362 results on '"Kenneth, Rosenfield"'
Search Results
2. Periprocedural Complications With Balloon Pulmonary Angioplasty
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Nishant Jain, Muhammad A. Sheikh, Divyansh Bajaj, Whitney Townsend, Richard Krasuski, Eric Secemsky, Saurav Chatterjee, Victor Moles, Prachi P. Agarwal, Jonathan Haft, Scott H. Visovatti, Thomas M. Cascino, Kenneth Rosenfield, Brahmajee K. Nallamothu, Vallerie V. Mclaughlin, and Vikas Aggarwal
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Cardiology and Cardiovascular Medicine - Published
- 2023
3. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions)
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Theodore A. Bass, J. Dawn Abbott, Ehtisham Mahmud, Sahil A. Parikh, Jamil Aboulhosn, Mahi L. Ashwath, Bryan Baranowski, Lisa Bergersen, Hannah I. Chaudry, Megan Coylewright, Ali E. Denktas, Kamal Gupta, J. Antonio Gutierrez, Jonathan Haft, Beau M. Hawkins, Howard C. Herrmann, Navin K. Kapur, Sena Kilic, John Lesser, C. Huie Lin, Rodrigo Mendirichaga, Vuyisile T. Nkomo, Linda G. Park, Dawn R. Phoubandith, Nishath Quader, Michael W. Rich, Kenneth Rosenfield, Saher S. Sabri, Murray L. Shames, Stanton K. Shernan, Kimberly A. Skelding, Jacqueline Tamis-Holland, Vinod H. Thourani, Jennifer A. Tremmel, Seth Uretsky, Jessica Wageman, Frederick Welt, Brian K. Whisenant, Christopher J. White, and Celina M. Yong
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Cardiology and Cardiovascular Medicine - Published
- 2023
4. Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia
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Alik Farber, Matthew T. Menard, Michael S. Conte, John A. Kaufman, Richard J. Powell, Niteesh K. Choudhry, Taye H. Hamza, Susan F. Assmann, Mark A. Creager, Mark J. Cziraky, Michael D. Dake, Michael R. Jaff, Diane Reid, Flora S. Siami, George Sopko, Christopher J. White, Max van Over, Michael B. Strong, Maria F. Villarreal, Michelle McKean, Ezana Azene, Amir Azarbal, Andrew Barleben, David K. Chew, Leonardo C. Clavijo, Yvan Douville, Laura Findeiss, Nitin Garg, Warren Gasper, Kristina A. Giles, Philip P. Goodney, Beau M. Hawkins, Christine R. Herman, Jeffrey A. Kalish, Matthew C. Koopmann, Igor A. Laskowski, Carlos Mena-Hurtado, Raghu Motaganahalli, Vincent L. Rowe, Andres Schanzer, Peter A. Schneider, Jeffrey J. Siracuse, Maarit Venermo, and Kenneth Rosenfield
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General Medicine - Abstract
Patients with chronic limb-threatening ischemia (CLTI) require revascularization to improve limb perfusion and thereby limit the risk of amputation. It is uncertain whether an initial strategy of endovascular therapy or surgical revascularization for CLTI is superior for improving limb outcomes.In this international, randomized trial, we enrolled 1830 patients with CLTI and infrainguinal peripheral artery disease in two parallel-cohort trials. Patients who had a single segment of great saphenous vein that could be used for surgery were assigned to cohort 1. Patients who needed an alternative bypass conduit were assigned to cohort 2. The primary outcome was a composite of a major adverse limb event - which was defined as amputation above the ankle or a major limb reintervention (a new bypass graft or graft revision, thrombectomy, or thrombolysis) - or death from any cause.In cohort 1, after a median follow-up of 2.7 years, a primary-outcome event occurred in 302 of 709 patients (42.6%) in the surgical group and in 408 of 711 patients (57.4%) in the endovascular group (hazard ratio, 0.68; 95% confidence interval [CI], 0.59 to 0.79; P0.001). In cohort 2, a primary-outcome event occurred in 83 of 194 patients (42.8%) in the surgical group and in 95 of 199 patients (47.7%) in the endovascular group (hazard ratio, 0.79; 95% CI, 0.58 to 1.06; P = 0.12) after a median follow-up of 1.6 years. The incidence of adverse events was similar in the two groups in the two cohorts.Among patients with CLTI who had an adequate great saphenous vein for surgical revascularization (cohort 1), the incidence of a major adverse limb event or death was significantly lower in the surgical group than in the endovascular group. Among the patients who lacked an adequate saphenous vein conduit (cohort 2), the outcomes in the two groups were similar. (Funded by the National Heart, Lung, and Blood Institute; BEST-CLI ClinicalTrials.gov number, NCT02060630.).
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- 2022
5. Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism
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Yevgeniy Brailovsky DO, MSc, Vladimir Lakhter DO, Ido Weinberg MD, Katerina Porcaro MD, Jeremiah Haines DO, Stephen Morris MD, Dalila Masic PharmD, Erin Mancl PharmD, Riyaz Bashir MD, Mohamad Alkhouli MD, Kenneth Rosenfield MD, Verghese Mathew MD, John Lopez MD, Carlos F. Bechara MD, Cara Joyce PhD, Jawed Fareed PhD, and Amir Darki MD, MSc
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Intermediate-risk pulmonary embolism (PE) has variable outcomes. Current risk stratification models lack the positive predictive value to identify patients at highest risk of PE-related mortality. We identified intermediate-risk PE patients who underwent catheter-based interventions and right heart catheterization (RHC) and identified those with low cardiac index (CI < 2.2 L/min/m 2 ). We utilized regression models to identify echocardiographic predictors of low CI and Kaplan Meier curve to evaluate PE-related mortality when stratified by the echocardiographic predictor. Of 174 intermediate-risk PE patients, 41 underwent RHC. Within this cohort, 46.3% had low CI. Univariable linear regression identified right ventricular outflow tract velocity time integral (RVOT VTI), right/left ventricular ratio, S prime, inferior vena cava diameter, and pulmonary artery systolic pressure as potential predictors of low CI. Multivariable linear regression identified RVOT VTI as significant predictor of low CI (β coefficient 0.124, 95% confidence interval [CI]: 0.01-0.24, P = .034). Right ventricular outflow tract velocity time integral
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- 2019
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6. The BEST-CLI Trial: Implications of the Primary Results
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Matthew T, Menard, Kenneth, Rosenfield, and Alik, Farber
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
7. Temporal Trends, Practice Variation, and Associated Outcomes With IVUS Use During Peripheral Arterial Intervention
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Sanjay Divakaran, Sahil A. Parikh, Beau M. Hawkins, Siyan Chen, Yang Song, Subhash Banerjee, Kenneth Rosenfield, and Eric A. Secemsky
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Peripheral Arterial Disease ,Treatment Outcome ,Endovascular Procedures ,Humans ,Prospective Studies ,Medicare ,Cardiology and Cardiovascular Medicine ,United States ,Ultrasonography, Interventional - Abstract
Intravascular ultrasound (IVUS) has been shown in limited prospective studies to improve procedural outcomes for patients undergoing lower extremity peripheral arterial intervention (PVI).The authors aimed to study temporal trends, practice variation, and associated outcomes with the use of IVUS during PVI among Medicare beneficiaries.All PVIs performed from 2016 to 2019 among Medicare beneficiaries aged65 years were included. Temporal trends in IVUS use were stratified by procedural location (inpatient, outpatient, or ambulatory surgery center [ASC]/office-based laboratory [OBL]) and physician specialty. The primary outcome was major adverse limb events (MALE). Inverse probability weighting was used to account for differences in baseline characteristics. Cox regression with competing risks was used to estimate weighted hazard ratios.During the study period, 543,488 PVIs were included, of which 63,372 (11.7%) used IVUS. A substantial growth in IVUS use was observed, which was driven by procedures performed in ASCs/OBLs (23.6% increase from quarter 1 of 2016 through quarter 4 of 2019). Among operators who used IVUS, there was also notable variation in use (median operator use 5.4% of cases; IQR: 2.2%-15.0%; range, 1%-100%). In weighted analysis, IVUS use during PVI was associated with a lower risk of MALE through a median of 514 days (adjusted hazard ratio: 0.73; 95% CI: 0.70-0.75; P 0.0001).In contemporary nationwide data, IVUS use during PVI has increased since 2016, driven by growth in the ASC/OBL setting. However, there remains substantial variation in operator practice. When used during PVI, IVUS was associated with a lower risk of short- and long-term MALE.
