report". World Journal of Clinical Cases 12, n.º 19 (6 de julho de 2024): 3956–60. http://dx.doi.org/10.12998/wjcc.v12.i19.3956.

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BACKGROUND Intracranial arterial narrowing is a significant factor leading to brief episodes of reduced blood flow to the brain, known as transient ischemic attacks, or full-blown strokes. While atherosclerosis is commonly associated with intracranial arterial narrowing, it is frequently of a non-atherosclerotic nature in younger patients. CASE SUMMARY Here, we present the case of a young stroke patient with narrowing of the middle cerebral artery (MCA), characterized as non-atherosclerotic lesions, who experienced an ischemic stroke despite receiving standard drug therapy. The patient underwent digital subtraction angiography (DSA) to assess the entire network of blood vessels in the brain, revealing significant narrowing (approximately 80%) in the M1 segment of the right MCA. Subsequently, the patient underwent Drug-Coated Balloon Angioplasty to treat the stenosis in the right MCA's M1 segment. Follow-up DSA confirmed the resolution of stenosis in this segment. Although the remaining branches showed satisfactory blood flow, the vessel wall exhibited irregularities. A review of DSA conducted six months later showed no evident stenosis in the right MCA, with a smooth vessel wall. CONCLUSION The use of drug-coated balloon angioplasty demonstrated favorable outcomes in repairing and reshaping the blood vessel wall in young patients. Therefore, it may be considered a promising treatment option for similar cases.

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Hartung, Viktor, Anne Marie Augustin, Jan-Peter Grunz, Henner Huflage, Jan-Lucca Hennes, Florian Kleefeldt, Süleyman Ergün et al. "Training for endovascular therapy of acute arterial disease and procedure-related complication: An extracorporeally-perfused human cadaver model study". PLOS ONE 19, n.º 2 (8 de fevereiro de 2024): e0297800. http://dx.doi.org/10.1371/journal.pone.0297800.

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Purpose The aim of this study was to evaluate the usability of a recently developed extracorporeally-perfused cadaver model for training the angiographic management of acute arterial diseases and periprocedural complications that may occur during endovascular therapy of the lower extremity arterial runoff. Materials and methods Continuous extracorporeal perfusion was established in three fresh-frozen body donors via inguinal and infragenicular access. Using digital subtraction angiography for guidance, both arterial embolization (e.g., embolization using coils, vascular plugs, particles, and liquid embolic agents) and endovascular recanalization procedures (e.g., manual aspiration or balloon-assisted embolectomy) as well as various embolism protection devices were tested. Furthermore, the management of complications during percutaneous transluminal angioplasty, such as vessel dissection and rupture, were exercised by implantation of endovascular dissection repair system or covered stents. Interventions were performed by two board-certified interventional radiologists and one resident with only limited angiographic experience. Results Stable extracorporeal perfusion was successfully established on both thighs of all three body donors. Digital subtraction angiography could be performed reliably and resulted in realistic artery depiction. The model allowed for repeatable training of endovascular recanalization and arterial embolization procedures with typical tactile feedback in a controlled environment. Furthermore, the handling of more complex angiographic devices could be exercised. Whereas procedural success was be ascertained for most endovascular interventions, thrombectomies procedures were not feasible in some cases due to the lack of inherent coagulation. Conclusion The presented perfusion model is suitable for practicing time-critical endovascular interventions in the lower extremity runoff under realistic but controlled conditions.

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Rangel-Castilla, Leonardo, Elad I. Levy e Adnan H. Siddiqui. "Direct Cervical Carotid Stenting and Angioplasty of Right Internal Carotid Artery and Brachiocephalic Artery Ostial Stenoses With Flow Reversal: 2-Dimensional Operative Video". Operative Neurosurgery 16, n.º 2 (28 de maio de 2018): 269–70. http://dx.doi.org/10.1093/ons/opy113.

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Abstract We present a case of tandem stenosis of the great vessels (cervical internal carotid artery [ICA] and brachiocephalic trunk ostium [BTO]) treated with stenting and balloon angioplasty of both lesions under flow arrest. A 70-yr-old woman with a history of hypertension, hyperlipidemia, coronary artery disease, and previous strokes presented with recurrent transient ischemic attacks of the left upper and lower extremities over the last 6 mo. She underwent right cervical endarterectomy (CEA) 16 yr prior. Neurological examination was unremarkable. Carotid Doppler ultrasonography revealed severely increased velocities of the right ICA. Cervical magnetic resonance angiography demonstrated 80% right ICA stenosis and 50% BTO stenosis. Digital subtraction cerebral angiography showed 80% right ICA stenosis and 70% BTO stenosis. The patient was not a candidate for standard carotid artery stenting because the BTO precluded endovascular access or for CEA because of the previous CEA; therefore, direct carotid access and flow reversal was an alternative. Under general anesthesia and systemic heparinization, the patient underwent right carotid artery surgical exposure. Under flow reversal using the Enroute System (Silk Road Medical, Sunnyvale, California), anterograde right ICA stenting angioplasty and retrograde BTO stenting and angioplasty were performed. Successful revascularization of the right ICA and BTO was obtained. No procedure-related complications occurred. The patient was discharged home 2 d postprocedure, neurologically intact. Direct carotid access with flow reversal is a safe and effective therapeutic alternative for patients with ICA (or common carotid artery) stenosis who cannot undergo CEA or when endovascular access from the aortic arch is not possible. Patient consent was obtained prior to performing the procedure. Institutional board approval is not required for the report of a single case.

