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A New Approach to the Assessment of the Results of Endovascular Correction of Coronary Artery Bifurcation  [PDF]
Е.V. Chebotar,О.V. Britvina,B.Е. Shakhov
Sovremennye Tehnologii v Medicine , 2012,
Abstract: The aim of the investigation is to study the results of endovascular treatment of patients with coronary bifurcation disorders performed under the control of selective coronography and intravascular manometry, and to assess on the basis of their analysis the manometric findings of blood flow in bifurcation branches when choosing endovascular correction management. Materials and Methods. The analysis of peculiarities and the results of endovascular correction of coronary bifurcations was performed in 67 patients with test T-stenting. The bifurcation state of the 1 st group patients (n=32) was assessed by contrast angiography and the measurement of fractional flow reserve, the patients of the 2 nd group (n=35) — by angiography findings only. Long-term results (follow-up period is 12 months) were studied in 30 patients (93.8%) of the 1 st group, and in 33 patients (94.3%) of the 2 nd group. Results. In 11 of 32 cases angiographic assessment of stenosis in the lateral branch mouth was different from that of manometric one. There was determined an average degree of correlation (R=0.46; р=0.008). In Y-type bifurcation there was no correlation between the assessments of hemodynamic significance of stenosis in the lateral branch (R=0.21; р=0.464). In a follow-up period, angina recurrence or the increase of its degree was revealed in 3 patients (10.0%) of the 1 st group, and in 11 patients (33.3%) of the 2 nd one (р=0.035). Restenoses in lateral branches were found in 2 patients (6.7%) of the group under study and in 10 patients (30.3%) in the control group (р=0.024).Conclusion. The use of complex approach to the assessment of the results of coronary bifurcation correction improves the results of surgeries due to the decrease of restenoses rate and the necessity of re-revascularization in the follow-up. The advantage of the approach is more accurate assessment of hemodynamic changes in bifurcation branches and, therefore, the possibility to choose an optimal technique of endovascular correction.
Clinical applications of fractional flow reserve in bifurcation lesions
Sang Hyun Park,Bon-Kwon Koo
老年心脏病学杂志(英文版) , 2012,
Abstract: Percutaneous coronary intervention (PCI) for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiographic evaluation alone is sometimes inaccurate and does not reflect the functional significance of bifurcation lesions. The fractional flow reserve (FFR) is an easily obtainable, reliable, and reproducible physiologic parameter. This parameter is epicardial lesion specific and reflects both degree of stenosis and the myocardial territory supplied by the specific artery. Recent studies have shown that FFR-guided provisional side branch intervention strategy for bifurcation lesions is feasible and effective and can reduce unnecessary complex interventions and related complications. However, an adequate understanding of coronary physiology and the pitfalls of FFR is essential to properly use FFR for PCI of complex bifurcation lesions.
Clinical applications of fractional flow reserve in bifurcation lesions

Sang Hyun Park,Bon-Kwon Koo,

老年心脏病学杂志(英文版) , 2012,
Abstract: Percutaneous coronary intervention (PCI) for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiographic evaluation alone is sometimes inaccurate and does not reflect the functional significance of bifurcation lesions. The fractional flow reserve (FFR) is an easily obtainable, reliable, and reproducible physiologic parameter. This parameter is epicardial lesion specific and reflects both degree of stenosis and the myocardial territory supplied by the specific artery. Recent studies have shown that FFR-guided provisional side branch intervention strategy for bifurcation lesions is feasible and effective and can reduce unnecessary complex interventions and related complications. However, an adequate understanding of coronary physiology and the pitfalls of FFR is essential to properly use FFR for PCI of complex bifurcation lesions.
X-ray Endovascular Correction of Bifurcation Involvements of Coronary Arteries. Part I. Classification of Involvements, Their Pathologic Characteristics, Methods of Correction
Е.V. Tchebotar
Sovremennye Tehnologii v Medicine , 2011,
Abstract: There have been considered the main classification of bifurcation involvements of coronary arteries, given present-day knowledge of pathologic characteristics having effect on the results on endovascular correction. There have been stated modern views on the assessment of functional significance of bifurcation lateral branches and the necessity of its protection during correction. The predictors of impairment and stagnation of circulation in lateral branch in the process of endovascular correction have been described. There have been considered in detail various techniques of endovascular correction of coronary bifurcations.
