bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Postsurgical Carotid Restenosis: Redo Surgery versus Angioplasty/Stenting
Authors: AbuRahma Ali F. , Bates Mark C. , Wulu John T. , Stone Patrick A. 
Published: March 2015

Purpose: To compare the results of balloon angioplasty/stenting (BA/S) versus redo surgery in patients with early carotid restenosis. Methods: Sixty-one patients (35 women; mean age 69 years, range 46–82) with early restenosis (<24 months from the primary endarterectomy) in 63 carotid arteries were treated during a 5-year period; 41 patients (41 arteries) had redo surgery (group A) and 20 patients (22 arteries) had BA/S (group B). Patients were followed regularly with duplex ultrasound to detect ≥50% recurrent restenosis (RRS) after redo surgery or BA/S. Kaplan-Meier life-table analysis was used to estimate the stroke-free survival rates and freedom from ≥50% RRS. Results: The demographic and clinical characteristics were comparable for both groups, as were the perioperative stroke and death rates (2.4% and 0% for group A, respectively, versus 4.5% and 0% for group B, p=0.46). Group A had a 12% incidence of cranial nerve injury (all transient) versus 0% for group B (p=0.11); however, group B had a higher incidence of ≥50% RRS than group A (32% versus 0%, p=0.0003). The stroke-free survival rates for redo surgery at 6, 12, 24, 36, and 48 months were 100%, 100%, 100%, 100%, and 88% versus 95%, 95%, 84%, 84%, and 63% for BA/S (p=0.067). Redo surgery had a 100% freedom from ≥50% RRS at the same time intervals, while recurrent restenosis rates for the BA/S patients were 95%, 86%, 69%, 52%, and 52% (p<0.0001). Conclusions: BA/S and redo surgery have comparable stroke and death rates in the treatment of early RCS; however, redo surgery is associated with cranial nerve injuries (transient), while stent patients have a higher incidence of recurrent lesions. These considerations should be kept in mind when selecting the appropriate treatment for patients with early postsurgical restenosis.
Restenting for Subclavian In-Stent Restenosis with Symptomatic Recurrent Coronary-Subclavian Steal
Authors: Bates Mark C. , AbuRahma Ali F. , Stone Patrick A. 
Published: March 2015

Purpose: To determine whether restenting for recurrent coronary-subclavian syndrome is technically feasible, provides durable results, and is a reasonable alternative to surgery. Case Report: A 58-year-old woman with a left internal mammary artery (LIMA) bypass to the left anterior descending artery underwent angioplasty and stent placement for left subclavian stenosis and coronary-subclavian steal. Twenty-three months later, she returned with progressive angina and left arm claudication; heart catheterization demonstrated restenosis of the subclavian artery at the stent site with recurrence of the coronary-subclavian steal. Successful redo angioplasty and stenting resulted in normal antegrade flow through the LIMA graft. The patient has remained asymptomatic for 3 years without evidence of recurrent in-stent stenosis on serial noninvasive studies. Conclusions: Restenting is technically feasible and appears to be a durable response to subclavian in-stent restenosis in patients with coronary subclavian steal.
Fatal Pericardial Tamponade after Wallstent Implantation for Malignant Superior Vena Cava Syndrome
Authors: Martin Matthias , Baumgartner Iris , Kolb Martin , Triller Jürgen , Dinkel Hans-Peter 
Published: March 2015

Purpose: To report a rare, fatal complication of superior vena cava Wallstent implantation. Case Report: A 59-year-old man presenting with superior vena cava syndrome caused by small-cell lung cancer underwent stent implantation of 2 kissing Wallstents >1.5 cm above the right atrium. Despite correct stent deployment, vessel perforation occurred in a section not encased by tumor, which led to fatal pericardial tamponade shortly after the procedure. Autopsy revealed perforation of a stent strut through the caval wall into the pericardial space. Anatomical and methodological reasons are discussed. Conclusions: The interventionist should be aware of this rare complication. Alternative stent designs avoiding the sharp ends of Wallstents and Palmaz stents should be considered.
Outcome of Abdominal Aortic Endografting in High-Risk Patients: A 4-Year Single-Center Study
Authors: Verzini Fabio , Cao Piergiorgio , Zannetti Simona , Parlani Gianbattista , De Rango Paola , Maselli Agostino , Lupattelli Luciano , Parente Basso 
Published: March 2015

