Biomedical subjects

K Deloose

Publications and source records attributed to K Deloose.

8 recordsLinked to original sources

PubMed2006

Does free cell area influence the outcome in carotid artery stenting?

OBJECTIVES: To identify if carotid stent design, especially free cell area, impacts on the 30-day rates for stroke, death and TIA after carotid artery stenting (CAS). MATERIAL AND METHODS: A CAS database of 3179 consecutive CAS patients was retrospectively assessed. The distribution of neurological complications were analysed for association with the different stent types and designs. Events where subdivided into procedural and postprocedural events. RESULTS: The overall combined rate of TIA, stroke and death was 2.8% at 30 days (late events 1.9%). The post-procedural event rate analyzed for differences stents varied from 1.2% using BSCI Carotid Wallstent to 5.9% using Medtronic Exponent. The late event rates varied from 1.2% to 3.4% for free cell areas <2.5mm(2) and >7.5mm(2) respectively (p<0.05). Post-procedural event rate was 1.3% for closed cells and 3.4% for open cells. All these differences were highly pronounced among symptomatic patients (p<0.0001). CONCLUSIONS: After carotid stenting, complication rates vary according to stent type, free cell area and cell design. In the symptomatic population (and also in the total population), post-procedural complication rates are highest for the open cell types and increase with larger free cell area.

Blood Vessel Prosthesis Implantation↗

PubMed2006

Review of stents for the carotid artery.

The individual characteristics of a stent may make it an attractive choice in some circumstances, but render it a less desirable option in others. The applicability depends primarily on the arterial anatomy and the specific details of the lesion being treated. A careful assessment by the interventionalist is required to select the proper type of stent that is of appropriate size. Certainly, personal preferences and familiarity with a specific device may legitimately influence the decision to choose one stent over another. Finally, stent design can play a role in the selection procedure. Although carotid stents are often functionally equivalent in the clinical setting and have been used successfully to treat a wide variety of lesions, a basic knowledge of stent geometry can contribute to make up your mind in certain carotid cases.

Angioplasty↗

PubMed2006

Percutaneous transluminal angioplasty for treatment of ''below-the-knee'' critical limb ischemia: early outcomes following the use of sirolimus-eluting stents.

AIM: We investigated the safety and efficacy of sirolimus-eluting stents in the treatment of patients with severe below-the-knee' critical limb ischemia. METHODS: Between October 2004 and January 2005 we performed 20 percutaneous transluminal angioplasty procedures on 18 patients (7 female, 11 male, mean age 72.8 years), implanting 24 sirolimus-eluting stents. At pre-procedure, 12 patients (66.7%) presented with a Rutherford Category 4, 4 (22.2%) with Category 5 and 2 (11.1%) with Category 6. The majority of patients (72.2%, n=13) were non-smokers and 77.8% (n=14) presented with hypercholesterolemia. Calcification was present in 52.2% (n=12) of lesions. Pre-dilation was performed in half the patients. The majority of lesions (95.7%, n=22) were treated with a single sirolimus-eluting stent. Two patients underwent 2 procedures, each one receiving 2 sirolimus-eluting stents. Clinical examination and quantitative vascular analysis were performed in all patients at discharge and at 6-month follow-up. RESULTS: Percutaneous transluminal angioplasty was successfully performed on all 18 patients. The mean stent length and stent diameter were 30.29 mm and 3.23 mm, respectively. Mean follow-up was 256 days (170-368 days). At the 6-month follow-up, the minimum lumen diameter as measured by Quantitative Vessel Analysis was 2.39 mm with an attendant LLS of 0.38 mm. The overall 6-month survival and limb salvage rate were 94.4% and 94%, respectively. CONCLUSIONS: Our results suggest that treatment with sirolimus-eluting stents can be considered as an effective and safe treatment of patients with critical ischemia.

Adult↗

PubMed2006

Balloon-expandable, radially reinforced ePTFE relining of the superficial femoral artery after remote endarterectomy.

AIM: The aim of this paper was to evaluate the mid-term results of remote endarterectomy and balloon-expandable, radially reinforced ePTFE endograft uplining of the superficial femoral artery (SFA) for long occlusions. METHODS: One hundred and two limbs in 92 patients were included in this prospective, multicenter study. Indications were disabling claudication (n=74), restpain (n=10) and tissue loss (n=16) due to an SFA occlusion of at least 10 cm in length. Remote endarterectomy of the SFA using a modified ringcutter in an over-the-wire technique, was followed by implantation of a balloon-expandable Enduring endovascular graft. Control visits were performed at 1, 3 and 6 months postprocedure and every half year from then on. Follow-up protocol included physical examination, Doppler ankle-brachial index measurement and, in case of doubt, duplex examination. RESULTS: A technical success rate of 98% was achieved. Mean follow-up was 36 months. Four patients were lost to follow-up and 17 patients died of nondevice-related causes. The primary, primary assisted and secondary patency rates were 68%, 73% and 97.5% at 1 year and 50%, 60%, and 89% at 3 years, respectively. CONCLUSION: Although technical success rate is high and early patency rates are good, mid-term results are inferior to those of conventional femoro-popliteal synthetic bypass grafts. In order to become competitive to conventional bypass surgery, further technical refinements will be necessary, especially to overcome the problem of stenoses at the distal transition zone.

Adult↗

PubMed2006

Will absorbable metal stent technology change our practice?

