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1.
Karl Schürmann Dierk Vorwerk Arno Bücker Stefanie Grosskortenhaus Rolf W. Günther 《Cardiovascular and interventional radiology》1998,21(5):411-418
Purpose: To compare patency and neointima formation of single and tandem arterial stents.
Methods: In each of six sheep, two Memotherm nitinol stents (tandem stents) were inserted into the external iliac artery on one side
and a single stent into the artery on the opposite side. The size of the iliac lumen was assessed in the proximal, middle,
and distal segments of the stents by intravascular ultrasound (IVUS) before, immediately after, and 1 month after implantation
when the sheep were killed. Neointimal thickness was determined in the proximal, middle, and distal segments of each stent
by light microscopy.
Results: All stents remained patent. There was no significant difference in lumen and neointimal thickness between single and tandem
stents. Cranial tandem stents showed a significantly wider lumen and smaller neointimal thickness than caudal tandem stents.
In the proximal and distal segments, the lumen of the stents was significantly smaller and the neointimal thickness greater
than in the middle segment; differences in neointimal thickness were significant only between the proximal and the middle
segment.
Conclusion: In an experimental setting, tandem stents did not interfere with one another with regard to patency and neointima formation
when compared with a single contralateral stent. Neointimal thickening after stent insertion seems to be inversely related
to the original arterial diameter. 相似文献
2.
Karl Schürmann Dierk Vorwerk Robert Uppenkamp Bernd Klosterhalfen Arno Bücker Rolf W. Günther 《Cardiovascular and interventional radiology》1998,21(3):189-198
Purpose: To compare intravascular ultrasound (IVUS) and angiography with histology in determining the degree of stent stenosis in
an in vivo experiment.
Methods: In 16 sheep, a total of 64 stents were implanted into the external iliac arteries. Two stents were inserted on either side.
Patency was followed by angiography and IVUS. Four types of stent were used: two Dacron-covered (Cragg Endopro and heparinized
Cragg Endopro) and two non-covered (Cragg and Memotherm stents). Eight animals were killed after 1 month, eight others after
6 months. Histological sections were prepared from the stented vessels. Measurements of the patent and total stent diameters
determined by IVUS, angiography, and histology were compared.
Results: Correlation between IVUS and angiography was 0.75, between IVUS and histology 0.77, and between angiography and histology
0.85. A mean stent stenosis of 17 ± 11% (range 0–51%) was found on angiography, of 10 ± 11% (0–46%) on IVUS, and of 20 ± 11%
(4%–49%) on histology. In comparison with histology, IVUS underestimated the degree of stenosis by 10 ± 8%, and angiography
underestimated it by 3 ± 6%. Resolution of IVUS was calculated to be about 0.35 mm and that of angiography to be about 0.15
mm.
Conclusion: Under experimental conditions, IVUS was not superior to angiography in determining the degree of stent stenosis in long-segment
stenoses of iliac artery stents, when measurements were correlated with histology. Angiography is sufficient for following
the patency of iliac artery stents. 相似文献
3.
J. Graeme Houston Peter T. McCollum Peter A. Stonebridge Zahid Raza J. William Shaw 《Cardiovascular and interventional radiology》1998,22(2):89-95
Purpose: To assess the technical success, initial clinical outcome, and intermediate follow-up of the Memotherm nitinol self-expanding
stent in aortic bifurcation reconstruction.
Methods: Thirty-three patients (13 male, 20 female), mean age 64 years, were treated, who had symptoms classified by the Surgical
Vascular Society/International Society of Cardiovascular Surgery (SVS/ICVS) classification as grade 2 in 11 (33%), grade 3
in 19 (58%) and grade 4 in 3 (9%) patients. Lesions were classified according to severity and type. Indications for placement
of a Memotherm nitinol self-expanding stent were failed angioplasty in 14 (42%), chronic occlusions in 12 (37%), and complex
stenoses in seven (21%) patients.
Results: Sixty-seven stents were technically successfully placed in 66 aorto-iliac segments in 33 patients, with one major complication.