Purpose: To evaluate feasibility, safety, and effectiveness of endovascular abdominal aortic aneurysm (AAA) repair in patients whose fitness for surgery is questionable. Methods: Between April 1997 and December 2001, 389 consecutive patients underwent endovascular AAA repair. Of these, 51 (13.1%) were ASA grade IV. The perioperative and late outcomes of this group were compared to the remaining 338 patients with ASA grades <IV. Failure of AAA exclusion was defined as late conversion to open repair, AAA rupture, increased aneurysm diameter, or persisting graft-related endoleak. Gender, age, ASA grade IV, EUROSTAR class E, and AAA diameter were examined by logistic regression analysis for their influence on perioperative death, survival, and failure of AAA exclusion. Results: Four (7.8%) perioperative deaths occurred in the ASA IV group compared to 1 (0.3%) in the ASA <IV group (p=0.001). Median follow-up was 22 months (range 1–56). Failure of AAA exclusion occurred in 3 (5.9%) patients in ASA IV group and in 25 (7.4%) in ASA <IV group (p>0.05). Actuarial survival at 30 months was 62.9% in ASA IV group and 88.0% in ASA <IV group (p=0.001, log-rank test). There were no independent predictors for failure of AAA exclusion; ASA IV was independently associated with perioperative mortality (HR 17.8; 95% CI 1.6 to 188; p=0.016). Conclusions: Endovascular AAA repair in ASA IV patients is feasible and effective in preventing AAA rupture in the mid term. High-risk patients experience a worse prognosis than their good-risk counterparts. An individualized approach in selecting high-risk patients for endoluminal repair is mandatory.
Neurological Outcomes after Carotid Stenting Protected with the NeuroShield Filter Compared to Unprotected Stenting
Authors: Macdonald Sumaira , McKevitt Fiona , Venables Graham S. , Cleveland Trevor J. , Gaines Peter A. 
Published: March 2015

Purpose: To compare outcomes for two nonrandomized cohorts of patients with high-grade carotid disease who underwent either unprotected carotid stenting or stent implantation protected by the NeuroShield filter. Methods: Under this protocol, symptomatic patients with carotid stenoses >70% or asymptomatic patients with bilateral carotid stenoses who were being evaluated for coronary artery bypass grafting were eligible for carotid stenting. Between December 1998 and November 2001, 75 consecutive patients (57 men; median age 67 years range 45–85) underwent carotid stenting without cerebral protection; concurrently, 75 carotid stent procedures protected with the NeuroShield filter were performed in 73 patients (51 men; median age 66 years, range 47–83). A neurologist reviewed all patients before and after treatment. The groups were comparable for age, sex, and symptoms, but the protected group had a higher proportion of postsurgical restenoses (14.7% versus 1.3%; p=0.003). Outcome measures included death and neurological events at 24 hours and 30 days. Results: There were minor technical difficulties in 12 of the protected group, but none were clinically relevant. The procedural all-stroke/death rates in the unprotected versus protected groups, respectively, were 5.3% (4/75) and 2.7% (2/75; p=0.681), while the disabling stroke/death rates were 4% (3/75) and 1.3% (1/75; p=0.620). At 30 days, the all-stroke/death rates were 10.7% (8/75) in the unprotected group and 4.0% (3/75) in the protected group (p=0.117); the death/major-disability-from-stroke rates were 6.7% (5/75) and 2.7% (2/75), respectively (p=0.442). Conclusions: Filter-related complications are well tolerated. Neuroprotection devices have the potential to reduce the procedural neurological event rate. Larger series and/or randomized trials are required for further evaluation.
Correlation of Periprocedural Systolic Blood Pressure Changes with Neurological Events in High-Risk Carotid Stent Patients
Authors: Howell Marcus , Krajcer Zvonimir , Dougherty Kathy , Strickman Neil , Skolkin Mark , Toombs Barry , Paniagua David 
Published: March 2015

