Follow-up Results of Stent Placement for Extracranial Carotid Artery Stenosis

Background and Objectives：Carotid artery stenting has evolved as a potential alternative to carotid endarterectomy in patients (pts) with significant carotid artery stenosis. We evaluated the feasibility and long-term outcome of carotid artery stenting in selected pts at high surgical risk. Materials and Methods：Between May, 1996 and September 1998 we performed carotid artery stenting at 35 lesions in 25 pts. There were 23 males and 2 females. Mean age was 63.2±6.6 (range 54-77). Eight four percent (21/25) of the pts had significant coronary artery disease. Sixty four percent (16/25) of the pts had significant peripheral artery lesions. Sixty percent (15/25) of the pts had neurologic symptoms or non-disabling stroke. We used Wallstent in 32 lesions and Palmaz stent in 3 lesions. Carotid stenting was undertaken in 33 internal carotid, 1 common carotid and 1 external carotid lesions. Bilateral carotid stenting was undertaken in forty percent (10/25) of the pts. Results： Carotid stenting was successful in all lesions. One patient died due to massive cerebral hemorrhage 3 days after carotid stenting, who had und-erwent stenting as a rescue procedure for failed endarterectomy. One major stroke developed during procedure with partial recovery. For the combined endpoint of strokes and death within 30 days of procedure, the incidence was 8% and 5.7% in terms of pts and procedures, respectively. On follow-up (12±7 months), we found neither neurologic complications nor death. Angiographic and/or duplex sonography which were performed at 5.5 month in all (18) eligible pts with 24 lesions revealed no evidence of stent deformity or restenosis (50% of diameter stenosis). Mean angiographic stenosis was 20% on follow-up angiography. Conclusion：Carotid artery stenting can be performed with high success and low complication rate in pts with significant carotid artery stenosis especially at high surgical risk. Follow-up clinical outcome of average 12 month was good with low restenosis rate.ope

Hybrid approach for complex thoracic aortic pathology

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Extracranial Carotid Stenting

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Endovascular Therapy Combined With Immunosuppressive Treatment for Occlusive Arterial Disease in Patients With Takayasu's Arteritis

PURPOSE: To evaluate the feasibility and efficacy of endovascular therapy combined with immunosuppression for the treatment of arterial occlusive disease in patients with Takayasu's arteritis (TA). METHODS: From January 1998 to June 2003, 25 patients (22 women; age 37.8+/-15.5 years) with TA were treated with angioplasty for symptomatic lesions or with a hemodynamically significant aortic narrowing. The patients with active disease, defined as an increase in inflammatory markers (e.g., erythrocyte sedimentation rate [ESR]), were treated with immunosuppressive agents before intervention. Angioplasty was performed after the ESR had been normalized. RESULTS: In the 25 patients, 58 vascular territories (7 aortic, 9 carotid, 3 vertebral, 11 subclavian, 2 superior mesenteric, 18 renal, 4 iliac, and 4 coronary arteries) were treated with angioplasty only (19 lesions) or with stents (39 lesions). The mean ESR when the vascular lesions were initially diagnosed was 35.6+/-26.2 mm/h, which fell to 18.5+/-7.8 mm/h after immunosuppressive therapy. The endovascular procedure was performed successfully in 52 (90%) of 58 lesions. During the mean 23.7+/-18.4-month follow-up, 9 (17%) treated segments restenosed; 4 were treated with repeat angioplasty. The overall cumulative primary clinical success rate was 82%; secondary clinical success was 90%. CONCLUSIONS: Endovascular therapy for stenotic lesions in patients with TA is safe and effective when disease activity is strictly controlled with immunosuppressive treatment.ope

Early Results of Carotid Artery Stenting

BACKGROUND: Surgical endarterectmy has been known to be the stendard treatment modality in management of carotid stenosis. However, endarterectomy has several limitations in high-risk patients, particulary with coronary artery disease. Percutaneous angioplasty and stenting have the patential to be less traumatic and safer, they may overcome the limitations of surgery. Early results of carotid stenting and it's safety and feasibility were analysed. 0aMETHODS: Twenty two carotid arteries from 16 patients with significant stenosis (% diameter stenosis> or s coronary artery bypass graft, previous ipsilateral carotid endarterectomy, and coronary artery stenosis, and Takayasu's arteritis in 2 patients (3 arteries) Target vessels were in internal carotid arteries in 17, external in 1, and common carotid in 4. Among the 22 stents, vascular Wallstents (Schneider Co Ltd) were inserted in 19, biliary Palmaz stents (Jonhson and Johnson) in 2, and coronary Microstent II (AVE) stent in 1. 0aRESULTS: 1) Angiographic and procedural success rates were 100%, and there were no acute or subacute stent thrombosis. 2) Immediately after initial stenting mean percent diameter reduced from 72larneous bilateral carotid stengings in 5 patients and combined stentings for coroanary and carotid arteries in 5 patients were performd. Carotid stentings were performed in 3 patients with total obstruction of contralateral carotid arteries. 4) There were no major strokes or myocardial infarctions during the procedures. There were 4 patients with contralateral total obstructions or bilateral stenosis of carotid arteries who had generalized seizures during balloon inflation; they were immediately resolved without sequele. One patient who underwent carotid endarterectomy died 3 days after stenting from intracranial hemorrhage due to uncontrolled hypertension. 0aCONCLUSIONS: Percutaneous carotid angioplasty with stenting is a safe and feasible procedure. It is associated with high immediate success rates and relatively low complications in the management of carotid artery stenosis. This interventional measure is especially recommended in combined high risk patients such as coronary artery disease and other comorbid diseases. Larger population study and follow-up data are warranted.ope