Initial clinical outcome was improvement in 25 (81%), no change in four (13%), and a worsening in two (6%) patients by Rutherford
criteria. Mean early ankle/brachial pressure index (ABI) gain was 0.27 for occlusions and 0.05 for stenoses. Clinical follow-up
was obtained in all patients, with retrospective angiographic follow-up in 28 (85%) at a mean of 16 months (range 12–26 months).
The decrease in ABI and the decrease in angiographic luminal diameter at follow-up was determined as the “late loss.” The
mean ABI late losses were −0.06, 0.00, and 0.09, and the mean angiographic late losses were 6.7%, 10% and 14% for occlusions,
stenoses, and normal segments respectively. Primary clinical patency was 96%, primary angiographic patency was 89%, and secondary
angiographic patency was 93%.
Conclusion: The high technical success of stent placement, the low complication rates for aortic bifurcation reconstruction using the
Memotherm self-expanding stent, and high clinical and angiographic patency maintained at intermediate follow-up support their
use in aortic bifurcation reconstruction. 相似文献
4.
Frank Schellhammer Jörg Haberstroh Ajay K. Wakhloo Eva Gottschalk Martin Schumacher 《Cardiovascular and interventional radiology》1998,21(2):158-164
Purpose: To evaluate different vein grafts for luminal coating of endovascular stents in normal canine arteries.
Methods: Twenty-four tantalum Strecker stents were coated with either autologous (n= 10), denatured heterologous (n= 11), or denatured homologous vein grafts (n= 3). The carotid artery (n= 11) and the iliac artery (n= 13) were stented using a transfemoral approach. Angiograms were performed at days 0, 7, and 21, and months 3, 6, and 9.
All grafts underwent histological examination.
Results: Eight of 10 autologous vein grafts showed patency during the whole observation period of 9 months, without histological signs
of inflammation. Denatured heterologous vein grafts revealed acute (n= 3), subacute (n= 5), or delayed (n= 3) vessel occlusion. Hyaloid transformation of the vein graft and lympho-plasmacellular formations were seen. Denatured
homologous vein grafts showed acute vessel occlusion. Although significant inflammatory tissue response was seen, no host-versus-graft
reaction was present.
Conclusion: Autologous vein graft-coated stents showed good biocompatibility in canine arteries. Preparation was cumbersome and required
surgical venae-sectio. Denatured vein grafts, however, were limited by inflammatory reactions. 相似文献
5.
Bertrand Janne d’Othée Hervé Rousseau Philippe Otal Francis Joffre 《Cardiovascular and interventional radiology》1999,22(5):424-427
We report a case of scapulothoracic dissociation with right subclavian artery traumatic injury that was managed by endovascular
treatment. Particular features are the use of a flexible self-expandable noncovered stent and simultaneous protection of the
right common carotid artery from distal embolization by inflating a balloon catheter. 相似文献
6.
Baran Önal Erhan T. Ilgit Cem Yücel Erdal Özbek Murat Vural Sergin Akpek 《Cardiovascular and interventional radiology》1998,21(5):386-392
Purpose: To evaluate the efficacy of primary stenting for complex atherosclerotic plaques in aortic and iliac stenoses that are not
amenable to balloon angioplasty alone.
Methods: Nineteen patients with complex atherosclerotic plaques were treated with a Palmaz stent (n= 19), Wallstent (n= 1), Strecker stent (n= 1), or Memotherm stent (n= 1). A total of 22 stenoses presenting with complex plaque morphology including ulcerated plaques, ulcerated plaques with
focal aneurysms, plaques with heavy calcification, severely eccentric plaques, plaques with overhanging edge, and plaques
with spontaneous dissection were stented. The lesions were in the aorta (n= 1), common iliac artery (n= 19), or external iliac artery (n= 2).
Results: Immediate angiography after stent placement revealed restoration of patency of the stented segment. Focal aneurysms and ulcerated
areas were occluded in the follow-up angiographies obtained 4–12 weeks after the procedure. In one case with poor distal runoff
and multiple complex lesions of the iliac artery, subacute occlusion occurred. Clinical and angiographic follow-up (3–46 months)
revealed patency of all other stented segments.
Conclusion: Primary stenting is an effective and reliable approach for complex plaques in stenoses. Patency of the arterial segment with
a smooth lumen can be created without the risk of acute complications such as distal embolization, dissection, or occlusion. 相似文献
7.