Purpose: To examine retrospectively the magnitude of change in systolic blood pressure (SBP) during carotid artery stenting and its relationship to neurological events. Methods: In a 5-year period ending October 2000, 60 patients (36 men; mean age 67 ± 9 years) were enrolled in a study to evaluate stenting in symptomatic or asymptomatic high-risk patients with ≥70% carotid artery stenosis. The majority (48, 80%) of the patients were symptomatic. Five patients with bilateral lesions were treated in staged procedures. Sixteen (25%) of the 65 lesions were postsurgical stenoses and 12 (18%) were secondary to neck radiation therapy. Results: There were 2 (3%) minor and 2 (3%) major strokes (94% procedural success), of which 1 was fatal. Six (9%) transient neurological events were recorded during balloon inflation. The mean SBP change during or after stenting in 55 cases without neurological events was 34 ± 14 mmHg, while the patients with transient or permanent neurological events had significantly greater changes in SBP (107 ± 31 mmHg [p<0.003] and 134 ± 14 mmHg [p<0.001], respectively). Patients exhibiting neurological sequelae had significantly higher SBP before the procedure than those without complications (203 ± 30 versus 165 ± 23 mmHg, p<0.001). There were no neurological events in patients with a <50-mmHg change in SBP. Conclusions: Patients with severely elevated baseline SBP (>180 mmHg) may be at higher risk for hemodynamic instability and neurological events during carotid stenting. The greater the change in SBP, the more severe the neurological event seems to be, but further studies in a greater number of patients are needed to evaluate the potential causes of SBP fluctuations in an effort to avoid neurological events.
Endograft Therapy for Diseases of the Descending Thoracic Aorta: Results in 43 High-Risk Patients
Authors: Lepore Vincenzo , Lönn Lars , Delle Martin , Bugge Mogens , Jeppsson Anders , Kjellman Ulf , Rådberg Göran , Risberg Bo 
Published: March 2015

Purpose: To report an initial experience with endovascular stent-graft implantation for diseases of the descending thoracic aorta in high-risk patients. Methods: Forty-three patients (28 men; mean age 67 years, range 17–82) with 16 descending thoracic aortic dissections, 14 aneurysms, 7 contained ruptures, 3 mycotic aneurysms, 2 posttraumatic pseudoaneurysms, and an aneurysm of an anomalous right subclavian artery were treated between June 1999 and July 2001. Twenty-three (53%) patients were treated emergently. Results: There were no conversions to open repair, but 3 (7%) patients died during the first 30 days (pneumonia, multiorgan failure, and acute bowel ischemia). Thirteen (30%) patients suffered 18 major complications (8 strokes, paraplegia in 3, respiratory insufficiency in 6, and 1 renal failure). Of 7 (16%) endoleaks detected in the early postoperative period, 3 required additional stents, while the other 4 were treated conservatively. Follow-up, which averaged 19 ± 6 months (median: 13; range 0–34), was 100% complete. Five (12%) patients died: 3 of aortic rupture at 34, 47, and 139 days, respectively, and 2 from heart failure at 3 and 15 months, respectively. No late migration or endoleaks have been detected in the remaining 35 patients; however, 1 (2%) patient showed progressive aortic dissection proximal to the stent-graft. In all other cases, the size of the aneurysm or the false lumen was unchanged or diminished. Conclusions: Treatment of descending thoracic aortic diseases with an endovascular approach has acceptable early mortality and morbidity in high-risk patients. In selected cases, stent-grafts may afford the best therapy.
Arterial Stenting and Overdilation: Does it Change Wall Mechanics in Small-Caliber Arteries?
Authors: Vernhet Hélène , Demaria Roland , Juan Jean-Marie , Oliva-Lauraire Marie-Claire , Senac Jean-Paul , Dauzat Michel 
Published: March 2015

Purpose: To evaluate changes in arterial wall mechanics induced by stent overdilation in the rabbit aorta. Methods: Twenty New Zealand white rabbits had initial stent deployment (3-mm × 8-mm Multilink) at 10% overdilation. Group A (n=11) had no subsequent balloon expansion of the stent and Group B (n=9) had 30% overdilation of the stent. A noninvasive B-mode ultrasound examination coupled with image processing allowed the measurement of systolic and diastolic diameter and the calculation of diameter compliance (Cd) and distensibility coefficient (DC) as indexes of arterial wall biomechanics. Measurements were performed before stenting in the infrarenal aorta, after initial stenting, and after stent overdilation at 3 locations: upstream, at the stent level, and downstream from the stent. Results: Cd was significantly lower in the stented aorta after initial stenting (p<0.0001) and after stent overdilation (p<0.0001) than before stenting. At the stent level, Cd and DC were significantly lower than downstream (p<0.0001) or upstream (p<0.0001) from the stent after initial stenting, as well as after stent overdilation. Downstream from the stent, Cd and DC were significantly lower after stent overdilation than before stenting (p<0.05). Conclusions: Endovascular stenting of the rabbit aorta produces a significant decrease in arterial wall compliance and distensibility. Stent overdilation is responsible for a slight additional decrease of compliance downstream from the stent.
Multiple Stenting in Takayasu Arteritis
Authors: Gradden Craig , McWilliams Richard , Gould Derek , Williams Peter , Harris Peter 
Published: March 2015

