1,721,092 research outputs found
Cobalt Chromium or Stainless Steel Balloon-Expandable Bare Metal Stents for Iliac Occlusive Disease?
No full textBackground: To compare the performance of a new-generation cobalt-chromium balloon-expandable bare metal stent with a stainless steel platform for the treatment of iliac occlusive disease. Methods: Consecutive patients treated for symptomatic iliac occlusive disease between 2014 and 2021 with the cobalt-chromium Dynetic-35 or the stainless steel Dynamic platform were retrospectively evaluated. Outcome measures included technical success, device- or procedure-related death, clinically-driven target lesion revascularization (CD-TLR), primary patency, and major index limb amputation up to 12 months. Results: In total, 222 Cobalt chromium (CC) stents were used in 159 patients (34.6% female; mean age 66.9 ± 9.5 years) for the treatment of 216 lesions, while 234 iliac lesions of 182 patients (34.6% female; mean age 66.3 ± 9.9 years) were treated with 252 stainless steel (SS) stents. The mean lesion length (30.2 ± 12.8 mm vs 28.7 ± 22.5 mm, p=0.36) and the mean calcification grade (2.0 vs 1.9, p=0.07) did not differ significantly between the 2 groups. Patients treated by the CC platform were more frequently on statins (p<0.001), whereas more active smokers and subjects with higher Rutherford class underwent a SS deployment (p<0.001). Technical success was significantly higher in the SS group (100% vs 97.3%; p=0.01). This was due to longitudinal deformation or stent dislocation after passing the Dynetic-35 with endovascular material. After 1 year, no difference was found following CC and SS stent deployment in terms of device- or procedure-related deaths (0.6% vs 1.1%, p=0.99), target limb amputations (1.9% vs 1.6%, p=0.99), primary patency (91.3% vs 93.5%), and CD-TLR (6.5% vs 2.8% p=0.07). Conclusions: Through 1 year, cobalt-chromium and stainless steel balloon-expandable stents are safe and effective in the treatment of iliac occlusive disease. Enhanced attention should be given passing the cobalt-chromium stent with endovascular devices to avoid procedural complications. Clinical Impact Stents with a thin-strut structure improve the flexibility and deliverability. The lower profile also increases the applicability lowering the risk of vascular access complications. In this study newer-generation cobalt chromium balloon-expandable stent did not confer advantages over stainless steel bare metal stent. On contrary, the technical success was inferior to stainless steel stents as longitudinal deformation or dislocation of the Dynetic-35 occurred. Therefore, enhanced attention should be given passing a Cobalt chromium stent with wires, catheters or sheaths to avoid stent deformation.biotronik https://doi.org/10.13039/50110000503
Emergency diagnostics of blunt abdominal trauma and treatment of retroperitoneal bleeding
No full textIVUS-Guided Intravascular Lithotripsy of the Juxtarenal and Visceral Coral Reef Aorta
No full textOpen-Access-Publikationsfonds 202
Treatment of Femoropopliteal Artery Disease with Polymer-Coated Drug-Eluting Stent: 5-Year Results of a Prospective, Non-Randomized Study Including the Halo Phenomenon
No full textAbstract
Purpose
To investigate the long-term results of the Eluvia drug-eluting stent (DES) implantation for femoropopliteal arterial disease, including the ‘halo’ phenomenon. Long-term data of DES is scarce. A focal reaction (‘halo’) following Eluvia DES deployment has been described. However, the long-term clinical impact of this phenomenon remains unclear.
Methods
This prospective, non-randomized, single-arm study included 130 consecutive patients treated with an Eluvia DES for symptomatic femoropopliteal disease between March 2016 and December 2018. Clinical outcomes and imaging were assessed after 6 months and annually thereafter for up to 5 years. The primary outcome measure was primary patency. Secondary outcomes were freedom from clinically driven target lesion revascularization (CD-TLR), freedom from major amputation, overall survival and amputation-free survival rates.
Results
The primary patency was 65% at 5 years. The freedom from CD-TLR and from major amputation at 5 years was 79 and 96%, respectively. The overall survival and amputation-free survival rates were 88 and 83% at 60 months, respectively. Out of the 27 patients with a halo sign, two showed an increased (7.4%) and 6 (22.2%) a decreased diameter. In 19 cases (70.4%), the diameter remained unchanged at the latest follow-up. The presence of the ‘halo’ sign was associated with increased primary patency (87% versus 59%, HR: 2.48, 95%CI 1.19–5.16,
P
= .015).
Conclusions
The presented patient cohort treated with the Eluvia DES for femoropopliteal artery lesions indicates durable efficacy and a good safety profile regardless of the halo phenomenon. The results need to be confirmed in a larger patient cohort.
Level of Evidence III
Non-randomized controlled cohort/follow-up study.