Jae-Kyu Kim Yun-Hyeon Kim Sang-Yeung Chung Heoung-Keun Kang 《Cardiovascular and interventional radiology》1999,22(4):278-281
Purpose: To report the clinical results for recanalizations of an occluded iliac artery by a self-expanding spiral stent.
Methods: We attempted to recanalize 36 iliac artery occlusions in 34 patients [33 men, 1 woman, aged 51–75 years (average 61.6 years)].
The average lesion length was 6.92 cm (range 1–14 cm). The patients' chief complaints were intermittent claudication and resting
pain. Fontaine classification was assigned before and after the procedure. Technical and clinical success were also analyzed.
Results: Forty-five stents were successfully deployed in 34 patients. All 36 lesions (13 in the external iliac artery, 12 in the common
iliac artery, and 11 in both) were patently recanalized on angiography. The follow-up period ranged from 6 months to 36 months
(mean 11.9 months). Fourteen stents (39%) with incomplete expansion were dilated with a balloon catheter. Good technical (100%)
and clinical (94%) results were obtained. The only complication was one hematoma at the puncture site. Reocclusions were noted
in two lesions (5%) at 1 week and 15 months, respectively.
Conclusion: A self-expanding spiral stent is a safe and effective device for recanalization of an iliac artery occlusion as the primary
stent without any previous intervention. 相似文献
8.
Walter Heindel M.D. Axel Gossmann Roman Fischbach Olaf Michel Klaus Lackner 《Cardiovascular and interventional radiology》1996,19(6):431-434
A patient suffering from esophagorespiratory fistula after bougienage of a benign stricture at the site of the anastomosis
between a jejunal interposition and the esophagus was referred for interventional treatment. A prototype nitinol stent centrally
covered with Dacron was implanted under regional anesthesia and fluoroscopic guidance. The self-expanding prosthesis dilated
the stenosis completely and closed the fistula, with consequent improvement in respiratory and nutritional status and thus
the general quality of life. The patient was able to eat and drink normally until death 3 months later due to progression
of his underlying malignant disease. 相似文献
9.
Gary P. Siskin Brian F. Stainken Valerie S. Mandell R. Clement Darling Kyran Dowling Allen Herr 《Cardiovascular and interventional radiology》1999,22(5):375-380
Purpose: To evaluate the role of metallic stents in treating stenoses involving prosthetic arterial bypass grafts.
Methods: Patients undergoing stent placement within a failing prosthetic bypass graft, during a 41-month period, were reviewed for
treatment outcome and complications. The indications for stent placement in 15 patients included severe claudication (n= 3), rest pain (n= 9), and minor or major tissue loss (n= 3). Lesions were at the proximal anastomosis (n= 6), the distal anastomosis (n= 3), or within the graft (n= 6).
Results: Treatment with metallic stents was successful in all patients. There was one acute stent thrombosis, successfully treated
with thrombolytic therapy. Follow-up data are available for a mean duration of 12.3 months. The mean duration of primary patency
was 9.4 months with 6- and 12-month primary patency rates of 51.9% and 37.0%, respectively. The mean duration of secondary
patency was 12.1 months with 6- and 12-month secondary patency rates of 80.0% and 72.7%, respectively. Two patients with discontinuous
runoff and preexisting gangrene required a below-knee amputation. Six patients were revised surgically after stent placement
(at a mean of 10.8 months). Three late deaths occurred during follow-up.
Conclusion: Given the mortality risks of surgical revision and the reduced life expectancy of this patient population, metallic stent
placement represents a viable, short-term treatment option for stenoses within or at the anastomoses of prosthetic grafts.
Further evaluation is warranted to compare intragraft stent placement with surgical graft revision. 相似文献
10.
Manfred Cejna Siegfried Thurnher Johann Pidlich Klaus Kaserer Maria Schoder Johannes Lammer 《Cardiovascular and interventional radiology》1999,22(4):305-310
Purpose: To investigate whether placement of a polyester-covered stent-graft increases the primary patency of transjugular intrahepatic
portosystemic stent shunts (TIPSS).