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- 2022
8. Intravascular ultrasound guidance for lower extremity arterial and venous interventions
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Eric A, Secemsky, Sahil A, Parikh, Maureen, Kohi, Michael, Lichtenberg, Mark, Meissner, Ramon, Varcoe, Andrew, Holden, Michael, Jaff, David, Chalyan, Daniel, Clair, Beau, Hawkins, and Kenneth, Rosenfield
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Treatment Outcome ,Lower Extremity ,Humans ,Calcium ,Arteries ,Coronary Artery Disease ,Prospective Studies ,Coronary Angiography ,Cardiology and Cardiovascular Medicine ,Ultrasonography, Interventional - Abstract
This review details the utility of intravascular ultrasound (IVUS) for the management of peripheral artery and venous disease. The purpose of this document is to provide an update in the use of IVUS in peripheral arterial and venous pathology and demonstrate the use of IVUS as a practical diagnostic imaging procedure to evaluate and treat peripheral vascular disorders. IVUS, a diagnostic tool that relies on sound waves to produce precise images of the vessel being evaluated, was originally introduced to the medical community for the purposes of peripheral artery imaging, though it was quickly adapted for coronary interventions with positive outcomes. The utility of IVUS includes vessel measurement, pre- and post-procedural planning, treatment optimisation, and detection of thrombus, dissection or calcium severity. While angiography remains the standard imaging approach during peripheral intervention, multiple observational studies and small prospective trials have shown that in comparison, IVUS provides more accurate imaging detail, which may improve procedural outcomes. IVUS can also address limitations of angiography, including the need to administer contrast medium and eliminate the ambiguity associated with other forms of imaging. This review provides contemporary examples of where IVUS is being used during peripheral intervention as well as representative imaging to serve as a resource for the practising clinician.
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- 2022
9. Appropriate Use of Intravascular Ultrasound During Arterial and Venous Lower Extremity Interventions
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Eric A. Secemsky, Ramya C. Mosarla, Kenneth Rosenfield, Maureen Kohi, Michael Lichtenberg, Mark Meissner, Ramon Varcoe, Andrew Holden, Michael R. Jaff, David Chalyan, Daniel Clair, Beau M. Hawkins, and Sahil A. Parikh
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Femoral Artery ,Consensus ,Treatment Outcome ,Lower Extremity ,Endovascular Procedures ,Humans ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Ultrasonography, Interventional - Abstract
There has been growing use of intravascular ultrasound (IVUS) during lower extremity arterial and venous revascularization. Observational data suggest that the use of IVUS can improve periprocedural and long-term outcomes, but largescale prospective data remain limited. Consensus opinion regarding the appropriate use of IVUS during peripheral intervention is needed.The purpose of this consensus document is to provide guidance on the appropriate use of IVUS in various phases of peripheral arterial and venous interventions.A 12-member writing committee was convened to derive consensus regarding the appropriate clinical scenarios for use of peripheral IVUS. The group iteratively created a 72-question survey representing 12 lower extremity arterial interventional scenarios. Separately, a 40-question survey representing 8 iliofemoral venous interventional scenarios was constructed. Clinical scenarios were categorized by interventional phases: preintervention, intraprocedure, and postintervention optimization. Thirty international vascular experts (15 for each survey) anonymously completed the survey instrument. Results were categorized by appropriateness using the median value and disseminated to the voting panel to reevaluate for any disagreement.Consensus opinion concluded that IVUS use may be appropriate during the preintervention phase for evaluating the etiology of vessel occlusion and plaque morphology in the iliac and femoropopliteal arteries. IVUS was otherwise rated as appropriate during iliac and femoropopliteal revascularization in most other preintervention scenarios, as well as intraprocedural and postprocedural optimization phases. IVUS was rated appropriate in all interventional phases for the tibial arteries. For iliofemoral venous interventions, IVUS was rated as appropriate in all interventional phases.Expert consensus can help define clinical procedural scenarios in which peripheral IVUS may have value during lower extremity arterial and venous intervention while additional prospective data are collected.
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- 2022
10. Baseline Modern Medical Management in the BEST-CLI Trial
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Matthew T. Menard, Michael R. Jaff, Alik Farber, Kenneth Rosenfield, Michael S. Conte, Christopher J. White, Joshua A. Beckman, Niteesh K. Choudhry, Leonardo C. Clavijo, Thomas S. Huber, Katherine R. Tuttle, Taye H. Hamza, Andres Schanzer, Igor A. Laskowski, Mark J. Cziraky, Alain Drooz, Max van Over, Michael B. Strong, and Ido Weinberg
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
11. Carotid Artery Stenting
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Christopher J. White, Thomas G. Brott, William A. Gray, Donald Heck, Tudor Jovin, Sean P. Lyden, David Christopher Metzger, Kenneth Rosenfield, Gary Roubin, Ravish Sachar, and Adnan Siddiqui
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Cardiology and Cardiovascular Medicine - Published
- 2022
12. Diagnosis and Management of Infective Endocarditis in People Who Inject Drugs
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Evin Yucel, Benjamin Bearnot, Molly L. Paras, Emily K. Zern, David M. Dudzinski, Chen-Pang Soong, Arminder S. Jassar, Kenneth Rosenfield, Jaclynne Lira, Eugene Lambert, Sarah E. Wakeman, and Thoralf Sundt
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Cardiology and Cardiovascular Medicine - Published
- 2022
13. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium
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Belinda Rivera-Lebron MD, MS, FCCP, Michael McDaniel MD, FACC, FSCAI, Kamran Ahrar MD, MBA, Abdulah Alrifai MD, David M. Dudzinski MD, Christina Fanola MD, MSC, Danielle Blais PharmD, BCPS-AQ Cardiology, David Janicke MD, PhD, Roman Melamed MD, FCCP, Kerry Mohrien PharmD, BCPS, Elizabeth Rozycki PharmD, BCPS, Charles B. Ross MD, FACS, Andrew J. Klein MD, Parth Rali MD, Nicholas R. Teman MD, Leoara Yarboro MD, Eugene Ichinose MD, Aditya M. Sharma MBBS, Jason A. Bartos MD, PhD, Mahir Elder MD, FACC, FSCAI, FCCP, Brent Keeling MD, Harold Palevsky MD, Soophia Naydenov MD, FCCP, Parijat Sen MBBS, MD, Nancy Amoroso MD, Josanna M. Rodriguez-Lopez MD, George A. Davis Pharm D, Rachel Rosovsky MD, Kenneth Rosenfield MD, MHCDS, FACC, FSCAI, Christopher Kabrhel MD, MPH, James Horowitz MD, Jay S. Giri MD, MPH, Victor Tapson MD, FCCP, FRCP, and Richard Channick MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients.
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- 2019
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14. Evolving Role and Clinical Evidence in the Global Practice of Balloon Pulmonary Angioplasty
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Nishant Jain, Sidney Perkins, Anand Reddy Maligireddy, and Kenneth Rosenfield
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Cardiology and Cardiovascular Medicine - Published
- 2023
15. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee
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Theodore A. Bass, J. Dawn Abbott, Ehtisham Mahmud, Sahil A. Parikh, Jamil Aboulhosn, Mahi L. Ashwath, Bryan Baranowski, Lisa Bergersen, Hannah I. Chaudry, Megan Coylewright, Ali E. Denktas, Kamal Gupta, J. Antonio Gutierrez, Jonathan Haft, Beau M. Hawkins, Howard C. Herrmann, Navin K. Kapur, Sena Kilic, John Lesser, Lin C. Huie, Rodrigo Mendirichaga, Vuyisile T. Nkomo, Linda G. Park, Dawn R. Phoubandith, Nishath Quader, Michael W. Rich, Kenneth Rosenfield, Saher S. Sabri, Murray L. Shames, Stanton K. Shernan, Kimberly A. Skelding, Jacqueline Tamis-Holland, Vinod H. Thourani, Jennifer A. Tremmel, Seth Uretsky, Jessica Wageman, Frederick Welt, Brian K. Whisenant, Christopher J. White, and Celina M. Yong
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Cardiology and Cardiovascular Medicine - Published
- 2023
16. Perioperative Systemic Complications and Adverse Events in the BEST-CLI Trial
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Jeffrey J. Siracuse, Alik Farber, Matthew T. Menard, Sharon C. Kiang, Cassius Iyad Ochoa Chaar, Nicholas Osborne, Niten Singh, Tze-Woei Tan, Michael B. Strong, Raul J. Guzman, and Kenneth Rosenfield
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
17. The Impact of Revascularization Strategy on Clinical Failure, Hemodynamic Failure, and Chronic Limb-Threatening Ischemia Symptoms in the BEST-CLI Trial
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Michael B. Strong, Matthew T. Menard, Alik Farber, Taye Hamz, Kenneth Rosenfield, Emiliano Chisci, Leonardo Clavijo, Michael Dake, Beau Hawkins, Ahmed Kayssi, Katharine L. McGinigle, Peter A. Schneider, and Michael S. Conte
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
18. Secondary Interventions Following Open vs Endovascular Revascularization for Chronic Limb-threatening Ischemia in the BEST-CLI Trial
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Michael S. Conte, Ezana Azene, Warren Gasper, Randy Guzman, Taye Hamza, Vikram Kashyap, Carlos Mena-Hurtado, Matthew Menard, Kenneth Rosenfield, Vincent Rowe, and Alik Farber
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
19. Interhospital Transfer of Patients With Acute Pulmonary Embolism
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George A. Davis, Kenneth Rosenfield, Robert A. Lookstein, Victor F. Tapson, Bhavinkumar Dalal, Christopher Kabrhel, David M. Dudzinski, Eugene Ichinose, Jonathan Berkowitz, Jean M. Elwing, Alicia Duval, Parth Rali, Rachel P. Rosovsky, Roman Melamed, Charles B. Ross, Daniel Sacher, Soophia Naydenov, Richard N. Channick, Ka U Lio, Brent Keeling, Shalom Sokolow, Bushra Mina, Michael C. McDaniel, Aniruddh Kapoor, Belinda Rivera-Lebron, and Eduardo Bossone
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine.drug_class ,Critically ill ,MEDLINE ,Low molecular weight heparin ,Critical Care and Intensive Care Medicine ,medicine.disease ,Unmet needs ,Pulmonary embolism ,Treatment modality ,St elevation myocardial infarction ,medicine ,Emergency medical services ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Abstract
Acute pulmonary embolism (PE) is associated with significant morbidity and mortality. The management paradigm for acute PE has evolved in recent years with wider availability of advanced treatment modalities ranging from catheter-directed reperfusion therapies to mechanical circulatory support. This evolution has coincided with the development and implementation of institutional pulmonary embolism response teams (PERT) nationwide and internationally. Because most institutions are not equipped or staffed for advanced PE care, patients often require transfer to centers with more comprehensive resources, including PERT expertise. One of the unmet needs in current PE care is an organized approach to the process of interhospital transfer (IHT) of critically ill PE patients. In this review, we discuss medical optimization and support of patients before and during transfer, transfer checklists, defined roles of emergency medical services, and the roles and responsibilities of referring and receiving centers involved in the IHT of acute PE patients.
