Effect of balloon angioplasty in femoropopliteal arteries assessed by intravascular ultrasound

Objective:To study the effects of balloon angioplasty (PTA) of the femoropopliteal artery with intravascular ultrasound (IVUS).Materials and methods:Corresponding IVUS cross-sections (n = 1033) obtained before and after PTA from 115 procedures were analysed. Vascular damage including plaque rupture, dissection and media rupture was assessed. Free lumen area (FLA), media-bounded area (MBA) and plaque area (PLA) were measured.Results:After PTA vascular damage was seen at the target site in 83 (72%) arteries: plaque rupture in 30 (26%), dissection in 66 (57%) and media rupture in 20 (17%) arteries. The FLA increased from 5.4 ± 3.4 mm2 to 14.1 ± 5.0 mm2 (p<0.001), MBA increased from 26.9 ± 10.0 mm2 to 32.9 ± 10.7 mm2 (p<0.001) and PLA decreased from 21.6 ± 8.5 mm2 to 18.8 ± 8.0 mm2 (p<0.001). The increase in MBA accounted for 68% of lumen gain. The frequency of vascular damage and the relative contribution of MBA increase and PLA decrease to luminal gain were not different in procedures with balloon diameter ≤ 5 mm and ≥ 6 mm.Conclusions:Vascular damage is common following PTA. Lumen gain is mainly due to vessel expansion and, to a lesser extent, to a decrease in plaque area

Dutch iliac stent trial:Long-term results in patients randomized for primary or selective stent placement

Purpose: To determine long-term results of the prospective Dutch Iliac Stent Trial. Materials and Methods: The study protocol was approved by local institutional review boards. All patients gave written informed consent. Two hundred seventy-nine patients (201 men, 78 women; mean age, 58 years) with iliac artery disease were randomly assigned to undergo primary stent placement (143 patients) or percutaneous transluminal angioplasty (PTA) with selective stent placement in cases in which the residual mean pressure gradient was greater than 10 nun Hg across the treated site (136 patients). Before and at 3, 12, and 24 months and 5-8 years after treatment, all patients underwent assessment, which included duplex ultrasonography (US), ankle-brachial index (ABI) measurement, Fontaine classification of symptoms, and completion of the Rand 36-Item Health survey for quality-of-life assessment. Treatment was considered successful for symptoms if symptoms increased at least one Fontaine grade, for ABI if ABI increased more than 0.10, for patency if peak systolic velocity ratio at duplex US was less than 2.5, and for quality of life if the RAND 36-Item Health Survey score increased more than 15 points. Effects of both treatments on symptoms, quality of life, patency, and ABI were compared by using survival analyses. Results: Patients who underwent PTA and selective stent placement had better improvement of symptoms (hazard ratio [HR], 0.8; 95% confidence limits [CLs]: 0.6, 1.0) than did patients treated with primary stent placement, whereas ABI (HR, 0.9; 95% CLs: 0.7, 1.3), iliac patency (HR, 1.3; 95% CLs: 0.8, 2.1), and score for quality of life for nine survey dimensions did not support a difference between treatment groups. Conclusion: Patients treated with PTA and selective stent placement in the iliac artery had a better outcome for symptomatic success compared with patients treated with primary stent placement, whereas data about iliac patency, ABI, and quality of life did not support a difference between groups. (c) RSNA, 200

