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Peter A Schneider

Publications and source records attributed to Peter A Schneider.

13 recordsLinked to original sources
PubMed2005

Safety and efficacy of carotid arteriography in vascular surgery practice.

OBJECTIVE: Carotid arteriography (CA) is an important method of assessing carotid artery occlusive disease and is the best method of planning for carotid angioplasty and stent placement (CAS). This study compared the results of CA performed by vascular surgeons in a contemporary series against widely recognized interdisciplinary quality standards for this procedure. Although many vascular surgeons perform CA, there is a paucity of data about its safety, efficacy, and compliance with quality standards in vascular practice. The importance of quality CA will likely increase as CAS emerges to assume a broader clinical role. METHOD: Carotid arteriograms performed by seven vascular surgeons at three institutions from September 2000 to May 2004 were reviewed. These results were compared with quality standards for the performance of CA. RESULTS: Five hundred three carotid arteriograms were performed over 45 months. Indications for the procedure were extracranial cerebrovascular disease (86%), trauma (5%), and other conditions (9%). Indications for the procedure were appropriate in 100% of patients (as determined by guidelines document) and exceeded the recommended standard of appropriate indications in 99%. All procedures successfully provided the information required, exceeding the threshold of 98% for procedural success. Reversible neurologic deficits occurred in 0.6% (two transient ischemic attacks and one stroke) compared with the threshold of 2.5%. A permanent neurologic deficit occurred in 0.2% (1 patient) compared with the published guideline of 1% after carotid arteriography. Major non-neurologic complications occurred in 1.2% (6 patients), less than the standard of 2.0%. CONCLUSIONS: The safety and efficacy of a contemporary series of CA performed in vascular surgery practice compared favorably with recognized interdisciplinary quality standards for this procedure. Ensuring safe and effective CA is likely to support the successful growth of CAS as a treatment option.

Aged↗
PubMed2005

Optimal training strategies for carotid stenting.

Future participation in the treatment of carotid occlusive disease is dependent on training to perform carotid stent placement. Reviewed herein are strategies for training in carotid stenting. Included in this discussion are; the skills required for carotid stenting, the carotid stent learning curve, a comparison of training and credentialing, and the roles of simulators, courses, and hands-on experience in carotid stent training.

Angioplasty↗
PubMed2005

Carotid stenting.

Explore the source record for details and available documents.

Angioplasty, Balloon↗
PubMed2005

What are the skills that prepare vascular surgeons for carotid stenting?

Although it has been clearly established that in certain groups of patients, such as in patients with symptomatic high-grade carotid stenosis and in selected asymptomatic patients with high-grade stenosis, carotid endarterectomy offers significant protection from stroke compared with medical therapy, the role of carotid stenting in this patients versus carotid endarterectomy is undergoing a rapid evolution. The definitive evidence awaits the results of ongoing prospective, randomized trials such as CREST and others, but it is clear that carotid stenting will increasingly occupy a significant role in the therapy of carotid bifurcation disease. In that context, vascular surgeons, traditionally the experts on the management of this condition, face the specter of other disciplines intervening in its treatment. In addition, if vascular surgeons do not acquire the skills and the expertise necessary to perform carotid stenting, it is self-evident that they run the risk of being spectators rather retaining the mantle of expert in the management of carotid bifurcation disease. As such, it is the duty of vascular surgeons to acquire the skills with which to retain their rightful place in its management and treatment. The purpose of this article is to describe the skills necessary to become competent in the endovascular management of carotid disease, offer some thoughts and strategy by which one can gain experience and develop an armamentarium of skills necessary to perform carotid stenting, and offer a comprehensive array of options of management and treatment to the patient with carotid disease.

Angiography↗
PubMed2005

Establishing sheath access for carotid interventions: tips and pitfalls.

Carotid angioplasty and stenting requires delivery of therapy through a sheath rather than open vascular access. Safe and successful sheath delivery facilitates the carotid angioplasty and stenting procedure and depends upon an ability to assess the aortic arch, catheterize its branches, perform remote access guidewire-catheter manipulation, and place a sheath.

Angioplasty, Balloon↗
PubMed2005

What are the key factors in setting up a successful carotid stent program?

Carotid stenting will drastically alter the management of carotid bifurcation stenosis. Key factors to include when initiating a carotid stent program are discussed. Questions addressed include the following: Who has clinical responsibility for patients with carotid disease? What is the rationale for a carotid stent program? How does one initiate a carotid stent program? How does one deal with endovascular realities? Training, patient selection, quality improvement, and proctoring are also reviewed.

Angioplasty, Balloon↗
PubMed2004

Early outcome of "cutting" balloon angioplasty for infrainguinal vein graft stenosis.

