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One-fifth of strokes occur in the territory of the posterior circulation, but their management, particularly acute reperfusion therapy and neurointervention procedures for secondary prevention, has received much less attention than similar interventions for the anterior circulation. In this review, we overview the treatment of posterior circulation stroke, including both interventions in the acute setting and secondary prevention. We focus on areas in which the management of posterior circulation stroke differs from that of stroke in general and highlight recent advances. Effectiveness of acute revascularization of posterior circulation strokes remains in large parts unproven. Thrombolysis seems to have similar benefits and lower hemorrhage risks than in the anterior circulation. The recent ATTENTION and BAOCHE trials have demonstrated that thrombectomy benefits strokes with basilar artery occlusion, but its effect on other posterior occlusion sites remains uncertain. Ischemic and hemorrhagic space-occupying cerebellar strokes can benefit from decompressive craniectomy. Secondary prevention of posterior circulation strokes includes aggressive treatment of cerebrovascular risk factors with both drugs and lifestyle interventions and short-term dual anti-platelet therapy. Randomized controlled trial (RCT) data suggest basilar artery stenosis is better treated with medical therapy than stenting, which has a high peri-procedural risk. Limited data from RCTs in stenting for vertebral stenosis suggest that intracranial stenosis is currently best treated with medical therapy alone; the situation for extracranial stenosis is less clear where stenting for symptomatic stenosis is an option, particularly for recurrent symptoms; larger RCTs are required in this area. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting. Methods: Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2020, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage, mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score and modified Rankin Scale were examined. The outcomes between patients receiving acute intracranial stenting + mechanical thrombectomy and patients that underwent mechanical thrombectomy alone were compared. Results: There were a total of 420 acute ischemic stroke patients who met criteria for the study (average age 70.6 ± 13.01 years; 46.9% were women). Analysis of 46 patients from the acute stenting + mechanical thrombectomy group (average age 70.34 ± 13.75 years; 37.0% were women), and 374 patients from the mechanical thrombectomy alone group (average age 70.64 ± 12.92 years; 48.1% were women). Four patients (8.7%) in the acute stenting + mechanical thrombectomy group experienced intracerebral hemorrhage versus 45 patients (12.0%) in the mechanical thrombectomy alone group (p = 0.506); no significant increases were noted in the median length of stay (7 vs 8 days; p = 0.208), rates of modified thrombolysis in cerebral infarction 2B-3 recanalization (p = 0.758), or good modified Rankin Scale scores (p = 0.806). Conclusion: Acute intracranial stenting in addition to mechanical thrombectomy was not associated with an increase in overall length of stay, intracerebral hemorrhage rates, or any change in discharge modified Rankin Scale. Further research is required to determine whether mechanical thrombectomy and acute intracranial stenting in acute ischemic stroke patients is unsafe. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our study is to compare the characteristics and clinical outcomes among the different endovascular treatment (EVT) strategies for large vessel occlusion underlying intracranial atherosclerosis (ICAS-LVO) in a recent nationwide registry. Methods: Patients with isolated ICAS-LVO were enrolled in our analysis and were categorized into three groups: first-line mechanical thrombectomy (MT) with rescue angioplasty and/or stenting (MT + RS), direct angioplasty and/or stenting without thrombectomy (DA), and MT alone. Baseline and periprocedural characteristics, successful recanalization, and 90-day functional outcomes were compared. Results: Of 396 patients with isolated ICAS-LVO in our study, successful recanalization was achieved in 94.5%, 100%, and 90.9% of patients in the MT + RS, DA, and MT groups, respectively. The 90-day functional independence in the three groups was 50.8%, 59.0%, and 45.1%. The main efficacy and safety outcomes showed no significant differences among the groups. First-pass recanalization (FPR) was more observed in the MT group (43.4%), the recanalization rate per attempt in the MT group gradually decreased until the fourth attempt, and further maneuvers showed recanalization rates of ≈0% per attempt. MT + RS (adjusted odds ratio [aOR] 0.10, p < 0.0001) and DA (aOR 0.18, p = 0.0013) were associated with lower FPR rate than MT alone in the multivariable logistic regression. Conclusions: The technical feasibility and favorable outcomes of several EVT strategies for ICAS-LVO were established in our study. First-line MT with a bailout angioplasty is a reasonable option for ICAS-LVO, and DA is an effective option for the cases when ICAS-LVO is strongly suspected before EVT procedure. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate technical feasibility and safety of common endovascular visceral interventions using a vascular robotic platform through preclinical study. Material and Methods: The CorPath GRX Robotic System (Corindus Inc, Waltham, Massachusetts) was tested in an anesthetized pig for its ability to navigate various commercially available devices in the abdominal vasculature and to perform routine endovascular visceral procedures. After manually placing a guiding catheter in the celiac trunk, several visceral branches were probed with microcatheters and -wires under robotic assistance, and embolization with liquids (lipiodol), detachable coils and plugs were performed. Furthermore, the origin of the celiac trunk was stented before accessing the left hypogastric artery for pelvic embolization. Results: All procedures were performed with technical success and without any complications. Navigating the catheters and wires via the steering console proved intuitive. Coil, plug and stent deployment were exclusively controlled by remote with remarkable precision and stability. Conclusion: Robotic-assisted visceral embolization and stenting as well as pelvic embolization using the CorPath GRX System is feasible and safe. Application of the platform in the abdominal vasculature is demonstrated for the first time. Considering the precision and the potential for reducing the operator's radiation exposure, further research in this area is highly encouraged to enable translation into clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Surgical plication of inferior vena cava was commonly used until the 1980s for prevention of pulmonary embolism, associated with high incidence of post-thrombotic syndrome (PTS). This study aims to assess the feasibility and safety of endovascular iliocaval recanalization after intentionally surgically interrupted inferior vena cava by external plicating clip. Materials and methods: Endovascular iliocaval recanalizations in relation to previous vena cava clip plication were extracted from the retrospective French multicentre database and further analysed. All procedure data were retrospectively reviewed, including technical aspects, technical success and outcomes (clinical response and ultrasound stent patency). Results: From 2016 to 2018, 8 patients from 4 different centres underwent endovascular iliocaval recanalization for PTS in relation to previous caval interruption by clip. Recanalization of iliocaval occlusion through the clip and stent reconstruction were successfully performed for all of them without complications. After angioplasty, plicating clip was opened in U shape (n = 3) or ovalized without significant residual stenosis (n = 5). Patency of the inferior vena cava was maintained for all patients with a mean follow-up of almost two years after stenting. All patients clinically improved. Conclusions: In this small cases series, endovascular recanalization and stenting of surgical vena cava clip plication seem technically feasible without morbidity. Restoration of blood flow through the iliocaval occlusion, using non-invasive endovascular technique, even as late treatment may be durable, with improvement of patient's venous symptoms. Level of evidence: 4, Short Communication. [ABSTRACT FROM AUTHOR]

Ischaemic stroke and transient ischaemic attack are of particular interest to the vascular surgeon as over one-third of all strokes are caused by thromboembolism from a stenotic carotid artery, making carotid artery stenosis the leading cause of stroke. If detected early, stenosis can be managed medically, surgically or endovascularly. However, treatment decisions depend on the timing of the transient ischaemic attack and the degree of stenosis, and must be balanced against procedural risk. This article discusses the evidence outlining the epidemiology, measurement and surgical management of carotid artery stenosis that inform national guidelines. Vascular and non-vascular trainees should understand these guidelines because of the potentially debilitating or fatal consequences of untreated carotid stenosis. [ABSTRACT FROM AUTHOR]