A Multi-Modal Public Transport Solution For Male, Maldives

Male, the island capital of the Maldives, an archipelago of over 1000 islands in the Indian Ocean faces chronic traffic congestion. This 2 sq km island is home to over 100,000 people. There is a taxi service comprising of around 450 vehicles and a dhoni (ferry) service amounting to over 100 vessels to neighbouring islands. Male, which is fast becoming a small urban centre faces typical peak period traffic issues. The vehicle fleet is dominated by motor cycles which still contribute to traffic congestion in narrow streets. The taxi system which comprises of individually owned taxis registered with a ‘call centre’, provide limited services but fails during peak demand periods especially on rainy days. There is very little coordination between the ferry and taxi services. The paper is based on the results of a detailed urban transport planning study carried out in Male Urban Area which included passenger interviews, vehicle counts and travel time surveys covering all modes of motorized and non-motorized travel. This paper investigates the introduction of a mini-bus transport system that would provide easy transfers between ferries and major traffic generators and attractors. The contribution of a mini-bus service in the long-term is also discussed with respect to implementation of traffic demand management measures. This paper discuses the most appropriate type of vehicle that could be used and the potential framework for ownership and management of such a system taking in to consideration the multi-modal connectivity and also the service parameters for the operation of a successful minibus service. The paper also analyses the present operation of the ferry services and investigates its ownership and operation parameters for efficiency and cost effectiveness. The paper reports reasons for the varied efficiencies seen on the different routes and the impact the informal and loosely regulated service providers have on the key performance indicators of these services. It also compares cost between different ferry services and studies the relationship between the ownership structure, technology levels, productivity and fare.Institute of Transport and Logistics Studies. Faculty of Economics and Business. The University of Sydne

Risk factors for lobar and non-lobar intracerebral hemorrhage in patients with vascular disease

Introduction Lobar and non-lobar non-traumatic intracerebral hemorrhage (ICH) are presumably caused by different types of small vessel diseases. The aim of this study was to assess risk factors for ICH according to location. Methods In two large prospective studies, SMART (n = 9088) and ESPRIT (n = 2625), including patients with manifest cardiovascular, cerebrovascular or peripheral artery disease or with vascular risk factors, we investigated potential risk factors for ICH during follow-up according to lobar or non-lobar location by Cox proportional hazards analyses. Results During 65,156 patient years of follow up 19 patients had lobar ICH (incidence rate 29, 95% CI 19-42 per 100,000 person-years) and 24 non-lobar ICH (incidence rate 37, 95% CI 26-51 per 100,000 person-years). Age significantly increased the risk of lobar ICH (HR per 10 years increase 1.90; 95% CI 1.17-3.10) in the multivariable analysis, but not of non-lobar hemorrhage. Anticoagulant medication (HR 3.49; 95% CI 1.20-10.2) and male sex (HR 3.79; 95% CI 1.13-12.8) increased the risk of non-lobar but not lobar ICH. Conclusion This study shows an elevated risk of future ICH in patients with manifestations of, or risk factors for, cardiovascular, cerebrovascular or peripheral artery disease. Our data suggest that risk factors for ICH vary according to location, supporting the hypothesis of a differential pathophysiology of lobar and non-lobar ICH

CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

Introduction: We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. Methods: We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R2 was assessed to determine the additional value of CTA and CTP. Results: At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8–69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79–0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82–0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87–0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87–0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R2 = 0.58) was superior to patient characteristics and non-contrast CT alone (R2 = 0.44) and to addition of CTA alone (R2 = 0.55) or CTP alone (R2 = 0.54; all p < 0.001). Conclusion: In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment

Iliac arterial occlusive disease: Cost-effectiveness analysis of stent placement versus percutaneous transluminal angioplasty

PURPOSE: To evaluate the relative benefits and cost-effectiveness of treating iliac arterial occlusive disease with various interventions. MATERIALS AND METHODS: Cost-effectiveness was analyzed in a hypothetical cohort of patients with intermittent claudication caused by an iliac arterial stenosis. primary stent placement, percutaneous transluminal angioplasty (PTA), and PTA with selective stent placement were analyzed. Reduction in the risk of failure after primary stent placement versus that after PTA with selective stent placement, quality of life, and cost data were derived from results of a randomized, controlled trial. Complication rates, patency results, and the reduction in risk of failure were derived from a published meta-analysis. RESULTS; PTA with selective stent placement yielded equivalent complication rates. patency results, and quality-of-life outcomes compared with those of primary stent cement, and the latter cost $957 less (95$726, $1,188). PTA with selective-stent placement was more expensive than PTA alone but yielded higher patency results (relative risk of long-term failure, 0.61; 95$20,000 per QALY gained. CONCLUSION: PTA with selective stent placement is a cost-effective treatment strategy compared with primary stent placement or PTA alone in the treatment of intermittent claudication caused by an iliac arterial stenosis