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Vascular Disease Management - ISSN: 1553-8036 - Volume 3 - Issue 3 - May 2006 | |
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| David E. Allie, MD, Chris J. Herbert, RT, RCIS, and Craig M. Walker, MD |
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The Status and Future of Carotid Stenting: Who are the Players and What is at Stake? |
| Kenneth Cavanaugh, Jr., PhD, •Lori Paserchia, MD, •Steve Phurrough, MD, MPA, Dorothy Abel, BS |
The ongoing controversy regarding interventional treatment of carotid stenosis using intravascular stents involves not only identification of the appropriate clinical indications for this procedure, but also the adequacy of the regulatory processes involved with both the FDA approval of this technology and CMS reimbursement for the indicated population. The evolution of carotid stenting in the United States has been influenced by several interested parties, including the medical community, patient population and regulatory agencies, each with their own expectations and challenges. In this article, we describe the FDA approval and CMS coverage processes for carotid stenting with embolic protection, evaluate the effects of off-label use and medical practice on acceptance of this technology, and identify future challenges and approaches for both government and medicine.
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Technical Considerations for Renal Artery Stenting |
| Jeffrey A. Goldstein, MD, Raghu Kolluri, MS, MD, Krishna Rocha-Singh, MD |
Renal artery stenosis (RAS) is the most common secondary cause of hypertension. It is associated with progressive renal failure. Percutaneous transluminal renal angioplasty and stenting (PTRAS) is associated with improved blood pressure control and preservation of renal function. PTRAS is associated with a high technical success rate and an acceptable adverse event and restenosis rate. Embolization and restenosis limit the benefit of this procedure, and are areas of future clinical research. After PTRAS, patients should be followed clinically and with duplex ultrasonography.
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Dethrombosis of the Lower Extremities: Pharmacologic and Mechanical Techniques |
| Nicolas W. Shammas, MD, MS |
Thrombus is widely present in the peripheral vasculature and its frequency depends on the patient’s clinical presentation. Thrombus is almost always present in acute critical limb ischemia (ALI) and is commonly found in patients with subacute presentations, chronic critical limb ischemia (CLI) and chronic occlusions. The approach to dethrombosing a vessel depends on multiple factors, including the age of the thrombus, but generally requires a combination therapy with chemical lysis and rheolytic thrombectomy, such as the use of Power-Pulse Spray (P-PS) technique, or atherectomy with dethrombosing capability such as the excimer laser. Surgery or chemical lysis as stand alone therapies carry very high rates of amputation and mortality.
The role of embolic protection devices is still unclear but is promising, as embolization of atherothrombus continues to be a frequent occurrence during peripheral angioplasty. In this review, algorithms to treat thrombus in peripheral arterial disease
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Recanalization of Occluded Iliac Artery Allowing Abdominal Aortic Aneurysm Stent Graft |
| Michael Wholey, MD, MBA, •Boulos Toursarkissian, MD, Darren Postoak, MD, Raj Suri, MD, Marco Cura, MD, •Lisa Beal, RN |
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