The upper urinary tract stenting allows to restore the ureteral patency in various situations. However, one of the main disadvantages of stenting is bacterial contamination, which can be a source of persistent infections that hardly respond to antibiotic therapy. The aim of this study was to investigate the local spectrum of bacterial pathogens and their susceptibility to antibiotics in order to optimize antibacterial therapy after upper urinary tract stenting. A prospective observational study was conducted in which 140 urine samples were examined (70 before stenting and 70 after stenting). Bacterial growth was detected in 37 patients (52.8%) before stenting and in 43 patients (61.4%) after stenting. E. coli (13 (28.8%)) and Streptococcus spp. (8 (17.6%)) strains were more commonly detected before stenting; P. aeruginosa (15 (31.2%)) and E. coli (8 (16.6%)) were usually revealed after stenting. The proportion of P. aeruginosa strains after stenting grew from 4.4% up to 31.2%. E. coli strains were resistant to ampicillin (92.3% before and 100% after stenting). Three strains of E. coli (23.1%) and six strains of P. aeruginosa (40%) were multidrug-resistant. Determination of the bacterial sensitivity to antibiotics and identification of antibiotic-resistant forms of bacteria is a factor in reducing the risk of complications and optimizing antibiotic therapy during the upper urinary tract stenting. [ABSTRACT FROM AUTHOR]

Aims: We performed a meta-analysis to indirectly compare the treatment effectiveness of balloon angioplasty and stenting for patients with intracranial arterial stenosis. Methods: Literature searches were performed in well-known databases to identify eligible studies published before January 04, 2021. The incidence of restenosis, transient ischemic attack (TIA), stroke, death, and dissection after balloon angioplasty or stenting were pooled. An indirect comparison of balloon angioplasty vs. stenting was performed, and the ratios of incidence (RIs) with 95% confidence intervals (CIs) were calculated using the random-effects model. Results: 120 studies that recruited 10,107 patients with intracranial arterial stenosis were included. The pooled incidence of restenosis after balloon angioplasty and stenting were 13% (95%CI: 8-17%) and 11% (95%CI: 9-13%), respectively, with no significant difference between them (RI: 1.18; 95%CI: 0.78–1.80; P = 0.435). Moreover, the pooled incidence of TIA after balloon angioplasty and stenting was 3% (95%CI: 0–6%) and 4% (95%CI: 3%-5%), and no significant difference was observed (RI: 0.75; 95%CI: 0.01–58.53; P = 0.897). The pooled incidence of stroke after balloon angioplasty and stenting was 7% (95%CI: 5–9%) and 8% (95%CI: 7–9%), respectively, and the difference between groups was found to be statistically insignificant (RI: 0.88; 95%CI: 0.64–1.20; P = 0.413). Additionally, the pooled incidence of death after balloon angioplasty and stenting was 2% (95%CI: 1–4%) and 2% (95%CI: 1–2%), with no significant difference between groups (RI: 1.00; 95%CI: 0.44–2.27; P = 1.000). Finally, the pooled incidence of dissection after balloon angioplasty and stenting was 13% (95%CI: 5–22%) and 3% (95%CI: 2–5%), respectively, and balloon angioplasty was associated with a higher risk of dissection than that with stenting for patients with intracranial arterial stenosis (RI: 4.33; 95%CI: 1.81–10.35; P = 0.001). Conclusion: This study found that the treatment effectiveness of balloon angioplasty and stenting were similar for patients with symptomatic intracranial arterial stenosis. [ABSTRACT FROM AUTHOR]

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Abstract Background Peripheral pulmonary artery stenosis (PPAS) is a rare and underdiagnosed phenomenon that is reported infrequently in adult patients. Most patients with PPAS have concomitant congenital heart diseases, a history of palliative surgical therapies during childhood, or syndromic characteristics. Acquired cases are rare, and they are underestimated in adulthood and managed inappropriately. Case presentation This case series describes 3 adult patients with PPAS of diverse etiologies and discusses their underlying causes, diagnostic modalities, and treatment strategies. Conclusions In patients with PPAS, sufficient heed should be paid to endovascular interventions such as balloon dilation and primary or bailout stenting, not least vis-à-vis the type and size of balloons or stents as well as complications and preventive strategies.

Abstract Background Mycotic aneurysms are rare vascular lesions, occurring in 0.6–2% of arterial aneurysms but with no reported venous cases. Venous aneurysms unrelated to an underlying infectious process have been previously described and are typically surgically repaired due to risk of thromboembolic events. Case presentation This case reports a bleeding external iliac vein mycotic aneurysm secondary to erosion of a chronic pelvic abscess, successfully treated with endovascular stenting, in an oncologic patient without alternative therapeutic options. Conclusion Venous aneurysms are uncommon vascular lesions which have historically been treated with open surgical repair. Given the lower degree of procedural morbidity, endovascular management of these lesions may be an effective option in the appropriate setting, particularly as a last resort in patients without surgical treatment options.

Modified Blalock‒Taussig shunt is a commonly performed palliative cardiac surgery. Complications like early or late occlusion have been reported in approximately 10% of patients. Thrombosis, stenosis, or kinking are possible mechanisms that lead to shunt obstruction which may be life-threatening and need urgent intervention in form of medical, surgical, or interventional catheterization. Traditionally, these patients are managed in the operating room with shunt revision but with advancing techniques, percutaneous interventions are being increasingly deployed to salvage these patients effectively. We describe our experience of two cases of blocked modified Blalock‒Taussig shunt, which was successfully managed by stenting the shunt.

Chronic mesenteric ischemia (CMI) is an urgent public health problem. The long asymptomatic course of the disease, sudden onset and an unfavorable prognosis in the absence of treatment make it necessary to pay closer attention to this pathology. There are currently two competitive treatments for CMI: surgical and endovascular revascularization. Despite numerous studies comparing these methods, the question of which one is more effective and reliable remains open. The review includes current data from clinical trials and meta-analyses demonstrating the advantages and disadvantages of both methods.

Background Patients with emergent large vessel occlusion secondary to intracranial atherosclerotic stenosis who fail mechanical thrombectomy pose a treatment challenge. The aim of this study is to report our single‐center experience using the Neuroform Atlas stent as a potential rescue modality. Methods Data were analyzed from a prospectively maintained database at a Comprehensive Stroke Center between January 2019 and September 2021 of all patients with intracranial atherosclerotic stenosis–emergent large vessel occlusion who underwent mechanical thrombectomy and required rescue stenting with the Neuroform Atlas. We systematically gathered demographic, clinical, procedural, and functional characteristics on patients presenting with emergent large vessel occlusion within 24 hours of last known normal. The primary outcome was the rate of revascularization following stenting. Results Twenty‐six patients met the inclusion criteria, with a mean age of 56.5 years, 34.6% of whom were women. On presentation, the median National Institutes of Health Stroke Scale was 11 and median Alberta Stroke Program Early Computed Tomography Score was 9. Mechanical thrombectomy was performed using a direct aspiration, first‐pass technique in all patients. Following Neuroform Atlas stent placement, 3 patients (11.5%) had moderate in‐stent stenosis, while severe stenosis was encountered in 4 patients (15.4%). The rate of successful revascularization (Thrombolysis in Cerebral Infarction 2B–3) was identified in 92.3% of the patients. On follow‐up vascular images, reocclusion occurred in 2 patients (7.7%) and symptomatic hemorrhage was encountered in 3 patients (11.5%). Excellent outcome at 90 days (modified Rankin scale 0–2) was achieved in 13 of 26 (50%) patients. Conclusion Our series provides preliminary safety and efficacy data regarding the use of the Neuroform Atlas stent as a rescue modality in intracranial atherosclerotic stenosis–emergent large vessel occlusion cases.

