bluuebunny/crossref_metadata_2025_split huggingface dataset:
Platelet Adhesion to Simulated Stented Surfaces
Authors: Robaina Samuel , Jayachandran Bhavani , He Yong , Frank Andreas , Moreno Michael R. , Schoephoerster Richard T. , Moore James E. 
Published: March 2015

Purpose: To determine if the protrusion of stent struts into the flow stream, which creates stagnation along the wall dependent on the strut spacing, has an effect on platelet adhesion. Methods: Three 2-dimensional stents with different strut spacings were placed in a flat-plate flow chamber. Human blood was collected and platelets were labeled with indium 111. The blood with radioactive platelets was pumped through the flow chamber for 30 minutes to produce a pulsatile wall shear stress of 10±5 dynes/cm2 (mean ± amplitude at 1 Hz). A gamma counter measured radioactivity along the surface and on the stents. Computational flow simulations provided specific data on flow separation and wall shear stress for each stent strut spacing tested (2.5, 4.0, and 7.0 times the strut height). Results: The presence of any stent provoked an elevation in platelet adhesion within the stented region (p<0.05). The stents with larger strut spacing had higher platelet adhesion on the substrate in the stented region (1.71±0.63 normalized platelet deposition for the 7.0 model and 2.11±1.02 for the 4.0 model) than stents with smaller strut spacing (1.37±0.68 for the 2.5 model, p<0.05). The stents themselves showed platelet adhesion levels that were 3 to 7 times higher than the substrates, with a similar dependence on stent strut spacing. Conclusions: Additional knowledge of the role of mechanical factors in stent restenosis will aid in designing stents that minimize intimal hyperplasia and restenosis. The results of this study demonstrate the importance of stent design-mediated blood flow patterns, with smaller strut spacings minimizing platelet adhesion per unit strut area.
Percutaneous Management of Extensive Clot Trapped in a Temporary Vena Cava Filter
Authors: Vrachliotis Thomas G. , Tachtaras Athanassios , Doundoulakis Nicholaos , Sheiman Robert G. , Papadopoulos Vassilios , Stringaris Kiriakos A. 
Published: March 2015

Purpose: To present percutaneous management of extensive clot trapped in a temporary inferior vena cava (IVC) filter. Case Report: A 20-year-old man with a large sacral tumor and left external iliac vein thrombosis had a wire-mounted Günther temporary filter (GTF) prophylactically placed in the infrarenal IVC prior to tumor resection. The 7-day postsurgical venogram prior to filter removal showed extensive clot trapped by the filter, as well as interval cephalic migration, with the filter tip now at the level of the renal veins. A Günther Tulip MReye (GTM) filter was deployed but not released above the renal veins to prevent clot migration during caudal withdrawal of the wire-mounted GTF. After creating enough space in the infrarenal IVC, the GTM was repositioned and fully released with its apex now below the renal veins. The GTF was then uneventfully removed. There was no clinical evidence for significant pulmonary embolism 12 months after placement. Conclusions: Cephalic migration of a clotted temporary IVC filter can be managed with intraprocedural protection against pulmonary embolism by first deploying a Günther Tulip filter above the renal veins, with subsequent advancement below the renal veins before temporary filter removal.
Patency Rates of Femorofemoral Bypasses Associated with Endovascular Aneurysm Repair Surpass Those Performed for Occlusive Disease
Authors: Lipsitz Evan C. , Ohki Takao , Veith Frank J. , Rhee Soo J. , Gargiulo Nicholas J. , Suggs William D. , Wain Reese A. 
Published: March 2015

Purpose: To evaluate the patency rates of femorofemoral grafts performed in conjunction with aortomonoiliac or aortomonofemoral (AMI/F) endografts. Methods: Over the past 8 years, 110 patients (98 men; mean age 77 ± 7 years, range 57–90) underwent aortoiliac aneurysm repair with an AMI/F endograft. Follow-up data in these patients were prospectively collected for a mean 2.3 years (range 1–68 months). Results: There were 2 early (<7 days) AMI/F endograft thromboses with secondary femorofemoral graft occlusion. In both patients, patency of all grafts was restored by thrombectomy plus stenting of the endograft. Three late (4, 5, and 10 months) AMI/F endograft thromboses led to femorofemoral graft failure; 2 were successfully treated, but the third patient refused further intervention. No femorofemoral bypass failed in the absence of AMI/F endograft thrombosis. There were no femorofemoral graft infections. Four-year life-table primary and secondary patency rates were 95% and 99%, respectively. Conclusions: Femorofemoral bypasses with AMI/F endografts for aneurysmal disease are durable procedures and have better patency than femorofemoral grafts used to treat occlusive disease. Femorofemoral bypass patency rates alone are not a disadvantage of aortomonoiliac endografts.
Improvement in Proximal Aortic Endograft Fixation: An Experimental Study Using Different Stent-Grafts in Human Cadaveric Aortas
Authors: Veerapen Reuben , Dorandeu Anne , Serre Isabelle , Berthet Jean-Phillipe , Marty-Ane Charles Henri , Mary Henri , Alric Pierre 
Published: March 2015