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Yilmaz, Saim, Kağan Çeken, Alihan Gürkan, Okan Erdoğan, Alper Demirbaş, Adnan Kabaalioğlu, Timur Sindel e Ersin Lüleci. "Endovascular Treatment of a Recipient Celiac Trunk Stenosis after Orthotopic Liver Transplantation". Journal of Endovascular Therapy 10, n.º 2 (abril de 2003): 376–80. http://dx.doi.org/10.1177/152660280301000234.

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Purpose: To present the successful endovascular treatment of a severe recipient celiac trunk stenosis that led to allograft ischemia following liver transplantation. Case Report: A 56-year-old woman underwent orthotopic liver transplantation because of hepatitis C—induced cirrhosis. After the operation, routine hepatic Doppler ultrasonography showed a tardus parvus flow pattern in the hepatic artery, suggesting an impending hepatic artery thrombosis. Digital subtraction angiography (DSA), however, showed severe stenosis of the recipient celiac trunk and moderate splenic artery steal. The stenosis was dilated and stented in the same session. The postprocedural DSA showed good dilation of the lesion with immediate improvement of hepatic opacification. Follow-up Doppler ultrasound scans showed normal flow patterns in the hepatic artery at 3 and 6 months. Conclusions: In the presence of a tardus parvus flow pattern on Doppler ultrasound after liver transplantation, the possibility of an undetected recipient celiac stenosis should be considered in the differential diagnosis. Such lesions can successfully be treated with angioplasty and stenting.

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Roy, Paul, Leo Finci, Pierre Bopp e Bernhard Meier. "Emergency balloon angioplasty and digital subtraction angiography in the management of an acute latrogenic occlusive dissection of a saphenous vein graft". Catheterization and Cardiovascular Diagnosis 16, n.º 3 (março de 1989): 176–79. http://dx.doi.org/10.1002/ccd.1810160308.

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Nishi, S., N. Hashimoto, T. Todaka e A. Nomura. "A Microguide Wire with a Scale (Scaler Guide)". Interventional Neuroradiology 3, n.º 2_suppl (novembro de 1997): 212–14. http://dx.doi.org/10.1177/15910199970030s246.

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There are various methods for measuring an affected vascular size during embolization or percutaneous transluminal angioplasty (PTA). Metallic balls, electrodes, grids, coins on the skin were simple and useful in this sense, but not stable and exact for measuring. A 0.014 “or 0.016” microguide wire with 5 gold markers in the tip is newly developed and used clinically (a scaler guide). One marker measures 1 mm in length. There is a distance of 4 mm between two neighboring markers. A microcatheter is navigated using a standard microguide wire into the vessels of the lesion. Bilateral digital subtraction angiography (DSA) is performed after exchange of a microguide wire with a scaler guide. Magnification ratio between distance measured by DSA and real distance from markers is calculated. Thereafter, the size of the vessels will be measured. With this method, the size of vessels was measured in patients with aneurysm or arteriovenous malformation or stenotic lesion. Selection of coils or PTA balloons could be made easily and effectively. Interventions were more safely performed with this new scaler guide.

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Usman, Fritz S., Rony Parlindungan Sinaga, Karina Dewi, Nilamsari, Daril Al Rasyid e Merlin P. Kastilong. "The effect of dual antiplatelet therapy for improvement of extracranial and intracranial artery stenosis evaluated by digital subtraction angiography". International Journal of Research in Medical Sciences 12, n.º 2 (30 de janeiro de 2024): 380–85. http://dx.doi.org/10.18203/2320-6012.ijrms20240201.

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Background: Stroke involving extracranial carotid (ECAS), vertebral (EVAS), and intracranial arteries (IAS) contributed to an annual stroke rate of 0.1-3.3%. Even though endarterectomy and/or angioplasty and stenting had revolutionized its’ management, best medical treatment (BMT) is still the mainstay of therapy to prevent secondary stroke/transient ischemic attack. This study aimed to evaluate the effect of BMT to reduce the degree of stenosis by using six-months double antiplatelet therapy (DAPT). Methods: A retrospective cohort study was conducted in a secondary private hospital in Indonesia, in January-December 2022. Adults ≥18 years old with ECAS, EVAS, or IAS detected using digital subtraction angiography (DSA), receiving DAPT for at least six months, and those who had second DSA evaluation were included. Any subjects with other brain pathologies or recorded incompliance to DAPT were excluded. Age, gender, stenosis degree, stenosis location, and conversion of stenosis degree were recorded and compared between pre-DAPT and post-DAPT group. Results: Of 30 subjects, there were insignificant changes (46.5±24.3% to 50.8±22.9%, p=0.09) of ECAS, EVAS, and IAS. There were 14 cases with constant stenosis (51.4±17.5%), 8 cases with decreasing stenosis (46.9±28.2% to 40.1±32.8%, p=0.012), and 12 cases with increasing stenosis (40.4±29.9% to 57.1±21.0%, p=0.002). No significant association were found among those groups related to traditional vascular risk factors. Conclusions: There was no difference in respect to the degree of stenosis following six months of DAPT in either ECAS, EVAS, or IAS. Routine evaluation as well as recognizing features of high-risk stroke/TIA are important to help decide individual who may be candidates of endovascular procedures earlier.