Purpose: To illustrate the possible peri- and postprocedural complications of stent treatment for Takayasu arteritis and suggest ways of reducing these risks. Case Report: A 69-year-old woman with Takayasu arteritis had multiple stents implanted in the aortic arch (3 Memotherm) and main branches of the thoracic aorta (individual Corinthian stents in the subclavian and brachiocephalic arteries) following balloon dilation. She suffered reperfusion injury with cerebral hemorrhage following the procedure, preventing the use of anticoagulation or antiplatelet therapy. Further cerebral infarctions/hemorrhages over the ensuing months led to her death. Conclusions: Severe vascular disease of any cause confers a poor prognosis. Endovascular stenting may seem an attractive option for management of these patients, but there is often significant morbidity and mortality associated with the underlying disease as well as the stent.
Endovascular Stent-Graft Treatment of a Ruptured Thoracic Aortic Ulcer
Authors: Faries Peter L. , Lang Elvira , Ramdev Pranay , Hollier Larry H. , Marin Michael L. , Pomposelli Frank B. 
Published: March 2015

Purpose: To describe a ruptured ulcer of the descending thoracic aorta treated with an endovascular stent-graft deployed under transesophageal echocardiographic (TEE) guidance. Case Report: An 82-year-old man with severe chronic obstructive pulmonary disease and congestive heart failure presented with sharp pain in the back radiating to the left flank. Computed tomography (CT) and angiography demonstrated a penetrating ulcer of the descending thoracic aorta associated with aortic dissection commencing 6 cm from the origin of the left subclavian artery with extravasation of contrast outside the aortic wall. The patient remained symptomatic with a decrease in hematocrit from 36% to 23%. Endovascular repair was performed using self-expanding nitinol stents sutured to a 35-mm × 12-cm Dacron conduit. The device was deployed with a 24-F delivery system under TEE guidance and fluoroscopy. Successful exclusion of the ruptured ulcer was demonstrated by TEE Doppler, arteriography, and CT. The patient remains asymptomatic 18 months after the procedure with no CT evidence of endoleak. Conclusions: Endovascular stent-graft repair under TEE guidance assists in the oftentimes difficult treatment of ruptured penetrating thoracic aortic ulcer.
Stent-Graft Treatment of Penetrating Thoracic Aortic Ulcers
Authors: Kos Xavier , Bouchard Louis , Otal Philippe , Chabbert Valérie , Chemla Patricia , Soula Philippe , Meites Geneviève , Joffre Francis , Rousseau Hervé 
Published: March 2015

Purpose: To evaluate the efficacy of stent-graft placement for the treatment of penetrating thoracic aortic ulcers. Methods: Ten patients (7 men; mean age 73.8 years, range 69–79) were treated for penetrating thoracic aortic ulcers using Talent or Excluder stent-grafts. Preoperative examinations included computed tomographic angiography (CTA), transesophageal echography, and digital subtraction angiography (DSA). Follow-up included predischarge multimodal imaging and periodic CTA scans after discharge. Endoleaks, aortic diameter changes, and clinical complications were tracked. Results: Technical success was achieved in 100%, but 1 major neurological complication led to death 3 months after the procedure. Radiological follow-up detected 4 early endoleaks (3 type I and a type II), all of which spontaneously regressed, and 1 secondary type II endoleak. The mean aortic diameter decreased by 22% over a mean 9-month follow-up. Conclusions: Aortic ulcers are potentially lethal lesions. Considering its low morbidity and mortality, endovascular repair could widen the treatment options for these lesions.
Endovascular Repair for Acute Rupture of the Descending Thoracic Aorta
Authors: Alric Pierre , Berthet Jean-Philippe , Branchereau Pascal , Veerapen Reuben , Marty-Ané Charles Henri 
Published: March 2015

