Use of Antiplatelet Inhibitors in Peripheral Vascular Interventions

In the past decade, a tremendous amount of information has been gathered about platelet function and its impact on percutaneous vascular interventions. Strategies for prevention of platelet aggregation have moved beyond aspirin administration. Powerful oral antiplatelet agents such as ticlopidine (Ticlid) and clopidogrel (Plavix) have been developed to prevent platelet aggregation and thrombosis. The discovery of the glycoprotein IIb/IIIa receptor, which is responsible for platelet aggregation, has led to the development of receptor antagonists. These drugs include abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat). Several large studies have demonstrated that these drugs can improve outcomes in coronary interventions. Because most of the data regarding antiplatelet agents in percutaneous interventions comes from studies of coronary interventions, knowledge of these studies is necessary before using the antiplatelet drugs in peripheral vascular interventions. This article reviews the use of these agents in percutaneous coronary artery interventions and discusses their potential use in peripheral interventions

MR Microscopy of the Arterial Wall in an Experimental Model of Atherosclerosis: Preliminary Results

To obtain images of the arterial lumen and wall in a rabbit model of atherosclerosis with use of high-resolution magnetic resonance (MR) imaging to follow morphologic changes during the induction of atherosclerosis and, hence, develop a non-invasive tool to investigate restenosis. In vivo microscopic MR images of rabbit aorta were acquired after balloon injury. Measurements of wall and lumen diameter from MR images area were compared with measurements obtained from histologic and angiographic examination. Injured rabbits exhibited an obvious thickening of the arterial wall, accompanied by an increased wall conspicuity, probably due to increases in T2. Quantitative MR morphometry corresponded well with morphologic measurements based on angiographic and histologic study. MR implanted coil technology affords imaging of the arterial lumen and wall, allowing temporal assessment of the morphologic changes due to intimal hyperplasia after balloon dilation and may enable the evaluation of novel techniques to eliminate restenosis

Interventional Radiology: Management of Biliary Complications of Liver Transplantation

Major advances in the field of liver transplantation have led to an increase in both graft and patient survival rates. Despite increased graft survival rate, biliary complications lead to significant postoperative morbidity and even mortality. A multidisciplinary approach to these complications is critical. As part of the team approach, less invasive techniques used by the interventional radiologist have an increasing role in the management of complications after liver transplantation. This paper will review the current role of the interventionalist in management of biliary complications

Management of Transplant Renal Artery Stenosis

Transplant renal artery stenosis is the most frequent vascular complication of transplantation. Early detection and correction reduce patients' morbidity and allograft dysfunction. Although noninvasive imaging can detect an underlying stenosis, angiography with subsequent angioplasty or stenting, or both, provides definitive diagnosis and treatment. With the introduction of alternative contrast agents and newer catheter and stent technology, these procedures can be performed safely with little risk of contrast-induced nephropathy or allograft loss

Contrast-Induced Nephropathy: What We Know, What We Think We Know, and What We Don't Know

Contrast-induced nephropathy is a common but poorly understood problem. A large body of literature devoted to the subject is replete with contradictions and conflicting reports. The purpose of this article is to summarize our current understanding of the problem by reviewing some of the best studies done to date. Recommendations based on the current literature are also provided