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- 2021
20. High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States
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Eric A. Secemsky, Kenneth Rosenfield, Kevin F. Kennedy, Michael Jaff, and Robert W. Yeh
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deep vein thrombosis ,pulmonary embolism ,readmission ,venous thromboembolism ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Venous thromboembolism (VTE) is the third leading cause of vascular disease and accounts for $10 billion in annual US healthcare costs. The nationwide burden of 30‐day readmissions after such events has not been comprehensively assessed. Methods and Results We analyzed adults ≥18 years of age with hospitalizations associated with acute VTE between January 1, 2010, and December 31, 2014, in the Nationwide Readmissions Database. International Classification of Disease, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes were used to identify hospitalizations associated with acute pulmonary embolism or deep vein thrombosis. The primary outcome was the rate of unplanned 30‐day readmission. Hierarchical logistic regression was used to calculate hospital‐specific 30‐day risk‐standardized readmission rates, a marker of healthcare quality. Among 1 176 335 hospitalizations with acute VTE, in‐hospital death occurred in 6.2%. VTE was associated with malignancy in 19.7%, recent surgery in 19.3%, recent trauma in 4.6%, hypercoagulability in 3.3%, and pregnancy in 1.0%. Among survivors to discharge, the 30‐day readmission rate was 17.5%, with no significant difference in rates across study years (17.4%–17.7%; P=0.10 for trend). Major predictors of readmission were malignancy (relative risk, 1.49, 95% confidence interval 1.47‐1.50), Medicaid insurance (relative risk, 1.48, 95% confidence interval 1.46‐1.50), and nonelective index admission (relative risk, 1.31, 95% confidence interval 1.29‐1.33). Top causes of readmission included sepsis (9.6%) and procedural complications (8.1%). Median rehospitalization costs were $9781.7 (interquartile range, $5430.7–$18 784.1), and 8.1% died during readmission. The interquartile range in risk‐standardized readmission rates was 16.6% to 18.3%, suggesting modest interhospital heterogeneity in readmission risk. Conclusions Nearly 1 in 5 patients with acute VTE were readmitted within 30 days. Predictors and causes of readmission were primarily related to patient characteristics and complications from comorbid conditions, whereas healthcare quality had a moderate impact on readmission risk.
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- 2018
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21. Relationship between WIfI (wound, ischemia, foot infection) stage and quality of life at revascularization in the BEST-CLI (best endovascular versus best surgical therapy in patients with chronic limb threatening ischemia) trial
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Jeffrey J. Siracuse, Vincent L. Rowe, Matthew T. Menard, Kenneth Rosenfield, Michael S. Conte, Richard Powell, Leonardo C. Clavijo, Kristina A. Giles, Taye H. Hamza, Max Van Over, Mark Cziraky, Christopher J. White, Michael B. Strong, and Alik Farber
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
22. Best Practices in the Technical Performance of Balloon Pulmonary Angioplasty
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Nimai Patel, Jay Giri, Kenneth Rosenfield, and Vikas Aggarwal
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Cardiology and Cardiovascular Medicine - Published
- 2023
23. Severe Tricuspid Valve Endocarditis
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Masaki Funamoto, Patrick Manning, Jerome C. Crowley, Paolo R. Ramirez, Jonah Rubin, Emily K. Zern, Kenneth Rosenfield, Yuval Raz, Kenneth Shelton, and David A. D'Alessandro
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medicine.medical_specialty ,TR, tricuspid regurgitation ,VV, veno-venous ,Case Report ,Internal medicine ,IVC, inferior vena cava ,Tricuspid valve endocarditis ,medicine ,TR - Tricuspid regurgitation ,Endocarditis ,Heart Care Team/Multidisciplinary Team Live ,cardiovascular diseases ,tricuspid regurgitation ,business.industry ,TEE, transesophageal echocardiography ,medicine.disease ,ECMO - Extracorporeal membrane oxygenation ,respiratory tract diseases ,surgical procedures, operative ,Cardiology ,cardiovascular system ,endocarditis ,VAV, veno-arterio-venous ,ECMO ,Cardiology and Cardiovascular Medicine ,business ,ECMO, extracorporeal membrane oxygenation ,VA, veno-arterial ,circulatory and respiratory physiology - Abstract
A 25-year-old woman with severe tricuspid valve endocarditis and septic pulmonary emboli required VA-ECMO for recurrent hypoxemia-induced cardiac arrest. We present the clinical challenges requiring ECMO circuit reconfiguration and a percutaneous approach for vegetation debulking. (Level of Difficulty: Intermediate.), Central Illustration
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- 2021
24. Safety of the transradial approach to carotid stenting
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Young Erben, Donald Heck, Thomas G. Brott, Brajesh K. Lal, George Howard, John D. Sorkin, Kenneth Rosenfield, James F. Meschia, Minerva Mayorga-Carlin, and Fayaz A Shawl
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medicine.medical_specialty ,medicine.medical_treatment ,Carotid endarterectomy ,Revascularization ,Asymptomatic ,Article ,Carotid artery disease ,medicine ,Clinical endpoint ,Humans ,Carotid Stenosis ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Stroke ,Aged ,Endarterectomy, Carotid ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,Female ,Stents ,Carotid stenting ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The multicenter prospective CREST-2 Registry (C2R) provides recent experience in performing carotid artery stenting (CAS) for interventionists to ensure safe performance of CAS. Objective To determine the periprocedural safety of CAS performed using a transradial approach relative to CAS performed using a transfemoral approach. Methods Patients with ≥70% asymptomatic and ≥50% symptomatic carotid stenosis, ≤80 years of age and at standard or high risk for carotid endarterectomy (CEA) are eligible for the C2R. The primary endpoint was a composite of severe access-related complications. Comparisons were made using propensity-score matched logistic regression. Results The mean age of the cohort was 67.6 ± 8.2 years and 1906 (35.1%) were female. Indications for CAS included 4063 (74.9%) for primary atherosclerosis. A total of 2868 (52.8%) cases underwent CAS for asymptomatic disease. Transradial access was used in 213 (3.9%) patients. The transradial cohort had lower use of general anesthesia (1.5% vs. 6.3%, p = 0.007) and higher use of distal embolic protection (96.7% vs. 89.4%, p = 0.0004). There were no significant differences between radial and femoral access groups in terms of a composite of major access-related complications (0% vs. 1.1%) or a composite of periprocedural stroke or death (3.3% vs. 2.4%; OR = 1.4 [confidence intervals 0.6, 3.1]; p = 0.42). Conclusion We found no significant differences in rates of major access-related complications or periprocedural stroke or death with CAS performed using transradial compared to transfemoral access. Our results support incorporation of the transradial approach to clinical trials comparing CAS to other revascularization techniques.
