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Complications of stenting for occlusive disease of aortic arch branches
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Christopher A. Latz, Mark F. Conrad
Early reports of endovascular repair showed that the primary patency was inferior to open surgical repair, and long-term studies are rare. In a recent report of 411 patients with long-term follow-up, restenosis occurred in 15% of patients, and most of these presented with symptom recurrence. The primary patency in this cohort was 92% at 1 year and 82.6% at 5 years, and patients with innominate interventions were more likely to present with recurrent stenosis.30 Follow-up after intervention usually consists of a clinic visit and noninvasive imaging at 6 weeks and then yearly thereafter. Most patients who developed restenosis experienced a return of symptoms as well. If a change is noted on noninvasive imaging, the anatomy can be further defined with axial imaging via a CTA or MRA. If a patient has restenosis but remains asymptomatic, they should be treated with medical therapy and monitoring with serial imaging. However, symptomatic patients should undergo re-intervention. Repeat intervention is usually endovascular, and open repair is rarely required. Indeed, in the previously noted study, the secondary patency at 5 years was 96%.30
Synthetic DNA-Based Compounds for the Prevention of Coronary Restenosis: Current Status and Future Challenges
Published in Eric Wickstrom, Clinical Trials of Genetic Therapy with Antisense DNA and DNA Vectors, 2020
Andrew Zalewski, Yi Shi, John D. Mannion, Femando Roqué
Coronary restenosis is defined as a repeat arterial following mechanical revascularization. Although the initial stenosis is usually due to advanced atherosclerosis, subsequent restenosis reflects an excessive repair response after a therapeutic injury, such as balloon angioplasty. Restenosis remains the "Achilles' heel" of interventional cardiology, notwithstanding significant procedural improvements that allow the achievement of initially successful coronary revascularization. Combined clinical and angiographic restenosis occurs in 30 to 50% of patients within the first 6 months after transcatheter coronary revascularization. This translates to several hundreds of thousands of patients worldwide afflicted by this condition. Likewise, similar vascular narrowing may occur after coronary/peripheral bypass surgery or other procedures that induce acute vascular injury, highlighting the need for an effective therapy to control the vascular repair process (Table 1).
High PAI-1 Levels as Marker of Rethrombosis after Successful Coronary Balloon Angioplasty
Published in Pia Glas-Greenwalt, Fibrinolysis in Disease Molecular and Hemovascular Aspects of Fibrinolysis, 2019
It has been proposed that the development of atherosclerosis might also be explained by local thrombin generation at the vessel wall after rupture of an atherosclerotic plaque followed by incorporation and organization of the thrombotic material.1-3 It might, therefore, be possible that local thrombus formation after mechanical trauma, e.g., after coronary balloon angioplasty (PTCA) might also be involved in the development of restenosis after successful PTCA. Restenosis has been described to occur in 25 to 40% of patients undergoing this intervention.4,5 Thrombin generation after a certain stimulus might be favored by different pathophysiological situations present at the time of initiation of vessel trauma, e.g., during prothrombotic or antifibrinolytic states.6,7
Stent failure: the diagnosis and management of intracoronary stent restenosis
Published in Expert Review of Cardiovascular Therapy, 2023
Majd B Protty, Tharindra Dissanayake, Daniel Jeffery, Ahmed Hailan, Anirban Choudhury
The definition of ISR varies, but the most recent consensus is summarized in the following three bullet points [3] Restenosis – luminal diameter reduction because of neointimal tissue proliferation.Binary angiographic restenosis – More than 50% percent luminal narrowing at subsequent angiography.Clinical restenosis – The presence of both binary angiographic restenosis and clinical symptoms or signs of ischemia (either at rest or with stress) OR restenosis, with a ≥ 70% reduction in lumen diameter even in the absence of clinical symptoms or signs.
Investigation of changing geometry parameters of nickel-titanium shape memory alloys wire stent in cardiovascular implants
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Mansour Alizadeh, Atefeh Aghajani Koopaie, Saber Shakeri Jousheghan
The superelastic material behavior generates analysis difficulties due to its path dependence and high non-linearity. ABAQUS West commercialized a user-define material subroutine UMAT specific to Nitinol-based on the generalized plasticity theory. Many applications demonstrated that the ABAQUS West’s UMAT is capable of predicting the uniaxial material response at different temperatures and a Nitinol stent’s deformation at any material point in addition to the stress and strain fields (Gong and Pelton 2002; Gong et al. 2004). The strong clinical evidence supported stent design as a factor in the development of restenosis. In addition, variation of artery diameter and plaque length, cause different geometrical parameters for the stent. Therefore it is important to know the effects of changing geometrical parameters on the superelastic behavior of Nitinol stents. Understanding the geometrical characteristics of different stent geometry may allow novel strategies for device design, use and medicines to better choice. In this investigation, considering the diameter of the stents used, we intend to study the abdominal aorta stenosis.
The critical period for development of secondary restenosis following post-intubation tracheal stenosis surgery
Published in Acta Oto-Laryngologica, 2022
Yilmaz Ozkul, Murat Songu, Asuman Feda Bayrak, Akif İşlek
Sixty-one patients were included in the study. Twenty-eight (45.9%) of the patients were female and 33 (54.1%) were male. The mean age of the patients was 46.9 ± 8.5 (range, 18 to 66) years. The causes of intubation which resulted as PITS were multiple trauma (n = 21, 34.5%), respiratory distress (n = 11, 18.1%), myocardial infarction and cardiac arrest (n = 10, 16.4%), cerebrovascular disease (n = 7, 11.4%), septic shock (n = 6, 9.8%), substance overdose (n = 3, 4.9%), and undefined (n = 3, 4.9%). The duration of intubation was 12.4 ± 3.6 days (range, 1 h to 25 days). Restenosis developed in 11 (18.0%) patients. The mean follow-up period of the study population was 266.3 ± 82.6 days. Restenosis was diagnosed after a mean of 39.3 ± 38.5 (range, 22 to 155) days. A summary of the findings is given in Table 1.