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Andreea, Varga, Szakacs Xantus Timea, Gliga Mirela, Podoleanu Cristian Gheorghe Calin, Bocicor Andreea Elena, Carasca Emilian e Tilea Ioan. "Rare Cause of Cephalalgia in a Young Woman - a Case Report". Acta Medica Marisiensis 61, n.º 4 (1 de dezembro de 2015): 382–86. http://dx.doi.org/10.1515/amma-2015-0045.

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AbstractBackground: Young adults meeting hypertension diagnostic criteria have a lower prevalence of a hypertension diagnosis. Headache is a rather common symptom among young people. Fibromuscular dysplasia (FMD) is an idiopathic, segmental, nonatherosclerotic and noninflammatory disease of the muscular tunica of arterial walls, leading to stenosis of small and medium-sized arteries. Fibromuscular dysplasia is much more common than previously thought and is a treatable cause of secondary hypertension.Case presentation: We present the case of an 18 y.o. young woman, with headache and high blood pressure. “White coat hypertension” was suspected. Clinical history with abrupt onset and increasingly difficult to treat hypertension especially in women, were suggestive for renal artery stenosis. Renal ultrasound and digital subtraction angiography confirmed the aspect of FMD. Sequential percutaneous renal artery angioplasty was later performed with improved evolution both from the clinical point of view and controlled blood pressure below 140/90 mmHg with minimal antihypertensive regimen. Angio CT exam of neck and brain arteries was performed, no other FMD typical lesions were identified.Conclusions: Medical treatment is first indicated for the hypertensive patient. In this particular case percutaneous renal artery angioplasty showed significant improvement in reduction of antihypertensive treatment in a young patient with secondary hypertension. Further monitoring and management of this patient will include blood pressure measurements at 3-month intervals and renal function measurements annual, as well as non-invasive duplex ultrasonography at 12-month intervals, follow-up is indefinite. It remains challenging whether the patient can be medically managed on antihypertensive medication alone.

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Wan, Yue, Hui Wang, Dapeng Wang, Hao Tian, Jing Zuo e Qi Fang. "The safety and efficacy of staged angioplasty for treating carotid stenosis with a high risk of hyperperfusion: A single-center retrospective study". Interventional Neuroradiology 26, n.º 5 (9 de agosto de 2020): 637–42. http://dx.doi.org/10.1177/1591019920946507.

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Objective Hyperperfusion syndrome (HPS) following carotid artery stenting (CAS) is a rare but life-threatening complication. Staged angioplasty (SAP) is an alternative method that prevents HPS by preventing a sudden increase in cerebral blood flow. In this study, we investigated the safety and efficacy of SAP. Methods A total of 114 patients with carotid stenosis underwent CAS treatment in our hospital between September 2014 and September 2019. Patients with severe stenosis and poor collateral circulation shown on digital subtraction angiography (DSA) and hypoperfusion of the ipsilateral diseased blood vessel shown on computed tomography perfusion (CTP) imaging were subjected to SAP treatment (the SAP group), and other patients received regular CAS treatment (the RS group). Results Twenty-two patients (19.3%) with a high risk of HPS underwent SAP treatment, 1 of whom had carotid dissection after stage I balloon angioplasty and underwent regular CAS. This patient had HPS after surgery. None of the other patients in either group had HPS. One patient in the SAP group (4.5%) had hyperperfusion phenomenon (HPP) after stage II stenting, and 2 patients in the RS group (2.2%) had HPP. One patient in the SAP group (4.5%) and 4 patients in the RS group (4.3%) had symptomatic ischemic complications postoperatively. None of the differences between the 2 groups were statistically significant. Three patients had reduced modified Rankin Scale (mRS) scores at 90 days after discharge. Conclusion This research suggests that SAP appears to be an effective method to prevent HPS for patients with a high risk of HPS.

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Tasaki, Yutaro, Eijun Sueyoshi, Hiroko Takamatsu, Yoshifumi Matsushima, Shuto Miyamura, Ichiro Sakamoto, Yasushi Mochizuki e Masataka Uetani. "The outcomes of carbon dioxide digital subtraction angiography for percutaneous transluminal balloon angioplasty of access circuits and venous routes in hemodialysis patients". Medicine 99, n.º 36 (4 de setembro de 2020): e21890. http://dx.doi.org/10.1097/md.0000000000021890.

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Fernández-Gómez, Miriam, Félix Gallo-Pineda, Carlos Hidalgo-Barranco, Gracia Castro-Luna e Patricia Martínez-Sánchez. "Accuracy of Computed Tomography Angiography for Diagnosing Extracranial Mural Lesions in Patients with Acute Internal Carotid Artery Occlusion: Correlation with Digital Subtraction Angiography". Journal of Personalized Medicine 13, n.º 7 (21 de julho de 2023): 1169. http://dx.doi.org/10.3390/jpm13071169.