Purpose: To compare the proximal fixation characteristics of different types of stent-grafts (SG) and the adjunctive effect of a proximally placed Palmaz stent. Methods: Human cadaveric aortas were obtained at autopsy and cut into 30 aortic segments. Appropriately oversized (10% to 20%) commercial stent-grafts (Zenith, Ancure, Excluder, Talent) and 4 configurations of homemade Palmaz-based stent-grafts (polytetrafluoroethylene or polyester coverings each with no uncovered proximal edge or a 20-mm bare section of stent) were implanted 20 mm into an aortic segment and balloon dilated. Each segment was placed in an experimental apparatus to measure the dislodgment force. Bare Palmaz stents were used to reinforce the proximal fixation of the commercial stent-grafts, and the measurements were repeated. Manual anastomoses were made and their dislodgment force tested for comparison. Results: The median dislodgment force ranged from 6.5 N for the Excluder to 26.5 N for the Zenith (8.0 N for the Talent, 11.8 N for the Ancure, and 8.1 to 10.7 N for the various Palmaz stent-graft designs). There was no significant difference between the Zenith and the Ancure groups or between the Excluder and the Talent groups. However, the Zenith and Ancure devices required significantly higher (p = 0.0004) force (∼25%) to displace them than the other stent-grafts tested. With the Palmaz stent added to the proximal attachment site, the median dislodgment force for the different commercial endografts was significantly improved for all devices (p < 0.03): 34% for the Zenith device, 69% for the Ancure, 73% for the Talent, and 80% for the Excluder endoprosthesis. Conclusions: The Zenith stent-graft had the best resistance to dislodgment. An additional Palmaz stent placed at the proximal attachment site greatly improves endograft fixation regardless of the type of stent-graft. For complex aneurysm necks or for intraoperative type I endoleak management, an adjunctive Palmaz stent could be used.
AneuRx Stent-Graft Failure Four Years after TAA Exclusion
Authors: Schepens Marc A. , van den Berg Jos C. , Moll Frans L. , Dossche Karl M. , Heijmen Robin H. 
Published: March 2015

Purpose: To present a case of graft material disruption 4 years after thoracic aortic aneurysm (TAA) exclusion with the AneuRx stent-graft. Case Report: In 1999, a 62-year-old man underwent successful exclusion of a descending 98-mm TAA with 2 AneuRx stent-grafts. A type I distal endoleak was diagnosed 1 month later, and a distal extension cuff was placed just proximal to the celiac trunk. One year later, a new endoleak was discovered (presumed to be type II); the patient refused proposed thrombin injection to seal the leak. The diameter of the aneurysm enlarged gradually, and in 2003, he presented with a ruptured TAA and a massive left-sided hemathorax. The patient underwent urgent open surgical repair using extracorporeal circulation; the 3 stent-grafts were removed. Unfortunately, the patient died from cardiac failure 2 days later. Macroscopic examination showed several disruptions of the graft fabric and a stent fracture, which presumably explains the endoleak and rupture. Conclusions: This case reaffirms the necessity of long-term stent-graft surveillance.
Impact of Symptomatic Peripheral Arterial Disease on 1-Year Mortality in Patients Undergoing Percutaneous Coronary Interventions
Authors: Nikolsky Eugenia , Mehran Roxana , Mintz Gary S. , Dangas George D. , Lansky Alexandra J. , Aymong Eve D. , Negoita Manuela , Fahy Martin , Moussa Issam , Roubin Gary S. , Moses Jeffrey W. , Stone Gregg W. , Leon Martin B. 
Published: March 2015