Graphical Abstrac
Long-Term Experimental Evaluation of In Situ Laser-Fenestrated Versus Custom-Made Fenestrated Endografts
No full textObjective: This study evaluates the biomechanical performance and long-term durability of in situ laser fenestration (ISLF) compared to custom-made fenestrated endografts (CMD) using a controlled bench-top experimental setup. Methods: In situ, laser fenestration was performed in a RelayPro Dacron endograft using a 2.0 mm Turbo Elite OTW Laser Atherectomy catheter. Ten BeGraft Bridging Stent-Grafts (BSG) were implanted in 5 ISLF and 5 CMD Zenith fenestrations and subjected to 50 million fatigue cycles. Fenestrations were evaluated radiographically and microscopically for shape, size, fraying, endograft tearing, and BSG integrity. Results: Fenestration areas (median 8.1 mm 2 ) and axis lengths (median long axis: 4.03 mm, median short axis: 2.33 mm) in the ISLF group were significantly less than CMD fenestrations (median area: 24 mm 2 ; median long axis: 5.83 mm, median short axis: 5.8 mm) immediately post-manufacturing (p=0.002), but increased significantly after stenting and fatigue (p=0.002). Tearing was observed in 3 of 5 ISLF after ballooning but resolved after BSG implantation. BSG integrity was superior in the ISLF group, with no all-layer defects, while 3 of the 5 tested BeGrafts used in the CMD group revealed fabric defects with partial fracture of the stent in 2 (p=0.007). Conclusion: ISLF fenestrations demonstrated comparable durability to CMD fenestrations after long-term fatigue testing, with distinct advantages in BSG integrity preservation. These findings support ISLF as a viable option for urgent treatment, although further research is warranted to validate these results. Clinical Impact In-situ laser fenestration is a feasible technique for urgent complex aortic repair when customized or off-the-shelf devices are unavailable or technically unfeasible. However, long-term mechanical stability and durability under fatigue testing have not been previously evaluated. This study is the first to directly compare the long-term mechanical performance of industry-made custom fenestrations with in-situ laser fenestrations using a fatigue model. Results demonstrate non-inferiority of in-situ laser fenestrations, supporting their use as an effective off-label strategy for emergency or bailout interventions
In Vitro Comparison of Retrograde In Situ Fenestration Using a Re-entry Catheter vs Electrified Guidewire in Thoracic Endografts
No full textObjective: To compare the in vitro feasibility and fenestration characteristics of 2 in situ fenestration (ISF) techniques—re-entry catheter (REC-ISF) and electrified guidewire (EW-ISF)—in commercially available thoracic stent-grafts. Methods: Forty in vitro fenestrations were performed in RelayPro and Valiant endografts using either REC or EW (n=10 per graft per technique). The grafts were completely submerged in a saline bath at 37°C, mimicking physiological temperature. All fenestrations were sequentially balloon dilated with 2 mm and 6 mm plain balloons. Outcomes fenestration geometry and fabric damage, and puncture and dilatation success, defined as success in penetrating the graft and success in advancing the balloons, respectively. The fenestration area was measured immediately after dilatation and after 24 hours to evaluate elastic recoil. Results: Initial puncture succeeded in 60% of REC-ISF cases in RelayPro and 70% in Valiant, whereas EW-ISF achieved 100% puncture success across both grafts (p<0.05). In the Valiant graft, balloon dilatation was successful in 9/10 cases with EW-ISF, but in 0/10 cases with REC-ISF (p<0.001), as the 2 mm balloons could not be advanced within the fenestration holes. For both methods, the dilatation was, however, successful in all fenestrations in the RelayPro. In this graft, post-dilatation fenestration areas were similar between techniques (6.0 vs 6.01 mm 2 ; p=0.809), but tearing occurred more frequently with EW-ISF (80% vs 0%, p<0.001). The REC-ISF produced elliptical, weft-aligned fenestrations; EW-ISF yielded variable shapes aligned with the warp. After 24 hours, REC-ISF fenestrations showed greater surface recoil than EW-ISF in RelayPro (23.1% vs 5.0%; p=0.037). Conclusion: The EW-ISF showed high technical feasibility across both analyzed grafts, producing consistent, easily reproducible, and dimensionally stable fenestrations. In contrast, REC-ISF demonstrated material-dependent technical limitations under the constraints of this model. These findings support the use of EW-ISF as an off-the-shelf ISF option in emergency settings when other fenestration tools (ie, excimer laser) are unavailable, even if a head-to-head comparison is warranted. Clinical Impact This paper presents a proof-of-concept evaluation of two newly described off-the-shelf techniques for in situ fenestration (ISF) in thoracic stent-grafts: electrified guidewire ISF (EW-ISF) and re-entry device ISF (RED-ISF). The findings demonstrate a clear technical advantage of EW-ISF, which achieved higher puncture success, more reproducible fenestration geometry, and greater dimensional stability compared with RED-ISF. As such, EW-ISF emerges as a more reliable off-the-shelf option when dedicated fenestration tools—such as excimer lasers—are unavailable. These results may broaden endovascular treatment possibilities in time-critical or anatomically challenging scenarios, ultimately enhancing procedural success and branch preservation during emergency thoracic aortic interventions
