Calcified Nodules in the Superficial Femoral Artery Confirmed by Intravascular Ultrasound, Angioscopy, and Histology.
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ABSTRACT:
SUBMITTER: Tanaka K
PROVIDER: S-EPMC8299250 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Heavily calcified lesions may limit optimal stent deployment resulting in stent underexpansion, thus increasing the risk of restenosis and thrombosis. We describe the case of overlapping stents underexpansion treated with a shockwave intravasuclar lithoplasty system (Shockwave Medical Inc., Santa Clara, CA, USA). A 65-year-old man with angina, underwent coronary angiography and intravascular ultrasound showing restenosis, in a site of overlapping stents, due to calcified tissue. Shockwave lithoplasty balloon was able to break calcified tissue in a site of overlapping stents, allowing subsequent vessel dilation and repeat stent implantation with optimal final stent expansion. <Learning objective> Heavily calcified lesions may limit optimal stent deployment resulting in stent underexpansion. Treating stent underexpansion or restenosis due to calcified tissue is a great challenge. Shockwave lithoplasty is effective in breaking calcified tissue also in a site of overlapping stents. The improved plaque compliance allows to repeat stent implantation with optimal final stent expansion.
| S-EPMC6962730 | biostudies-literature
Project description:BackgroundCalcified lesions represent a hard obstacle to overcome in renal arteries, particularly when renal angioplasty represents the only feasible course of action in the setting of high-risk bilateral renal artery stenosis (RAS) with refractory systemic hypertension and recurrent flash pulmonary oedema.Case summaryWe herein report a case of symptomatic bilateral severely calcified RAS, treated successfully with intravascular ultrasound (IVUS)-guided coronary and peripheral intravascular shockwave lithotripsy systems and stenting.DiscussionIntravascular shockwave lithotripsy is an attractive modality for the treatment of challenging, heavily calcified renal arteries that combines the calcium-disrupting capability of lithotripsy with the familiarity of balloon catheters to facilitate proper stent deployment.
| S-EPMC7809723 | biostudies-literature
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| S-EPMC8084382 | biostudies-literature
Project description:Background/objectivesDrug-coated balloon therapy for diseased superficial femoral arteries remains controversial. Despite its clinical relevance, only a few computational studies based on simplistic two-dimensional models have been proposed to investigate this endovascular therapy to date. This work addresses the aforementioned limitation by analyzing the drug transport and kinetics occurring during drug-coated balloon deployment in a three-dimensional geometry.MethodsAn idealized three-dimensional model of a superficial femoral artery presenting with a calcific plaque and treated with a drug-coated balloon was created to perform transient mass transport simulations. To account for the transport of drug (i.e. paclitaxel) released by the device, a diffusion-reaction equation was implemented by describing the drug bound to specific intracellular receptors through a non-linear, reversible reaction. The following features concerning procedural aspects, pathologies and modelling assumptions were investigated: (i) balloon application time (60-180 seconds); (ii) vessel wall composition (healthy vs. calcified wall); (iii) sequential balloon application; and (iv) drug wash-out by the blood stream vs. coating retention, modeled as exponential decay.ResultsThe balloon inflation time impacted both the free and specifically-bound drug concentrations in the vessel wall. The vessel wall composition highly affected the drug concentrations. In particular, the specifically-bound drug concentration was four orders of magnitude lower in the calcific compared with healthy vessel wall portions, primarily as a result of reduced drug diffusion. The sequential application of two drug-coated balloons led to modest differences (~15%) in drug concentration immediately after inflation, which became negligible within 10 minutes. The retention of the balloon coating increased the drug concentration in the vessel wall fourfold.ConclusionsThe overall findings suggest that paclitaxel kinetics may be affected not only by the geometrical and compositional features of the vessel treated with the drug-coated balloon, but also by balloon design characteristics and procedural aspects that should be carefully considered.
| S-EPMC8504744 | biostudies-literature
Project description:A patient with occlusion of the left superficial femoral artery (SFA) underwent endovascular intervention. Six-month follow-up angiography revealed aneurysmal dilatation of the previously stented artery. This finding may be a result of maladaptive vascular remodeling or arterial injury resulting in aneurysmal dilatation secondary to subintimal crossing, atherectomy, and paclitaxel therapies. (Level of Difficulty: Beginner.).
| S-EPMC8311142 | biostudies-literature
Project description:BackgroundLocal blood flow affects vascular disease and outcomes of endovascular treatment, but quantifying it is challenging, especially inside stents. We assessed the feasibility of blood flow quantification in native and stented femoral arteries, using high-frame-rate (HFR) contrast-enhanced ultrasound (CEUS) particle image velocimetry (PIV), also known as echoPIV.MethodsTwenty-one patients with peripheral arterial disease, recently treated with a stent in the femoral artery, were included. HFR CEUS measurements were performed in the native femoral artery and at the inflow and outflow of the stent. Two-dimensional blood flow was quantified through PIV analysis. EchoPIV recordings were visually assessed by five observers and categorised as optimal, partial, or unfeasible. To evaluate image quality and tracking performance, contrast-to-tissue ratio (CTR) and vector correlation were calculated, respectively.ResultsFifty-eight locations were measured and blood flow quantification was established in 49 of them (84%). Results were optimal for 17/58 recordings (29%) and partial for 32 recordings (55%) due to loss of correlation (5/32; 16%), short vessel segment (8/32; 25%), loss of contrast (14/32; 44%), and/or shadows (18/32; 56%). In the remaining 9/58 measurements (16%) no meaningful flow information was visualised. Overall, CTR and vector correlation were lower during diastole. CTR and vector correlation were not different between stented and native vessel segments, except for a higher native CTR at the inflow during systole (p = 0.037).ConclusionsBlood flow quantification is feasible in untreated and stented femoral arteries using echoPIV. Limitations remain, however, none of them related to the presence of the stent.Trial registrationClinicalTrials.gov, NCT04934501 (retrospectively registered).