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Extracranial carotid mural lesions (CML), caused by atherosclerosis or dissection, are frequently observed in acute internal carotid artery (ICA) occlusion, often requiring angioplasty or stenting. This study aimed to assess the diagnostic accuracy of computed tomography angiography (CTA) in differentiating extracranial CML from thromboembolic etiology in acute ICA occlusion in patients eligible for endovascular treatment. Two neuroradiologists retrospectively studied patients with apparent extracranial ICA occlusion on CTA. Patients were divided into two groups: thromboembolism and CML, based on findings from CTA and digital subtraction angiography (DSA). CTA sensitivity and specificity were calculated using DSA as the gold standard. Occlusive patterns and cervical segment widening were evaluated for atherosclerosis, dissection, and thromboembolism etiologies. CTA had a sensitivity of 84.91% (74.32–95.49%) and a specificity of 95.12% (87.31–100%) in detecting extracranial CML. Atherosclerosis was the most common cause, distinguishable with high accuracy using CTA (p < 0.001). No significant differences were found in occlusive patterns between dissection and thromboembolism (p = 0.568). Cervical segment widening was only observed in dissection cases due to mural hematoma. Conclusions: CTA accurately differentiates extracranial CML from thromboembolic etiology in acute ICA occlusion. The pattern of the occlusion and the artery widening help to establish the location and the etiology of the occlusion.

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Park, Yung Ki, Kijeong Lee, Byung Ju Jung, Jaseong Koo, Bum-Soo Kim, Yong Sam Shin e Jai Ho Choi. "Relationship between ophthalmic artery flow direction and visual deterioration after carotid angioplasty and stenting". Journal of Neurosurgery 133, n.º 5 (novembro de 2020): 1428–34. http://dx.doi.org/10.3171/2019.6.jns19906.

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OBJECTIVEVisual deterioration is one of the disabling complications that can occur after carotid angioplasty and stenting (CAS). The purpose of this study was to evaluate the risk factors for newly developed visual symptoms after CAS, focusing on ophthalmic artery (OA) flow pattern and etiology of visual loss.METHODSA retrospective review of 127 patients with 138 internal carotid artery (ICA) stenosis lesions that were treated with CAS from February 2009 to October 2017 in a single institution was performed. The flow pattern of the OA was evaluated with digital subtraction angiography and classified into 3 types: type I, antegrade OA flow before and after CAS; type II, antegrade OA flow reversal after CAS; and type III, retained nonantegrade OA flow after CAS.RESULTSThe degree of ipsilateral ICA stenosis was significantly higher in the nonantegrade group than that in the antegrade group (81.73% ± 9.87% vs 75.74% ± 10.27%, p = 0.001). Independent risk factors for newly developed visual symptoms after CAS were visual symptoms before CAS (OR 65.29, 95% CI 5.14–827.2; p = 0.001) and type III OA flow pattern (OR 55.98, 95% CI 2.88–1088.0; p = 0.008). The post-CAS visual symptoms in 10 patients were related to acute elevation of intraocular pressure in 6 patients and retinal artery occlusion in 3 patients.CONCLUSIONSMaintained retrograde or undetected OA flow after CAS and initial visual symptoms before CAS were related to post-CAS visual symptoms. Thus, careful attention is needed for these patients during the perioperative period, and immediate evaluation and management are required for patients with post-CAS visual loss.

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Popitiu, Mircea Ionut, Vlad Adrian Alexandrescu, Giacomo Clerici, Stefan Ionac, Gloria Gavrila-Ardelean, Miruna Georgiana Ion e Mihai Edmond Ionac. "Angiosome-Targeted Infrapopliteal Angioplasty: Impact on Clinical Outcomes—An Observational Study". Journal of Clinical Medicine 13, n.º 3 (2 de fevereiro de 2024): 883. http://dx.doi.org/10.3390/jcm13030883.

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Background: Revascularization based on the angiosome concept (AC) is a controversial subject because there is currently no clear evidence of its efficacy, due to the heterogeneity of patients (multiple and diverse risk factors and comorbidities, multiple variations in the affected angiosomes). Choke vessels change the paradigm of the AC, and the presence or absence of the plantar arch directly affects the course of targeted revascularization. The aim of this study was to evaluate the effect of revascularization based on the AC in diabetic patients with chronic limb-threatening ischemia (CLTI). Methods: This retrospective analysis included 51 patients (40 men, 11 women), with a mean age of 69 years (66–72) and a total of 51 limbs, who presented with Rutherford 5–6 CLTI, before and after having undergone a drug-coated balloon angioplasty (8 patients) or plain balloon angioplasty (43). Between November 2018 and November 2019, all patients underwent below-the-knee balloon angioplasties and were followed up for an average of 12 months. The alteration of microcirculation was compared between directly and indirectly revascularized angiosomes. The study assessed clinical findings and patient outcomes, with follow-up investigations, comparing wound healing rates between the different revascularization methods. Patient records and periprocedural leg digital subtraction angiographies (DSA) were analyzed. Differences in outcomes after direct revascularization and indirect percutaneous transluminal angioplasty (PTa) were examined using Cox proportional hazards analysis, with the following endpoints: ulcer healing, limb salvage, and also amputation-free survival. Results: Direct blood flow to the angiosome supplying the ulcer area was achieved in 38 legs, in contrast to 13 legs with indirect revascularization. Among the cases, there were 39 lesions in the anterior tibial artery (ATA), 42 lesions in the posterior tibial artery (PTA), and 8 lesions in the peroneal artery (PA). According to a Cox proportional hazards analysis, having fewer than three (<3) affected angiosomes (HR 0.49, 95% CI 0.19–1.25, p = 0.136) was associated with improved wound healing. Conversely, wound healing outcomes were least favorable after indirect angioplasty (p = 0.206). When adjusting the Cox proportional hazard analysis for the number of affected angiosomes, it was found that direct drug-coated angioplasty resulted in the most favorable wound healing (p = 0.091). At the 1-year follow-up, the major amputation rate was 17.7%, and, according to a Cox proportional hazards analysis, atrial fibrillation (HR 0.85, 95% CI 0.42–1.69, p = 0.637), hemodialysis (HR 1.26, 95% CI 0.39–4.04, p = 0.699), and number of affected angiosomes > 3 (HR 0.94, 95% CI 0.63–1.39, p = 0.748) were significantly associated with poor leg salvage. Additionally, direct endovascular revascularization was associated with a lower rate of major amputation compared to indirect angioplasty (HR 1.09, 95% CI 0.34–3.50, p = 0.884). Conclusions: Observing the angiosomes concept in decision-making appears to result in improved rates of arterial ulcer healing and leg salvage, particularly in targeted drug-coated balloon angioplasty for diabetic critical limb ischemia, where multiple angiosomes are typically affected.