Objective: Intravascular ultrasonography (IVUS) is the gold standard for evaluating plaque, lumen, and vessel dimensions. Iatrogenic internal carotid artery (ICA) dissection is a well-known complication of mechanical thrombectomy for acute stroke. Carotid artery stenting (CAS) is used to treat medically intractable lesions. Thus, IVUS-assisted CAS can be an effective treatment option for preventing intraoperative complications and stroke recurrence in patients with iatrogenic ICA dissection. Case presentation: An 85-year-old woman presented with right hemiplegia and aphasia. Magnetic resonance angiography revealed left ICA occlusion, and she underwent mechanical thrombectomy with an aspiration catheter and stent retriever. Thrombolysis in cerebral infarction 2b recanalization was achieved; however, the cervical ICA showed severe stenosis and dissection. Since the cervical lesion was not sufficiently dilated through percutaneous transluminal angioplasty, we decided to perform CAS. The proximal and distal ends of the dissection cavity were confirmed using IVUS, allowing the stent to be placed in the appropriate position. She had no postoperative complications and was transferred to a rehabilitation hospital with a modified Rankin Scale score of 4. Conclusion: This case demonstrates that IVUS is useful for determining and confirming the stent position in patients with iatrogenic ICA dissection.

AimsWe performed a meta-analysis to indirectly compare the treatment effectiveness of balloon angioplasty and stenting for patients with intracranial arterial stenosis.MethodsLiterature searches were performed in well-known databases to identify eligible studies published before January 04, 2021. The incidence of restenosis, transient ischemic attack (TIA), stroke, death, and dissection after balloon angioplasty or stenting were pooled. An indirect comparison of balloon angioplasty vs. stenting was performed, and the ratios of incidence (RIs) with 95% confidence intervals (CIs) were calculated using the random-effects model.Results120 studies that recruited 10,107 patients with intracranial arterial stenosis were included. The pooled incidence of restenosis after balloon angioplasty and stenting were 13% (95%CI: 8-17%) and 11% (95%CI: 9-13%), respectively, with no significant difference between them (RI: 1.18; 95%CI: 0.78–1.80; P = 0.435). Moreover, the pooled incidence of TIA after balloon angioplasty and stenting was 3% (95%CI: 0–6%) and 4% (95%CI: 3%-5%), and no significant difference was observed (RI: 0.75; 95%CI: 0.01–58.53; P = 0.897). The pooled incidence of stroke after balloon angioplasty and stenting was 7% (95%CI: 5–9%) and 8% (95%CI: 7–9%), respectively, and the difference between groups was found to be statistically insignificant (RI: 0.88; 95%CI: 0.64–1.20; P = 0.413). Additionally, the pooled incidence of death after balloon angioplasty and stenting was 2% (95%CI: 1–4%) and 2% (95%CI: 1–2%), with no significant difference between groups (RI: 1.00; 95%CI: 0.44–2.27; P = 1.000). Finally, the pooled incidence of dissection after balloon angioplasty and stenting was 13% (95%CI: 5–22%) and 3% (95%CI: 2–5%), respectively, and balloon angioplasty was associated with a higher risk of dissection than that with stenting for patients with intracranial arterial stenosis (RI: 4.33; 95%CI: 1.81–10.35; P = 0.001).ConclusionThis study found that the treatment effectiveness of balloon angioplasty and stenting were similar for patients with symptomatic intracranial arterial stenosis.

Abstract Background Abnormal hypoperfusion on the surgical side after carotid artery stenting is rare. Neurological deterioration caused by it is deceptive, which can easily lead to misdiagnosis. The mechanism of hypoperfusion has rarely been demonstrated. We present here a fully studied case with a high probability of intracerebral steal phenomenon. Case presentation A 68-year-old male with severe right internal carotid artery stenosis and left internal carotid artery occlusion underwent right stenosis stent implantation. Restlessness and left limb hemiplegia occurred within 24 h after the procedure, which was similar to hyperperfusion syndrome. However, postoperative computerized tomography perfusion (CTP) revealed abnormal hypoperfusion in the right hemisphere. Transcranial Doppler (TCD) also showed decreased flow velocity in the right middle cerebral artery, and increased flow velocity in the right anterior cerebral artery. We considered that intracerebral steal phenomenon might be the cause, then hypervolemic therapy was accepted and the symptoms completely resolved after 3 days. Conclusions Ipsilateral hypoperfusion is rarely seen after carotid artery stenting. Intracerebral steal phenomenon may be the underlying mechanism. CTP or TCD is helpful for the early detection of this adverse event.

The article presents the results of stenting of the left renal vein in 35 patients with proven hemodynamically significant compression of the vein in “aorto-mesenteric tweezers”. Clinical manifestations of lesions of the left renal vein are very diverse, and pathogenetic mechanisms remain not fully understood. Therefore, the determination of indications for stenting and perfect technical performance are predictors of success in the near and long-term periods of postoperative follow-up. Our experience in stenting the left renal vein demonstrates the possibility of achieving intraoperative technical success in 100 % of cases, as well as a significant improvement in the quality of life in most patients after endovascular intervention, due to a significant reduction in the clinical manifestations of the pathological phenomenon.

Background Approximately 10-62% of patients with primary sclerosing cholangitis (PSC) will develop dominant strictures at some point during their disease. Because of the paucity of available data, optimal endoscopic therapeutic strategies remain unclear. We performed a systematic review and meta-analysis of endoscopic balloon dilation vs. balloon dilation plus stenting of dominant strictures in PSC Methods A comprehensive literature search from inception to November 2020 was performed. Primary outcomes were clinical and technical success. Secondary outcomes reported were adverse events (AE). Clinical success was defined in most studies as improvement in symptoms such as fever, abdominal pain, pruritus, fatigue and/or liver enzymes. The statistical analysis was done using comprehensive meta-analysis (CMA Version 3) Results The technical success rates for balloon and balloon plus stent were 96.8% and 91.9%, respectively. The clinical success rates for balloon and balloon plus stent were 86.5% and 70.8%, respectively. The overall AE rates for balloon and balloon plus stent were 11.2% and 26.9%, respectively. Other AE rates in balloon and balloon plus stent were cholangitis (4.8% vs. 11.4%), bile duct perforation (1.3% vs. 1.6%), post-procedural pancreatitis (2.2% vs. 9.8%), and bleeding (1.5% vs. 1.2%), respectively. Low to considerable heterogeneity was noted in our meta-analysis Conclusions Balloon dilation appears to be superior in terms of clinical and technical successes, with overall lower rates of AE compared to balloon dilation plus stenting for the management of PSC dominant strictures. Further trials are needed to validate our findings. [ABSTRACT FROM AUTHOR]