Purpose: To determine the impact of symptomatic peripheral arterial disease (PAD) on clinical outcomes in patients treated with percutaneous coronary interventions (PCI). Methods and Results: Symptomatic PAD was identified in 1969 (18.9%) of 10440 consecutive patients undergoing PCI. Patients with PAD were older, more frequently female, and had smaller body surface area and more atherosclerotic risk factors, chronic renal insufficiency, and heart failure. Patients with PAD had lower rates of procedural success (94.2% versus 96.2%, p<0.0001) and higher rates of in-hospital complications, including all-cause mortality (2.1% versus 1.1%, p=0.0002), cardiac death (1.5% versus 0.7%, p=0.0009), urgent coronary artery bypass grafting (1.9% versus 1.2%, p=0.01), recurrent ischemia (5.6% versus 2.8%, p<0.0001), re-PCI to the target lesion (2.4% versus 1.1%, p<0.0001), stroke (0.6% versus 0.3%, p=0.0344), transient ischemic attack (0.4% versus 0.1%, p=0.01), femoral hematoma (10.3% versus 8.5%, p=0.01), retroperitoneal hematoma (0.8% versus 0.3%, p=0.009), limb ischemia (3.0% versus 0.7%, p<0.0001), gastrointestinal bleeding (1.9% versus 0.9%, p<0.0001), and blood transfusion (10.1% versus 5.2%, p<0.0001). At 1-year follow-up, patients with PAD had a higher mortality rate (13.6% versus 5.2%, p<0.0001), a higher rate of myocardial infarction (8.3% versus 6.5%, p=0.008), and also more target lesion (21.2% versus 19.8%, p=0.02) or target vessel revascularization (24.6% versus 21.2%, p=0.002). By multivariate analysis, PAD was an independent predictor of 1-year mortality (odds ratio 1.71, 95% confidence interval 1.42 to 2.07, p<0.0001). Conclusions: Nearly a fifth of patients undergoing PCI have symptomatic PAD. The presence of PAD is associated with lower rates of procedural success, higher rates of in-hospital and 1-year adverse events, and is independently associated with increased 1-year mortality.
Intravascular Stents in the Last and the Next 10 Years
Authors: Palmaz Julio C. 
Published: March 2015

The first balloon-expandable coronary stent was approved “for the prevention of restenosis” in 1994, the same year that the Journal of Endovascular Therapy was inaugurated. Since then, the development of the stent has paralleled the evolution of endovascular intervention as a new specialty. Innovators have pushed to explore new and varied stent applications outside the coronary arteries. Carotid stenting, transjugular intrahepatic portocaval shunts, and covered stents are a few of these new applications that have now become commonplace. Dozens of stent designs and several new materials have been tested to solve the problem of in-stent restenosis, but it is the drug-eluting stent (DES) that has emerged as the most promising, at least in the coronary arteries. However, the benefits of DES technology are not likely to be effective in the more pervasive forms of in-stent restenosis, such as encountered in the femoropopliteal segment. In the future, technologies aimed at stimulating rather than inhibiting tissue response to an implant may be part of the next wave of developments, as we take aim against the poor and/or slow tissue incorporation that manifests as leaks and dislodgement. In the superficial femoral artery, for example, mechanical stresses that cause fractures and dislocations may be addressed by using a very flexible endovascular device with a tissue-friendly inner surface that promotes rapid stent endothelialization to counter the biological effects of motion and microtrauma. The rapidly developing fields of nanotechnology, microelectronics, and advanced materials technology will enable the surface engineer to design molecular-specific surfaces for a new generation of vascular devices. Interactive implantable or injectable microdevices aimed at providing specific information upon demand from an external source will revolutionize disease prevention, as emphasis shifts toward monitoring cardiovascular risk exposure. There is no doubt that during the next 10 years, we will witness impressive technological progress in the field of cardiovascular implantable devices.
Renal Function after Endovascular Aortic Aneurysm Repair: A Single-Center Experience with Transrenal versus Infrarenal Fixation
Authors: Waasdorp Evert , Hullenaar Casper van't , van Herwaarden Joost , Kelder Hans , van de Pavoordt Eric , Overtoom Tim , Moll Frans , de Vries Jean-Paul 
Published: March 2015

