Percutaneous transluminal angioplasty for suspected vertebral artery stump syndrome.
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ABSTRACT:
SUBMITTER: Oda K
PROVIDER: S-EPMC7788676 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundVertebral artery stenosis (narrowing of the vertebral artery) is an important cause of posterior circulation ischaemic stroke. Medical treatment (MT) e.g. controlling risk-factors and drug treatment, surgery, and endovascular treatment (ET) are the prevailing treatment strategies for symptomatic vertebral artery stenosis. ET consist s of percutaneous transluminal angioplasty (balloon catheter through the skin), with or without stenting. However, optimal management of people with symptomatic vertebral artery stenosis has not yet been established.ObjectivesTo assess the safety and efficacy of percutaneous transluminal angioplasty, with or without stenting, combined with MT, compared to MT alone, in people with episodes of cerebral ischaemia due to vertebral artery stenosis.Search methodsWe searched the Cochrane Stroke Group, MEDLINE, Embase, BIOSIS, and two other indexes in Web of Science, China Biological Medicine Database, Chinese Science and Technique Journals Database, China National Knowledge Infrastructure and Wanfang Data, as well as ClinicalTrials.gov trials register and the World Health Organization (WHO) International Clinical Trials Registry Platform to 23 July 2021.Selection criteriaWe included all randomised controlled trials (RCTs) that compared ET plus MT with MT alone in treating people aged 18 years or over with symptomatic vertebral artery stenosis. We included all types of ET modalities (e.g. angioplasty alone, balloon-mounted stenting, and angioplasty followed by placement of a self-expanding stent). MT included risk factor control, antiplatelet therapy, lipid-lowering therapy, and individualised management for people with hypertension or diabetes.Data collection and analysisTwo review authors independently screened potentially eligible studies, extracted data, and assessed trial quality and risk of bias. We applied the GRADE approach to assess the certainty of evidence. The primary outcomes were 30-day post-randomisation death/stroke (short-term outcome) and fatal/non-fatal stroke after 30 days post-randomisation to completion of follow-up (long-term outcome). MAIN RESULTS: We included three RCTs with 349 participants with symptomatic vertebral artery stenosis with a mean age of 64.4 years. The included RCTs were at low risk of bias overall. However, all included studies had a high risk of performance bias because blinding of the ET was not feasible. There was no significant difference in 30-day post-randomisation deaths/strokes between ET plus MT and MT alone (risk ratio (RR) 2.33, 95% confidence interval (CI) 0.77 to 7.07; 3 studies, 349 participants; low-certainty evidence). There were no significant differences between ET plus MT and MT alone in fatal/non-fatal strokes in the territory of the treated vertebral artery stenosis after 30 days post-randomisation to completion of follow-up (RR 0.51, 95% CI 0.26 to 1.01; 3 studies, 349 participants; moderate-certainty evidence), ischaemic or haemorrhagic stroke during the entire follow-up period (RR 0.77, 95% CI 0.44 to 1.32; 3 studies, 349 participants; moderate-certainty evidence), death during the entire follow-up period (RR 0.78, 95% CI 0.37 to 1.62; 3 studies, 349 participants; low-certainty evidence), and stroke or transient ischaemic attack (TIA) during the entire follow-up period (RR 0.65, 95% CI 0.39 to 1.06; 2 studies, 234 participants; moderate-certainty evidence).Authors' conclusionsThis Cochrane Review provides low- to moderate-certainty evidence indicating that there are no significant differences in either short- or long-term risks of stroke, death, or TIA between people with symptomatic vertebral artery stenosis treated with ET plus MT and those treated with MT alone.
| S-EPMC9112859 | biostudies-literature
Project description:We report a case of retrograde percutaneous transluminal angioplasty with stenting to chronically occluded upper limb vessels in a young female with Takayasu arteritis. A self-expanding stent (Supera peripheral stent system - Abbott Vascular, Santa Clara, CA, USA) was tracked retrogradely via ipsilateral radial access and the procedure was successful with good results. To our knowledge this is the first report of a Supera stent being tracked retrogradely through the radial artery. <Learning objective: This case demonstrates the feasibility of tracking and successful deployment of Supera stent transradially.>.