Methods: Between 1995 and 1997 Cragg Endopro or Passager MIBS stent-grafts were used for the creation of TIPSS in eight male patients,
35–59 years of age (mean 48 years). All patients suffered from recurrent variceal bleeding and/or refractory ascites due to
liver cirrhosis. Seven stent-grafts were dilated to a diameter of 10 mm, one to 12 mm. Follow-up was performed with duplex
ultrasound, clinical assessment, and angiography.
Results: The technical success rate for creation of a TIPSS was 100%. The mean portosystemic pressure gradient decreased from 25 mmHg
to 12 mmHg. In seven of eight patients TIPSS dysfunction occurred between 2 days and 3 years after stent-graft placement.
In one patient the TIPSS is still primarily patent (224 days after creation). The secondary patency rates are 31 days to 3
years.
Conclusion: The primary use of polyester-covered stent-grafts for TIPSS did not increase primary patency rates in our small series. 相似文献
11.
Recurrent TIPS failure associated with biliary fistulae: Treatment with PTFE-covered stents 总被引:3,自引:0,他引:3
Daniel Y. Sze Thomas Vestring Robert P. Liddell Noriyuki Kato Charles P. Semba Mahmood K. Razavi Stephen T. Kee Michael D. Dake 《Cardiovascular and interventional radiology》1999,22(4):298-304
Purpose: To evaluate the efficacy of covered stents for the treatment of transjugular intrahepatic portosystemic shunt (TIPS) obstruction
in human subjects with identified or suspected biliary fistulae.
Methods: Five patients were treated for early failure of TIPS revisions. All had mid-shunt thrombus, and four of these had demonstrable
biliary fistulae. Three patients also propagated thrombus into the native portal venous system and required thrombolysis.
TIPS were revised in four patients using a custom-made polytetrafluoroethylene (PTFE)-covered Wallstent, and in one patient
using a custom-made PTFE-covered Gianturco Z-stent.
Results: All identified biliary fistulae were successfully sealed. All five patients maintained patency and function of the TIPS during
follow-up ranging from 2 days to 21 months (mean 8.4 months). No patient has required additional revision. Thrombosis of the
native portal venous system was treated with partial success by mechanical thrombolysis.
Conclusion: Early and recurrent failure of TIPS with mid-shunt thrombosis, which may be associated with biliary fistulae, can be successfully
treated using covered stents. Stent-graft revision appears to be safe, effective, and potentially durable. 相似文献
12.
Jun-Ichiro Sanada Osamu Matsui Jun Yoshikawa Toshihiko Matsuoka 《Cardiovascular and interventional radiology》1998,21(1):45-49
Purpose: To evaluate the effects of bare stents and covered stents on the aortic wall, especially the vasa vasorum.
Methods: Eight bare stents and nine covered stents were placed in the infrarenal aorta of nine dogs. The dogs were euthanized at 4–45
weeks after stent placement. The vasa vasorum was evaluated by microstereoscopy with vascular casting, and the histopathology
of the aortic wall was examined by light microscopy.
Results: In the unstented normal aorta, vasa vasorum nourished the adventitia and the outer media, and the intima and inner media
were avascular. In the stented segment, vascular dilatation and proliferation of vasa vasorum, medial atrophy, and intimal
hyperplasia were observed, more prominent for covered stents than for bare stents.
Conclusion: Intravascular stent placement caused not only medial atrophy and intimal hyperplasia but also proliferation of the vasa vasorum,
probably due to hypoxia in the aortic wall.
Received: 0/00/00/Accepted: 0/00/00 相似文献
13.
Isabel T. Pinto M.D. Laura Paul Carlos Grande 《Cardiovascular and interventional radiology》1998,21(6):450-453
Purpose: To evaluate initial results in patients with epiphora secondary to obstruction of the nasolacrimal duct treated by placement
of a polyurethane stent, and to discuss the technical problems and complications arising during the procedure, with visualization
of the anatomy of the drainage apparatus using computed tomography (CT).
Methods: We inserted 20 polyurethane Song stents under fluoroscopic guidance after dacryocystography in 19 patients with grade 3–4
epiphora caused by idiopathic obstruction of the nasolacrimal duct. CT scans were obtained following stent placement in all
patients.