Introduction: Pathologies of the descending thoracic aorta inwardly extended towards the aortic arch actually shorten the proximal landing zone for aortic prosthesis. This, in turn, worsens the accessibility of the aorta for endovascular therapeutic options of those pathologies. Aim: This work considers the blockage of the left subclavian artery (LSA) through endovascular treatment of the pathologies of the descending aorta as the main work question, based on the hypothesis that there is no necessity for primary standard revascularization of the LSA in TEVAR with LSA covering. The researchers have 12 years of experience in the treatment of different thoracic aortic lesions. Their experience will also be reviewed in this paper. Materials and methods: Retrospective unicenter cohort study in consecutive patients to describe the real-world situation of daily clinical practice. All patients who had undergone endovascular, hybrid, or open operative therapy of different pathologies of the descending aorta were included in this study. Various parameters were investigated, including therapeutic procedures such as 1) pure endovascular vs. hybrid; 2) year of therapy; 3) symptomatic vs. asymptomatic status of the patients; 4) different epidemiological factors (age, sex, risk factors, mortality, and follow-up); 5) overstenting/blocking of the LSA; 6) complications of applied therapies; 7) further operations/interventions to treat such complications; 8) radiological aortic measurements (such as lumen extensions, false lumen measurements, distance to the supra-aortic and visceral vessels); and 9) multiple other pathological features. Different statistical parameters were also examined. Survival was analysed with the Kaplan-Meier assessment in the group of whole patients vs. the group of over-stented patients. The analysis of variance was performed for independent parameters for the revascularized patients – not the revascularized patients – who had undergone LSA coverage. For statistical approval, the U-test was used. The P-value < 0.05 was considered significantly different. The literature review was performed by means of a search in PubMed, Google scholar, Research Gate, ScienceDirect, and Cochrane library, using the following terms: endovascular, TEVAR, revascularization, stroke, and left-subclavian-artery ischemia. The literature is classified accordingly in relation to the main topic. In fact, the literature underwent further analysis depending on the fact whether it went with or against our hypothesis. Results: Overall, 112 patients were enrolled in the study. There was no significant difference comparing the non-revascularized vs.the revascularized group of patients, considering the consequences on cerebrovascular circulation (hemorrhagic, n = 1 case [4.8%] vs. 0 case [0%]; p = 0.32 and ischemic, n = 2 cases [9.6%] vs. 1 case [4.8%]; p = 0.56). There was no registered cases of spinal cord ischemia or left arm ischemia. As the main result, there was no case of left arm ischemia or death (mortality, 0). Survival was as follows for both groups: 22 [95% CI, 14.154–29.904] months vs. 43 [95% CI, 33.655–51.921] months, respectively, with no significant statistical difference (P > 0.05). The only statistically significant risk factor found was renal insufficiency (P, 0.028) but this too was considered a trend by the urgency of revascularization. Postoperatively, pneumonia showed a trend of higher frequency (P = 0.058) in the revascularized cases (n = 0 in the non-revascularized vs. n = 3 [21.4%] in the revascularized cases). There was no significant difference in the occurance of postoperative neurovascular complications (such as cerebrovascular accidents, spinal cord ischemia, or left arm ischemia) by comparing the groups of non-revascularized and revascularized patients. Conclusions: The revascularization of the overstented LSA due to TEVAR should be limited to certain indications, including 1) inadequate intracerebral circle of Willis; 2) predominantly perfused left vertebral artery with inadequate blood perfusion via the right vertebral artery (e.g., by stenosis), 3) anatomic variance such as the left vertebral artery originating directly from the aortic arch (and must be blocked by TEVAR); 4) need of an adequate left internal thoracic artery for coronary artery bypass grafting (CABG); 5) need of a patent LSA for the dialysis shunt of the left arm. However, there is no appropriate evidence as yet based on sufficient study results achieved in trials with an advanced design (such as [double-]blind, multicenter randomized study) that appears to be urgently required. [ABSTRACT FROM AUTHOR]

Objectives: The oncological outcomes, especially high recurrence rate, of bridge‐to‐surgery (BTS) self‐expandable metallic stent (SEMS) placement remain concerning, emphasizing the necessity of standardized SEMS placement. However, its impact on long‐term BTS outcomes is unknown. We investigated the long‐term outcomes of BTS colonic stenting using standardized SEMS placement. Methods: This prospective, multicenter cohort study conducted at 46 hospitals in Japan (March 2012 to October 2013) included consecutive patients with stage II and III obstructive colorectal cancer managed with BTS SEMS placement. The SEMS placement technique was standardized by information dissemination among the participating hospitals. The primary outcome was overall survival (OS) after SEMS placement, and the secondary outcomes were relapse‐free survival (RFS), recurrence, and short‐term outcomes of SEMS placement and surgery. Results: The 1‐, 3‐, and 5‐year OS rates were 94.1%, 77.4%, and 67.4% (Kaplan–Meier), respectively, with high technical success (99.0%, 206/208) and low perforation (1.9%, 4/208) rates. The 1‐, 3‐, and 5‐year RFS rates were 81.6%, 65.6%, and 57.9% (Kaplan–Meier), respectively, and the overall recurrence rate was 31.0% (62/200). The RFS rate was significantly poorer in patients with perforation (n = 4) than in those without perforation (n = 196) (log‐rank P = 0.017); moreover, perforation was identified as an independent factor affecting RFS (hazard ratio 3.31; 95% confidence interval 1.03–10.71, multivariate Cox regression). Conclusion: This large, prospective, multicenter study revealed satisfactory long‐term outcomes of BTS colonic stenting using a standardized SEMS insertion method, which might be specifically due to the reduced perforation rate. (UMIN000007953). [ABSTRACT FROM AUTHOR]

Objectives: Cervical radiotherapy can lead to accelerated carotid artery stenosis, increased incidence of stroke, and a higher rate of in-stent restenosis in irradiated patients. Our objective was to reveal the morphological characteristics of radiation-induced carotid stenosis (RICS) and the stent–vessel interactions in patients with previous cervical radiotherapy by optical coherence tomography (OCT). Materials and Methods: Between November 2017 and March 2019, five patients with a history of cervical radiotherapy were diagnosed with severe carotid artery stenosis and underwent carotid artery stenting (CAS). OCT was conducted before and immediately after the carotid stent implantation. Two patients received OCT evaluation of carotid stenting at 6- or 13-month follow-up. Results: The tumor types indicating cervical radiotherapy were nasopharyngeal carcinoma (n = 3), cervical esophageal carcinoma (n = 1), and cervical lymphoma (n = 1). The median interval from the radiotherapy to the diagnosis of RICS was 8 years (range 4–36 years). Lesion characteristics of RICS were detected with heterogeneous signal-rich tissue, dissection, and advanced atherosclerosis upon OCT evaluation. Post-interventional OCT revealed 18.2–57.1% tissue protrusion and 3.3–13.8% stent strut malapposition. Follow-up OCT detected homogeneous signal-rich neointima and signal-poor regions around stent struts. In the patient with high rates of tissue protrusion and stent strut malapposition, the 6-month neointima burden reached 48.9% and microvessels were detected. Conclusion: The morphological features of RICS were heterogeneous, including heterogeneous signal-rich tissue, dissection, and advanced atherosclerosis. Stenting was successful in all 5 patients with severe RICS. One patient, with high rates of tissue protrusion and stent strut malapposition immediately after stenting, received in-stent neointimal hyperplasia at a 6-month follow-up. [ABSTRACT FROM AUTHOR]