| S-EPMC6135029 | biostudies-literature
Project description:We report on a female patient who underwent a standard radical mastectomy and radiation therapy for right breast cancer at the age of 50 years without recurrence. At the age of 76 years, she started to experience fatigue in the right upper limb. The symptom gradually worsened and she was admitted to our hospital for further investigation. With computed tomography scan and angiography, we observed a high degree of subclavian artery (SCA) stenosis and asymptomatic right common carotid artery (CCA) stenosis. After undergoing carotid artery stenting to the right CCA stenosis at another hospital, we performed percutaneous transluminal angioplasty to SCA. Although we chose to treat the highly calcified lesion only with a balloon and slightly decreased the degree of stenosis, her symptoms clearly improved. Since arterial severely stenotic lesions were limited in the area of radiation exposure while other part of the arteries looked smooth and relatively free of sclerosis, it was highly suspected that arterial injury was induced by radiation. There are few reports of radiation-induced injury of upper limbs. However, this case suggests that we need to consider the possibility of radiation-induced arterial injury in patients with a history of radiation therapy. <Learning objective: There are few reports regarding upper limb arterial stenosis and occlusion due to radiation-induced arterial injury. However, the underlying mechanism might be overlooked because the symptoms such as fatigue and numbness of the upper limb caused by arterial stenosis and occlusion resembled those of lymphedema and nerve disorders that frequently occur after mastectomy. This case suggests that we need to consider the possibility of radiation-induced arterial injury in the patients with a history of radiation therapy.>.
| S-EPMC6262156 | biostudies-other
Project description:Concomitant percutaneous transluminal angioplasty (PTA) at the time of percutaneous coronary intervention (PCI) is often performed because lower extremity artery disease (LEAD) commonly coincides with coronary artery disease. We investigated the impact of concomitant PTA on both cardiovascular and limb outcomes in the Korean National Health Insurance Service registry. Among 78,185 patients undergoing PCI, 6563 patients with stable LEAD without limb ischemia were included. After 1:5 propensity score matching was conducted, 279 patients in the PTA + PCI group and 1385 patients in the PCI group were compared. Multivariate Cox proportional hazard models showed that the risk of all-cause death was higher in the PTA + PCI group than in the PCI group, whereas the risks of myocardial infarction, repeat revascularization, stroke, cardiovascular death and bleeding events were not different between the 2 groups. In contrast, the risks of end-stage renal disease and unfavorable limb outcomes were higher in the PTA + PCI group. Mediation analyses revealed that amputation and PTA after discharge significantly mediated the association between concomitant PTA and all-cause death. Concomitant PTA was not associated with an increased risk of cardiovascular events but may increase the risk of all-cause death mediated by unfavorable renal and limb outcomes in patients with stable LEAD.
| S-EPMC9338082 | biostudies-literature
Project description:ObjectiveFor patients with atherosclerotic renal artery stenosis (ARAS), the role of percutaneous transluminal renal angioplasty (PTRA) remains inconclusive. This study aimed to comparatively evaluate the benefits of best medical therapy (BMT) plus PTRA and BMT alone in treating ARAS.MethodsWe performed a systematic review and meta-analysis, and searched for all randomized, controlled trials that reported patients with ARAS. The effectiveness and safety in the BMT plus PTRA and BMT alone groups were estimated, taking into account hypertension, stroke, renal events, cardiac events, and mortality.ResultsNine randomized, controlled trials involving 2309 patients were included. In the BMT plus PTRA group, the incidence of refractory hypertension was significantly lower compared with that in the BMT alone group (odds ratio 0.09; 95% confidence interval 0.01, 0.70). However, there were no significant differences in the rates of stroke, renal events, cardiac events, cardiac mortality, and all-cause mortality between the two groups.ConclusionsPTRA plus BMT improves blood pressure in patients with ARAS, but there is insufficient evidence for this therapy in improving stroke, renal events, cardiac events, and cardiac and all-cause mortality.