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Filgueiras, Dante Togeiro Bastos, Fábio de Castro Sampaio, Seleno Glauber de Jesus-Silva, Melissa Andreia de Moraes Silva e Rodolfo Souza Cardoso. "Tratamento da Isquemia Mesentérica Crônica através da Angioplastia do Tronco Celíaco: Série de Casos / Treatment of Chronic Mesenteric Ischemia through Celiac Trunk Angioplasty: Case Series". REVISTA CIÊNCIAS EM SAÚDE 6, n.º 3 (30 de setembro de 2016): 142–51. http://dx.doi.org/10.21876/rcsfmit.v6i3.579.

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Introdução: A estenose aterosclerótica das artérias viscerais pode ser responsável pela manifestação da Isquemia Mesentérica Crônica (IMC). Apesar de o Tronco Celíaco (TC) ser o vaso mais frequentemente acometido, o tratamento cirúrgico é cada vez menos utilizado. O tratamento endovascular, apesar de possuir perviedade inferior a longo prazo, tornou-se o método de escolha devido à fácil execução e baixo índice de complicações. Relato de Casos: Descreve-se quatro casos de revascularização endovascular do TC com implante de stent em pacientes com sintomas de IMC. A avaliação diagnóstica foi realizada através de angioTC helicoidal. Três casos foram realizados por meio do acesso femoral. O sucesso técnico foi de 100%, entretanto um caso necessitou de conversão para acesso braquial. Houve um caso de migração proximal do stent. Todos os pacientes apresentaram melhora subjetiva dos sintomas. Conclusão: Os métodos de imagem são fundamentais para o diagnóstico e planejamento terapêutico. O tratamento endovascular para as lesões estenóticas do TC é o método de escolha na atualidade, devido aos baixos índices de complicações e aceitável taxa de perviedade primária no curto e médio prazo. A aplicação objetiva de questionários de qualidade de vida, entretanto, é necessária para confirmar a eficácia clínica do tratamento.Palavras-chave: Isquemia Mesentérica, Artéria Celíaca, Angiografia Digital, Implante de Prótese Vascular, Oclusão Vascular Mesentérica, Relatos de CasosABSTRACTIntroduction: Atherosclerotic stenosis of visceral arteries may be responsible for the manifestation of Chronic Mesenteric Ischemia (CMI). Although the Celiac Trunk (CT) is the most commonly affected vessel, surgical treatment has been less used. Endovascular treatment, despite lower long-term patency, has become the method of choice due to feasibility and low complication rates. Cases Report: Four cases of endovascular revascularization of CT with stenting are described in patients with suggestive symptoms of CMI. The diagnostic evaluation was performed using multislice CT angiography. Three cases were performed through femoral access. Technical success was 100%, however in one patient conversion to brachial access was needed. There was one case of proximal stent migration. All patients had subjective improvement of symptoms. Conclusion: Imaging methods are essential for diagnosis and treatment planning. Stenting of CT stenosis is the current method of choice, because of low complication rates of and acceptable short and mid-term primary patency. The objective application of QOL questionnaires, however, is required to confirm clinical efficacy.Keywords: Mesenteric Ischemia, Celiac Artery, Digital Subtraction Angiography, Blood Vessel Prosthesis Implantation, Mesenteric Vascular Occlusion, Case Reports

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Bashir, Qasim, e Ammad Anwar Baig. "Carotid Revascularization with and without the Use of an Embolic Protection Device: A Single-Center Experience from Pakistan". Interventional Neurology 7, n.º 6 (2018): 378–88. http://dx.doi.org/10.1159/000489711.