Background: Peripheral arterial disease is a progressive atherosclerotic disease with symptoms ranging from an intermittent claudication to acute critical limb ischemia and amputations. Drug-coated balloons and stents were developed to prevent neo-intimal proliferation and restenosis after percutaneous transluminal angioplasty. Randomized controlled trials showed that drug-coated, notably paclitaxel-coated, devices reduce restenosis, late lumen loss, and the need for target lesion re-vascularization compared with uncoated ones. However, the size of these trials was too small to prove superiority for "hard" clinical outcomes. Moreover, available studies were characterized by too restrictive eligibility criteria. Finally, it remains unclear whether paclitaxel-coated balloons may impair long-term survival. Alternative drug-coated balloons, the so-called limus-based analogs, have been approved for clinical use in patients with peripheral arterial disease. By encapsulating sirolimus in phospholipid drug nanocarriers, they optimize adhesion properties of sirolimus and provide better bioavailability.Methods: In this investigator-initiated all-comer open-label phase III randomized controlled trial, we will evaluate whether sirolimus-coated balloon angioplasty is non-inferior and eventually superior, according to a predefined hierarchical analysis, to uncoated balloon angioplasty in adults with infra-inguinal peripheral arterial disease requiring endovascular angioplasty. Key exclusion criteria are pregnancy or breastfeeding, known intolerance or allergy to sirolimus, and participation in a clinical trial during the previous 3 months. The primary efficacy outcome is the composite of two clinically relevant non-subjective "hard" outcomes: unplanned major amputation of the target limb and endovascular or surgical target lesion re-vascularization for critical limb ischemia occurring within 1 year of randomization. The primary safety outcome includes death from all causes.Discussion: By focusing on clinically relevant outcomes, this study will provide useful information on the efficacy and safety of sirolimus-coated balloon catheters for infra-inguinal peripheral arterial disease in a representative ("all-comer") population of unselected patients. As regulatory agencies had raised safety concerns in patients exposed to paclitaxel-coated devices (versus uncoated ones), collect mortality data up to 5 years after randomization will be collected.Trial Registration: ClinicalTrials.gov NCT04238546. [ABSTRACT FROM AUTHOR]

Trapped temporal horn is a rare type of noncommunicating focal hydrocephalus, and no standard treatment has been established yet for trapped temporal horn. Recent studies have shown the efficacy of endoscopic ventriculocisternostomy by opening the choroidal fissure; however, some surgical complications were reported during the procedure. Thus, we aimed to report a novel endoscopic ventriculocisternostomy and stenting technique for trapped temporal horn. In this technique, a 5.8-mm transparent acryl puncture needle with a 2.7-mm 0° rigid endoscope was used to open the choroidal fissure. It can fenestrate the choroidal fissure under real-time endoscopic observation of the critical neurovascular structures over the choroidal fissure. Moreover, the dull tip of the needle is less likely to injure the critical neurovascular structures, resulting in safer ventriculocisternostomy than the previously reported technique. Then, a stent is placed along the tract to prevent future obstruction of the stoma. Six trapped temporal horns in four patients were treated using the technique. All the patients showed improved symptoms with no surgical complications. None of the patients showed recurrence of trapped temporal horn during the mean follow-up period of 39.3 months. The combination of endoscopic ventriculocisternostomy and stenting with a transparent acryl puncture needle is a safe and effective treatment option for trapped temporal horn. [ABSTRACT FROM AUTHOR]

Objective: Stenting of the iliac vein is increasingly recognized as a treatment for chronic venous insufficiency (CVI). However, the pharmacologic management after stent placement is unclear. This review was conducted to illustrate recent trends in anticoagulation and antiplatelet regimens following stent placement for nonthrombotic iliac vein lesions (NIVL). Methods: The MEDLINE database was searched using the term "iliac vein stent." Retrieval of articles was limited to studies conducted on humans and published in English between 2010 and 2020. Studies were included that described iliac vein stent placement. Studies were excluded that contained fewer than 25 patients, performed procedures other than stent placement, did not specify the postoperative anticoagulant used, or treated lesions of thrombotic origin. Results: 12 articles were included in this review, yielding a total of 2782 patients with a male-to-female ratio of 0.77. The predominant CEAP classification encountered was C3. The most common stent used in the included studies was the Wallstent (9/12), and the most common pharmacologic regimen was 3 months of clopidogrel (6/12). Warfarin, aspirin, cilostazol, and rivaroxaban were among other agents used. Primary stent patency ranged from 63.1 to 98.3%. There was no apparent correlation between pharmacologic agent used and stent patency or subjective patient outcomes. Conclusion: Multiple different approaches are being taken to pharmacologically manage patients following stent placement for NIVL. There is no consensus on which agent is best, nor is there a formal algorithmic approach for making this decision. Additionally, the findings in this study call into question whether anticoagulation following stenting for NIVL is necessary at all, given the similar outcomes among the different agents utilized. This review underscores the potential value of undertaking a multi-institutional prospective study to determine what is the best pharmacologic therapy following venous stent placement for NIVL. [ABSTRACT FROM AUTHOR]

Background: Carotid artery stenting is a minimally invasive, durable alternative treatment option, which is an alternative to the reference method, carotid endarterectomy, for patients with carotid artery stenosis; however, silent new ischemic cerebral lesions (SNICLs) after carotid artery stenting remain as a matter of concern. Hence, we aimed to assess the effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures. Methods: We prospectively evaluated 122 patients (mean age: 69.5 ± 7.1 years, male:83) who underwent carotid artery stenting for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after carotid artery stenting were excluded. The presence of a new hyperintense lesions on diffusion-weighted imaging without any neurological findings was considered as the SNICL. Patients were classified into two groups as DWI-positive and DWI-negative patients. Results: Among the study population, 32 patients (26.2%) had SNICLs. The DWI-positive group had a significantly higher common carotid artery (CCA)-internal carotid artery (ICA) angle, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the DWI-negative group. High CCA-ICA angle was identified as one of the independent predictors of SNICL (OR (odds ratio) = 1.103 95%CI (confidence interval): (1.023–1.596); p = 0.034), and CCA-ICA angle higher than 34.5 degrees predicted SNICL with a sensitivity of 62.5% and a specificity of 62.2% (area under the curve: 0.680; 95% CI: 0.570 to 0.789; p = 0.003). Conclusions: The higher CCA-ICA angle may predict pre-procedure SNICL risk in carotid artery stenting and may have clinical value in the management of patients with carotid artery stenosis. [ABSTRACT FROM AUTHOR]

Summary: Background: Anastomotic insufficiency of the esophagus is the most feared complication of surgeons, leading to high postoperative morbidity and mortality. However, there is no internationally accepted guideline for its classification and treatment algorithm. Therefore, the aim of this study was to analyze the detection of anastomotic leaks as well as to discuss and validate the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound in late 2018. Methods: All patients undergoing surgery for malignancy of the esophagogastric junction between 2013 and 2020 were analyzed. Out of these patients, those diagnosed with an anastomotic insufficiency were extracted and classified according to the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound. Continuous variables were expressed as medians, categorical variables were compared using Fisher's exact test or chi-square test. Results: From 2013 to 2020, all 23 patients (10.84%) who developed an anastomotic leak after esophageal surgery were included in this study. The study revealed a significant increase in median hospital stay, median intensive care unit stay, and overall mortality rate (p = 0.028) with increased classification type. Conclusion: The results of this study showed that the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound can be validated and that there is a clear differentiation between the subtypes. Standardized diagnosis and management improve the overall outcome of patients. Main novel aspects: This article gives an introduction to classifying anastomotic insufficiencies according to the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound. Results of the classification can be validated, with a clear differentiation of postoperative outcome between subtypes. [ABSTRACT FROM AUTHOR]