Results: We focus on the technical problems and complications that arose during these procedures. During negotiation of the guidewire
past the obstruction at the level of the junction of the duct with the lacrimal sac, the guidewire created a false passage
in a posterior suborbital direction in two cases and towards the posterior midline in another. In all cases the guidewire
was withdrawn and reinserted through the proper anatomic route without further difficulty or complications. In two cases the
stent was improperly positioned wholly or partially outside the nasolacrimal system (one medially, one posteriorly). In one
case the stent was removed and reinserted; in the other it remains in place and functional. CT was performed in all these
cases to ensure proper anatomic alignment and determine what had gone wrong. The epiphora was completely resolved in 13 cases
and partially relieved in four; there were three cases of stent obstruction. Epistaxis of short duration (1 hr) occurred in
seven patients and headache in one.
Conclusions: Treatment of epiphora with polyurethane stents is a technique that is well tolerated by patients and achieves a high success
rate, yet problems in placement may be encountered. Though no major consequences for patients are involved, cognizance of
such difficulties is important to avoid incorrect positioning of stents. 相似文献
14.
Giuseppe Sangiorgi Eloisa Arbustini Paolo Lanzarini Barbara del Bello Marcello Maestri Annalisa Gaspari Marco Solcia Renu Virmani Luigi Inglese 《Cardiovascular and interventional radiology》2001,24(4):260-270
Purpose: To test the vascular wall response to an expanded polytetrafluoroethylene-covered stent, compared with conventional stenting,
up to 6 months after deployment in the vascular district of a swine model.
Methods: Fourteen minipigs underwent implantation of expanded polytetrafluoroethylene-covered stents (CS) and bare stents (BS) in
five peripheral arteries. Animals were killed at different time points (from 1 to 180 days). Histopathologic assessment by
morphologic and morphometric analysis and by scanning electron microscopy (SEM) were used to assess the incorporation characteristics
and re-endothelialization extent of the two types of stents.
Results: A total of 70 stents (14 CS and 14 BS in the renal arteries; 28 CS in the iliac arteries, and 14 CS in the aorta) were implanted.
Microscopic examination confirmed the absence of occlusive thrombi in both the CS and BS groups. Microthrombi were observed
in 10 of 13 CS (77% of cases) and in four of four BS (100% of cases, p < 0.05). Inflammation was mild in 69% of segments in which a CS was implanted and in 74% of segments in which a BS was implanted (p= NS), while a severe inflammatory reaction was observed in 6% of CS segments and in 8% of BS segments (p= NS). No differences were detected at the long-term analysis between neointimal thickness in CS compared with BS segments
(0.46 ± 0.18 mm vs 0.42 ± 0.26 mm at 90 days and 0.36 ± 0.08 mm vs 0.35 ± 0.04 mm at 180 days; p= NS, respectively). At SEM analysis, re-endothelization was evident 15 days after the implant in both CS and BS starting
from the stent edges.
Conclusion: CS implantation did not elicit a more severe thrombotic deposition compared with that of BS. A similar inflammatory reaction
of the arterial wall was present in the two stent groups 3 and 6 months following the implant. In addition, CS implantation
did not stimulate excessive neointimal formation when compared with BS. 相似文献
15.
Jeannette Bakker M.D. Pierre P. Goffette Michel Henry Willem P. T. M. Mali Jean-Pierre Melki Jon G. Moss Claudio Rabbia Eric Therasse Kenneth R. Thomson Siegfried Thurnher Claudio Vignali 《Cardiovascular and interventional radiology》1999,22(6):468-474
Purpose: To assess, in a multicenter setting, safety, technical results, and restenosis rate of the Palmaz stent for treatment of
atherosclerotic ostial renal artery stenosis.
Methods: Ten centers enrolled 106 patients (120 treated renal artery stenoses) in the study. Patient selection was based on unsuccessful
percutaneous transluminal renal angioplasty (residual stenosis ≥ 20%) performed for treatment of ostial stenosis ≥ 50%, in
patients with hypertension and/or impaired renal function. Safety was assessed by means of the complication rate, and technical
results by the number of successful stent placements and occurrence of restenosis (>50%) at intraarterial angiographic follow-up.