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- 2021
25. Carotid Stenosis and Stroke: Medicines, Stents, Surgery – 'Wait-and-See' or Protect?
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Piotr Musialek, Kenneth Rosenfield, Adnan Siddiqui, and Iris Q Grunwald
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Hematology - Abstract
no abstract
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- 2022
26. Relationship between WIfI Stage and Quality of Life at the time of Revascularization in the BEST-CLI Trial
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Jeffrey J, Siracuse, Vincent L, Rowe, Matthew T, Menard, Kenneth, Rosenfield, Michael, Conte, Richard, Powell, Leonardo C, Clavijo, Kristina A, Giles, Taye H, Hamza, Max, Van Over, Mark, Cziraky, Christopher J, White, Michael B, Strong, and Alik, Farber
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WIfI stage measures the extent of wounds, ischemia, and foot infection in patients with chronic limb threatening ischemia (CLTI) and has been associated with risk of major amputation. Patients with CLTI have impaired health-related quality of life (HRQoL), which may be multifactorial in nature. We hypothesize that severity of limb threat (WIfI) is associated with poor QoL among patients with CLTI presenting for revascularization.The dataset of the Best Endovascular versus Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial, a prospective randomized trial comparing open and endovascular revascularization strategies, was queried for HRQoL assessment at time of patient enrollment. HRQOL assessments included (1) Vascular Quality of Life (VascuQoL), (2) SF-12, containing (a) utility index score (SF-6D-R2) - incorporating physical, emotional, and mental wellbeing, (b) mental (MCS) and (c) physical (PCS) components, and (3) EQ-5D. Multivariable regression analysis was used to identify independent associations with baseline HRQoL assessments.There were 1568 patients with complete WIfI data analyzed, of which 71.5% were male. WIfI distribution was 35.5% stage 4, 29.6% stage 3, 28.6% stage 2, and 6.3% stage 1 patients. Patients presenting with WIfI stage 4, compared to stages 1-3, were more often male (74.9% vs. 69.6%), current smokers (25.4% vs. 17.6%), had end stage renal disease (13.3% vs. 8.5%), diabetes (83.6% vs. 60.2%), were not independently ambulatory (56.8% vs. 38.5%), and had higher median morbidity score (4 vs. 3) (P.05 for all). On multivariable analysis, WIfI stage 4, compared to stages 1-3, was associated with lower SF-12 MCS (-2.43, 95% CI -3.73, -1.13, P.001) and SF6D-R2 Utility index scores (-.02, 95% CI -.03-.001, P=.04). WIfI stage was not independently associated with baseline VascuQoL, SF-12 PCS, or EQ-5D assessment.WIfI stage is independently associated with poorer quality of life due to mental rather than physical health in patients with CLTI. Clinicians should be aware of the burden of mental stress borne by those with greatest limb impairment.
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- 2022
27. Pharmacomechanical Catheter-Directed Thrombolysis With the Bashir Endovascular Catheter for Acute Pulmonary Embolism: The RESCUE Study
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Riyaz, Bashir, Malcolm, Foster, Ayman, Iskander, Amir, Darki, Wissam, Jaber, Parth M, Rali, Vladimir, Lakhter, Ripal, Gandhi, Andrew, Klein, Rohit, Bhatheja, Charles, Ross, Kannan, Natarajan, Aravinda, Nanjundappa, John F, Angle, Kenneth, Ouriel, Nancy E, Amoroso, Brian G, Firth, Anthony J, Comerota, Gregory, Piazza, Kenneth, Rosenfield, and Akhilesh K, Sista
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Treatment Outcome ,Tissue Plasminogen Activator ,Humans ,Hemorrhage ,Pulmonary Embolism - Abstract
Catheter-directed thrombolysis (CDT) has been associated with rapid recovery of right ventricular (RV) function. The Bashir catheter was developed for enhanced thrombolysis in large vessels such as the pulmonary arteries (PAs) with lower doses of tissue plasminogen activator (tPA).The aim of this study was to evaluate the efficacy and safety of tPA infused using a pharmacomechanical (PM) CDT device called the Bashir endovascular catheter in patients with intermediate-risk acute pulmonary embolism (PE).Patients with symptoms of acute PE with computed tomographic evidence of RV dilatation were enrolled. The Bashir catheter was used to deliver 7 mg tPA into each PA over 5 hours. The primary efficacy endpoint was the core laboratory-assessed change in computed tomographic angiography-derived RV/left ventricular (LV) diameter ratio at 48 hours, and the primary safety endpoint was serious adverse events (SAEs) including major bleeding at 72 hours.At 18 U.S. sites, 109 patients were enrolled. The median device placement time was 15 minutes. At 48 hours after PM-CDT, the RV/LV diameter ratio decreased by 0.56 (33.3%; P 0.0001). PA obstruction as measured by the refined modified Miller index was reduced by 35.9% (P 0.0001). One patient (0.92%) had 2 SAEs: a retroperitoneal bleed (procedure related) and iliac vein thrombosis (device related). Two other procedure-related SAEs were epistaxis and non-access site hematoma with anemia.PM-CDT with the Bashir endovascular catheter is associated with a significant reduction in RV/LV diameter ratio and a very low rate of adverse events or major bleeding in patients with intermediate-risk acute PE. The notable finding was a significant reduction in PA obstruction with low-dose tPA. (Recombinant tPA by Endovascular Administration for the Treatment of Submassive PE Using CDT for the Reduction of Thrombus Burden [RESCUE]; NCT04248868).
- Published
- 2022
28. Practice Patterns in the Management of Chronic Limb Threatening Ischemia by BEST-CLI Investigators
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Alik Farber, Jeffrey J. Siracuse, Kenneth Rosenfield, Richard J. Powell, Michael S. Conte, Igor Laskowski, Christopher J. White, Kristina A. Giles, Douglas W. Jones, Michael B. Strong, Gheorghe Doros, and Matthew T. Menard
- Subjects
Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
29. Three-dimensional reconstruction of conventional catheter angiography-identified coronary artery aneurysms and ectasias
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Klaudia Proniewska, Kacper Miłosz Książek, Piotr Musialek, Krzysztof Piotr Malinowski, Grażyna Wnuk, Jagoda Dradrach, Kenneth Rosenfield, Łukasz Partyka, and Jakub Chmiel
- Subjects
medicine.medical_specialty ,Catheters ,business.industry ,Angiography ,Coronary Aneurysm ,General Medicine ,medicine.disease ,Coronary Vessels ,Interventional Cardiology ,Imaging, Three-Dimensional ,Aneurysm ,medicine.anatomical_structure ,Catheter angiography ,Ectasia ,Internal medicine ,medicine ,Cardiology ,Humans ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Dilatation, Pathologic ,Artery - Published
- 2021
30. Clinical trials in chronic limb-threatening ischaemia
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Alik Farber, Kenneth Rosenfield, and Matthew T Menard
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Surgery - Published
- 2023
31. Intravascular ultrasound in peripheral venous and arterial interventions: A contemporary systematic review and grading of the quality of evidence
- Author
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Sahana Natesan, Ramya C Mosarla, Sahil A Parikh, Kenneth Rosenfield, Joanna Suomi, David Chalyan, Michael Jaff, and Eric A Secemsky
- Subjects
Treatment Outcome ,Angiography ,Humans ,Reproducibility of Results ,Arteries ,Cardiology and Cardiovascular Medicine ,Ultrasonography, Interventional - Abstract
Although angiography has been the primary imaging modality used in peripheral vascular intervention, this technique has major limitations due to the evaluation of three-dimensional vessels in two dimensions. Intravascular ultrasound (IVUS) is an important adjunctive tool that can address some of these limitations. This systematic review assesses the appropriateness of IVUS as an imaging modality for guiding peripheral intervention through evidence collection and clinical appraisal of studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a cohort of 48 studies (29 arterial; 19 venous) detailing IVUS use in peripheral vascular intervention were extracted. Qualitative assessment of the studies evaluated pre- and postprocedure efficacy of IVUS and revealed that IVUS-guided peripheral intervention in arterial and venous diagnosis and treatment was superior to other imaging techniques alone. Each study in the cohort was further assessed for reliability and validity using the Oxford Centre for Evidence Based Medicine (CEBM) level of evidence scale. The majority of both arterial (79.3%) and venous (73.7%) studies received a 2b rating, the second highest level of evidence rating. The evidence to date indicates that IVUS results in better clinical outcomes overall and should be more widely adopted as an adjunctive imaging modality during peripheral intervention. (PROSPERO Registration No.: CRD42021232353)
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- 2022
32. A Randomized Controlled Trial of Mobile Health Intervention in Patients With Heart Failure and Diabetes
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G. MICHAEL FELKER, ABHINAV SHARMA, ROBERT J. MENTZ, LILIN SHE, CYNTHIA L. GREEN, BRADI B. GRANGER, JOHN F. HEITNER, LAUREN COOPER, JEFF TEUTEBERG, JUSTIN L. GRODIN, KENNETH ROSENFIELD, LORI HUDSON, LYDIA COULTER KWEE, OLGA ILKAYEVA, and SVATI H. SHAH
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Heart Failure ,Quality of Life ,Diabetes Mellitus ,Humans ,Cardiology and Cardiovascular Medicine ,Telemedicine ,Medication Adherence - Abstract
Mobile health (mHealth) platforms can affect health behaviors but have not been rigorously tested in randomized trials.We sought to evaluate the effectiveness of a pragmatic mHealth intervention in patients with heart failure (HF) and diabetes (DM).We conducted a multicenter randomized trial in 187 patients with both HF and DM to assess an mHealth intervention to improve physical activity and medication adherence compared to usual care. The primary endpoint was change in mean daily step count from baseline through 3 months. Other outcomes included medication adherence, health-related quality of life and metabolomic profiling.The mHealth group had an increase in daily step count of 151 steps/day at 3 months, whereas the usual-care group had a decline of 162 steps/day (least squares mean between-group difference = 313 steps/day; 95% CI: 8 619; P = 0.044). Medication adherence, measured using the Voils Adherence Questionnaire, did not change from baseline to 3 months (LS-mean change -0.08 in mHealth vs -0.15 in usual care; P = 0.47). The mHealth group had an improvement in Kansas City Cardiomyopathy Questionnaire Overall Summary Score compared to the usual-care group (LS-mean difference = 5.5 points, 95% CI: 1.4, 9.6; P = 0.009). Thirteen metabolites, primarily medium- and long-chain acylcarnitines, changed differently between treatment groups from baseline to 3 months (P0.05).In patients with HF and DM, a 3-month mHealth intervention significantly improved daily physical activity, health-related quality of life and metabolomic markers of cardiovascular health but not medication adherence.Heart failure (HF) and diabetes (DM) have overlapping biological and behavioral risk factors. We conducted a multicenter randomized, clinical trial in 187 patients with both HF (regardless of ejection fraction) and DM to assess whether an mHealth intervention could improve physical activity and medication adherence. The mHealth group had an increase in mean daily step count and quality of life but not in medication adherence. Medium- and long-chain acylcarnitines changed differently in treatment groups from baseline to 3 months (P0.05). These data have important implications for designing effective lifestyle interventions in HF and DM.
