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1.
J Vasc Surg Cases Innov Tech ; 6(2): 177-180, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32322770

ABSTRACT

Persistent primitive hypoglossal artery (PPHA) is a rare internal carotid-vertebrobasilar anatomic variant. Awareness of this anomaly and its propensity for atherosclerotic disease is important to avoid misinterpretation of diagnostic studies and to allow appropriate interventional planning. As the predominant vascular supply to the anterior and posterior cerebral circulation, its luminal compromise can lead to devastating ischemic complications. Carotid endarterectomy and carotid stenting have both been performed to treat lesions involving a PPHA. Herein, we report a case of carotid endarterectomy involving a PPHA and discuss the clinical and surgical implications of a carotid lesion in the presence of a PPHA.

2.
J Vasc Interv Radiol ; 24(2): 165-73; quiz 174, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23369553

ABSTRACT

PURPOSE: To evaluate the performance of a heparin-bonded, expanded polytetrafluoroethylene (ePTFE)-lined nitinol endoprosthesis in the treatment of long-segment occlusive disease of the femoropopliteal artery (FPA) and to identify factors associated with loss of patency. MATERIALS AND METHODS: In a single-arm, prospective, 11-center study (VIPER [Gore Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease] trial), 119 limbs (113 patients; 69 men; mean age, 67 y), including 88 with Rutherford category 3-5 disease and 72 with Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) C or D lesions of the FPA, underwent stent graft implantation. The mean lesion length was 19 cm; 56% of lesions were occlusions. Follow-up evaluations included color duplex ultrasonography in all patients, with patency defined as a peak systolic velocity ratio< 2.5. RESULTS: At 12 months, Rutherford category and ankle-brachial index (ABI) were significantly improved (mean category improvement, 2.4; ABI increased from 0.6±0.2 to 0.9±0.19; P<.0001). Primary and secondary patency rates were 73% and 92%. The primary patency for devices oversized<20% at the proximal landing zone was 88%, whereas the primary patency for devices oversized by>20% was 70% (P = .047). Primary patency was not significantly affected by device diameter (5 vs 6 vs 7 mm) or lesion length (≤20 cm vs>20 cm). The 30-day major adverse event rate was 0.8%. CONCLUSIONS: The heparin-bonded, ePTFE/nitinol stent graft provided clinical improvement and a primary patency rate of 73% at 1 year in the treatment of long-segment FPA disease. Careful sizing of the device relative to vessel landing zones is essential for achieving optimal outcomes.


Subject(s)
Drug-Eluting Stents , Heparin/administration & dosage , Peripheral Arterial Disease/therapy , Polytetrafluoroethylene/chemistry , Aged , Anticoagulants/administration & dosage , Coated Materials, Biocompatible/chemical synthesis , Equipment Design , Equipment Failure Analysis , Female , Femoral Artery/drug effects , Femoral Artery/surgery , Humans , Male , Peripheral Arterial Disease/diagnosis , Popliteal Artery/drug effects , Popliteal Artery/surgery , Treatment Outcome , United States
3.
Catheter Cardiovasc Interv ; 79(1): 167-73, 2012 Jan 01.
Article in English | MEDLINE | ID: mdl-21805584

ABSTRACT

BACKGROUND: Continuous improvement in carotid artery stenting (CAS) outcomes, especially for periprocedural death and stroke in high-surgical-risk patients, have been seen in recent randomized trials of CAS versus carotid endarterectomy and CAS registries. However, these studies use stringent inclusion/exclusion criteria for patient, institution, and physician selection. The Carotid Stenting Boston Scientific Surveillance Program (CABANA) study was initiated to evaluate periprocedural outcomes with modern versions of the Carotid Wallstent and FilterWire EZ System for operators with a wide range of clinical specialties, CAS experience and training levels, in patients with a broad range of high-surgical-risk conditions and lesion types. METHODS: This prospective, single-arm study enrolled 1,097 subjects with 1,098 carotid artery lesions at 99 study centers. Investigators were grouped into one of three tiers according to whether they had a high, medium, or low level of previous CAS experience and were also categorized by their CAS-credential-based training requirements for the CABANA study. Follow-up at 30 days includes clinical evaluation and independent neurological and NIH stroke scale assessments. The primary endpoint rate of 30-day composite stroke, death, and MI, as well as the rates of these individual events, will be evaluated across the overall study, by physician experience tier, and by physician training tier. DISCUSSION: The evaluation of periprocedural CAS safety in a real-world environment with modern devices in high-surgical-risk patients treated by physicians with a broad range of training and experience will better inform treatment decisions in the future.


Subject(s)
Angioplasty/instrumentation , Carotid Stenosis/therapy , Embolic Protection Devices , Research Design , Stents , Angioplasty/adverse effects , Angioplasty/mortality , Carotid Stenosis/complications , Carotid Stenosis/mortality , Clinical Competence , Humans , Myocardial Infarction/etiology , Patient Safety , Product Surveillance, Postmarketing , Prospective Studies , Prosthesis Design , Registries , Risk Assessment , Risk Factors , Stroke/etiology , Time Factors , Treatment Outcome
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