Transcatheter closure of patent ductus arteriosus (PDA) is now the standard of care with some exceptions. Best treatment for peripheral pulmonary artery (PA) stenosis in small children is still debatable. Surgical augmentation, balloon dilatation, and stenting are the available options with each having its own risks and limitations. Here, we are reporting complete transcatheter management of three cases of congenital rubella syndrome who had PDA and left branch PA stenosis by device closure and stent placement, with successful outcome in two cases and complication, leading to surgery in one. We also share our understanding of case selection for a better outcome. [ABSTRACT FROM AUTHOR]

Abstract This report describes a patient who presented with acute but transient right arm weakness and altered sensation secondary to severe stenosis of the left common carotid artery (CCA) origin. Endovascular stenting of the stenosed origin was achieved utilising a novel rendezvous technique through combined retrograde common carotid artery and anterograde transfemoral approaches. This technique has numerous potential advantages over traditional transfemoral endovascular and open retrograde common carotid artery approaches. It allows increased procedural control and success in traversing the stenosis and provides a smooth transition for the stent delivery catheter. An open cutdown procedure or open surgical technique is not required. Our patient recovered well from the procedure with no complications within the three-month follow up period.

Carotid artery stenting (CAS) involves dilatation of carotid bulb which can trigger a series of neuronal responses resulting in hemodynamic depression that might influence the outcome of the procedure. This is a frequent but underdiagnosed complication of CAS. Although it is mild, transient and self-limiting in majority of cases, it can result in significant morbidity and mortality if persistent. Neurologists should be aware of the predisposing factors and management of this common complication. In patients who present with stroke following carotid stenting, neurologists should be aware of hypoperfusion secondary to hemodynamic depression as a cause of stroke apart from the stent thrombosis and occlusion.

Introduction: Aorto-iliac Occlusive Disease (AIOD) involves the infra-renal aorta and the iliac arteries. Recent studies advocate endovascular management in TASC C and D lesions also. It involves balloon angioplasty with or without stent deployment.5 The aim of this retrospective study is to evaluate the results of endovascular balloon angioplasty and primary stenting in patients of AIOD. Methods: Twenty-five patients with Aorto-iliac occlusion disease who met the inclusion criteria during 1-year study period were included. Patients with acute thrombosis, abdominal aorta or iliac artery aneurysm and additional common femoral artery occlusion were excluded. The TASC II classification was used to define the characteristics of the lesions. The baseline data, procedural details and follow-up results were analysed. Results: Amongst 25 patients studied, age ranged from 40-75 years. Self-expanding metallic stent was employed in all patients. Technical success following primary stenting was achieved in all patients. Procedural times for TASC-II A, B, C and D lesions were 90+ 30, 110+ 40, 135+35 and 155+ 45 minutes, respectively. During follow-up, the cumulative primary patency rates at 1 month and 6 months were 100%. Cumulative primary patency rates at 1 year were 91.67%. Conclusion: Short- term outcomes of balloon angioplasty and stenting for Aorto-iliac artery occlusions in terms of primary patency rates were excellent.

The rate of heart failure and subsequent placement of left ventricular assistive devices (LVADs) has been increasing. The extra-anatomic placement of the LVAD and outflow graft presents a challenging problem for repair when complications arise. The present report describes a case of a 63-year-old man who had presented with acute pseudoaneurysm of the outflow graft of his recently placed LVAD. Percutaneous access of the left subclavian artery and percutaneous, transthoracic access of the outflow graft was obtained to allow for sheath placement and stent deployment within the outflow graft. The patient underwent successful endovascular repair of the defect without complications.

Reperfusion therapy is the most effective treatment for acute ischemic stroke. At present, many clinical studies have shown that mechanical thrombectomy is efficient and safe for acute ischemic stroke of large artery occlusion disease in the time window of 24 h. However, there is limited information on the safety and effectiveness of this technique in cases of recurrent ischemic stroke. We report a case of early recurrent stroke of the anterior circulation after a week of the first stroke. Imaging examinations showed that there existed occlusion of corresponding vessels and obvious ischemic penumbra. Symptoms of the patient were progressive worsening and medical treatment failed; therefore, the corresponding vessel was opened. The low perfusion status in brain tissue and clinical defect symptoms of the patients have improved a lot. In conclusion, thrombectomy for early recurrent ischemic stroke may be effective. Moreover, there may be a wider reperfusion time window for ischemic stroke patients.

Stenosis of the iliac veins is common in patients with chronic venous insufficiency. The article describes the methods for the diagnosis and treatment of iliac vein stenosis. The causes of iliac vein stenosis include extravasal compression or the consequences of ileofemoral thrombosis. Stenosis of the iliac veins exists in 1/4 of the entire adult population, but clinical manifestations do not occur in all patients. Stenosis of the iliac veins should be considered in case of an unknown edema, more often in the left lower extremity, since venous duplex ultrasound of lower extremities is not sensitive and specific enough when examining the veins above the inguinal ligament. The most accurate diagnostic method is intravascular ultrasound (IVUS) but the appeared computed tomography angiography (CTA) and magnetic resonance angiography (MRA) with high-quality images have become a good replacement for IVUS. The main method of treatment of iliac vein stenosis, besides stenting, isindispensable drug therapy consisting of antithrombotic and phlebotonic drugs.

Objective ‒ to develop a technique for endovascular treatment of symptomatic ostial stenosis of the vertebral arteries, which allows to minimize risks of delayed stent breakage and restenosis. Materials and methods. This is analysis of prospectively collected data from patients presenting from 2016 to 2019 in the endovascular center of the Dnepropetrovsk Regional Clinical Hospital named after I.I. Mechnikov. One hundred four stents were placed in 99 patients using the author’s complex method, which is based on our modification of Szabo technique. The principles of the method were developed based on a literature review and in vitro tests using 7 silicone models of the initial segments of the subclavian and vertebral arteries with different angles of divergence of the vertebral arteries (30, 45, 60, 90, 120, 135, 150°) and 9 balloon mounted drug-eluting stents with open-cell design Resolute (Medtronic). Results. There were no cases of displacement of the stent proximally or distally during implantation. In all cases, stents were implanted in the affected segment exactly and did not prolapse more than 1 mm beyond the ostium of the vertebral artery into the subclavian artery. There were no «clinical» ischemic complications in the early postoperative period. In 5 cases, isolated subclinical ischemic lessions in the carotid circulation were revealed during one-session stenting of ostial stenosis of the vertebral arteries and carotid stenting. In the posterior circulation, ischemic lessions on MRI in the early postoperative period were not detected in any observations. Conclusions. Developed complex stenting method based on our modification of Szabo technique allows us to achieve optimal long-term results of stenting of symptomatic ostial stenosis of the vertebral arteries.