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- 2022
33. Clinical practice patterns and ascertainment bias for cardiovascular events in a randomized trial: A survey of investigators in the BEST-CLI trial
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Kenneth Rosenfield, Maria F. Villarreal, Matthew T. Menard, Mazen Albaghdadi, Sandra Siami, Michael Strong, Mohammed M. Chowdhury, Susan F. Assmann, Taye H. Hamza, Alik Farber, and Michael N. Young
- Subjects
Chronic Limb-Threatening Ischemia ,medicine.medical_specialty ,Time Factors ,Blinding ,Critical Illness ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Revascularization ,Amputation, Surgical ,law.invention ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Risk Factors ,law ,medicine ,Humans ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Cardiac risk ,Sampling bias ,business.industry ,Incidence (epidemiology) ,Endovascular Procedures ,Critical limb ischemia ,Limb Salvage ,Clinical Practice ,Cross-Sectional Studies ,Treatment Outcome ,Emergency medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Ascertainment bias is a well-recognized source of bias in research, but few studies have systematically analyzed sources of ascertainment bias in randomized trials in which blinding is not possible and endpoint assessment is not protocolized. In the current study, we sought to evaluate differences in the clinical practice patterns of trial investigators with respect to bias in the ascertainment of pre-revascularization patient risk and the incidence of secondary endpoints post-revascularization. We conducted a cross-sectional survey of active investigators ( n = 936) from the Best Endovascular Versus Best Surgical Therapy for Patients with Critical Limb Ischemia (BEST-CLI) trial. The total survey response rate was 19.6% (183/936). Vascular surgeons were more likely than nonsurgical interventionalists to order tests for cardiac complications after both surgical bypass ( p < 0.001) and endovascular revascularization ( p = 0.038). Post-procedure, investigators were more likely to order additional testing for cardiac complications in open surgery versus endovascular cases (7% vs 16% never, 41% vs 65% rarely, 43% vs 17% sometimes, 9% vs 2% always, respectively; p < 0.0001). Significant variation in practice patterns exist in the pre- and post-procedure assessment of cardiac risk and events for patients with CLI undergoing revascularization. Variation in the ascertainment of risk and outcomes according to the type of revascularization procedure and physician specialty should be considered when interpreting the results of clinical studies, such as the BEST-CLI trial. ClinicalTrials.gov Identifier: NCT02060630
- Published
- 2021
34. Important considerations for trials for peripheral arterial disease: Lessons learned from the paclitaxel mortality signal: A report on behalf of the registry assessment for peripheral interventional Devices (RAPID) Paclitaxel Pathways Program
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Daniel J. Bertges, Carla A. Erickson, Misti L. Malone, Rebecca W. Wilgus, George Papandreou, Kenneth Rosenfield, Megan L. Fox, Eleni M. Whatley, Li Wang, Mitchell W. Krucoff, Sara M. Royce, Andrew Farb, Aaron E. Lottes, Asiyah Y. Lin, and Jenny H. Jiang
- Subjects
medicine.medical_specialty ,Atherectomy ,Paclitaxel ,Accrual ,Advisory Committees ,MEDLINE ,030204 cardiovascular system & hematology ,Risk Assessment ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Meta-Analysis as Topic ,Humans ,Medicine ,Popliteal Artery ,Medical physics ,030212 general & internal medicine ,Mortality ,Case report form ,Randomized Controlled Trials as Topic ,Common Data Elements ,Data collection ,business.industry ,Data Collection ,Angioplasty ,Reproducibility of Results ,Drug-Eluting Stents ,Missing data ,Tubulin Modulators ,Data Accuracy ,Femoral Artery ,Data quality ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Angioplasty, Balloon - Abstract
The Registry Assessment of Peripheral Devices (RAPID) convened a multidisciplinary group of stakeholders including clinicians, academicians, regulators and industry representatives to conduct an in-depth review of limitations associated with the data available to assess the paclitaxel mortality signal. Available studies were evaluated to identify strengths and limitations in the study design and data quality, which were translated to lessons learned to help guide the design, execution, and analyses of future studies. We suggest numerous actionable responses, such as the development and use of harmonized data points and outcomes in a consensus lean case report form. We advocate for reduction in missing data and efficient means for accrual of larger sample sizes in Peripheral arterial disease studies or use of supplemental datasets. Efforts to share lessons learned and working collaboratively to address such issues may improve future data in this device area and ultimately benefit patients. Condensed Abstract: Data sources evaluating paclitaxel-coated devices were evaluated to identify strengths and limitations in the study design and data quality, which were translated to lessons learned to help guide the design, execution, and analyses of future studies. We suggest numerous actionable responses, which we believe may improve future data in this device area and ultimately benefit patients.
- Published
- 2021
35. Acute Kidney Injury Following In-Patient Lower Extremity Vascular Intervention
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Kevin F. Kennedy, David M. Safley, Adam C. Salisbury, Thomas T. Tsai, John A. Spertus, Lawrence A. Garcia, R. Kevin Rogers, Anand Prasad, Kenneth Rosenfield, Nicolas W. Shammas, Matthew A. Cavender, Eric A. Secemsky, and Faisal Latif
- Subjects
medicine.medical_specialty ,urogenital system ,business.industry ,Incidence (epidemiology) ,medicine.medical_treatment ,Acute kidney injury ,Renal function ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,medicine.disease ,Logistic regression ,female genital diseases and pregnancy complications ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Heart failure ,Diabetes mellitus ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Dialysis - Abstract
Objectives The authors analyzed data from the NCDR (National Cardiovascular Data Registry) PVI Registry and defined acute kidney injury (AKI) as increased creatinine of ≥0.3 mg/dl or 50%, or a new requirement for dialysis after PVI. Background AKI is an important and potentially modifiable complication of peripheral vascular intervention (PVI). The incidence, predictors, and outcomes of AKI after PVI are incompletely characterized. Methods A hierarchical logistic regression risk model using pre-procedural characteristics associated with AKI was developed, followed by bootstrap validation. The model was validated with data submitted after model creation. An integer scoring system was developed to predict AKI after PVI. Results Among 10,006 procedures, the average age of patients was 69 years, 58% were male, and 52% had diabetes. AKI occurred in 737 (7.4%) and was associated with increased in-hospital mortality (7.1% vs. 0.7%). Reduced glomerular filtration rate, hypertension, diabetes, prior heart failure, critical or acute limb ischemia, and pre-procedural hemoglobin were independently associated with AKI. The model to predict AKI showed good discrimination (optimism corrected c-statistic = 0.68) and calibration (corrected slope = 0.97, intercept of −0.07). The integer point system could be incorporated into a useful clinical tool because it discriminates risk for AKI with scores ≤4 and ≥12 corresponding to the lower and upper 20% of risk, respectively. Conclusions AKI is not rare after PVI and is associated with in-hospital mortality. The NCDR PVI AKI risk model, including the integer scoring system, may prospectively estimate AKI risk and aid in deployment of strategies designed to reduce risk of AKI after PVI.