BACKGROUND: Recurrent stenotic lesions associated with vein graft bypass grafts are often fibrous and smooth. Unlike de novo atherosclerotic lesions, they respond poorly to balloon angioplasty, and may often result in a dissection requiring stent placement to avoid early recurrent thrombosis or open repair of residual stenosis. A novel balloon designed with three or four longitudinally placed 0.127-mm atherotomes was used at angioplasty to treat focal peripheral vein graft stenosis, in an attempt to minimize dissection by producing a controlled plaque fracture. METHODS: Over 11 months, patients with focal (<2 cm) peripheral vein graft stenosis underwent cutting balloon angioplasty (Boston Scientific, San Diego, Calif) at two separate centers. Baseline patient demographic data, type of bypass, velocity at pre-procedural and post-procedural duplex scanning, procedural results, complications, and type of long-term anticoagulation were recorded. Follow-up consisted of duplex ultrasound scanning at 1, 3, and 6 months and every 6 months for 2 years. RESULTS: The mean age of the patients was 66.8 +/- 10 years. No intent to treat failure was noted. In most patients a 4-mm balloon was used (15 of 19) to treat 10 above-knee vein bypass grafts and 9 below-knee vein bypass grafts. No patient required placement of a stent or conversion to open surgery because of recoil, dissection, or suboptimal angioplasty. The mean velocity at pre-procedure duplex scanning at the site of vein graft stenosis was 373 +/- 56.8 cm/s, and the mean velocity post-treatment at 1-month follow-up was 144 +/- 50 cm/s. The mean length of stay was 26 +/- 32 hours. Overall, four patients continued to receive warfarin anticoagulation therapy, in addition to aspirin. During a mean follow-up of 11.4 +/- 7 months, recurrent stenosis developed in one patient. No other complications or graft recurrent thrombosis was noted. CONCLUSION: Cutting balloon angioplasty may help overcome hoop stress early, by producing a controlled, longitudinal neointimal lesion laceration and thereby facilitating a fracture line along predetermined microincisions. Our study results demonstrate acceptable early outcomes, with no requirement for bail-out stenting or open surgery.

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PubMed2004

Effect of ethnicity on access and device complications during endovascular aneurysm repair.

INTRODUCTION: There are no published reports on the association between ethnicity and outcome after aortoiliac stent grafting to treat aneurismal disease. Because Hawaii is a state with an ethnically diverse population, we conducted a retrospective study to examine this potential association. We hypothesized that individuals of Asian ancestry may have higher complication rates after endovascular repair compared with non-Asians. METHODS: All endovascular devices placed to treat aneurysm disease from 1996 to 2003 were evaluated in two institutions. The association between ethnicity and access-related and device-related complications, both periprocedural and delayed, was examined with logistic regression analysis. RESULTS: Ninety-two aortoiliac endografts were placed during the study period, including 87 in patients with abdominal aortic aneurysms with or without iliac aneurysm disease, and five patients with isolated iliac artery aneurysms. Forty-four percent of patients were categorized as Asian, 39% as white, 16% as Pacific Islander, and 1% as African American. Access-related and device-related complications (ADRCs) occurred in 11 of 92 (12%) of these patients. The following parameters were significantly associated with ADRCs: Asian ethnicity (P =.015), age greater than 80 years (P =.02), and external iliac diameter smaller than 7.5 mm (P =.01). Asian patients were more likely to have experienced ADRCs than were non-Asian patients (odds ratio, 7.3; 95% confidence interval, 1.5-35.8; P =.015). Asians also had smaller external iliac artery diameters (P =.0003) and more tortuous iliac arteries (P =.03) compared with non-Asians. After adjusting for iliac artery diameter and tortuosity, the association between Asian ethnicity and ARDCs became nonsignificant (P =.074), which suggests that the association between race and complications may be at least in part due to small and tortuous iliac arteries. There was no association between age, gender, or ethnicity and postoperative detection of endoleak. CONCLUSION: Our data indicate that individuals of Asian ancestry are far more likely to experience adverse access-related and device-related complications after aortoiliac stent grafting than are non-Asians. We found that this association is at least partly attributable to the smaller and more tortuous iliac arteries in persons of Asian ancestry.

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PubMed2004

Advances in stent technology and drug-eluting stents.

From an initially simple concept, vascular stents have evolved into highly specialized instruments, and are poised to develop into sophisticated drug-delivery systems. Although primary research has mostly targeted the coronary circulation, newer generation stents, deliverable almost anywhere, retarding neointimal hyperplasia and thrombosis, and promoting endothelial overgrowth, will offer the next approximation of true vascular healing. This, in turn,promises to promote less invasive, safer, and finally durable endovascular solutions to current surgical problems.

Angioplasty, Balloon↗
PubMed2003

Filter devices for cerebral protection during carotid angioplasty and stenting.

The risk of embolization during carotid artery stenting (CAS) has been the foremost reason for the cautious acceptance of this percutaneous alternative to carotid endarterectomy. To address this issue, numerous embolic protection devices are being evaluated as an adjunct to CAS for neuroprotection. Among the 3 main categories of these devices, distal filters, which trap embolic debris while maintaining distal cerebral perfusion, have attracted the most corporate interest. This review focuses on the emerging field of embolic protection filters for use in CAS.

Angioplasty, Balloon↗
PubMed2002

Endovascular or open surgery for aortoiliac occlusive disease?

Endovascular and open surgical techniques form a spectrum of options for the optimal, current treatment of aortoiliac occlusive disease. The results of endovascular intervention are determined primarily by lesion characteristics and the associated pattern of occlusive disease while the results of open vascular surgery are more significantly influenced by the patients' comorbid conditions and surgical risk. Categorizing lesions according to severity enhances appropriate patient selection. The long-term success is higher with open surgery while the initial morbidity is lower with endovascular techniques. Open surgery is a better choice for patients with extensive occlusive disease and/or less severe comorbid conditions. Endovascular surgery is not as durable but offers a reasonable option for patients with focal disease and/or contraindications to surgery.

Angioplasty, Balloon↗