Internal stenting of the upper urinary tract is a widespread urological surgery. Its frequency in modern practice is high and continues to grow due to the widespread use of endourological, percutaneous, and laparoscopic interventions. The presence of a stent in the patient's body often leads to a decrease in the quality of life due to the occurrence of stent-dependent symptoms, which often requires urgent hospitalization. According to various data, they are registered in at least 80% of patients. The most common stent-dependent symptoms are frequent and / or painful urination, urge to mix (up to imperative), nocturia, pain in the lumbar region, macrohematuria. According to existing data, a fair share of responsibility for the development of these symptoms lies with the distal (vesicular) curl of the internal stent, especially if the technology of its installation is not followed or the length of the drainage is incorrectly selected. The review describes methods for correct installation of internal ureteral stents by transurethral retrograde, antegrade, and laparoscopic approaches, as well as a method for installing and removing mono-pigtail drains. The internal drainage procedure is standard, so the focus is on the nuances and details of this widespread manipulation. The given cohort of patients and the range of surgical interventions indicate a significant experience of the authors in this issue. All illustrations are author's own and taken from the daily workflow. It should be noted that the modern understanding of the process and technological equipment ensure correct stenting when performing any interventions with any access. An adequate choice of installation method and correct positioning of the stent, knowledge of simple details and "secrets" allow not only to restore urodynamics, but also to effectively prevent the development of stent-dependent symptoms, thereby preserving patients quality of life.

The occurrence of tracheal fistulas of ischemic genesis combined with the failure of esophagogastroanastomosis and the communication between them is a rare and formidable complication after esophagectomy with mediastinal lymphadenectomy due to its anatomical position and extensiveness. However, it is insufficiently documented in the literature, both in terms of treatment and in terms of its causes. This observation aims to demonstrate the rare cause of this complication and the atypical successful treatment. In this case, a patient with squamous cell carcinoma G2 of the middle third of the esophagus and TNM stage cT3NxM0. On the McKeown thoracoscopic-laparotomy esophagectomy intraoperatively a short arterial vessel with a diameter of about 3 mm, which passed through the paracancerous infiltration and supplied blood to the esophagus and trachea revealed. The vessel was not isolated from the infiltrate, but was clipped and crossed between the aorta and infiltrate to maintain surgery ablastic. On the 7th day after the operation the insolvency of esophagogastroanastomosis, the fistula of the trachea with mediastinum and the communication between the leak of esophagogastroanastomosis and the fistula of the trachea were diagnosed. We consider this combination as a special case of esophagogastroanastomosis fistula, complicated by the communication between the right pleural cavity and pneumothorax. According to our experience, partial leak of esophagogastroanastomosis successfully heals by secondary tension within 10–15 days against the background of cervicotomic wound drainage and feeding through a nasointestinal tube. In this case there was a leak of saliva in the mediastinum and its penetration into the lumen of the trachea and the right pleural cavity. Surgical diversion of the fistula and stenting of the trachea were considered, but not applied, as the fistula in our opinion was controlled, but the aggressive content of the gastric conduit prevented healing. The patient was on assisted lung ventilation with minimal pressure support and inflow increased oxygen fractio. For this reason, we considered the best stenting of the esophagogastroanastomosis leak area to be covered with a stent in order to stop the aggressive content of the gastric stem from entering the fistula, which led to the successful treatment of the developed severe complication. It should be noted that this method of treatment may be ineffective in patients who need pressure support during ventilation.

ObjectivesCervical radiotherapy can lead to accelerated carotid artery stenosis, increased incidence of stroke, and a higher rate of in-stent restenosis in irradiated patients. Our objective was to reveal the morphological characteristics of radiation-induced carotid stenosis (RICS) and the stent–vessel interactions in patients with previous cervical radiotherapy by optical coherence tomography (OCT).Materials and MethodsBetween November 2017 and March 2019, five patients with a history of cervical radiotherapy were diagnosed with severe carotid artery stenosis and underwent carotid artery stenting (CAS). OCT was conducted before and immediately after the carotid stent implantation. Two patients received OCT evaluation of carotid stenting at 6- or 13-month follow-up.ResultsThe tumor types indicating cervical radiotherapy were nasopharyngeal carcinoma (n = 3), cervical esophageal carcinoma (n = 1), and cervical lymphoma (n = 1). The median interval from the radiotherapy to the diagnosis of RICS was 8 years (range 4–36 years). Lesion characteristics of RICS were detected with heterogeneous signal-rich tissue, dissection, and advanced atherosclerosis upon OCT evaluation. Post-interventional OCT revealed 18.2–57.1% tissue protrusion and 3.3–13.8% stent strut malapposition. Follow-up OCT detected homogeneous signal-rich neointima and signal-poor regions around stent struts. In the patient with high rates of tissue protrusion and stent strut malapposition, the 6-month neointima burden reached 48.9% and microvessels were detected.ConclusionThe morphological features of RICS were heterogeneous, including heterogeneous signal-rich tissue, dissection, and advanced atherosclerosis. Stenting was successful in all 5 patients with severe RICS. One patient, with high rates of tissue protrusion and stent strut malapposition immediately after stenting, received in-stent neointimal hyperplasia at a 6-month follow-up.

Introduction: The treatment of complex arterial lesions with long occlusions and involvement of the bifurcation of the tibial arteries remains a technical challenge in the endovascular area that often culminates in the choice of a conventional surgical alternative. Given the similarities in arterial caliber and necessary material, the adaptation of techniques used in lesions of bifurcations in the coronary circulation to the infrapopliteal territory has allowed a change in the treatment paradigm. Material and methods: This article presents a clinical case of a patient with complex peripheral arterial disease treated with the double kissing (DK) crush technique. Clinical case: 74-year-old male patient, hypertensive, and smoker, previously submitted to endovascular exclusion of infra-renal abdominal aortic aneurysm and bilateral saphenectomy, diagnosed with chronic limb-threatening ischemia of the left limb – Rutherford 4. AngioCT revealed a long (30 cm) femoropopliteal occlusion with rehabilitation at the level of the tibioperoneal trunk (TPT). Despite the extent and location of the lesion, the patient's surgical history, the absence of a great saphenous vein, and multiple previous femoral surgical approaches led the patient to be initially proposed for endovascular treatment using the DK crush technique. The lesion was recanalized through percutaneous access of the ipsilateral superficial femoral artery, and a guidewire was placed in the peroneal and posterior tibial arteries. The TPT bifurcation was predilated in kissing (1st kissing balloon), and a balloon-expandable stent (Xience Sierra® 3×18mm) was placed in the posterior tibialis (PT). Subsequently, a second balloon-expandable stent (Xience Sierra® 3.5×18mm) was placed in the peroneal artery with the consequent crush of the proximal portion of the 1st stent. The PT guidewire was removed and reintroduced through the stent mesh, and then the second kissing balloon of the bifurcation was performed, with an excellent angiographic result. Finally, femoropopliteal angioplasty was performed with placement of self-expanding stents (Zilver PTX®) in increasing degrees. The patient had no complaints and maintained patency of the entire arterial axis at nine months of follow-up, namely the peroneal and PT arteries, evident on the control ultrasound. Conclusion: In the case presented here, the adaptation of the DK crush technique to the tibial-peroneal territory allowed the effective revascularization of a complex arterial lesion, with good results in the medium term.