A Case Report of Percutaneous Transluminal Angioplasty with Stenting in Treatment of Superior Mesenteric Artery Stenosis

Percutaneous transluminal angioplasty(PTA) was first described by Dotter and Jukins in 1964 and subsequently modified by Gruentzig and Hoff in 1974. PTA has proved a safe and effective treatment for focal atherosclerotic disease of the aorta and its major extremity branches. The complications of PTA of the peripheral vessels are less frequent and less serve than those associated with the comparable surgical procedure. Intestinal angina is a clinical syndrome compromising postprandial abdominal pain, nausea, vomiting, diarrhea, weight loss, and eventually fear of eating. The syndrome is thought to be due to visceral ischemia, with stenosis or occlusion of the three visceral arteries being necessary for the syndrome to occur. Although the first report of mesenteric PTA appeared in 1980, the series of PTA with stenting of the visceral arteris reported in the literature have been small or included limited follow-up. We report a case of a intestinal angina due to superior mesenteric arterial stenosis. A 69-year-old male complained of serve postprandial pain, chronic diarrhea for 1 year. PTA with stening in superior mesenteric artery results in recannulation of obstructed artery and relief of symptom.ope

Analysis of the Left Ventricular Contractile Reserve Using End-systolic Pressure-Volume Relation (ESPVR) in Idiopathic Dilated Cardiomyopathy: Its Correlation with Pathologic Findings

Background Left ventricular (LV) end-systolic pressure volume relation (ESPVR) is considered as a load independent contractile index. However, its application in human beings has been limited by the difficulty in the accurate real time measurement of the LV volume changes. With introduction of the echocardiographic automatated edge detection method, on-line generation of multiple LV pressure volume-loops has become possible to assess ESPVR. This study was performed to investigate the correlation of the degree of myocardial damages with myocardial contractility and contractile reserve assessed by ESPVR as a surrogate of contractility index. Methods Studies were attempted in ten patients with idiopathic dilated cardiomyopathy. Baseline two-dimensional and Doppler echocardiography, cardiac catheterization for hemodynamic assessment and endomyocardial biopsy were performed. Generation of multiple LV pressure-volume loops during occlusion and release of the inferior vena cava by a balloon catheter was performed using the volume signals from the echocardiographic automatated edge detection method and the pressure signals from a 5F fluid-filled lumen catheter. ESPVR was measured at the baseline and after 3 minutes of dobutamin infusion (10 microgram/Kg/min). Results No correlation was observed between the degree of myocyte hypertrophy change or interstitial fibrosis and the two-dimensional echocardiographic or hemodynamic data. However, restrictive LV filling pattern was more common in the patients with severe degree of myocyte hypertrophy change. Myocardial contractility and contractile reserve were also significantly reduced in this patient group. The degree of interstitial fibrosis did not affect myocardial contractility or contractile reserve in this particular patient group. Conclusion Assessment of ESPVR using the echocardiographic automatated edge detection method was feasible in the patients with idiopathic dilated cardiomyopathy. The degree of myocardial hypertrophy change was prominent in the patients with reduced contractility and contractile reserve.ope

Implantation of Balloon-Expandable Stent for Coarctation of the Aorta, Associated with Congenital Mitral Stenosis

Coarctation of aorta is a rare cause of secondary hypertension, and premature death will occur if no appropriate treatment is given. The only effective treatment was surgery before 1980, but restenosis was frequent. Several works on percutaneous transluminal angioplasty of the disease were reported. In patients with previously operated recoarctation, there is no doubt that balloon angioplasty is now the first choice of the therapy because of the surgical risks of reoperation. Nevertheless, there has still been some controversy regarding the applications of this therapy to native coarctation, because of the potential risk of aortic disruption and the high incidence restenosis. There have been some clinical reports of successfiil stent implantation for coarctation without ma complications since 1991. We report on our experience with balloon-expandable stent implantation for nazi coarctation of the aorta in a 23-year-old man with congenital mitral stenosis. Aortogram showed a coarct aortic segment of 3 mm in diameter and 25 mm long just distal to the left subdavian artery. The peak systo pressure gradient across the coarctation before stent implantation was 100 mmHg. Stent implantation w performed with 14 x 40 mm balloon with Palmaz P308 stent. The peak systolic pressure gradient decreased zero and the diameter of the coarctation of aorta increased to 14 mm after stent implantation immediately. The patient tolerated well and no significant complications were encountered during the procedure.ope

Endovascular Abdominal Aortic Aneurysmal Repair:A Korean Perspective

Endovascular aneurysm repair (EVAR) was initially introduced as a less invasive alternative to conventional open repair. EVAR was subsequently adopted as a treatment option for abdominal aortic aneurysm. In Korea, open repair is more widely available than EVAR, although EVAR can be performed in several hospitals. Due to the rapidly aging population in Korea, there has been a shift from private healthcare to government-regulated universal coverage and EVAR may be a more feasible option for cardiovascular interventionalists in these days. The improvement of EVAR was rapidly attained by many pioneers for the last two decades. Although issues such as indications and durability of EVAR remain to be elucidated, its application can be extended further of milder invasiveness-related effects on comorbidities and less discomfort to patients. Aortic stent-grafting has been performed for various aortoiliac pathologies over the last 13 years at our cardiovascular center.1)2)3) This article presents a comprehensive review on EVAR by focusing on the clinical trials, indications, complications, and expertise in decision making for EVARope

Genetic Polymorphism of PAI-1 Gene and Cardiovascular Disease: eta-analysis of Case-Control Studies

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