Results: Stent placement was successful (n = 112) or partially successful (n = 5) in 117 (98%) arteries. Complications occurred in 19 procedures; seven were of serious clinical significance. Angiographic
follow-up was performed in 89 of 117 (76%) cases, at a mean of 8 months (range 2.5–18 months). Fifteen stents (16.9%) showed
restenosis (at a mean of 8.5 months), of which 10 were successfully redilated.
Conclusion: Renal artery stenting has a high technical success rate, a complication rate comparable to percutaneous transluminal renal
angioplasty, and a low rate of restenosis at 8 months angiographic follow-up. 相似文献
16.
Bilbao JI Herrero JI Martínez-Cuesta A Quiroga J Pueyo JC Vivas I Delgado C Pardo F 《Cardiovascular and interventional radiology》2000,23(2):149-151
Liver transplantation preserving the retrohepatic inferior vena cava, the so-called piggyback technique, is becoming more
frequently used because it avoids caval cross-clamping during the anhepatic phase of surgery. However, hepatic venous outflow
blockade causing ascites seems to be less infrequent after piggyback than with cavo-caval anastomosis. We report a 62-year-old
patient who underwent liver transplantation using the piggyback technique and developed a stenosis in the anastomosis between
the hepatic veins and the inferior vena cava leading to severe postoperative ascites. Ascites was unresponsive to diuretic
therapy and was associated with renal function impairment. Since the etiology of the stenosis was mechanical (torsion), percutaneous
transluminal angioplasty was unsuccessful. Finally, an autoexpandable prosthesis was placed across the anastomosis resulting
in rapid and permanent (3 years of follow-up) resolution of ascites. 相似文献
17.
Jean-Paul Beregi Alain Prat Serge Willoteaux Marc-Antoine Vasseur Valérie Boularand Frédéric Desmoucelle 《Cardiovascular and interventional radiology》1999,22(1):13-19
Purpose: To evaluate initial and midterm results of percutaneous treatment of peripheral aneurysms using covered stents.
Methods: Between June 1994 and December 1997 we used covered stents (EndoPro System or Passager) on 19 patients with peripheral aneurysms
(7 iliac, 5 subclavian, 3 femoral, 3 popliteal, 1 carotid).
Results: Successful aneurysm exclusion was achieved in 18 of 19 patients (95%). In the short term (<30 days), one patient died of
puncture site hemorrhage complicated by myocardial infarction; two femoral stents were surgically removed because of leakage.
At subsequent follow-up (mean 20 months) two further unrelated deaths occurred. At 1 year (intention-to-treat) the stent was
patent in 13 of 19 patients (68%) and the aneurysm was excluded in 17 of 19 (89%).
Conclusion: Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural success. Continued exclusion
of the aneurysms is achieved in a large proportion of patients but there is a relatively high rate of stent thrombosis. 相似文献
18.
Retrievable IVC square stent filter: Experimental study 总被引:3,自引:0,他引:3
Dusan Pavcnik Barry T. Uchida Frederick S. Keller Christopher L. Corless Josef Rösch 《Cardiovascular and interventional radiology》1999,22(3):239-245
Purpose: In vitro and in vivo evaluation of a new retrievable, home-made, inferior vena cava (IVC) Square stent filter (SSF) with
two trapping levels.
Methods: In vitro, the SSF was compared in a flow model with the stainless steel Greenfield filter (SGF) for emboli- trapping efficiency
by serially passing 300 emboli of 3 and 6 mm in diameter and 15–30 mm in length in each type of filter. Nine swine were used
for the in vivo testing of the SSF for deployment and retrievability, emboli-trapping efficiency, stability, and self-centering
ability and two were used (total of 11 swine) for testing repositioning and retrievability of the SSF at 2 weeks and for gross
and histologic IVC changes at 2 months.
Results: In vitro, the SSF and SGF had similar efficiency in trapping large emboli but the SSF had significantly better efficiency
than the SGF for trapping all sizes of emboli (91.7% vs 81%), medium size emboli (93% vs 80%), and small emboli (86% vs 69%).