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Background: To assess the safety and clinical efficacy of carotid artery stenting with and without an embolic protection device (EPD) in both symptomatic and asymptomatic carotid disease cases. Methods: Retrospective data of 55 symptomatic (≥50% occlusion by digital subtraction angiography [DSA], ≥70% by ultrasound, computed tomography angiography [CTA], and magnetic resonance angiography [MRA]) and asymptomatic (≥60% by DSA, ≥70% by ultrasound, ≥80% by CTA and MRA) carotid disease cases undergoing carotid stenting/angioplasty revascularization from February 2014 to October 2017 was reviewed. All symptomatic patients either experienced recurrent transient ischemic attacks or one or more stroke attacks. An EPD protocol was designed for its selective use based on plaque morphologies and working diameters. The primary end points at 30 days of follow-up were a periprocedural incidence of any stroke, myocardial infarction or death, and ipsilateral stroke during the follow-up period. Results: Of the 55 cases, 39 were males and 16 females; mean age was 64.8 years. Fifty-one patients (92.7%) were symptomatic, with a mean stenosis of 80.1%. EPD was used in only 11 cases (20%). Minor stroke rate during the first 30 postoperative days was 1.8% (1 case) with EPD; no myocardial infarction or mortality. No stroke occurred during the median 1.5 years’ follow-up. Conclusion: Based on our single-center experience and findings of a relatively small sample size, carotid revascularization with stenting and angioplasty without EPD in experienced hands was found to be safe and efficacious. In addition, it proves cost-effective for patients by limiting the use of unnecessary disposables. These results are comparable to those reported in major trials and are well within the complication thresholds suggested in current guidelines. These results also show promise and illustrate the need for a larger, randomized controlled trial in order to thoroughly address this aspect of carotid revascularization.

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Verbelen, Tom, Laurent Godinas, Peter Dorfmüller, Deepa Gopalan, Robin Condliffe e Marion Delcroix. "Clinical–radiological–pathological correlation in chronic thromboembolic pulmonary hypertension". European Respiratory Review 32, n.º 170 (20 de dezembro de 2023): 230149. http://dx.doi.org/10.1183/16000617.0149-2023.

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and potentially life-threatening complication of acute pulmonary embolism. It is characterised by persistent fibro-thrombotic pulmonary vascular obstructions and elevated pulmonary artery pressure leading to right heart failure. The diagnosis is based on two steps, as follows: 1) suspicion based on symptoms, echocardiography and ventilation/perfusion scan and 2) confirmation with right heart catheterisation, computed tomography pulmonary angiography and, in most cases, digital subtraction angiography. The management of CTEPH requires a multimodal approach, involving medical therapy, interventional procedures and surgical intervention. This clinical–radiological–pathological correlation paper illustrates the diagnostic and therapeutic management of two patients. The first had chronic thromboembolic pulmonary disease without pulmonary hypertension at rest but with significant physical limitation and was successfully treated with pulmonary endarterectomy. The second patient had CTEPH associated with splenectomy and was considered unsuitable for surgery because of exclusive subsegmental lesions combined with severe pulmonary hypertension. The patient benefited from multimodal treatment involving medical therapy followed by multiple sessions of balloon pulmonary angioplasty. Both patients had normalised functional capacity and pulmonary haemodynamics 3–6 months after the interventional treatment. These two examples show that chronic thromboembolic pulmonary diseases are curable if diagnosed promptly and referred to CTEPH centres for specialist treatment.

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Murumkar, Vivek, Shumyla Jabeen, Sameer Peer, Aravinda Hanumanthapura Ramalingaiah e Jitender Saini. "Ruptured vertebrobasilar junction aneurysm unmasking subclavian steal syndrome". Surgical Neurology International 11 (4 de dezembro de 2020): 419. http://dx.doi.org/10.25259/sni_561_2020.

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Background: Subclavian steal occurs due to stenosis or occlusion of the subclavian artery or innominate artery proximal to the origin of the vertebral artery. Often asymptomatic, the condition may be unmasked due to symptoms of vertebrobasilar insufficiency triggered by strenuous physical exercise involving the affected upper limb. The association of vertebrobasilar junction (VBJ) aneurysms with subclavian steal syndrome has been rarely reported. Hereby, we present a case of VBJ aneurysm associated with subclavian steal treated successfully with endovascular coiling. Case Description: A 65-year-old female presented in the emergency department with acute severe headache and vomiting with no focal neurological deficits. Non-contrast computed tomography of the brain showed modified Fischer Grade 3 subarachnoid hemorrhage. Subsequent digital subtraction angiogram (DSA) showed VBJ aneurysm directed inferiorly with the left subclavian artery occlusion. There was retrograde filling of the left vertebral artery on right vertebral injection, confirming the diagnosis of subclavian steal. Balloon assisted coiling of the VBJ aneurysm was performed while gaining access through the stenotic left vertebral artery ostium which provided a more favorable hemodynamic stability to the coil mass. Conclusion: Subclavian steal exerting undue hemodynamic stress on vertebrobasilar circulation can be an etiological factor for the development of the flow-related aneurysms. Access to the VBJ aneurysms may be feasible through the stenosed vertebral artery if angioplasty is performed before the coiling of the aneurysm.

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Yamauchi, Keita, Yukiko Enomoto, Katharina Otani, Yusuke Egashira e Toru Iwama. "Prediction of hyperperfusion phenomenon after carotid artery stenting and carotid angioplasty using quantitative DSA with cerebral circulation time imaging". Journal of NeuroInterventional Surgery 10, n.º 6 (2 de setembro de 2017): 576–79. http://dx.doi.org/10.1136/neurintsurg-2017-013259.

