Volume 2 - Issue 3 - May/June 2005
Editor's Corner »
Current developments with Carotid Stenting (CAS): The Perfect Vascular Storm Re-Visited
CAS developments were portrayed as “The Perfect Vascular Storm” in the second issue of VDM (December 2004). These were the days before VDM had decided to adopt a new format and become a peer-review journal. In that article, I described and opined on the current state of affairs with “the hottest vascular topic of the day, carotid stenting.” Unequivocally, it continues to be the case! But things have evolved in the short few months since its publication and significant additional developments have taken place. Powerful among these was CMS’s reimbursement decision, anno
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Hepatic Artery Dissection Treated with a Rapamycin-Coated Stent: Report of a case with 1-year angiographic follow-up
Introduction
Hepatic artery dissection is an uncommon clinical event with few reported cases in the literature. Although rare, most reported dissections have occurred in the setting of intra-arterial hepatic artery chemotherapy or as a complication of liver transplant.1–3 Treatment strategies have included surgery and, more recently, percutaneous balloon angioplasty (PTA) with adjunctive bare-metal stents.1,2,4,5 Improved endovascular technology has led the way to greater success in treating complex arterial disease. Drug-eluting stents (DES), specifically, have
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De Novo Periaortitis Following Endovascular Aneurysm Repair: A report of two cases
Endovascular aneurysm repair (EVAR) has emerged as a routine and viable alternative in the treatment of abdominal aortic aneurysms (AAA). Its efficacy has been confirmed in many studies, and its role in the treatment of atherosclerotic aneurysms is becoming defined as long-term follow-up data is analyzed. Major complications such as migration, thrombosis, kinking of the graft, endoleaks and continued expansion with eventual rupture have been described and well studied. EVAR has also been shown to induce a systemic inflammatory response in patients leading to local perianeurysmal inflammation a
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Commentary
Ever since Dr. Gruentzig performed the first coronary balloon angioplasty in 1977, we have, as interventional specialists, begun to see our own types of complications. First, the phenomenon of intimal hyperplasia with restenosis was born after the introduction of balloon angioplasty. When Parodi first described a technique to less invasively exclude abdominal aortic aneurysms, we also developed our own unique type of endovascular complications. Potential endoluminal graft complications include dissection or perforation, device malfunction or failure, a thromboembolic event, prosthetic occlusio
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Emergency Stent-graft Repair for Thoracic Aortic Injury
Introduction
Blunt thoracic aortic injuries (BTAIs) due to a deceleration trauma are highly lethal and remain a therapeutic challenge. BTAIs represent only 10% of all thoracic vascular traumas and usually involve the isthmic portion of the aorta, but up to 80% of patients with acute rupture die at the scene of injury or before reaching the operating room.1,2 In fact, for patients who survive, prognosis is still poor, because even in a properly-monitored unit, there is a 30% mortality rate within the first six hours and up to a 50% mortality rate within the first twenty-four
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Commentary
Emergency Stent-graft Repair for Thoracic Aortic Injury by Castelli et al. is an important paper that lends further credence to the notion that endovascular repair is rapidly becoming the new standard of care in the treatment of traumatic transection of the thoracic aorta. The results herein reported, like many others, are exciting and very promising. They seem to ‘overshadow’ anything and everything that standard surgical repair has accomplished over the past several decades as serious operative morbidity and mortality rates have remained high.
Thoracic stent-graft technologies
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Cutting Balloon Angioplasty for the Treatment of Stenosis in Hemodialysis Arteriovenous Fistulas
Introduction
Hemodialysis fistulas (AVFs) are an element of fundamental importance in the treatment of patients undergoing dialysis. Their correct functioning is an indispensable condition for the success of the dialysis procedure.
Interventional radiology has taken on an increasingly important role in the percutaneous management of failing grafts and fistulas.1,2 In some patients, the fistula stenosis can be resistant to dilation with conventional angioplasty balloons3,4 and even high-pressure balloons.5
The cutting balloon (Boston Scientific,
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Optimal Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention: New insights from the randomized ARMYDA-
Percutaneous coronary intervention (PCI) with stenting has been shown to enhance platelet aggregation.1 Accordingly, optimization of antiplatelet therapy has a crucial role in patients undergoing percutaneous revascularization and even more “aggressive” antiplatelet therapies have been employed to prevent postprocedural thrombotic complications.2,3
Dual oral antiplatelet pretreatment with aspirin plus ticlopidine has dramatically reduced the occurrence of subacute thrombosis and early adverse events after coronary stenting.4 Clopidogrel is an antiplate
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Commentary: Optimal Antiplatelet Therapy: Lessons Learned from PCI Applicable to PAD and PPI
Patti et al. have further added to the mounting evidence that optimal antiplatelet therapy translates to clinical benefits in PCI by reporting the results of the ARMYDA-2 trial, which was a prospective, randomized trial between a pretreatment (mean 6 hours) with 600 mg versus 300 mg loading dose of clopidogrel (Plavix, Sanofi-Synthelabo, Inc., New York City, NY). The 600mg dose had less periprocedural myocardial infarction (50% risk reduction) and improved 30-day event-free survival (96% versus 86%, p = 0.017). This underscores the critical role of platelets in PCI but identifies the need for
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Commentary: Achieving Optimal Platelet Inhibition During Percutaneous Coronary Interventions
Vascular injury leads to platelet activation and aggregation, and subsequent fibrin deposition and thrombosis. Antithrombin therapy alone without optimal platelet inhibition leads to an inferior outcome during percutaneous coronary intervention (PCI).
Early experience with PCI was performed with unfractionated heparin (UFH) in patients pretreated with aspirin. Aspirin is only partially effective as an antiplatelet drug by inhibiting the cyclooxygenase enzyme and therefore partially blocking thromboxane A2 and collagen-mediated platelet activation and aggregation. However, there are several
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