Search

A method has been developed to increase the probability of success of percutaneous transluminal balloon angioplasty of total occlusions of the common iliac artery when conventional methods have failed. In 10 patients with a totally obstructed iliac artery, a guide wire was passed through a catheter placed from the contralateral side around the aortic bifurcation and antegrade through the total obstruction. The end of the wire was either snared by a retrieval basket or guided through a sheath in the ipsilateral common femoral artery, thus providing a firmly anchored pathway for subsequent manipulations. Balloons were then inserted retrograde through both common femoral arteries and dilated. In the first five patients, ipsilateral retrograde passage of a guide wire had failed despite multiple attempts with a variety of devices. In the other five patients, the contralateral antegrade approach was used initially. The new method was successful in all 10 patients with totally obstructed common iliac arteries.

Percutaneous angioplasty of supraaortic arteries has developed to a valuable treatment modality characterized by a high technical success and low complication rate. Vessels suited for angioplasty are: subclavian, innominate, vertebral as well as common, internal, and external carotid arteries.

Percutaneous angioplasty In the management of renovascular hypertension. W. B. McKenzie, J. Palmer and D. E. L. Wilcken, Aust. N.Z. J. Med., 1982,12, pp. 189–191. Percutaneous transluminal angioplasty for renal artery stenosis is a brief procedure which has proven effectiveness and which can be performed under local anaesthesia with a low incidence of side effects. This report details the successful treatment of a patient with severe renovascular hypertension due to a stenotic left renal artery. Follow–up three months after balloon dilatation revealed continued wide patency of the vessel and the patient's blood pressure remained easily controlled.

Certain problems remain within the field of percutaneous angioplasty including crossing occlusions, acute re-occlusion and long term patency rates. Lasers have been used specifically to address the problem of crossing occlusions.

Percutaneous transluminal angioplasty of the infrarenal abdominal aorta has been reported by a few authors. In the present series, aortic stenoses in 32 patients were treated with various percutaneous angioplasty techniques. Isolated aortic stenoses and primary aortic stenoses extending into the iliac arteries were successfully dilated. The initial success rate was 100%, without evidence of rupture, thrombosis, dissection, or distal embolization. In only three of the 28 patients who returned for follow-up did symptoms recur or noninvasive vascular laboratory indexes deteriorate (mean follow-up, 25 months). Percutaneous transluminal aortic angioplasty has proved safe and efficacious in the treatment of atherosclerotic aortic stenoses.

The balloon-tipped catheter for percutaneous transluminal angioplasty (PTA) is a potentially dangerous weapon. Safe use requires considerable technical skill. Complications have already caused significant risk to, and loss of, limbs and life. Although there is no question that the incidence of successful dilatation in competent hands is quite high, the risks of complication are still not completely known. Any new procedure must be compared with existing effective modes of treatment, in this case, surgical revascularization. Therefore, this new procedure must be examined and compared in terms of acute hemodynamic effectiveness, mortality and morbidity, specific indications, long-term results (durability), and consequences of long-term failure. Pertinent surgical experience is reported to provide data for this comparison and information from which some predictions about percutaneous angioplasty can be made. Although complete information about these issues is needed before we can confidently accept balloon catheter angioplasty as a therapeutic procedure and assign it its proper role, cautious and judicious application of angioplasty should proceed with some definite guidelines.

