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Target Audience: Physicians, nurses, and technologists.
This activity is supported by an educational grant from Terumo Medical Corporation.
Clinical Review
Drug-Eluting Stents and Drug-Coated Balloons in Peripheral Interventions
Author Affiliations:
From the Department of Angiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (TZ) and the Department of Diagnostic and Interventional Radiology, University Tuebingen, Germany.
Correspondence: Dr. Thomas Zeller, Herz-Zentrum Bad Krozingen, Südring 15, D-79189 Bad Krozingen, Germany. E-mail address: thomas.zeller@herzzentrum.de.
Manuscript submitted July 17, 2008, provisional acceptance given August 18, 2008, manuscript accepted September 5, 2008.
Why Drug-Eluting Stents May Not Work for Most Patients with Leg Ischemia Caused by Below-Knee Arterial Occlusive Disease
Although the use of stents is common in other peripheral vessels, the application of stents remains highly controversial in the infrapopliteal bed (BTK). In general, infrapopliteal stent implantation is reserved for cases with a suboptimal outcome after PTA (i.e., > 50% residual stenosis, flow-limiting dissection). The fear that early thrombosis and late luminal loss due to intimal hyperplasia may lead to suboptimal long-term patency rates explains the reluctance on implanting stents in these small-diameter vessels. In the effort to optimize stent outcomes, coronary drug-eluting stent (DES) te
Re-establishing Macro Vascular Flow and Wound Healing: Beyond the Vascular Intervention
Introduction
Since approximately 70% of wounds treated at outpatient wound centers in the United States are lower extremity venous ulcerations, we will use a leg ulcer as case study for the purposes of this article. A 65-year-old Caucasian female presents to the wound center with a 10 x 8 cm wound just above the medial malleoli. The wound has been present for 2 years and is slowly increasing in size. The skin surrounding the wound is hyperpigmented and the soft tissue is firm on palpation. The ankle circumference is 16 cm, while the mid-calf circumference is 3
Long-Term Safety and Economic Impact of Drug-Eluting Stents
Drug-eluting stents (DES) were designed to prevent neointimal proliferation via the controlled release of antiproliferative agents. Two such DES have been approved for use in the United States. The sirolimus-eluting Cypher stent (SES, Cordis Corporation, Miami Lakes, Florida) and paclitaxel-eluting TAXUS stent (PES, Boston Scientific Corporation, Natick, Massachusetts) were approved for use after randomized controlled clinical trials demonstrated their superiority over bare-metal stents (BMS) at reducing restenosis rates and the need for repeat revascularization. Months afte
A New Treatment Option for Treating Peripheral Vascular Stenosis: Orbital Atherectomy
Introduction
Peripheral artery disease (PAD) is a manifestation of atherosclerosis that results in compromised functional capacity and an impaired quality of life for the affected individual.1,2 There are many risk factors for PAD, including diabetes mellitus, current or past smoking history, age greater than 50 years, high blood pressure, obesity, hyperlipidemia, and a family history of heart disease or stroke.3 Classic symptoms affecting the lower extremities include pain with exercise (intermittent claudication) or, in extreme cases, rest pain,
Mesenteric Artery Stenting for Chronic Mesenteric Ischemia
Introduction
CMI is caused by atherosclerosis in more than 90% of the cases. Nonatheromatous conditions include: median arcuate ligament compression syndrome (compression of celiac artery by diaphragmatic crus), Takayasu arteritis, dysplastic lesions, thromboangiitis obliterans, and radiation-induced vascular injury.1–4 The disease generally presents in patients over 60 years and the incidence is three times higher in women.5 Approximately half of the patients with CMI have significant coronary artery disease and peripheral vascular disease.6,2
The
Influence of Hyperlipidemia and its Treatment on Outcome in Patients with Peripheral Arterial Disease
Multiple large prospective randomized trials have compared the treatment of patients that have arteriosclerotic occlusive disease or diabetes with 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors versus placebo. These studies demonstrate a 25% reduction in the rate of cardiovascular death, myocardial infarction (MI), stroke and revascularization procedures.1–4 These beneficial results were identified in patients with a wide range of serum cholesterol low-density lipoprotein cholesterol (LDL-c) levels at study entry; many of these patients had lipid levels previ
delete me Abdominal Aortic Aneurysm and Renal Artery Stenosis
The Role of Embolic Protection Devices in Renal Angioplasty and Stenting
Introduction
Atherosclerotic renovascular disease is increasingly recognized thanks to technical improvements in duplex ultrasound, magnetic resonance angiography, CT scan, routine renal angiography during cardiac catheterization, coronary procedures and particularly in hypertensive or multivascular diseased patients. It represents an important public health problem.
A renal artery stenosis (RAS) is usually caused by atherosclerosis (80% of cases in patients over 40 years), and in rare cases is due to fibromuscular dysplasia (10% of cases and more often in young patients), arteriti
Patient, Technique, and Device Selection for Coronary CTO Therapy: Clinical and Angiographic Considerations
Introduction
Over the last decade, there has been remarkable progress in the percutaneous management of coronary artery disease (CAD) as an established alternative to coronary artery bypass surgery. When compared to dilatation of coronary lesions with balloons, the scaffolding properties of stents have resulted in increased safety and predictable results, with reduced rates of acute closure and late restenosis. Recently, the addition of antiproliferative agents on the surface of the metal stents (drug-eluting stents) has been shown to markedly attenuate the vascular responses of neoint
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CME Showcase
"Diabetic Peripheral Neuropathy"
Upcoming Accredited Webcast Release Date: December 22, 2008 Expiration Date: December 22, 2009 This activity is supported by an educational grant from PamLabs. To register for this Webcast, visit www.naccme.com/program/n-558/ |
 LUMEN 2009 - THE SYMPOSIUM ON OPTIMAL TREATMENTS FOR ACUTE MI Live Symposium Date: February 26-28 Location: Loews Miami Beach Hotel Miami Beach, Florida 33139 Phone: (305) 604-1601 Toll Free: 1-877-563-9762 This activity is sponsored by the North American Center for Continuing Medical Education. |
 CARDIAC PET: Optimizing CAD Patient Management with Diagnostic Confidence A Complimentary CME Accredited Lunch Symposium Date: Friday, September 12, 2008 12:00 pm - 1:15 pm Location: Hynes Convention Center 900 Boylston Street, Room 304 Boston, MA 02115 This activity is supported by an educational grant from Bracco Diagnostics Inc. |
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