Outcomes of Endovascular Treatment of Intracranial Aneurysms at Bifurcation Sites  [PDF]
Ahmed Saied, Mohamed Gomaa, Talal Amer, Mohamed Saad, Demetrius Lopes
World Journal of Neuroscience (WJNS) , 2018, DOI: 10.4236/wjns.2018.84034
Abstract: Background and Purpose: Endovascular coiling is widely used for treatment of both ruptured and unruptured aneurysms. Intracranial bifurcation aneurysms were classically considered unsuitable for endovascular treatment because of the risk of coil protrusion into the parent vessel. The introduction stent assisted coiling has allowed the bifurcation aneurysms to be endovascularly treated. The present study aims to evaluate the efficacy of the endovascular treatment of the intracranial bifurcation aneurysms. Methods: This study was conducted on 76 patients with radiologically documented intracranial aneurysms at bifurcation sites either ruptured (12 aneurysms) or unruptured (64 aneurysms). Endovascular coiling of intracranial aneurysms was done for all patients in our study aided in some with single or Y-configuration stenting. The radiological outcome was assessed immediately postoperative, and at follow-up at 6 and 12 month with grading of the angiograms on the basis of modified 3-point Raymond
Endovascular Embolisation of Visceral Artery Pseudoaneurysms  [PDF]
Yasir Jamil Khattak,Tariq Alam,Rana Hamid Shoaib,Raza Sayani,Tanveer-ul Haq,Muhammad Awais
Radiology Research and Practice , 2014, DOI: 10.1155/2014/258954
Abstract: Objective. To evaluate the technical success, safety, and outcome of endovascular embolization procedure in management of visceral artery pseudoaneurysms. Materials and Methods. 46 patients were treated for 53 visceral pseudoaneurysms at our institution. Preliminary diagnostic workup in all cases was performed by contrast enhanced abdominal CT scan and/or duplex ultrasound. In all patients, embolization was performed as per the standard departmental protocol. For data collection, medical records and radiology reports of all patients were retrospectively reviewed. Technical success, safety, and outcome of the procedure were analyzed. Results. Out of 46 patients, 13 were females and 33 were males. Mean patient age was years and mean pseudoaneurysm size was ?mm. Technical success rate for endovascular visceral pseudoaneurysm coiling was 93.47% . Complication rate was 6.52% . Followup was done for a mean duration of months (0.5–69 months). Complete resolution of symptoms or improvement in clinical condition was seen in 36 patients (80%) out of those 45 in whom procedure was technically successful. Conclusion. Results of embolization of visceral artery pseudoaneurysms with coils at our center showed high success rate and good short term outcome. 1. Introduction Visceral arteries include arteries of the splanchnic circulation and the renal arteries [1]. The pseudoaneurysms of visceral arteries (VPAs) are uncommon and attributed to degeneration of the vessel wall mostly due to infections and adjacent inflammation, trauma, and iatrogenic causes [2]. Hemorrhage due to rupture of these pseudoaneurysms is a rare but often life threatening complication which manifests as intra-abdominal or retroperitoneal bleeding and requires emergency treatment [3, 4]. Using digital subtraction angiography the bleeding site can be evaluated followed by embolization of the bleeding vessel or pseudoaneurysm employing superselective catheterization technique [5, 6]. To the best of our knowledge there is no published data available from the developing world regarding clinical presentation, procedural results, and clinical outcome of endovascular management of visceral artery pseudoaneurysms. This study was hence carried out to present details of our initial experience with the procedure at a tertiary care hospital in a third world country. 2. Materials and Methods This cross-sectional study was carried out at radiology department of a tertiary care hospital in third world country. The study was performed in accordance with the declaration of World Medical Association Declaration of
Endovascular treatment of extracranial vertebral artery stenosis  [cached]
Burak Kocak,Bora Korkmazer,Civan Islak,Naci Kocer
World Journal of Radiology , 2012, DOI: 10.4329/wjr.v4.i9.391
Abstract: Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery (VA) stenosis seems a safe, effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation, with a low complication rate and good long-term results. In patients with severe tortuosity of the vessel, stent placement is a real challenge. The new coronary balloon-expandable stents may be preferred. A large variability of restenosis rates has been reported. Drug-eluting stents may be the solution. After a comprehensive review of the literature, it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible, but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.