WOS: 000254243500009, PubMed ID: 17513211, Objective: Carotid artery stenting is a new approach alternative to surgical carotid endarterectomy. Cerebral protection devices improved the applicability of this technique. In this study, we evaluated applicability, safety and late clinical outcomes of percutaneous interventions for carotid artery stenosis. Methods: A prospective study included 26 patients (15 female, 11 male, mean age 70 16 years) undergoing percutaneous transluminal angioplasty and stenting with different sizes of balloons and stents for 28 internal carotid artery stenoses at Kadir Has University Department of Interventional Radiology between March 2002 and December 2004. Ten patients were asymptomatic, one had amaurosis fugax, four had transient ischemic attack within last four months, one had drop attacks, one had headache, seven had the findings of hemiparesis and three had hemiplegia. Results: Stenosis rates were calculated according to North America Symptomatic Carotid Endarterectomy Trial. Median stenosis rate was 85% (range: 60%-95%). All of the 28 internal carotid artery stenoses were managed with balloon dilatation and stenting (technical success rate 100%). Median residual stenosis rate after procedure was 14% (range: 0%-30%). Asystole developed in five patients and bradycardia in eight patients. Ipsilateral middle cerebral artery infarction occurred in two patients. One patient had intracranial reperfusion bleeding four hours after the procedure. No procedural death was observed within one month of follow-up. One patient died of myocardial infarction four months after the procedure. Cranial computed tomography revealed multiple metastases in one patient complaining of intractable headache and primary source was found to be pulmonary carcinoma. No stent restenosis was defined at Doppler ultrasonographic examinations performed 6 and 12 months after procedures with normal flow patterns and velocities. Two patients underwent control angiography at 12th month and myointimal proliferations with insignificant obstruction (25% and 30%) were detected. Conclusion: Carotid artery stenting seems to be applicable and safe procedure but it is associated with infrequent major complications. Results of studies comparing surgery and angioplasty will be helpful in defining role of stenting in the treatment of carotid occlusive disease.

We compared the efficacy and safety of percutaneous transluminal renal angioplasty for the treatment of renovascular disease in 66 patients. Thirty-four were aged less than 60 years, and 32 more than 60 years. The younger patients had a shorter known duration of hypertension and higher levels of diastolic pressure (6.4 +/- 9 years and 109 +/- 15 mmHg) than the older patients (12.8 +/- 8 years and 101 +/- 11 mmHg, P less than 0.01 for both comparisons). They also had higher creatinine clearance rates (78 versus 46 ml/min, P less than 0.01) and less severe renal artery disease. A total of 70 percutaneous transluminal renal angioplasties were performed in 70 arteries with a technical success rate of 100% in the younger group versus 67% in the older group (P less than 0.01); complications occurred more frequently in the older group. Our data indicate that, when technically successful, percutaneous transluminal renal angioplasty improves blood pressure to a similar extent in both younger and older patients. However, in patients over 60 years, the safety of the procedure is limited by more severe age-associated atheroma of renal and extrarenal arteries.

Subacute stent thrombosis (SST) (0 – 30 days) remains an important complication post primary percutaneous intervention (PPCI), with morbidity and mortality reaching those of spontaneous myocardial infarction. To date, our information on angiographic and clinical predictors of SST in ST- segment

Questions and answers continue to fly regarding the use of percutaneous transluminal coronary angioplasty (PTCA).One recent occasion was a session at the meeting of the American College of Chest Physicians in Chicago. Since, as Ronald E. Vlietstra, MB, ChB, noted, "most patients with symptomatic coronary disease have stenosis in more than one vessel," the question of treating multivessel disease arose. Vlietstra said that in an ongoing study (the first report of which appeared in Mayo Clinic Proceedings [1983;58:563-567]), his research group at the Mayo Clinic is examining the effectiveness—in terms of both success and safety—of PTCA for this purpose.Vlietstra, an associate professor of medicine at the Mayo Medical School, defined multivessel disease as 70% or greater stenosis in at least one major epicardial vessel, as well as 50% or greater stenosis in at least one other major vessel. Single vessel disease is defined by the first condition alone.

Although balloon angioplasty (BA) has been extensively reported to treat peripheral artery occlusive disease, only little information is available about its use for critical hand ischemia. We report a case of a patient with painful ulcerated ischemic lesions of the right hand digits successfully treated by BA of the radial artery (RA) and its deep palmar branch (DPB). The 6-month angiographic follow-up showed a focal restenosis that was approached by a second BA session. Larger series are encouraged to determine the clinical outcome of percutaneous approach in this arterial district.