- Published
- 2021
36. 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease
- Author
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Tyler J Gluckman, Dharam J. Kumbhani, Adam Cuker, Christopher P. Cannon, Craig J. Beavers, Vinod H. Thourani, Sarah A. Spinler, Benjamin E Peterson, Steven R. Messé, Kenneth Rosenfield, Nimesh Patel, Roxana Mehran, Deepak L. Bhatt, and Joseph E. Marine
- Subjects
medicine.medical_specialty ,Consensus ,medicine.drug_class ,medicine.medical_treatment ,Cardiology ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Oversight Committee ,Intensive care medicine ,Societies, Medical ,Atherosclerotic cardiovascular disease ,business.industry ,Anticoagulant ,Expert consensus ,Percutaneous coronary intervention ,Atrial fibrillation ,Venous Thromboembolism ,medicine.disease ,United States ,Cardiovascular Diseases ,Cardiology and Cardiovascular Medicine ,business ,Venous thromboembolism ,Platelet Aggregation Inhibitors - Abstract
This article has been temporarily removed as it was inadvertently posted ahead of an agreed-upon embargo. The article will be reinstated upon embargo expiry. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal .
- Published
- 2021
37. Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic
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Thomas M. Todoran, Jay Giri, Belinda Rivera-Lebron, James M. Horowitz, Aaron S. Weinberg, Victor F. Tapson, Rachel P. Rosovsky, Charles Grodzin, Timothy A. Morris, Christopher Kabrhel, Geno J. Merli, George A. Davis, Kenneth Rosenfield, Richard N. Channick, and Robert A. Lookstein
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,medicine.disease ,Diagnostic modalities ,Pulmonary embolism ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Ambulatory care ,Pandemic ,medicine ,Extracorporeal membrane oxygenation ,Position paper ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,Risk assessment ,business - Abstract
The coexistence of coronavirus disease 2019 (COVID-19) and pulmonary embolism (PE), two life-threatening illnesses, in the same patient presents a unique challenge. Guidelines have delineated how best to diagnose and manage patients with PE. However, the unique aspects of COVID-19 confound both the diagnosis and treatment of PE, and therefore require modification of established algorithms. Important considerations include adjustment of diagnostic modalities, incorporation of the prothrombotic contribution of COVID-19, management of two critical cardiorespiratory illnesses in the same patient, and protecting patients and health-care workers while providing optimal care. The benefits of a team-based approach for decision-making and coordination of care, such as that offered by pulmonary embolism response teams (PERTs), have become more evident in this crisis. The importance of careful follow-up care also is underscored for patients with these two diseases with long-term effects. This position paper from the PERT Consortium specifically addresses issues related to the diagnosis and management of PE in patients with COVID-19.
- Published
- 2020
38. Superior Vena Cava Syndrome
- Author
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Akhilesh K. Sista, Riyaz Bashir, Neal B. Shah, Kenneth Rosenfield, Abdul Hussain Azizi, DO Robert Schainfeld, and Irfan Shafi
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Superior Vena Cava Syndrome ,medicine.medical_specialty ,Vena Cava, Superior ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Endovascular therapy ,03 medical and health sciences ,Therapeutic approach ,0302 clinical medicine ,Superior vena cava ,Angioplasty ,Humans ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Superior vena cava syndrome ,business.industry ,Endovascular Procedures ,SVC SYNDROME ,Thrombolysis ,Radiation therapy ,Treatment Outcome ,Stents ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Superior vena cava (SVC) syndrome comprises a constellation of clinical signs and symptoms caused by obstruction of blood flow through the SVC. The management of patients with life-threatening SVC syndrome is evolving from radiation therapy to endovascular therapy as the first-line treatment. There is a paucity of data and societal guidelines with regard to the management of SVC syndrome. This paper aims to update the practicing interventionalists with the contemporary and the evolving therapeutic approach to SVC syndrome. In addition, the review will focus on endovascular techniques, including catheter-directed thrombolysis, angioplasty, and stenting, and their associated complications.
- Published
- 2020
39. Determinants of Optimal Medical Therapy in Patients with Chronic Limb-threatening Ischemia
- Author
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Matthew Menard, Michael Jaff, Ido Weinberg, Kenneth Rosenfield, Michael Conte, Christopher White, Thomas Huber, Taye Hamza, Andres Schanzer, Igor Laskowski, and Alik Farber
- Subjects
Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
40. Carotid Artery Stenting: JACC State-of-the-Art Review
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Christopher J, White, Thomas G, Brott, William A, Gray, Donald, Heck, Tudor, Jovin, Sean P, Lyden, David Christopher, Metzger, Kenneth, Rosenfield, Gary, Roubin, Ravish, Sachar, and Adnan, Siddiqui
- Subjects
Carotid Arteries ,Treatment Outcome ,Humans ,Carotid Stenosis ,Stents ,Medicare ,United States ,Aged ,Randomized Controlled Trials as Topic - Abstract
Significant advances in the field of carotid artery stenting (CAS) have occurred, including new randomized trial data, recent professional societal statements for competency, new techniques and new devices that have been developed, and perhaps most importantly, our understanding of how to better select candidates for CAS to avoid periprocedural complications. The current Centers for Medicare and Medicaid Services coverage decision regarding CAS is outdated, and our review supports our recommendation to approve CAS in selected candidates who are symptomatic with a carotid stenosis ≥50% and ≤99% and for asymptomatic patients with carotid stenosis ≥70% and ≤99% for stroke prevention. Optimized CAS strategies have allowed experienced operators to better assess procedure risk before CAS and have led to continued improvement in CAS outcomes. New technologies including enhanced embolic protection devices and dual-layered stents should result in further improvement.
- Published
- 2022
41. Design and Rationale of the Best Endovascular Versus Best Surgical Therapy for Patients With Critical Limb Ischemia (BEST‐CLI) Trial
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Matthew T. Menard, Alik Farber, Susan F. Assmann, Niteesh K. Choudhry, Michael S. Conte, Mark A. Creager, Michael D. Dake, Michael R. Jaff, John A. Kaufman, Richard J. Powell, Diane M. Reid, Flora Sandra Siami, George Sopko, Christopher J. White, and Kenneth Rosenfield
- Subjects
atherosclerosis ,cost‐effectiveness ,critical limb ischemia ,endovascular ,outcome ,quality ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundCritical limb ischemia (CLI) is increasing in prevalence, and remains a significant source of mortality and limb loss. The decision to recommend surgical or endovascular revascularization for patients who are candidates for both varies significantly among providers and is driven more by individual preference than scientific evidence. Methods and ResultsThe Best Endovascular Versus Best Surgical Therapy for Patients With Critical Limb Ischemia (BEST‐CLI) Trial is a prospective, randomized, multidisciplinary, controlled, superiority trial designed to compare treatment efficacy, functional outcomes, quality of life, and cost in patients undergoing best endovascular or best open surgical revascularization. Approximately 140 clinical sites in the United States and Canada will enroll 2100 patients with CLI who are candidates for both treatment options. A pragmatic trial design requires consensus on patient eligibility by at least 2 investigators, but leaves the choice of specific procedural strategy within the assigned revascularization approach to the individual treating investigator. Patients with suitable single‐segment of saphenous vein available for potential bypass will be randomized within Cohort 1 (n=1620), while patients without will be randomized within Cohort 2 (n=480). The primary efficacy end point of the trial is Major Adverse Limb Event–Free Survival. Key secondary end points include Re‐intervention and Amputation‐Free‐Survival and Amputation Free‐Survival. ConclusionsThe BEST‐CLI trial is the first randomized controlled trial comparing endovascular therapy to open surgical bypass in patients with CLI to be carried out in North America. This landmark comparative effectiveness trial aims to provide Level I data to clarify the appropriate role for both treatment strategies and help define an evidence‐based standard of care for this challenging patient population. Clinical Trial RegistrationURL: https://www.clinicaltrials.gov/. Unique identifier: NCT02060630.
