Dataset Information

Temporal reverse flow by proximal femoral artery occlusion during drug-coated balloon dilatation: a technique to minimize downstream particle embolization and systemic adverse effects.

ABSTRACT: Downstream paclitaxel particle embolization for nonhealing ischemic ulcers and systemic adverse effects caused by a paclitaxel drug-coated balloon are of concern, and safety measures to prevent these adverse risks are needed. To reduce distal particle embolization and movement of the paclitaxel particles to systemic blood flow during drug-coated balloon inflation, proximal balloon occlusion using a sheathless temporary occlusion balloon-guiding catheter and extraction by manual aspiration of the paclitaxel-containing blood through the catheter are good treatment options to overcome these risks. Here, we introduce this method with tips and tricks, and demonstrate initial experience of this technique.

SUBMITTER: Kimura M

PROVIDER: S-EPMC8591398 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Temporal reverse flow by proximal femoral artery occlusion during drug-coated balloon dilatation: a technique to minimize downstream particle embolization and systemic adverse effects.

Kimura Masayoshi M Shiraishi Jun J Hyogo Masayuki M Sawada Takahisa T

Journal of vascular surgery cases and innovative techniques 20211013 4

Downstream paclitaxel particle embolization for nonhealing ischemic ulcers and systemic adverse effects caused by a paclitaxel drug-coated balloon are of concern, and safety measures to prevent these adverse risks are needed. To reduce distal particle embolization and movement of the paclitaxel particles to systemic blood flow during drug-coated balloon inflation, proximal balloon occlusion using a sheathless temporary occlusion balloon-guiding catheter and extraction by manual aspiration of the ...[more]

PMID: 34816069

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Project description:BackgroundThe effects of the drug-coated balloon (DCB)-only strategy in the treatment of chronic total occlusion (CTO) coronary lesions remain controversial. Patients who underwent an in-stent restenosis (ISR) CTO percutaneous coronary intervention (PCI) had a significantly poorer prognosis than those who underwent a de novo CTO PCI. This retrospective analysis evaluated the efficacy and safety of the DCB-only strategy in the treatment of CTO lesions, and the factors associated with adverse events in the patients.MethodsPatients with CTO lesions who were treated with the DCB-only strategy from 1 January 2016 to 1 May 2021 were retrospectively enrolled in this study. The patients were stratified into the ISR and de novo (primary) groups. All the patients were re-admitted to the hospital and underwent clinical and/or angiographic follow-up.ResultsOf the 68 patients with CTO lesions, 38 (55.9%) were categorized as having ISR, and 30 (44.1%) were categorized as having de novo lesions. The outcomes measured included target lesion revascularization (TLR), lumen gain after intervention, and late lumen loss (LLL). After an average follow-up period of 16 months, a total of 15 patients experienced target lesion failure (13 in the ISR group and 2 in the de novo group). The rate of major adverse cardiac events (MACEs) was significantly lower in the de novo group than the ISR group (10% vs. 39%, P=0.004). There was a significant difference in LLL between the two groups, with the de novo group showing a decrease (-0.04±0.83 mm) and the ISR group showing an increase (0.97±1.45 mm) (P=0.03). The univariable Cox proportional hazard analyses revealed that the incidence of TLR was independently associated with the stenosis type (either ISR or de novo lesions) [odds ratio (OR): 7.28; 95% confidence interval (CI): 1.494-35.464; P=0.01]. Male gender (OR: 3.726; 95% CI: 1.014-12.818; P=0.03) and body mass index (BMI) (OR: 1.246; 95% CI: 1.022-1.518, P=0.03) were also associated with the incidence of TLR. However, after adjusting for the variables of age, gender, and BMI, no significant association was found between MACE occurrence and ISR (OR: 4.156, 95% CI: 0.734-23.522; P=0.11).ConclusionsTreatment using the DCB-only strategy was found to be beneficial for patients suffering from CTO coronary lesions, especially those presenting with de novo lesions.

Project description:BackgroundBalloon dilatation is widely used for patients with achalasia; however, the efficacy and safety of Chinese medicine combined with balloon dilatation for achalasia patients is still unclear. Therefore, we conducted a meta-analysis to compare the treatment effectiveness of treatment with Chinese medicine plus balloon dilatation versus balloon dilatation alone for patients with achalasia.MethodsRandomized controlled trials (RCTs) compared the effectiveness of Chinese medicine plus balloon dilatation with balloon dilatation as examined in studies in the PubMed, Springer, Embase, Wiley-Blackwell, Chinese Journal Full-text Database, and the Cochrane library from their inception up to May 2019. The odds ratios (ORs) and weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were used to calculate categories and continuous outcomes using the random-effects model. The inclusion of studies according to the PICOS (participants, interventions, comparisons, outcomes) criteria, the assessment of risk of bias of included studies adhered to the Cochrane criteria guidelines.ResultsThe initial electronic searches produced 378 records, and 10 RCTs that recruited 504 achalasia patients were included in the final quantitative analysis. Except for other potential biases with moderate to high-risk bias of 20-40%, the other six items had a low-risk bias of 80-90%. Overall, we noted that patients who received the Chinese medicine plus balloon dilatation treatment had a greater incidence of improvement at 1 year (OR: 2.20; 95% CI: 1.45-3.33; P<0.001), and 5 years (OR: 1.83; 95% CI: 1.23-2.74; P=0.003), and reduced the risk of gastroesophageal reflux (OR: 0.42; 95% CI: 0.24-0.76; P=0.004) than patients who underwent balloon dilation only. However, patients who received the Chinese medicine plus balloon dilatation treatment did not have a greater risk of perforation (OR: 0.53; 95% CI: 0.24-1.19; P=0.123) compared with patients undergoing balloon dilation. Finally, Chinese medicine plus balloon dilatation was associated with high esophageal sphincter pressure (WMD: 2.01; 95% CI: 1.19-2.84; P<0.001) compared with patients who underwent balloon dilatation only.ConclusionsChinese medicine plus balloon dilatation had better effects after treatment than balloon dilatation alone for achalasia patients. Given the risk of bias of included studies, the conclusion should be made with cautions.

Dataset Information

Temporal reverse flow by proximal femoral artery occlusion during drug-coated balloon dilatation: a technique to minimize downstream particle embolization and systemic adverse effects.

Publications

Temporal reverse flow by proximal femoral artery occlusion during drug-coated balloon dilatation: a technique to minimize downstream particle embolization and systemic adverse effects.

Similar Datasets

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