| S-EPMC9256892 | biostudies-literature
Project description:BackgroundA femoral aneurysm is a weakness and bulging in the femoral artery wall located in the thigh. Femoral aneurysms can burst, which may cause uncontrolled bleeding and life-threatening conditions. The aneurysm may also cause a blood clot, showering emboli, potentially resulting in leg ischemia and amputation.Case reportA 49-year-old man with hypertension presented significant swelling in his right thigh. The patient had a history of surgery for arteriovenous fistula repair. The arteriovenous fistula in the thigh was caused by a bullet injury during the war. Diagnosis of the superficial femoral artery aneurysm was determined using magnetic resonance angiogram. The aneurysm was surgically excised and a prosthetic vascular graft was inserted.DiscussionThe exact cause of femoral aneurysms is unknown, although atherosclerosis and hypertension may play a key role. Trauma to the artery may also be a contributing factor. Long-standing occult arteriovenous fistula plays a significant role in the cause of distal aneurysms.ConclusionFemoral aneurysms are usually treated surgically. A surgeon will replace the artery with a graft or create a bypass around the area of the artery where the aneurysm is present.
| S-EPMC7272507 | biostudies-literature
Project description:The femoropopliteal artery is one of the commonest sites of involvement in peripheral artery disease (PAD) leading to intermittent claudication and/or critical limb ischemia. Endovascular therapy for superficial femoral artery (SFA) disease has been recognized as a safe and efficient therapy and is recommended by current guidelines as the first-line approach. Although the widespread use of new-generation, self-expanding, nitinol stents in SFA stenosis has reduced the shortcomings associated with plain old balloon angioplasty (POBA), lumen renarrowing at the stented (in-stent restenosis - ISR) level still represents a relevant clinical problem, because of higher risk of recurrent ISR, occlusion and surgical revascularization compared to de-novo lesions. In this setting, different treatment options are available and drug-coated balloons (DCBs) have shown good results in terms of safety and effectiveness. In this review we examine the results of different trials exploring the outcome of using DCBs for the treatment of SFA ISR. The available data demonstrate that SFA ISR can be safely treated with percutaneous transluminal angioplasty with a DCB, with a reduction in recurrent restenosis and target lesion revascularization (TLR) at least at 1 year after POBA. The consistent and positive results of different registries and randomized trials support the use of DCB to reduce SFA ISR recurrence.
| S-EPMC5939540 | biostudies-other
Project description:BackgroundPrevalence of coronary artery calcification is high among patients with advanced age, chronic kidney disease, and diabetes. Percutaneous coronary intervention of heavily calcified coronary artery remains a significant challenge for interventional cardiologists. Although there are several modalities available in treating calcified coronary arteries, lesion preparation of certain heavily calcified vessels remains inadequate prior to stent deployment and/or often associated with worse periprocedural adverse outcomes.Case summaryWe report feasibility and safety of 3.5 mm peripheral intravascular lithotripsy (IVL) for the treatment of severely calcified coronary stenosis in two patients after orbital atherectomy failed to debulk calcified plaque to enable stent deployment.DiscussionIntravascular lithotripsy has recently emerged as a therapeutic option in treating calcified peripheral artery disease. However, coronary IVL is currently available only in a few centres in the USA. Studies are ongoing in the safety and efficacy of this technology in treating coronaries.
| S-EPMC7649492 | biostudies-literature
Project description:OBJECTIVE:The coronary artery dimensions have important diagnostic and therapeutic implications in management of coronary artery disease (CAD). There is paucity of data on the coronary artery size in the Indian population as measured by intravascular ultrasound (IVUS). METHODS:A total of 303 patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) with intravascular ultrasound underwent analysis along with quantitative coronary angiography (QCA). Of the 492 proximal coronary segments; 221 relating to left main (LM), 164 to left anterior descending artery (LAD), 45 to left circumflex artery (LCX), and 62 to right coronary artery (RCA) were considered. RESULTS:Patient's mean age was 53.37 ± 3.5 years; men 80%; hypertension 35% and diabetes 24.8%. On IVUS, mean minimal lumen diameter as compared to QCA in LM (4.60 mm versus 4.50 mm, p < 0.001), LAD (3.71 mm versus 3.45 mm, p < 0.001), LCX (3.55 mm versus 3.16 mm, p < 0.001) and RCA (3.85 mm versus 3.27 mm, p < 0.001) were significantly larger. Lumen and external elastic membrane (EEM) cross-sectional area (CSA) were larger in males as compared to females with statistical significance for lumen CSA in LM (p = 0.04); RCA (p = 0.02) and EEM CSA in LM (p = 0.03); RCA (p = 0.006) but no significance for adjusted body surface area (BSA). In multivariate models, BSA and age were independent predictors of LM and LAD diameters and areas, but age was an independent predictor indexed to BSA. CONCLUSION:The coronary artery dimensions by IVUS are significantly larger than QCA. No gender difference in coronary artery size. Age was an independent predictor of coronary artery size in left main and LAD. The coronary artery size may not be a risk factor for acute coronary syndrome.
| S-EPMC7013999 | biostudies-literature