- Published
- 2016
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42. Paclitaxel Drug-Coated Balloon Angioplasty Suppresses Progression and Inflammation of Experimental Atherosclerosis in Rabbits
- Author
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Farouc A. Jaffer, Haitham Khraishah, Christian L. Lino Cardenas, Chase W. Kessinger, Adam Mauskapf, Kenneth Rosenfield, Michael R. Jaff, Mark E. Lindsay, Madeleine S. Grau, Mazen Albaghdadi, Guillermo J. Tearney, Peter Libby, Zhonglie Piao, Mohammed M. Chowdhury, Eric A. Osborn, Kanwarpal Singh, Stephan Kellnberger, and Elazer R. Edelman
- Subjects
IVUS, intravascular ultrasound ,0301 basic medicine ,Experimental atherosclerosis ,endocrine system ,medicine.medical_specialty ,CSA, cross-sectional area ,Drug coated balloon ,medicine.medical_treatment ,drug-coated balloon ,Urology ,PAV, percent atheroma volume ,Inflammation ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Balloon ,PRECLINICAL RESEARCH ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,DCB, drug-coated balloon ,Restenosis ,peripheral arterial disease ,PAD, peripheral arterial disease ,Angioplasty ,TAV, total atheroma volume ,Intravascular ultrasound ,otorhinolaryngologic diseases ,medicine ,NIRF, near-infrared fluorescence ,OCT, optical coherence tomography ,medicine.diagnostic_test ,business.industry ,imaging ,medicine.disease ,female genital diseases and pregnancy complications ,PB, plaque burden ,PTX, paclitaxel ,PTA, percutaneous transluminal angioplasty ,surgical procedures, operative ,030104 developmental biology ,Paclitaxel ,chemistry ,inflammation ,2D, 2-dimensional ,atherosclerosis ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,EEM, external elastic membrane - Abstract
Visual Abstract, Highlights • Restenosis limits the efficacy of PTA or stent treatment of atherosclerosis in peripheral and coronary artery disease. • Paclitaxel DCBs effectively reduce restenosis; however, recently, their overall safety profile has been called into question. • In an in vivo molecular-structural imaging study of 25 rabbits with experimental atherosclerosis, DCB-PTA, plain PTA, or sham-PTA was investigated using serial intravascular NIRF-OCT and IVUS. • DCB-PTA reduced lesion inflammation on NIRF-OCT and halted lesion progression on IVUS, compared with PTA or sham-PTA. • These findings indicated the potential for DCBs to serve effectively and safely as a regional anti-atherosclerosis therapy., Summary Paclitaxel drug-coated balloons (DCBs) reduce restenosis, but their overall safety has recently raised concerns. This study hypothesized that DCBs could lessen inflammation and reduce plaque progression. Using 25 rabbits with cholesterol feeding- and balloon injury-induced lesions, DCB-percutaneous transluminal angioplasty (PTA), plain PTA, or sham-PTA (balloon insertion without inflation) was investigated using serial intravascular near-infrared fluorescence−optical coherence tomography and serial intravascular ultrasound. In these experiments, DCB-PTA reduced inflammation and plaque burden in nonobstructive lesions compared with PTA or sham-PTA. These findings indicated the potential for DCBs to serve safely as regional anti-atherosclerosis therapy.
- Published
- 2020
43. Enrollment Obstacles in a Randomized Controlled Trial: A Performance Survey of Enrollment in BEST-CLI Sites
- Author
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Alik Farber, Michael Strong, Susan F. Assmann, Kenneth Rosenfield, Jeffrey J. Siracuse, Flora S. Siami, Matthew T. Menard, and Maria F. Villarreal
- Subjects
Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Time Factors ,Randomization ,Attitude of Health Personnel ,Research Subjects ,Critical Illness ,medicine.medical_treatment ,MEDLINE ,030204 cardiovascular system & hematology ,Revascularization ,030218 nuclear medicine & medical imaging ,law.invention ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Quality of life ,Ischemia ,law ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Motivation ,Performance status ,business.industry ,Patient Selection ,Endovascular Procedures ,General Medicine ,Critical limb ischemia ,Patient Acceptance of Health Care ,Research Personnel ,Europe ,Treatment Outcome ,Sample Size ,North America ,Vascular Grafting ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,New Zealand - Abstract
Background Although randomized controlled trials (RCTs) provide the most reliable form of scientific evidence, they are challenging to complete because of a variety of enrollment obstacles. We evaluated obstacles in a large RCT by comparing survey results at high-performing sites (HPS) and low-performing sites (LPS). Methods The Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial is a prospective, pragmatic, multicenter, and multispecialty RCT that will compare clinical outcomes, quality of life, and cost in patients with CLI randomized to surgical bypass or endovascular therapy. BEST-CLI aims to enroll 2100 patients at 160 sites in North America, Europe, and New Zealand. We surveyed the 30 HPS and 30 LPS to assess perceptions of enrollment obstacles. HPS were defined by enrollment of 0.5 subjects or more per month or more than 8 total subjects enrolled. LPS were defined by enrollment of 0.1 subjects per month or only 1 subject total. Responses were compared by site performance status. Results There were 22 of 30 (73%) HPS and 14 of 30 (47%) LPS that answered the survey (P = 0.06), including 17 investigators and 31 coordinators. The mean total enrollment and rate of enrollment at HPS and LPS were 12.5 subjects at 1.5 subjects/month and 1.0 subject at 0.1 subjects/month, respectively. The most common barrier to enrollment at HPS was difficulty convincing patients and their families to participate (36%), whereas at LPS both difficulty convincing patients and difficulty motivating investigators to enroll (29% each) were most frequently cited. At HPS, the most common obstacle to consenting patients for the trial was patient/family having strong preference toward revascularization strategy (32%) and at LPS it was patient/family not wanting to have treatment chosen at random (36%). At 55% of HPS and 43% of LPS, the trial team was reported as extremely collaborative (P = 0.73), whereas 68% of HPS and 64% of LPS reported having identified a trial champion on their team (P = 1). The most restrictive perceived enrollment criterion at HPS was prior index limb stenting with significant restenosis (32%), whereas at LPS it was excessive risk for surgical bypass (43%). Materials to aid enrollment were used equally at HPS and LPS: patient brochures at 59% HPS and 64% LPS (P = 1); investigator talking points at 45% of HPS and 36% of LPS (P = 0.73). Conclusions Patient perceptions and investigator biases are significant challenges to enrollment in large RCTs. In the BEST-CLI trial, difficulty convincing patients and families to allow treatment randomization and difficulty in motivating investigators were major enrollment obstacles.
- Published
- 2020
44. Clinical outcomes of second- versus first-generation carotid stents : a systematic review and meta-analysis
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Adam Mazurek, Krzysztof Malinowski, Kenneth Rosenfield, Laura Capoccia, Francesco Speziale, Gianmarco de Donato, Carlo Setacci, Christian Wissgott, Pasqualino Sirignano, Lukasz Tekieli, Andrey Karpenko, Waclaw Kuczmik, Eugenio Stabile, David Christopher Metzger, Max Amor, Adnan H. Siddiqui, Antonio Micari, Piotr Pieniążek, Alberto Cremonesi, Joachim Schofer, Andrej Schmidt, and Piotr Musialek
- Subjects
“mesh-covered” dual-layer stents ,carotid artery stenting ,stent design ,stroke prevention ,General Medicine ,systematic review and meta-analysis - Abstract
Background: Single-cohort studies suggest that second-generation stents (SGS; “mesh stents”) may improve carotid artery stenting (CAS) outcomes by limiting peri- and postprocedural cerebral embolism. SGS differ in the stent frame construction, mesh material, and design, as well as in mesh-to-frame position (inside/outside). Objectives: To compare clinical outcomes of SGS in relation to first-generation stents (FGSs; single-layer) in CAS. Methods: We performed a systematic review and meta-analysis of clinical studies with FGSs and SGS (PRISMA methodology, 3302 records). Endpoints were 30-day death, stroke, myocardial infarction (DSM), and 12-month ipsilateral stroke (IS) and restenosis (ISR). A random-effect model was applied. Results: Data of 68,422 patients from 112 eligible studies (68.2% men, 44.9% symptomatic) were meta-analyzed. Thirty-day DSM was 1.30% vs. 4.11% (p < 0.01, data for SGS vs. FGS). Among SGS, both Casper/Roadsaver and CGuard reduced 30-day DSM (by 2.78 and 3.03 absolute percent, p = 0.02 and p < 0.001), whereas the Gore stent was neutral. SGSs significantly improved outcomes compared with closed-cell FGS (30-day stroke 0.6% vs. 2.32%, p = 0.014; DSM 1.3% vs. 3.15%, p < 0.01). At 12 months, in relation to FGS, Casper/Roadsaver reduced IS (−3.25%, p < 0.05) but increased ISR (+3.19%, p = 0.04), CGuard showed a reduction in both IS and ISR (−3.13%, −3.63%; p = 0.01, p < 0.01), whereas the Gore stent was neutral. Conclusions: Pooled SGS use was associated with improved short- and long-term clinical results of CAS. Individual SGS types, however, differed significantly in their outcomes, indicating a lack of a “mesh stent” class effect. Findings from this meta-analysis may provide clinically relevant information in anticipation of large-scale randomized trials.