Efficiency decreased in both filters from the first to the fifth embolus in each series but was still significantly better
for the SSF. With the SSF, 89% of emboli were caught at the primary and 11% at the secondary filtration level. In the nine
animals used for acute studies, the SSF was easily placed in all 27 attempts, assumed a central position 26 times, and was
easily retrieved in 21 of 22 attempts. One tilted filter needed additional manipulation for retrieval. During emboli injection
in five swine, the SSF had 97.2% emboli-trapping efficiency and demonstrated good stability. In the two animals used for longer-term
evaluation, the filters were easily retrieved 2 weeks after implantation. Histologic evaluation at 2 months showed neointimal
proliferation around the SSF wires in contact with the IVC wall, which was otherwise normal.
Conclusion: The SSF is a promising filter. It is easy to place and retrieve, is stable after placement, and has high efficiency for trapping
emboli. Promising results justify further experimental and eventual clinical studies with a commercially manufactured SSF. 相似文献
19.
Alexander V. Tielbeek Dammis Vroegindeweij Elma J. Gussenhoven Jacob Buth Guido H.M. Landman 《Cardiovascular and interventional radiology》1997,20(6):413-419
Purpose: To evaluate the role of intravascular ultrasound (IVUS) before and after directional atherectomy (DA) in the treatment of
femoropopliteal artery stenosis.
Methods: In 12 patients with 16 stenoses IVUS was performed before and immediately after an angiographically successful DA. This was
defined as a diameter reduction (DR) ≤ 50%, which was calculated using the minimal lumen diameter compared with the diameter
of a nearby ``normal' segment. In the presence of residual plaque on IVUS an additional DA was performed. Endpoints studied
were DR ≤ 30% on IVUS compared with the IVUS findings of the angiographically normal reference segment, or when no additional
atherosclerotic material could be removed by further DA passages.
Results: Additional DA (mean 1.6 per lesion) had to be performed in all patients. Initial DA increased the cross-sectional free lumen
area (FLA) from 3.8 ± 2.0 mm2 to 8.1 ± 2.7 mm2 (p= 0.0004). Additional DA increased FLA to 9.3 ± 2.3 mm2 (p= 0.002) after the second passage and to 9.8 ± 2.4 mm2 (p= 0.09) after the final DA run. The plaque area (PLA) before DA decreased from 18.1 ± 4.2 mm2 to 15.4 ± 4.8 mm2 (p= 0.002) after the first passage, and to 13.5 ± 5.0 mm2 (p= 0.004) and 12.8 ± 4.4 mm2 (p= 0.07) after the second and final DA runs, respectively. PLA of the reference segment (9.5 ± 5.7 mm2) was significantly smaller (p= 0.006) than the final PLA of the treated lesion, indicating a large amount of retained plaque. As a result of DA there was
an increase in the area bordered by the medial layer, i.e., the total vessel area (from 21.9 ± 4.7 mm2 to 23.0 ± 4.7 mm2), significantly in eccentric and soft lesions. On IVUS, dissection and plaque rupture after the final passage was seen in
12 of 16 stenoses; two dissections were seen on the completion angiogram. After the final passage in all stenoses except three,
the DR with IVUS was ≤ 30%.
Conclusion: Lumen enlargement following DA is predominantly due to plaque excision. Vessel expansion combined with plaque excision varies
in different stenoses and is an important factor in eccentric and soft lesions. Despite additional DA considerable plaque
remains.
Received: 0/00/00/Accepted: 0/00/00 相似文献
20.
Klaus A. Hausegger Kurt Tiessenhausen Martin Klimpfinger Johann Raith Hubert Hauser Josef Tauss 《Cardiovascular and interventional radiology》1998,21(4):334-337
Three patients with dialysis access graft shunts, having a symptomatic pseudoaneurysm and a hemodynamically significant stenosis
at the anastomosis between the graft shunt and the subclavian vein, were treated with percutaneous transluminal angioplasty
and insertion of a Wallstent. Pseudoaneurysms were excluded by percutaneous insertion of a Cragg Endo-Pro stent-graft with
a diameter of 6 mm and a length of 6–10 cm. All three aneurysms were excluded successfully. In two patients, the stent-graft
was punctured repeatedly during follow-up and the aneurysms recurred after 7 and 8 months, respectively. The patency of the
dialysis shunt after stent-graft insertion was 8 (n= 1) and 9 months (n= 2). Due to the recurrence of the aneurysm (n= 2) or recurrent thrombosis (n= 1) the use of these shunts was discontinued. 相似文献