| S-EPMC7841243 | biostudies-literature
Project description:The number of patients in dialysis increases every year. In this review, we will evaluate the role of percutaneous transluminal angioplasty (PTA) according to patency of arteriovenous fistula and grafts. The main indication of P?? is stenosis > 50% or obstruction of the vascular lumen of an arteriovenous fistula and graft. It is usually performed under local anesthesia. The infection rate is as low as the number of complications. Fistula can be used in dialysis in the same day without the need for a central venous catheter. Primary patency is >50% in the first year while primary assisted patency is 80-90% in the same time period. Repeated PTA is as durable as the primary PTA. An early PTA carries a risk of new interventions. Cutting balloon can be used as a second-line method. Stents and covered stents are kept for the management of complications and central outflow venous stenosis. PTA is the treatment of choice for stenosis or obstruction of dialysis fistulas. Repeated PTA may be needed for better patency. Drug eluting balloon may become the future in PTA of dialysis fistula, but more trials are needed.
| S-EPMC5892221 | biostudies-other
Project description:For management of Budd-Chiari syndrome (BCS), a step-wise therapeutic approach starting with medical treatment, followed by endovascular recanalization, transjugular intrahepatic portosystemic shunt, and finally liver transplantation has been adopted. We retrospectively analyzed 51 patients with symptomatic short segment (≤ 30 mm) hepatic vein (HV)-type BCS who underwent percutaneous transluminal balloon angioplasty (PTBA) with/without stenting to determine the feasibility, clinical effectiveness, and long-term outcomes. The intervention was technically successful in 94.1% of cases (48/51)-32 patients underwent PTBA and 16 patients underwent HV stenting. Procedure-related complications occurred in 14 patients (29.1%). The clinical success rate at 4 weeks was 91.7% (44/48). Nine patients underwent reintervention, six patients due to restenosis/occlusion and three patients with clinical failure. The mean primary patency duration was 64.6 ± 19.9 months (CI, 58.5-70.8; range, 1.2-81.7 months). The cumulative 1-, 2-, and 5-year primary patency rates were 85.4, 74.5, and 58.3%, respectively. The cumulative 1-, 2-, and 5-year secondary patency rates were 93.8, 87.2, and 75%, respectively. The cumulative 1-, 2-, and 5-year survival rates were 97.9, 91.5, and 50%, respectively. Percutaneous transluminal angioplasty with and without stenting is effective and achieves excellent long-term patency and survival rates in patients with symptomatic HV-type BCS. With its lower incidence of re-occlusion and higher clinical success rate, HV angioplasty combined with stenting should be the preferred option especially in patients with segmental HV-type BCS.
| S-EPMC9388522 | biostudies-literature
Project description:BackgroundPercutaneous transluminal angioplasty (PTA) is increasingly requested in the therapy of peripheral arterial occlusive disease. The evaluation of the technical result after balloon angioplasty with regard to bailout stenting is highly dependent on the operators´ subjective assessment and mainly based on the monochromatic digital subtraction angiography (DSA) images. The aim of this study was to compare color-coded single image as a novel diagnostic tool with monochromatic DSA for the analysis of flow limitation and need for stent implantation after PTA of superficial femoral artery (SFA) stenoses.MethodsDuring a period of 18?months, 213 SFA lesions were treated by PTA with a standard balloon in 170 patients, resulting in a total of 193 endovascular procedures. The median age of the patients was 77?years (range, 35-96?years). Median length of the treated lesions was 10.5?cm (range, 1.0-50?cm). Three interventional radiologists retrospectively evaluated the results of balloon angioplasty with monochromatic as well as post-processed color-coded DSA images for flow limitations to decide if subsequent stent implantation was necessary. Consensus reading of two experienced interventional radiologists 2 months after the initial review served as reference standard to perform a receiver operating characteristics (ROC) analysis.ResultsROC analysis for readers A, B and C showed area under the curve (AUC) values of 0.797, 0.865 and 0.804 for color-coded DSA and AUC values of 0.792, 0.843 and 0.872 for monochromatic DSA: a significant advantage of color-coded over conventional monochromatic DSA was not found for readers A and B (p?>?0.05). Results of reader C were significantly better in the assessment of monochromatic images (p?=?0.023). Diagnostic confidence using color-coded images was slightly higher than in monochromatic images (??=?0.486 vs. ??=?0.459).ConclusionsIn this study, color coded DSA did not reveal to be superior to conventional monochromatic DSA when evaluating results of PTA and when deciding whether stent implantation is necessary or not. This technology, however, requires further experiences with special regard to homogeneously trained radiologists and to the time requirement.