- Published
- 2022
45. Outcomes Associated With Peripheral Artery Disease in Myocardial Infarction With Cardiogenic Shock
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Nino Mihatov, Ramya C. Mosarla, Ajay J. Kirtane, Sahil A. Parikh, Kenneth Rosenfield, Siyan Chen, Yang Song, Robert W. Yeh, and Eric A. Secemsky
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Aged, 80 and over ,Male ,Peripheral Arterial Disease ,Myocardial Infarction ,Shock, Cardiogenic ,Humans ,Hospital Mortality ,Cardiology and Cardiovascular Medicine ,Medicare ,United States ,Aged - Abstract
Mortality rates for patients presenting with acute myocardial infarction (AMI) and cardiogenic shock (CS) remain high despite advances in revascularization strategies and mechanical circulatory support (MCS) devices.This study sought to elucidate the association between comorbid lower extremity peripheral artery disease (PAD) and outcomes in CS and AMI.PAD status was defined in Medicare beneficiaries hospitalized with CS and AMI from October 1, 2015 to June 30, 2018. Primary outcomes ascertained through December 31, 2018 included in- and out-of-hospital mortality. Secondary outcomes included bleeding, amputation, stroke, and lower extremity revascularization. Multivariable regression models with adjustment for confounders were used to estimate risk. Subgroup analyses included patients treated with MCS and those who underwent coronary revascularization.Among 71,690 patients, 5.9% (N = 4,259) had PAD. Mean age was 77.8 ± 7.9 years, 58.7% were male, and 84.3% were White. Cumulative in-hospital mortality was 47.2%, with greater risk among those with PAD (56.3% vs 46.6% without PAD; adjusted OR: 1.50; 95% CI: 1.40-1.59). PAD patients also had greater risk of in-hospital amputation (1.6% vs 0.2%; adjusted OR: 7.0; 95% CI: 5.26-9.37) and out-of-hospital mortality (67.9% vs 40.7%; adjusted HR: 1.78; 95% CI: 1.67-1.90). MCS was less frequently utilized in PAD patients (21.5% vs 38.6% without PAD; P 0.001) and was associated with higher mortality, need for lower extremity revascularization, and amputation risk. Findings were consistent in patients who underwent coronary revascularization.Among patients presenting with AMI and CS, PAD was associated with worse limb outcomes and survival. In addition to lower MCS utilization rates, those with PAD who received MCS had increased mortality, lower extremity revascularization, and amputation rates.
- Published
- 2021
46. Closing the Gaps in Racial Disparities in Critical Limb Ischemia Outcome and Amputation Rates: Proceedings from a Society of Interventional Radiology Foundation Research Consensus Panel
- Author
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Yolanda Bryce, Barry Katzen, Parag Patel, Carla C. Moreira, Foluso A. Fakorede, Shipra Arya, Melissa D’Andrea, Jihad Mustapha, Vincent Rowe, Kenneth Rosenfield, Suresh Vedantham, Nadine Abi-Jaoudeh, and Paul J. Rochon
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Chronic Limb-Threatening Ischemia ,Peripheral Arterial Disease ,Consensus ,Research ,Racial Groups ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Radiology, Interventional ,Cardiology and Cardiovascular Medicine ,Amputation, Surgical - Abstract
Minority patients such as Blacks, Hispanics, and Native Americans are disproportionately impacted by critical limb ischemia and amputation due to multiple factors such as socioeconomic status, type or lack of insurance, lack of access to health care, capacity and expertise of local hospitals, prevalence of diabetes, and unconscious bias. The Society of Interventional Radiology Foundation recognizes that it is imperative to close the disparity gaps and funded a Research Consensus Panel to prioritize a research agenda. The following research priorities were ultimately prioritized: (a) randomized controlled trial with peripheral arterial disease screening of at-risk patients with oversampling of high-risk racial groups, (b) prospective trial with the introduction of an intervention to alter a social determinant of health, and (c) a prospective trial with the implementation of an algorithm that requires criteria be met prior to an amputation. This article presents the proceedings and recommendations from the panel.
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- 2021
47. Utilization of and Outcomes Associated with Intravascular Ultrasound during Deep Venous Stent Placement among Medicare Beneficiaries
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Sanjay Divakaran, Mark H. Meissner, Maureen P. Kohi, Siyan Chen, Yang Song, Beau M. Hawkins, Kenneth Rosenfield, Sahil A. Parikh, and Eric A. Secemsky
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Treatment Outcome ,Humans ,Stents ,Thrombosis ,Radiology, Nuclear Medicine and imaging ,Medicare ,Coronary Angiography ,Cardiology and Cardiovascular Medicine ,United States ,Ultrasonography, Interventional ,Aged - Abstract
To evaluate temporal trends, practice variation, and associated outcomes with the use of intravascular ultrasound (US) during deep venous stent placement among Medicare beneficiaries.All lower extremity deep venous stent placement procedures performed between January 1, 2017, and December 31, 2019 among Medicare beneficiaries were included. Temporal trends in intravascular US use were stratified by procedural setting and physician specialty. The primary outcome was a composite of 12-month all-cause mortality, all-cause hospitalization, or repeat target vessel intervention. The secondary outcome was a composite of 12-month stent thrombosis, embolization, or restenosis.Among the 20,984 deep venous interventions performed during the study period, 15,184 (72.4%) utilized intravascular US. Moderate growth in intravascular US use was observed during the study period in all clinical settings. There was a variation in the use of intravascular US among all operators (median, 77.3% of cases; interquartile range, 20.0%-99.2%). In weighted analyses, intravascular US use during deep venous stent placement was associated with a lower risk of both the primary (adjusted hazard ratio, 0.72; 95% confidence interval [CI], 0.69-0.76; P.001) and secondary (adjusted hazard ratio, 0.32; 95% CI, 0.27-0.39; P.001) composite end points.Intravascular US is frequently used during deep venous stent placement among Medicare beneficiaries, with further increase in use from 2017 to 2019. The utilization of intravascular US as part of a procedural strategy was associated with a lower cumulative incidence of adverse outcomes after the procedure, including venous stent thrombosis and embolization.
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- 2022
48. Interventional Imaging Roadmap to Successful Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension
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Nimai Patel, Syed N. Hyder, Erinleigh Michaud, Victor Moles, Prachi P. Agarwal, Kenneth Rosenfield, Kohtaro Abe, Jonathan Haft, Scott H. Visovatti, Thomas M. Cascino, William R. Auger, Vallerie V. Mclaughlin, and Vikas Aggarwal
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- 2022
49. Participation in a Chronic Limb Threatening Ischemia Randomized Trial Is Inversely Correlated With Regional Amputation Rate in Limb Threatening Ischemia Patients
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Jeffrey J, Siracuse, Philip P, Goodney, Matthew T, Menard, Kenneth, Rosenfield, Maxwell, Van Over, Taye H, Hamza, Mark, Eid, Maria F, Villarreal, Michael B, Strong, and Alik, Farber
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Male ,Research Subjects ,Endovascular Procedures ,Limb Salvage ,Amputation, Surgical ,United States ,Peripheral Arterial Disease ,Treatment Outcome ,Lower Extremity ,Ischemia ,Humans ,Female ,Aged ,Retrospective Studies - Abstract
The National Health Service demonstrated that regions of the United Kingdom with the highest number of patients enrolled in research studies had the lowest risk-adjusted mortality when patients were admitted to the hospital. Our goal was to investigate if this correlation was evident for patients with chronic limb threatening ischemia (CLI) treated in the United States (US). Accordingly, we examined correlations among sites participating in the Best Endovascular versus best Surgical Therapy in patients with Critical (BEST-CLI) trial, a multicenter, National Institute of Health-sponsored, international randomized controlled trial (RCT) comparing revascularization strategies in patients with CLI, and regional rates of major amputation from CLI.We measured regional participation in the BEST-CLI trial by evaluating trial participation and enrollment rosters. To determine regional rates of lower limb amputation, we queried the Medicare database (2007-2016) for patients with concurrent peripheral arterial disease (PAD) and diabetes, then assessed how many had lower extremity amputations. Correlation of regional amputation rates with distribution of BEST-CLI sites in four US geographical regions was calculated using Pearson's correlation coefficients. Simple regression equations were used to calculate the significance of these correlation coefficients.Of 9,231,909 CLI patients, 342,406 underwent amputation in the Medicare dataset. Amputation rates per 1000 CLI patients differed by region (South 40.42, Midwest 40.12, West 34.81, Northeast 31.14). There were 116 US vascular centers, selected by volume and expertise that participated in BEST-CLI with the following distribution: South (n = 30, 26%), Midwest (n = 26, 22%), West (n = 29, 25%), and Northeast (n = 31, 27%). There was a negative correlation between the number of amputations per 1000 for Medicare CLI patients with diabetes and PAD and the number of BEST-CLI sites in the region which trended toward significance (Pearson R= -0.61, P = 0.39).Amputation rate among Medicare CLI patients is inversely correlated with US BEST-CLI site distribution. Higher participation in clinical research, especially within large RCTs, may be a marker of optimal PAD management.
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- 2021
50. Relationship Between WIfI (Wound, Ischemia, Foot Infection) Stage and Quality of Life at Revascularization in Best-CLI (Best Endovascular vs. Best Surgical Therapy in Patients With Critical Limb Ischemia) Trial
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Jeffrey Siracuse, Vincent Rowe, Matthew Menard, Kenneth Rosenfield, Michael Conte, Richard Powell, Kristina Giles, Taye Hamza, Michael Strong, Christopher White, Niteesh Choudhry, and Alik Farber
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
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