Purpose: To report the endovascular treatment of acute descending thoracic aortic rupture as an alternative to open surgery in high-risk patients. Methods: Between November 1999 and April 2001, 10 patients (7 men; median age 75 years) underwent endovascular stent-grafting of the descending thoracic aorta for acute rupture from an aneurysm (n = 7) or blunt trauma (n = 3). All patients were evaluated as high operative risk. The aortic rupture was associated with isolated mediastinal hematomas (n = 7), left hemothorax (n = 2), or aortobronchial fistula (n = 1). The Excluder Thoracic Endoprosthesis was used predominantly. Results: The mean interval to the endovascular repair was 45.3 ± 28.4 hours. All stent-grafts were successfully deployed. Two patients required common iliac artery access, and 2 needed covered stents for iatrogenic iliac artery rupture. There was 1 postoperative death (myocardial infarction) and no renal failure, neurological complications, embolization, stent-graft migration, or perigraft leak. One patient died 4 months later from an unrelated cause. At a mean follow-up of 7.9 ± 5.1 months, all aneurysms and rupture sites were excluded with no evidence of endoleak or hematoma. Conclusions: Endoluminal treatment is a feasible technique for the management of acute rupture of the descending thoracic aorta. Long-term studies are required to assess the effectiveness and durability of this technique in comparison to open repair.
Successful Endoluminal Repair of an Infected Thoracic Pseudoaneurysm Caused by Methicillin-Resistant Staphylococcus Aureus
Authors: Bell Rachel E. , Taylor Peter R. , Aukett Marion , Evans George H. , Reidy John F. 
Published: March 2015

Purpose: To report the successful endoluminal repair of an infected thoracic aneurysm secondary to methicillin-resistant Staphylococcus aureus (MRSA). Case Report: A 76-year-old man presented with an infected thoracic pseudoaneurysm 9 weeks after an elective infrarenal aneurysm repair. Blood cultures were positive for MRSA. Computed tomography (CT) showed an 11.5-cm false aneurysm of the descending thoracic aorta just proximal to the celiac axis. An Excluder stent-graft was used to successfully repair the lesion. Recovery was uneventful, and the patient was treated with linezolid for 6 weeks. Follow-up CT scans at 3 and 12 months confirmed exclusion of the aneurysm and progressive shrinkage of the aneurysm sac with no evidence of graft infection. Conclusions: Endoluminal repair is an alternative to open surgery for the treatment of infected aneurysms of the thoracic aorta.
Endovascular Management of Acute Carotid Artery Dissection with a Waxing and Waning Neurological Deficit
Authors: Sbarigia Enrico , Battocchio Cesare , Panico Maria A. , Zaccagnini Davide , Salvatori Filippo M. , Argentino Corrado 
Published: March 2015

Purpose: To evaluate the feasibility and efficacy of emergent carotid stenting for an acute internal carotid artery (ICA) dissection. Case Report: A 51-year-old man was admitted to our emergency department's stroke unit 1 hour after the onset of left hemiparesis. Computed tomographic and transcranial Doppler scans showed no pathological findings, but the color Doppler study detected a double lumen in the right carotid bifurcation extending to the proximal ICA. Within the first 2 hours after admission, the patient's neurological status began to fluctuate; the NIH Stroke Scale (NIHSS) and Rankin scores evaluated each hour after admission ranged from 0 to 12 and from 0 to 3, respectively. Emergency carotid angiography confirmed the dissection of the bulb and proximal right ICA, which prompted implantation of 2 Wallstents from the internal to common carotid artery. Forty-eight hours later, the patient was almost totally asymptomatic with an NIHSS score of 1 and a Rankin score of 0; he was discharged on postoperative day 3. At 3 months, the patient was free of neurological symptoms and the stented carotid artery was patent. Conclusions: In patients with fluctuating neurological signs and symptoms consistent with carotid artery dissection that are refractory to medical therapy, a stent can be placed to prevent permanent neurological deficits provided that the anatomical conditions are suitable.
Recurrent Vertebral Arteriovenous Fistula after Surgical Repair: Treatment with a Self-Expanding Stent-Graft
Authors: Surber Ralf , Werner Gerald S. , Cohnert Tina U. , Wahlers Thorsten , Figulla Hans R. 
Published: March 2015

Purpose: To describe successful endovascular repair of a recurrent vertebral arteriovenous fistula (AVF) after surgical correction. Case Report: A 42-year-old woman presented with recurrent dizziness, nausea, and headaches. A loud bruit in the right neck was present. Central venous catheter insertion had been done 1 year previously, creating an angiographically documented right-sided vertebral AVF that was successfully excluded by a surgical procedure. Four weeks later, the AVF reappeared. Successful endovascular repair with a self-expanding stent-graft was performed. Follow-up over 12 months was uneventful, with a patent vertebral artery and no recurrence of symptoms. Conclusions: Endovascular stent-graft repair is feasible and offers a therapeutic alternative in the treatment of vertebral AVF, in particular for recurrence after initial surgery. This minimally invasive method may become the treatment of choice in the management of such lesions, preserving patency of the vertebral artery.