Purpose: To describe the short-term consequences of endovascular aortic aneurysm repair (EVAR) on renal function after infrarenal (IR) versus transrenal (TR) stent-graft fixation. Methods: Between December 1996 and January 2006, 369 consecutive patients were treated with EVAR. All patients had an AneuRx or a Talent stent-graft implanted using IR (AneuRx) or transrenal (Talent) fixation. Post-EVAR, a standardized follow-up scheme included computed tomography (CT) scanning and serum creatinine measurements at 2 days, 3 months, and 12 months. Postoperative renal dysfunction was defined as a >20% decrease in serum creatinine clearance compared to baseline, the presence of new-onset dialysis, or both. Of the 369 patients, 309 (291 men; mean age 71±7 years, range 63–82) had complete 1-year follow-up and were included in this study. An IR stent-graft was placed in 190 patients, and a TR stent-graft was placed in the remaining 119 patients. Results: At discharge, renal dysfunction occurred in 3.7% of the patients in the IR group versus 5.9% in the TR group (p=NS) and rose significantly to 13.7% in the IR group (p=0.001) and 15.1% in the TR group (p=0.02) at the 1-year follow-up. However, no significant difference was noted between the IR and TR groups at either time point. At the 1-year follow-up, at least 50% of renal dysfunction was caused by obstructions of (accessory) renal arteries and renal infarctions. During the follow-up interval, 3 (0.97%) of 309 patients underwent new-onset dialysis. Conclusion: Both infrarenal and transrenal fixation techniques in EVAR will lead to a significant rise in renal dysfunction during the first year. A few patients with dysfunction will require dialysis.
Double Tube Stent-Grafts for Infrarenal Aortic Aneurysm: A New Concept
Authors: Ruppert Volker , Erz Kerstin , Bürklein Dominik , Treitl Marcus , Steckmeier Bernd , Stelter Wolf , Umscheid Thomas 
Published: March 2015

Purpose: To present the concept of double tube stent-grafts and examine the indications for and results achieved with these devices. Methods: From January 1, 2000, to December 31, 2005, 759 patients who underwent endovascular repair of infrarenal aortic aneurysms at 2 centers. Of these, 45 (5.9%) patients received a double tube stent-graft; complete operative and follow-up data were available for retrospective analysis in 41 patients (33 men; mean age 73.1±8.9 years). Diameters measured before stent-graft implantation and at follow-up (12, 24, 36, and 48 months) with clinical examination, 2-phase computed tomographic angiography, duplex sonography, and biplanar abdominal radiography were tested for significant changes using ANOVA with the Bonferroni-Dunn correction. Late outcomes (clinical success and endoleak) were analyzed by the Kaplan-Meier method. Results: The postoperative complication rate was 12.2%, with 2.4% systemic complications (1 patient with angina pectoris); the early mortality rate was 0%. Mean follow-up was 21.9±12.8 months (range 12–61) for the 41 patients. Four (9.8%) patients died during follow-up of cardiac causes (n=2), lung cancer (n=1), and bowel ischemia (n=1). Four (9.8%) endoleaks were observed during follow-up: 1 distal type I, 2 type II, and 1 type III. Maximum aneurysm diameters shrank from 52.0±9.5 mm preoperatively to 44.0±10.8 mm (p<0.0001) postoperatively at the latest available follow-up. Conclusion: Our study supports the use of this double tube technique for repair of appropriate saccular infrarenal aortic aneurysms. The double tube stent-graft method appears safe in terms of endoleaks and migration, so we recommend that it be considered an option of endovascular aortic aneurysm therapy.
In Vivo Antegrade Fenestration of Abdominal Aortic Stent-Grafts
Authors: Tse Leonard W. H. , Bui Bao T. , Lerouge Sophie , Salazkin Igor , Therasse Eric , Benko Andrew , Héon Hélène , Oliva Vincent L. , Soulez Gilles 
Published: March 2015

Purpose: To examine in a canine model the feasibility of antegrade fenestration of abdominal aortic stent-grafts to preserve the patency of the renal arteries. Methods: Two large dogs underwent antegrade fenestration of stent-grafts in the perirenal aorta. Before fenestration, bare stents were inserted in both renal arteries as fluoroscopic landmarks. A 12-mm iliac extension served as the canine aortic endograft. The first procedure was done under ultrasound and fluoroscopic guidance, using an intravascular ultrasound (IVUS) probe inserted in the vena cava and a Pioneer IVUS catheter. The second was performed exclusively under fluoroscopic guidance with a Brockenbrough needle. Angiograms and duplex ultrasound were planned for 1 month, after which the dogs would be sacrificed for autopsy. The explanted endograft was subjected to biomaterials analysis, with a focus on fabric tear. Results: Perforation of the aortic graft and catheterization of the renal arteries with a floppy guidewire were possible in both animals. In dog 1, aortic graft dilation and subsequent fenestration were not possible, and the experiment was terminated. However, the procedure was successful in both renal arteries of dog 2. At 1-month follow-up in this dog, both renal arteries were patent. Stent fractures were observed bilaterally. There was no extension of the damage to the fabric beyond the area of fenestration. Conclusion: In vivo antegrade fenestration of aortic endografts is technically feasible. However, improvements in technique, instrumentation, and materials are required to make it a reliable and reproducible way of allowing stent-graft vascularization of aortic side branches.
Differential Effects of Carotid Artery Stenting versus Carotid Endarterectomy on External Carotid Artery Patency
Authors: Woo Edward Y. , Karmacharya Jagajan , Velazquez Omaida C. , Carpenter Jeffrey P. , Skelly Christopher L. , Fairman Ronald M. 
Published: March 2015