The optimal approach for supravalvar right ventricular outflow tract obstruction(RVOTO) after arterial switch operation(ASO) is unclear. The results of percutaneous balloon dilatation have been variable. We report the results of simultaneous double balloon dilation for RVOTO after ASO. Sixteen patients (1.3(0.7-3.8) years; 9.8(8.1-15.1) kgs underwent the procedure at 14(8-44.5) months after ASO. Salient technical features included placement of balloons over stiff guide-wires positioned in both branch pulmonary arteries to enable dilation of the distal-most main pulmonary artery (MPA) with high inflation pressures (~ 12-14 atmospheres) and short inflation-deflation cycles. Effective balloon size was based on the PA annulus or MPA distal to the narrowing. The final balloon: narrowest segment diameter ratio was 2.7. Following dilation, the right ventricle to systemic systolic pressure ratio decreased from 0.9 ± 0.18 to 0.52 ± 0.16 (p  < 0.001) and mean RVOT gradient from 78 ± 18 to 34 ± 13.9 mmHg (p < 0.001). Narrowest diameter improved from 5.4 ± 2.2 to 9.2 ± 2.2 mm. There were no major complications. Two patients with inadequate relief (final RV-systemic ratios: 1.03 and 0.7) were referred for surgery. At median follow up of 9 months, IQR 7-22, range 5-73, others are free of re interventions with median RVOT gradient of 42, IQR 27-49, range 21-55 mmHg. The immediate and short-term follow up results of double balloon dilatation for supravalvar RVOTO is encouraging and may avoid the need for repeat surgery in the majority of patients. Further follow up is needed to determine the long-term durability of the results., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Cerebral aneurysms are weakened blood vessel dilatations that can result in spontaneous, devastating hemorrhage events. Aneurysm treatment aims to reduce hemorrhage events, and strategies for complex aneurysms often require surgical bypass or endovascular stenting for blood flow diversion. Interventions that divert blood flow from their normal circulation patterns have the potential to result in unintentional ischemia. Recent developments in computational modeling and in vivo assessment of hemodynamics for cerebral aneurysm treatment have entered into clinical practice. Herein, we review how these techniques are currently utilized to improve risk stratification and treatment planning.

Carotid artery stenosis is responsible for up to 12% of all ischemic strokes. The prevalence of bilateral carotid artery stenosis is nearly 8-39% among patients with stroke, and its management is still controversial. This study aimed to report the treatment results of bilateral carotid artery stenosis with simultaneous bilateral angioplasty and stenting (sbCAS) in a single institution during the last 10 years. 315 patients underwent carotid stenting in the Scientific-Practical Center of Endovascular Neuroradiology, NAMS of Ukraine during 2010-2020. 39 (12.4%) patients (mean age 57.9±2.1 - 28 men) underwent sbCAS. Primary clinical endpoints (stroke, myocardial infarction, or death) and secondary endpoints (hemodynamic depression (HD) - hypotension (<90 mmHg) or bradycardia (<60 bpm) and hyperperfusion syndrome (HPS) were evaluated. All sbCAS were technically successful, and a reduction of stenosis was noted in each case. There were two periprocedural neurological complications, one transient ischemic attack (TIA), and one minor stroke with the Modified Rankin Scale (mRS) - 3 at discharge. No myocardial infarction (MI) or death during hospitalization was noted. 28 patients (71.8%) had HD, and 2 (5.1%) had HPS. All patients except those with periprocedural stroke were discharged or transferred to another hospital without neurological deterioration. sbCAS is an effective and relatively safe procedure for carefully selected patients with bilateral carotid stenosis. Patients with bilateral carotid stenosis should be carefully examined, and the best treatment strategy should be assessed using a multidisciplinary approach taking into account the possibility of sbCAS. [ABSTRACT FROM AUTHOR]

Résumé: Le drainage biliaire percutané des voies biliaires est indiqué en situation palliative dans les lésions avancées de type Bismuth III et IV et en cas d'impossibilité ou en complément du drainage endoscopique. Un bilan d'extension incluant un scanner thoraco-abdomino-pelvien, une imagerie par résonance magnétique hépato-biliaire, et une concertation au sein d'une équipe spécialisée pluridisciplinaire sont les étapes cruciales pour envisager les différentes options thérapeutiques. Pour restaurer la perméabilité biliaire, l'opérateur dispose de drains externes ou au mieux interne-externes et de prothèses métalliques nues ou couvertes. De nombreuses innovations, permettent d'augmenter la perméabilité de ces prothèses. Un environnement anesthésique est indispensable car la procédure est douloureuse et pourvoyeuse de complications septiques. Percutaneous drainage of malignant biliary obstructions is often palliative in advanced lesions Bismuth III and IV, and in case of failure or in addition to endoscopic drainage. An assessment including whole body CT and hepatobiliary MRI as well as a discussion in a multidisciplinary team are crucial steps for therapeutic options. To restore the patency of the biliary duct, the operator uses external or better internal-external drains, and also uncovered or covered metallic stents. Numerous innovations aim to increase the patency of these prostheses. An anesthetic environment is mandatory for pain and septic complications management. [ABSTRACT FROM AUTHOR]

Purpose: To assess the results of endovascular treatment in a large population of patients suffering from post-thrombotic syndrome (PTS) due to iliocaval occlusive disease.Methods: In this retrospective multi-center study, 698 patients treated by stenting for PTS in 15 French centers were analyzed. Primary, primary assisted, and secondary patency rates were assessed, and clinical efficacy was evaluated using Villalta and Chronic Venous Insufficiency Questionnaire in 20 questions (CIVIQ-20) scores. Outcomes were compared against pre-operative CT-based severity of the post-thrombotic lesions in the thigh (4 grades).Results: Technical success, defined as successful recanalization and stent deployment restoring rapid anterograde flow in the targeted vessel, was obtained in 668 (95.7%) patients with a complication rate of 3.9%. After a mean follow-up of 21.0 months, primary patency, primary assisted patency, and secondary patency were achieved in 537 (80.4%), 566 (84.7%), and 616 (92.2%) of the 668 patients, respectively. Venous patency was strongly correlated to the grade of post-thrombotic changes in the thigh, with secondary patency rates of 96.0%, 92.9%, 88.4%, and 78.9%, respectively, for grades 0 to 3 (p = .0008). The mean improvements of Villalta and CIVIQ-20 scores were 7.0 ± 4.7 points (p < .0001) and 19.1 ± 14.8 points (p < .0001), respectively.Conclusion: Endovascular stenting as a treatment option for PTS due to chronic iliocaval venous occlusion generates a high technical success, low morbidity, high midterm patency rate, and clinical improvement. Venous patency was strongly correlated to the severity of post-thrombotic lesions in the thigh. [ABSTRACT FROM AUTHOR]

Purpose/aim of the study: Posterior circulation stroke (PCS) accounts for 20% of ischemic stroke, and vertebrobasilar stenosis is an important cause of PCS. Notably, not all patients with artery stenosis progress to ischemic stroke, and one of the important reason is that collateral circulation construction plays important protection role in this process. Clinical presentation: Here, we present the case of a 71-year-old male who presented with lightheadedness and three episodes of loss of consciousness after bilateral subclavian artery stenting. Digital subtraction angiography (DSA) demonstrated severe stenosis of the left vertebral artery, and the bilateral subclavian artery was kept open. The patient was then given the left vertebral artery stenting in an effort to resolve the vascular stenosis. As expected, he achieved a complete remission after stenting. However, 6 months later the patient suffered from loss of consciousness again. Repeat DSA confirmed restenosis of the left vertebral artery, and revealed a collateral flow to the left vertebral artery which fed by external carotid collateral branches. Then DSA was performed after 12 months, and another collateral circulation involving thyrocervical trunk was also found supplying flow to the left vertebral artery. In this process, the frequency of loss of consciousness gradually decreased as the collateral circulation construction. Conclusion: Through this case, we observe the whole process of the collateral circulation construction. Moreover, this case serves as a testament to the variability and complexity of vertebrobasilar arteriopathies, suggesting promotion of collateral flow offers the opportunity for outcome improvement. [ABSTRACT FROM AUTHOR]