Peripheral stents aim to support revascularization procedures of intravascular stenoses by mechanically preventing vessel recoil and counteracting pathophysiologic processes of luminal re-narrowing triggered by procedural injury of the vessel wall. Despite improvements in stenting techniques and concomitant medication, repeated intervention due to target lesion re-stenosis is necessary on a significant percentage of patients. The permanent presence of an artificial implant plays a prominent role in the discussion of mechanisms causing in-stent restenosis. Permanent metallic implants pose the risk of a continuous interaction between non-absorbable stent and surrounding tissue, leading to physical irritation, long-term endothelial dysfunction, or chronic inflammatory reactions. In addition, there is a risk of stent fracture due to external mechanical forces. To overcome these shortcomings, technology of stenting has moved towards the development of temporary implants composed of biocompatible materials which mechanically support the vessel during the period of high risk for recoil and then completely degrade in the long-term perspective. This removes a potential trigger for late restenosis.

Absorbable Implants↗

PubMed2006

Results with heparin bonded polytetrafluoroethylene grafts for femorodistal bypasses.

AIM: Expanded polytetrafluoroethylene (ePTFE) grafts are commonly used for femoropopliteal (FP) and femorocrural (FC) bypass grafting. Especially in below-knee (BK) reconstructions, patency is often inferior to the outcome in patients eligible for venous bypass grafting. This study assesses whether the Carmeda BioActive Surface (CBAS), which employs covalent end-point linkage to retain heparin on the device surface, as it is used on the Propaten vascular graft successfully, can prolong patency. METHODS: From June 2002 to December 2005, 138 patients (97 men and 41 women; mean age: 73 years) received the CBAS-ePTFE graft for 153 infrainguinal bypass procedures. Seventy-five above-knee (AK) and 78 BK (including 37 FC) procedures were performed. Follow-up evaluations consisted of clinical examinations, ultrasonographic studies, and distal pulse assessments. Patency and limb salvage rates were assessed by using life-table analyses. RESULTS: The overall primary and secondary 2-year patency rates were 73.6% and 86%, respectively. Two-year primary patency rates according to bypass type were 76.2%, 72.6%, and 68.9% for AK FP, BK FP, and FC bypasses, respectively; the corresponding secondary patency rates were 87.5%, 87.8%, and 79.4%. The 2-year limb salvage rate in patients with critical limb ischemia (n=68) was 89.9%. CONCLUSION: Our findings show that CBAS-ePTFE bypass grafts appear to give prolonged patency rates and indicate that the use of this graft may represent a viable alternative for BK bypasses, which have traditionally yielded less than desirable outcomes. A prospective randomized trial is required to provide more definitive information about the graft's patency and limb salvage performance.

Aged↗

PubMed2005

Endovascular treatment strategies for supra-aortic arterial occlusive disease.

Because of the focal nature of stenoses or occlusions in the supra-aortic vasculature, the high blood-pressures in this area and the very low morbidity rates related to percutaneous therapy have largely replaced surgical revascularization as the initial treatment of choice for patients with supra-aortic arterial occlusive disease. The initial technical success and durability of percutaneous angioplasty (PTA) and stenting in these lesions is excellent. Nevertheless several factors can make PTA and stenting a complex procedure that requires advanced endovascular skills for a successful outcome. Profound knowledge of surgical reconstruction techniques or extra-anatomic bypasses remains mandatory, as it is occasionally required for failure of endovascular techniques or if contraindications exist.

Angiography↗

PubMed2005

Does carotid artery stenting work on the long run: 5-year results in high-volume centers (ELOCAS Registry).

AIM: Although the first long-term results of Carotid Artery Stenting (CAS) became available only recently, CAS has become an accepted treatment for carotid artery disease. We report CAS data up to 5 years, both late stroke rate and patency rates as observed in 4 high-volume European centers. METHODS: Between February 1, 1993 and December 31, 2004, 2 172 patients were selected over the 4 participating centres, with intention to treat endovascularly. Conscientious follow-up was done according to the in-hospital stipulations of each centre and was entered into a database both retrospectively and prospectively. Long-term restenosis and stroke-death rates were investigated and statistically analysed and stratified using the Kaplan-Meier method. RESULTS: Of the 2 172 patients with intention to treat 2 165 (99.7%) were technically successful. Of these 306 (14.1%) were performed without and 1 859 (85.9%) with embolic protection device (EPD); 96 patients (4.4%) received balloon dilation only and stenting was performed in 2 069 (95.6%) cases. Kaplan-Meier analysis of major stroke/all death and of significant restenosis (>50%) for the total population showed stroke/death rates of 4.1% (nar=1 356), 10.1% (nar=476) and 15.5% (nar=138); and restenosis rates of 1% (nar=1 363), 2% (nar=480) and 3.4% (nar=139), after 1, 3 and 5 years respectively. CONCLUSIONS: The patency and stroke/death rates resulting from our database analysis are pleasing and indicate that CAS also on longer term is a valuable treatment method for carotid artery disease. Due to the fact that our dataset contains prospective as well as retrospective data, it may have its limitations. Until this moment, data indicating that certain patient subgroups are at increased risk for neurological complications and in-stent restenosis during and after CAS are sparse. Further multivariant analysis on this unique dataset is mandatory in order to identify any potential links in between plaque morphology, preprocedural neurological complications, risk factor distribution, procedural steps and clinical outcome.

Adult↗