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BackgroundHyperperfusion syndrome after carotid interventions has a low incidence but it can lead to morbidity and mortality.ObjectiveTo evaluate the usefulness of quantitative DSA for predicting hyperperfusion phenomenon (HPP) after carotid artery stenting and angioplasty.MethodsThirty-three consecutive patients with carotid stenosis treated with carotid artery stenting or angioplasty between February 2014 and August 2016 were included. Color-coded digital subtraction angiograms showing the time to maximum contrast intensity of each image pixel were obtained from conventional DSA before and after procedures. The cerebral circulation time (CCT) was defined as the difference in the relative time to maximum intensity between arterial and venous regions of interest set on the angiograms. HPP was diagnosed straight after the procedure with qualitative 123I-IMP single-photon emission CT (SPECT). Cut-off points for detecting HPP for preprocedural CCT and periprocedural change of CCT were assessed by receiver operating characteristic analysis using 123I-IMP SPECT as reference standard.Results123I-IMP SPECT showed HPP in 4 of 33 patients. In these 4 patients, preprocedural prolongation of CCT (13.0±6.1 vs 7.2±1.3 s; p<0.001) was seen compared with patients without HPP as well as larger periprocedural changes of CCT (5.9±5.7 vs 0.5±1.3 s; p<0.001). The optimal cut-off points of preprocedural CCT and change of CCT for predicting HPP were 8.0 s (100% sensitivity, 69% specificity) and 3.2 s (75% sensitivity, 100% specificity), respectively.ConclusionsPreprocedural prolongation and greater periprocedural change of CCT are associated with the occurrence of HPP. Periprocedural evaluation of CCT may be useful for predicting HPP.

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Beck, Jürgen, Andreas Raabe, Heiner Lanfermann, Joachim Berkefeld, Richard Du Mesnil De Rochemont, Friedhelm Zanella, Volker Seifert e Stefan Weidauer. "Effects of balloon angioplasty on perfusion- and diffusion-weighted magnetic resonance imaging results and outcome in patients with cerebral vasospasm". Journal of Neurosurgery 105, n.º 2 (agosto de 2006): 220–27. http://dx.doi.org/10.3171/jns.2006.105.2.220.

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Object The aim of this study was to analyze the effects and outcome of transluminal balloon angioplasty (TBA) on brain tissue perfusion by using combined perfusion- and diffusion-weighted (PW/DW) magnetic resonance (MR) imaging in patients with cerebral vasospasm after subarachnoid hemorrhage. Methods Ten consecutive patients with cerebral vasospasm treated using TBA were included in this prospective study. Hemodynamically relevant vasospasm was diagnosed using a standardized PW/DW MR imaging protocol. Digital subtraction angiography was used to confirm vasospasm, and TBA was performed to dilate vasospastic arteries. The PW/DW imaging protocol was repeated after TBA. The evaluation of the passage of contrast medium after standardized application using the bolus tracking method allowed for the calculation of the time to peak (TTP) before and after TBA. Tissue at risk was defined based on perfusion delays in individual vessel territories compared with those in reference territories. In cases with proximal focal vasospasm, TBA could dilate spastic arteries. Follow-up PW/DW MR imaging showed the disappearance of, or a decrease in, the mismatch. A TBA-induced reduction in the perfusion delay of 6.2 ± 1 seconds (mean ± standard error of the mean) to 1.5 ± 0.45 seconds resulted in the complete prevention of infarction; a reduction in the delay of 6.2 ± 2.7 to 4.1 ± 1.9 seconds resulted in the preservation of those brain tissue parts having only small infarcts in the vessel territories. Without TBA, however, the perfusion delay remained or even increased (11.1 ± 3.7 seconds), and the complete infarction of a territory occurred. Conclusions Angioplasty of vasospastic arteries leads to hemodynamic effects that can be quantified using PW/DW MR imaging. In cases of a severe PW/DW imaging mismatch successful TBA improved tissue perfusion and prevented cerebral infarction. The clinical significance of PW/DW MR imaging and the concept of tissue at risk is shown by cerebral infarction in vessels not accessible by TBA.

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Velázquez, Maite, Nicolás Maneiro, Ana Lareo, Agustín Albarrán, Sergio Huertas, Allende P. Olazábal, Juan F. Delgado et al. "Selective Segmental Pulmonary Angiography: Anatomical, Technical and Safety Aspects of a Must-Learn Technique in Times of Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension". Journal of Clinical Medicine 10, n.º 15 (29 de julho de 2021): 3358. http://dx.doi.org/10.3390/jcm10153358.

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With the advent of balloon pulmonary angioplasty (BPA) for non-surgical chronic thromboembolic pulmonary hypertension (CTEPH) patients, there is renewed interest in the pulmonary angiography technique. This technique is still the standard imaging modality to confirm CTEPH, which, in addition, helps to determine the most appropriate treatment. Furthermore, learning this technique fulfills two main purposes: to identify BPA candidates and to provide the operator with the catheter handling needed to perform BPA. Operators interested in performing BPA must learn not only the pulmonary arteries’ anatomy, but also which are the best angiographic projections and the most suitable catheters to canalize and display each segmental branch. Unfortunately, this information is scarce in the literature. With this goal, learning the diagnostic pulmonary angiography technique can be a first step on the way to perform BPA. Although there are descriptions on how to perform a pulmonary angiography with balloon-tipped catheters and the digital subtraction technique, this technique does not provide operators with the catheter knowledge and manual skill needed to cannulate each segmental branch. In contrast, learning the conventional selective segmental pulmonary angiography (SSPA) technique provides the operator with this knowledge and skills. In this review, based on the experience of the authors, we describe the pulmonary arteries’ anatomy and detail the practical aspects of the SSPA procedure, with the aim of providing operators with the anatomical and technical knowledge needed to perform BPA. We also summarize the contemporary complications of SSPA in CTEPH patients at a reference center.