| S-EPMC7302343 | biostudies-literature
Project description:PurposeTo perform a systematic review assessing the safety and efficacy of percutaneous transluminal angioplasty (PTA) for treatment of critical hand ischemia (CHI) due to below-the-elbow (BTE) obstructive arterial disease.Materials and methodsMEDLINE and EMBASE systematic searches were performed from inception to December 2020 to identify studies assessing PTA for management of BTE obstructive arterial disease. Three independent reviewers performed abstract selection, data extraction, and quality assessment. The Newcastle-Ottawa Scale was used to assess individual study bias for non-randomized controlled trials.ResultsEight studies comprising 176 patients with obstructive BTE vessel disease were included. All studies had a score >5 on the Newcastle-Ottawa Scale, indicative of high quality. All studies used low-profile balloons (1.5-4 mm) for PTA of stenotic lesions or chronic total occlusions (CTOs). The weighted average technical success and clinical success rates were 89.3% (range = 82%-100%) and 69.9% (range = 19%-100%), respectively, at a mean follow-up of 29.7 ± 17.1 months. The short-term (<30 days) complication rate was low at 4.7% and most commonly included access site hematomas, pseudoaneurysms, and radial artery perforation or re-thrombosis. Nearly 20% of patients required an amputation, and most (96%) were minor (either distal phalanges or digits). Only 2 patients required above-wrist amputations. The primary and secondary patency rate at 5 years were 38% and 54%, respectively. The cumulative 5-year mortality rate was 33.1%.ConclusionsPTA for CHI due to BTE obstructive arterial disease is feasible with a high technical success rate and a low short-term complication rate. Additional long-term comparative studies are required to unequivocally establish the clinical benefit of endovascular treatment compared with conservative management or surgical bypass.
| S-EPMC9096593 | biostudies-literature
Project description:IntroductionTransplant renal artery stenosis (TRAS) is one of the major vascular complications and is mostly reported within six months following kidney transplant.Case presentationThe present case was a 16-year-old female whose blood urea nitrogen (BUN) and creatinine rose seven days after a kidney transplant. Ultrasound investigation revealed well-prefusion with a 90-degree angle anastomosis, apparent narrowing, and peak systolic velocity of 300 cm/s. Fourteen days after the transplant, with pre-and post-intervention hemodialysis and well hydration, an angiography with diluted iodinated contrast was done for the patient, which revealed >80 % narrowing at the anastomosis site. Percutaneous transluminal angioplasty (PTAS) with stenting was carried out for the patient, resulting in normal levels of BUN, creatinine, and urinary output.Clinical discussionWhile the patient did not have any risk factors for TRAS and was young, an early stenosis occurred in her left internal iliac artery one week after the kidney transplant. Due to the lower accuracy of CO2 angiography, diluted iodinated contrast angiography with well hydration and pre- and post-intervention dialysis was preferred. Endovascular treatment was preferred by the patient and attending physician due to possible adhesion and complications of open surgery and the possibility of arterial rupture.ConclusionPerforming PTAS two weeks after the renal transplantation at the anastomosis site can be a treatment in patients with early TRAS. However, due to the higher risk of rupture at the anastomosis site, it should be carried out carefully and with consideration of the need for open surgery.
| S-EPMC10819742 | biostudies-literature