Quantificação volumétrica da hiperplasia neointimal em artérias ilíacas após implante de suporte intravascular metálico
01 Aug 2009-Radiologia Brasileira (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem)-Vol. 42, Iss: 4, pp 231-234
TL;DR: In this paper, the authors quantify neointimal hyperplasia in iliac arteries after stent implantation, correlating clinical, arterial factors and stent material.
Abstract: OBJECTIVE: To quantify neointimal hyperplasia in iliac arteries after stent implantation, correlating clinical, arterial factors and stent material. MATERIALS AND METHODS: In the period from June/2003 to August/ 2005, 60 patients were submitted to percutaneous transluminal angioplasty and stenting. Among these patients, 30 were followed-up with intravascular ultrasonography. Data were analyzed in a laboratory of quantitative analysis by means of a specific software. RESULTS: Sixteen (53.3%) patients were men, and 14 (46.7%), women, and the mean age was 60.3 years. Arterial hypertension was observed in 22 patients (73.3%), smoking in 18 (62.1%), hyperlipidemia in 20 (66.7%), and diabetes in 9 (30%). A total of 20 nitinol stents (66.7%) and 10 stainless steel stents (33.3%) were implanted. Four patients were classified as TASC A (13.3%), 15 TASC B (50%) and 11 TASC C (36.7%). The neointimal hyperplasia volume ranged from 49.02 mm3 to 112.87 mm3 (mean, 80.33 mm3). The rate of intrastent obstruction ranged from 18% to 47% (mean, 27.4%). The clinical outcomes achieved with stenting were sustained through the follow-up. CONCLUSION: Neointimal hyperplasia is a common finding after percutaneous transluminal angioplasty and stenting, but in the present study the stenosis rate was never higher than 50%. There was no statistically significant difference in intrastent stenosis rates in relation to stents materials, clinical and arterial risk factors.
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TL;DR: The results of this case series and literature review results allow to conclude that the endovascular approach is an effective and safe option to treat peripheral arterial occlusive disease in iliac arteries.
Abstract: BACKGROUND: Endovascular treatment of peripheral arterial occlusive disease has become increasingly frequent in the past few years. Because it is a less invasive procedure, lower morbidity and mortality rates are associated with this form of treatment. OBJECTIVES: To describe the endovascular procedures performed in iliac arteries for the treatment of peripheral arterial occlusive disease. METHODS: This retrospective study assesses 59 cases of iliac artery angioplasty performed according to a specific protocol from January 2004 to February 2010. RESULTS: Mean age of patients was 62 years (minimum: 42, maximum: 89). Thirty seven were male (62.72%) and 22 female (37.28%). The main indications for treatment were moderate to severe intermittent claudication in 30 cases (50.84%) and rest pain or trophic lesions (critical ischemia) in 29 cases (49.15%). Postoperative follow-up included ankle-brachial index measurements and a duplex ultrasound at 30 days, 3 months, 6 months, 12 months, and every 6 months thereafter. Minimum follow-up time was 3 months, and maximum, 72 months (6 years), with primary and secondary patency rates of 91.37 and 94.82%, respectively. CONCLUSIONS: The results of this case series, combined with literature review results, allow to conclude that the endovascular approach is an effective and safe option to treat peripheral arterial occlusive disease in iliac arteries.
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TL;DR: Long-term results of iliac recanalization are excellent without major complications if the procedure is technically successful and the endovascular procedure can be an alternative to an iliofemoral or aortobifemoral bypass in a high risk population.
Abstract: Objectives: To evaluate the long-term results of recanalization with primary stenting for long and complex iliac artery occlusions.Design: Retrospective non-randomized study.Methods: Between 1996 a...
30 citations
TL;DR: Oral everolimus suppresses in-stent neointimal growth in rabbit iliac arteries by four weeks and is more effective than 7 days of high-doseEverolimus.
25 citations
TL;DR: CBA shows high immediate technical and midterm clinical success in symptomatic iliac artery ISR, and during a mean follow-up of 23.6 months, no patient showed clinical deterioration, and no recurrent ISR was detected with color duplex.
Abstract: PURPOSE To report our preliminary experience using cutting balloon angioplasty (CBA) in symptomatic iliac artery in-stent restenosis (ISR). METHODS Fourteen cases of hemodynamically significant iliac artery ISR (4 common and 10 external) were treated in 12 men (mean age 64 years, range 55-75). Of the 14 stents involved, 8 were balloon-expandable models and 6 were self-expanding. All patients had symptomatic deterioration of at least 1 clinical category over an average period of 50.2 months (range 6-120) post stenting. The mean length of ISR was 11.9 mm (range 2-48), and the average stenosis was 75.4% (range 52%-98%). Nine ISR lesions were focal ( 10 mm), and 1 extended outside the stent margins. RESULTS CBA was performed after conventional angioplasty failure in 7 lesions and as a primary treatment method in 7 lesions. Single (9 focal lesions) or multiple overlapping (5 diffuse or proliferative lesions) inflations were performed using 6-x10-mm (1 lesion), 7-x10-mm (3 lesions), and 8-x10-mm (10 lesions) devices. There was 1 contained rupture treated with a covered stent. In the remainder of the cases, the cutting balloons allowed successful treatment without further stent implantation. During a mean follow-up of 23.6 months (range 12-60), no patient showed clinical deterioration, and no recurrent ISR was detected with color duplex. CONCLUSION CBA shows high immediate technical and midterm clinical success in symptomatic iliac artery ISR.
16 citations
TL;DR: It is concluded that anti-inflammatory strategies are able to interfere with growth factor expression after vascular injury and administration of anti-ICAM-1 monoclonal antibodies following either balloon angioplasty or stent implantation results in a suppression of bFGF in the early phase of restenosis.
Abstract: OBJECTIVES After vascular intervention, cell adhesion molecules such as ICAM-1 and VCAM are fundamental in inflammatory processes. In particular, ICAM-1 expression is strongly associated with macrophage-rich areas in restenotic lesions. Therefore, we hypothesized an anti-restenotic effect by systemic application of anti-ICAM-1 monoclonal antibodies (mAb). METHODS Thirty two rabbits underwent balloon angioplasty and stent implantation either in the right or left iliac artery, Animals received either anti-ICAM mAb or saline solution as a control. Animals were sacrificed 7 (n=8) and 14 (n=8) days and tissue was analyzed for basic fibroblast growth factor (bFGF) and transforming growth factor beta (TGF-beta) expression. Sixteen animals were sacrificed 6 months following treatment and tissue was harvested for histomorphometric analysis. RESULTS After balloon injury, bFGF significantly increased from 7 to 14 days only in the control group and was significantly higher compared to the anti-ICAM group. At 14 days after stent implantation, controls showed a significant increase of both bFGF and TGF-beta, whereas the anti-ICAM group only showed a significant increase of TGF-beta. Histomorphometric analysis for neointimal growth did not show any differences between control and anti-ICAM groups either after balloon injury or after stent implantation at 6 months. CONCLUSION Administration of anti-ICAM-1 mAb following either balloon angioplasty or stent implantation results in a suppression of bFGF in the early phase of restenosis, whereas TGF-beta significantly increases from 7 to 14 days after stent implantation independent of anti-ICAM-1 mAb application. Therefore we conclude that anti-inflammatory strategies are able to interfere with growth factor expression after vascular injury.
12 citations
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