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Lylyk, Pedro, José E. Cohen, Rosana Ceratto, Angel Ferrario e Carlos Miranda. "Endovascular reconstruction of intracranial arteries by stent placement and combined techniques". Journal of Neurosurgery 97, n.º 6 (dezembro de 2002): 1306–13. http://dx.doi.org/10.3171/jns.2002.97.6.1306.

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Object. The authors investigated the feasibility, safety, and short-term outcome of stent treatment for intracranial aneurysms, stenoses, and dissections. Methods. One hundred twenty-three consecutive patients with intracranial saccular, dissecting, and fusiform aneurysms, atherosclerotic lesions, and dissections were selected for intracranial stent implantation with or without adjunctive coil placement. One hundred eleven patients (mean age 47 years, range 3–73 years) underwent stent treatment; 12 patients (9.8%) were not treated. These 111 patients were divided into four groups: in Group 1 there were 62 patients with saccular aneurysms; Group 2 included nine patients (10 lesions) with dissecting or fusiform aneurysms; in Group 3 there were 36 patients with symptomatic intracranial atheromatous stenoses of more than 50%; and Group 4 included four patients with symptomatic intracranial dissections. All patients underwent computerized tomography scanning and/or magnetic resonance imaging and cerebral digital subtraction angiography preoperatively. Of the 72 aneurysms in Groups 1 and 2, 59 (82%) were treated with combined endovascular stent implantation and endosaccular coil placement. In 67 aneurysms (93%) we achieved complete or nearly complete obliteration. All patients with arterial narrowing achieved residual stenoses of less than 30% postangioplasty. One patient required repeated angioplasty. The morbidity rate in the series was 10.9% and the mortality rate was 6.3%. Conclusions. These findings indicate that stent treatment is feasible and seems to be an effective modality for arterial reconstruction. This versatile tool allows the treatment of a wide variety of challenging intracranial lesions.

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Shigeyasu, Masashi, Natsuhi Sasaki, Shogo Nishino e Nobuyuki Sakai. "Giant cell arteritis with simultaneous onset of multiple intracranial vascular occlusions: A case report". Surgical Neurology International 13 (20 de janeiro de 2022): 21. http://dx.doi.org/10.25259/sni_1001_2021.

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Background: Giant cell arteritis (GCA) causes severe stenosis or occlusion of the arteries but rarely affects the intracranial arteries. We report a rare case of GCA along with autopsy results. Case Description: A 69-year-old man developed gait disturbance due to vertebral artery (VA) occlusion. As is common in atherothrombotic stroke, dual antiplatelet therapy was administered. The patient’s symptoms improved temporarily. However, his symptoms relapsed and his consciousness was acutely disturbed. Digital subtraction angiography revealed an appearance of stenosis of the internal carotid artery (ICA) C2 portion on the right side and decreased retrograde basilar artery (BA) blood flow through the right posterior communicating artery. Balloon angioplasty was performed, and BA blood flow increased. GCA was suspected, and a definitive diagnosis was made based on temporal artery biopsy findings. Steroid therapy was initiated but failed to control disease progression, and the patient died. The autopsy findings revealed GCA in the bilateral ICAs and VAs, and no signs of GCA were found in other intracranial arteries, despite occlusion on magnetic resonance angiography. Conclusion: GCA of the intracranial blood vessels is rare and might be more likely to occur in the ICAs and VAs than in other intracranial blood vessels. GCA of the intracranial blood vessels has a poor prognosis, and as such, if rapid changes are observed in the ICAs or VAs, GCA should be considered a part of the differential diagnosis and immediate treatment should be administered.

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Kizilkilic, Osman, Naci Kocer, George Emmanuel Metaxas, Drazenko Babic, Robert Homan e Civan Islak. "Utility of VasoCT in the treatment of intracranial aneurysm with flow-diverter stents". Journal of Neurosurgery 117, n.º 1 (julho de 2012): 45–49. http://dx.doi.org/10.3171/2012.4.jns111660.

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Object The small size and tortuous anatomy of intracranial arteries require that flow-diverter stents in the intracranial vasculature have a low profile, high flexibility, and excellent trackability. However, these features limit the degree of radiopacity that can be incorporated into the stents. Visualization of these stents and the degree of stent deployment using conventional radiographic techniques is suboptimal. To overcome this drawback, the authors used a new combined angiography/CT suite that uses flat-panel detector technology for higher resolution angiography. Methods The authors present their preliminary experience in the imaging of flow-diverter stents in 31 patients in whom VasoCT was used with a new flat-panel detector angiographic system. Results Intraarterial VasoCT was performed after flow-diverter stent deployment in all cases. In 4 of these cases, balloon angioplasty or telescopic stent deployment–related decisions were made after checking VasoCT images. At 3- and 6-month follow-up in 27 patients, digital subtraction angiography was performed in 12 patients and intravenous VasoCT in 11 patients. Twenty-three of 31 patients had their aneurysm occluded during short-term follow-up, and 4 of the 31 patients still had minimal residual filling of the aneurysms. None of the 27 patients had stenosis of the parent artery. Conclusions The authors found that VasoCT provides clear visualization of flow-diverter stents. The images obtained both intraarterially and intravenously are very promising. The initial results provide a high confidence and reproducibility rate for further utilization of this new technique.

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