Transprosthetic Fenestration With Electrified Wires. Experimental Evaluation of Three Multifilament Endografts
No full textPurpose: In situ fenestration of aortic endografts is an alternative endovascular technique for treatment of complex aortic aneurysms. While this technique has been carried out also to pass stent-grafts in individual cases, its feasibility and safety using different stent-grafts needs to be evaluated. Methods: In a saline bath at water temperature of 37°C, a 0.018” Astato 30 guidewire was advanced through 3 different stent-grafts (RelayPro, Zenith and Endurant II) by applying external current of 180 W via an electrosurgery pencil. Puncture efficacy and quality of the fenestration after ballooning with a 6 mm percutaneous transluminal angioplasty (PTA) catheter were assessed. Then, balloon-expandable covered stents were deployed in the fenestrations and evaluated for stenosis, using microscopy and radiography. Results: Crossing of the electrified guidewire was instantaneous in the Zenith (n:10) and RelayPro (n:10) groups but not in 3 of 10 punctures in the Endurant group (p<.05). The fenestration area created after PTA was significantly larger in the RelayPro (5.3 mm 2 ± 1.8, interquartile range [IQR] 1.6) and Zenith group (6.7 mm 2 ± 0.7, IQR 0.5) compared to Endurant (2.3 mm 2 ± 0.4, IQR 0.5, p<.001). Fraying was observed in all groups while graft shredding was found in 8 cases after PTA of the Zenith and Endurant endografts and in 5 of the RelayPro group, but the difference was not significant. Vertical tearing was detected after RelayPro (2 out of 10) and Zenith (6 out of 10) fenestrations, no damage was found in the Endurant group (p<.01). Residual stenosis at the level of the fenestration after implantation of a 6 × 79 mm VBX stent had to be corrected in all Endurant cases with a high-pressure PTA catheter. No stenosis was found in the RelayPro and Zenith groups before and after flaring. Conclusions: The “electrified wire” technique is a feasible tool that can be used to perform in situ fenestration by perforation of the endograft fabric. Based on this experimental evaluation the “ideal graft” for this technique could not be identified. Long-term fatigue tests and comparison with other fenestration techniques are required. Clinical Impact In situ endograft fenestration can be a useful technique in emergent aortic repair. Recently, the electrified wire technique has been proposed as alternative option to laser, radiofrequency and needle-based techniques. In comparison to these methods, the use of electrified wires can be performed without modifications of routine equipment. Additionally, the material costs can be substantially reduced. However, the effectiveness of this approach for fenestration of different prosthetic grafts is unknown. Based on our experimental studies, the electrified wire technique is feasible but the Endurant endograft requires more attempts, and the placement of a bridging stent should be completed with high-pressure balloons
Association of Genetic Polymorphisms with Abdominal Aortic Aneurysm in the Processes of Apoptosis, Inflammation, and Cholesterol Metabolism
No full textBackground and Objectives: This study aims to identify the minor allele of the single nucleotide polymorphisms (SNPs) DAB2IP rs7025486, IL6R rs2228145, CDKN2BAS rs10757278, LPA rs3798220, LRP1 rs1466535, and SORT1 rs599839 in order to assess the risk of abdominal aortic aneurysm (AAA) formation and define the linkage among these SNPs. Materials and Methods: A case-control study with AAA patients (AAA group) and non-AAA controls (control group) was carried out in a study population. DNA was isolated from whole blood samples; the SNPs were amplified using PCR and sequenced. Results: In the AAA group of 148 patients, 87.2% of the patients were male, 64.2% had a history of smoking, and 18.2% had relatives with AAA. The mean ± SD of age, BMI, and aneurysmal diameter in the AAA group were 74.8 ± 8.3 years, 27.6 ± 4.6 kg/m2, and 56.2 ± 11.8 mm, respectively. In comparison with 50 non-AAA patients, there was a significantly elevated presence of the SNPs DAB2IP rs7025486[A], CDKN2BAS rs10757278[G], and SORT1 rs599839[G] in the AAA group (p-values 0.040, 0.024, 0.035, respectively), while LPA rs3798220[C] was significantly higher in the control group (p = 0.049). A haplotype investigation showed that the SNPs DAB2IP, CDKN2BAS, and IL6R rs2228145[C] were significantly elevated in the AAA group (p = 0.037, 0.037, and 0.046) with minor allele frequencies (MAF) of 25.5%, 10.6%, and 15.4%, respectively. Only DAB2IP and CDKN2BAS showed significantly higher occurrences of a mutation (p = 0.028 and 0.047). Except for LPA, all SNPs were associated with a large aortic diameter in AAA (p < 0.001). Linkage disequilibrium detection showed that LPA to DAB2IP, to IL6R, to CDKN2BAS, and to LRP1 rs1466535[T] had D’ values of 70.9%, 80.4%, 100%, and 100%, respectively. IL6R to LRP1 and to SORT1 had values for the coefficient of determination (r2) of 3.9% and 2.2%, respectively. Conclusions: In the investigated study population, the SNPs CDKN2BAS rs10757278, LPA rs3798220, SORT1 rs599839, DAB2IP rs7025486, and IL6R rs2228145 were associated with the development of abdominal aortic aneurysms. Individuals with risk factors for atherosclerosis and/or a family history of AAA should be evaluated using genetic analysis
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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