Purpose: To determine the effect of stent coverage of the external carotid artery (ECA) after carotid artery stenting (CAS) compared to eversion endarterectomy of the ECA after carotid endarterectomy (CEA). Methods: The records of 101 CAS and 165 CEA procedures performed over 2 years were reviewed. Duplex velocities and history and physical examinations were taken prior to the procedure, at 1 month, and at 6-month intervals subsequently. CAS was performed by extending the stent across the internal carotid artery (ICA) lesion into the common carotid artery (CCA) thereby covering the ECA. CEA was performed with eversion endarterectomy of the ECA. Results: The mean peak systolic velocities (PSV) in the ICA pre-CAS and pre-CEA were 361 and 352 cm/s, respectively. In terms of CAS, there was a significant increase in ECA velocities versus baseline at 12 (p=0.009), 18 (p=0.00001), and 24 (p=0.005) months. In the CEA group, there was a significant decrease in ECA velocities versus baseline at 1 (p=0.01) and 6 (p=0.004) months. There were 2 occluded ECAs in follow-up in the CAS group and none in the CEA group. No significant differences were noted when comparing preprocedural ICA or ECA velocities. However, at the 1-, 6-, and 12-month intervals, the ECA velocities in the CAS group were significantly higher than in the CEA group (p=0.03, p=0.001, and p=0.0004, respectively). There were no neurological symptoms in any patients during the study period. Conclusion: Although progressive stenosis of the ECA is noted during CAS, the ECA usually does not occlude. Furthermore, there are no associated neurological symptoms. Thus, apprehension for progressive ECA occlusion should not be a contraindication to CAS. In addition, concern for ECA coverage should not deter stent extension from the ICA to the CCA during CAS.
Tandem Balloon Protection during Emergency Carotid Artery Stenting of a Stenotic ICA Lesion with Intraluminal Thrombus
Authors: Imai Keisuke , Makino Masahiro , Niwa Fumitoshi , Takegami Tetsuro , Koike Hironori , Azuma Yumiko , Oshima Fumiko , Oda Kenichiro , Kakita Kiyohito 
Published: March 2015

Purpose: To report a technique for emergency CAS of a stenotic internal carotid artery (ICA) lesion with an intraluminal thrombus, which predisposes to distal thromboembolism and could aggravate pre-existing neurological symptoms. Case Report: A 77-year-old man with fluctuating stroke underwent successful emergency CAS for an ICA stenosis with intraluminal thrombus using a tandem balloon protection technique featuring proximal balloon blockade and a PercuSurge GuardWire system for distal protection. Conclusion: This experience suggests that emergency CAS with tandem balloon protection is a potential treatment for a stenotic lesion with an intraluminal thrombus in patients with fluctuating stroke.
Ultrasound-Enhanced Thrombolysis
Authors: Motarjeme Amir 
Published: March 2015

Purpose: To report a single-center clinical experience with ultrasound-enhanced thrombolysis in the treatment of both arterial and venous thromboses. Methods: From January 2005 to June 2006, 33 patients (23 men; age range 39–90 years) with 36 occlusions were treated using ultrasound-enhanced thrombolytic therapy for acute and chronic arterial and venous occlusions. After diagnostic angiography, the occlusions were crossed with an appropriately sized Lysus infusion catheter for infusion of urokinase (80,000–120,000 IU/h). Results: Technical success and complete lysis was achieved in 96% of the arterial and 83% of the venous occlusions. Two patients with chronic occlusions (one superficial femoral artery and one iliac vein) were refractory to lytic therapy. Average time for complete lysis was 16.4 hours (range 3–25) for arterial occlusions and 21.2 hours (range 6–43) in patients with deep vein thrombosis. Conclusion: Successful clot lysis can be achieved with a high rate of success in a shorter time than conventional thrombolysis using ultrasound-enhanced thrombolysis in both acute and chronic arterial and venous thromboses.