Myocardial FFR (Fractional Flow Reserve) in patients with angiographically intermediate coronary artery stenosis - an initial institutional experience  [cached]
Jagadish H. Ramaiah,Raghu T. Ramegowda,Srinivas B. Chikkaswamy,Manjunath C. Nanjappa
International Journal of Research in Medical Sciences , 2013, DOI: 10.5455/2320-6012.ijrms20130202
Abstract: Background: The clinical significance of coronary artery stenosis of intermediate severity can be difficult to determine. The management of intermediate coronary lesions, defined by a diameter stenosis of I40% to U70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Myocardial fractional flow reserve (FFR) is an index of the functional severity of coronary stenosis that is calculated from pressure measurements made during coronary angiography. The objective of the study is to evaluate the usefulness of FFR in patients with angiographically intermediate coronary artery stenosis. Methods: 20 patients with intermediate coronary stenosis and chest pain of uncertain origin. The Exercise Electrocardiography (TMT), Myocardial Perfusion Imaging study (MPI), Quantitative Coronary Angiography (QCA) were compared with the results of FFR measurements. Results: 20 patients were undergone FFR measurement during the study period. With the mean age of 57.25 à11.2 and male patients were 16 (80%), female patients 4 (20%), in all 13 patients with an FFR of <0.75, reversible myocardial ischemia was demonstrated unequivocally on at least one noninvasive test. In contrast, 5 of 7 patients with an FFR of >0.75 tested negative for reversible myocardial ischemia on TMT and MPI study. No revascularization procedures were performed in 7 (35%) patients, and no adverse cardiovascular events were noted in all these patients during 6 months of follow-up. Conclusions: In patients with coronary stenosis of intermediate severity, FFR appears to be a useful index of the functional severity of the stenosis and the need for coronary revascularization. [Int J Res Med Sci 2013; 1(1.000): 4-11]
Endovascular Treatment of a Giant Aneurysm of the Maxillary Artery
J. A. Stephenson,S. Panteleimonitis,E. Choke,M. Dennis,M. Glasby
Case Reports in Vascular Medicine , 2011, DOI: 10.1155/2011/818241
Abstract: Aneurysms of the maxillary artery are rare and the majority of the literature refers to false aneurysms. We report the first case of what we believe to be a spontaneous true maxillary artery aneurysm and its endovascular management.
Endovascular and surgical management of carotid artery restenosis  [PDF]
Sagi? D.?.,Antoni? ?.D.,Petrovi? B.B.,Duvnjak S.N.
Acta Chirurgica Iugoslavica , 2007, DOI: 10.2298/aci0703043s
Abstract: Background. The incidence of recurrent carotid stenosis after primary endarterectomy ranges from 10-34%. We presented our four year experience and comparing reoperation versus endovascular treatment. Methods. In period from 2001 to 2005, 50 patients, 37 men and 13 women, were treated surgically and endovascular due to restenosis. Results. There were no minor or major stroke, death and myocardial infarction periprocedural and in first 30 days in either group. In endovascular group one patients 3,17% had transient ischemic attack and two patients 11,76% in surgical group. One patient died from myocardial infraction in follow up in surgical group. There were no restenosis >50% in endovascular group, two patients have restenosis >50% in surgical group. Conclusions. Endovascular treatment of carotid artery restenosis represents a safe and efficient way of treatment, connected with minor number of serious complications than redo operation.
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