PURPOSE: To report the results of a prospective, single-arm study to establish whether the initial treatment of acute or subacute limb ischemia (ALI and SLI, respectively) can be accomplished successfully using endovascular mechanical debulking of the target vessels to avoid the risks associated with thrombolysis and/or open surgery. MATERIALS AND METHODS: From April 2009 to April 2015, 316 consecutive patients (mean age 70.9±12 years; 184 men) with ALI (202, 63.9%) or SLI (114, 36.1%) were enrolled; the only exclusion criterion was irreversible ischemia. The ALI group included 146 (72.3%) participants with category IIb ischemia and 56 (27.7%) with category IIa. Critical limb ischemia was diagnosed in 74 (64.9%) of the 114 patients with SLI. Target occlusions of thrombotic (n=256) or embolic (n=60) origin were located in the femoropopliteal segment (n=231), prosthetic or venous femoropopliteal bypass grafts (n=75), and the aortoiliac segment (n=35). The mean occlusion length was 22.9±14.8 cm. RESULTS: The overall technical success (residual stenosis ≤30%) was 100% after debulking and adjunctive techniques (aspiration, dilation, stenting) at the level of the target lesions. No open surgical or thrombolytic modalities were necessary to bypass or recanalize the target vessels, and no death occurred in association with target occlusion therapy. Additional infrapopliteal interventions were performed in 195 (61.7%) patients (adjunctive thrombolysis in 29) to treat acute, subacute, and chronic lesions. Minor complications directly related to the debulking procedure occurred in 26 (8.2%) patients. Serious complications occurred in 11 (3.5%) patients, including hemorrhage in 8 (2.5%) patients (associated with infrapopliteal thrombolysis in 5). At 30 days, primary and secondary patency rates were 94.3% and 97.2%, respectively; mortality was 0.3% (1 fatal intracranial hemorrhage after adjunctive thrombolysis). Of 229 patients eligible for 1-year follow-up, amputation-free survival was estimated to be 87.4% in 199 patients with available data. CONCLUSION: In this all-comers study, mechanical debulking with the Rotarex alone or with adjunctive techniques is feasible as a primary therapy for occluded supratibial vessels in patients with ALI or SLI.
- MeSH
- akutní nemoc MeSH
- amputace MeSH
- časové faktory MeSH
- doba přežití bez progrese choroby MeSH
- dolní končetina krevní zásobení MeSH
- dospělí MeSH
- endovaskulární výkony * škodlivé účinky přístrojové vybavení mortalita MeSH
- ischemie diagnostické zobrazování mortalita patofyziologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- onemocnění periferních arterií diagnostické zobrazování mortalita patofyziologie terapie MeSH
- prospektivní studie MeSH
- průchodnost cév MeSH
- recidiva MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- trombektomie * škodlivé účinky přístrojové vybavení mortalita MeSH
- trombolytická terapie MeSH
- záchrana končetiny MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVES: The Tack implant is designed for focal, minimal metal management of dissections. This study evaluated Tacks for treating postpercutaneous transluminal angioplasty (PTA) dissection in patients with below-the-knee (BTK) arterial occlusive disease. BACKGROUND: PTA is the most commonly used endovascular treatment for patients with occlusive disease of the BTK vessels. Post-PTA dissection is a significant clinical problem that results in poor outcomes, but currently there are limited treatment options for managing dissections. METHODS: This prospective, single-arm study evaluated patients with CLI and BTK lesions; 11.4% were Rutherford category (RC) 4 and 88.6% were RC 5. BTK occlusive disease was treated with standard PTA and post-PTA dissections were treated with Tack placement. The primary safety endpoint was a composite of major adverse limb events (MALE) and perioperative death (POD) at 30 days. Other endpoints included: device success; procedure success (vessel patency in the absence of MALE); freedom from clinically driven target lesion revascularization (CD-TLR); primary patency; and changes in RC. Data through 12 months are presented. RESULTS: Thirty-two of 35 (91.4%) patients had post-PTA dissection and successful deployment of Tacks. Procedural success was achieved in 34/35 (97.1%) patients with no MALEs at 30 days. The 12-month patency rate was 78.4% by vessel, 77.4% by patient, and freedom from CD-TLR was 93.5%. Significant (P < .0001) improvement from baseline was observed in RC (75% of patients improved 4 or 5 steps). CONCLUSION: Tack implant treatment of post-PTA dissection was safe and effective for treatment of BTK dissections and resulted in reasonable 12-month patency and low rates of CD-TLR.
- MeSH
- balónková angioplastika škodlivé účinky přístrojové vybavení mortalita MeSH
- bérec krevní zásobení MeSH
- časové faktory MeSH
- doba přežití bez progrese choroby MeSH
- endovaskulární výkony škodlivé účinky přístrojové vybavení mortalita MeSH
- ischemie diagnostické zobrazování mortalita patofyziologie terapie MeSH
- kritický stav MeSH
- lidé MeSH
- onemocnění periferních arterií diagnostické zobrazování mortalita patofyziologie terapie MeSH
- poranění cév diagnostické zobrazování etiologie chirurgie MeSH
- prospektivní studie MeSH
- protézy - design MeSH
- průchodnost cév MeSH
- rizikové faktory MeSH
- samoexpandibilní metalické stenty * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- slitiny MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
- Nový Zéland MeSH
PURPOSE: To evaluate the effectiveness of percutaneous mechanical thrombectomy using Rotarex S in the treatment of acute limb ischemia (ALI) in infrainguinal occlusions in a retrospective study of patients treated in our institution. METHODS: In this study, we identified a total of 147 ALI patients that underwent mechanical thrombectomy using Rotarex S at our institution. In 82% of the cases, percutaneous thrombectomy was used as first-line treatment, and for the remainder of the cases, it was used as bailout after ineffective aspiration or thrombolysis. Additional fibrinolysis and adjunctive aspirational thrombectomy were utilized for outflow occlusion when required. Procedural outcomes, amputation rate, and mortality at 30 days were evaluated. RESULTS: Of the 147 patients treated with mechanical thrombectomy, Rotarex S was used as first-line treatment in 120 cases and as second-line treatment in 27 cases. Overall, we achieved 90.5% procedural revascularization success rate when combining mechanical thrombectomy with limited thrombolysis for severe outflow obstruction, and 1 death and 3 amputations were observed. We achieved primary success in 68.7% of the patients with the mechanical thrombectomy only, and in 21.8% of the patients, we successfully used additional limited thrombolysis in the outflow. The overall mortality was 0.7% and amputation rate was 2% at 30 days. CONCLUSION: Percutaneous mechanical thrombectomy as first-line mini-invasive treatment in infrainguinal ALI is safe, quick, and effective, and the performance outcomes can be superior to that of traditional surgical embolectomy.
- MeSH
- akutní nemoc MeSH
- dospělí MeSH
- endovaskulární výkony škodlivé účinky přístrojové vybavení metody MeSH
- ischemie mortalita chirurgie MeSH
- končetiny * krevní zásobení chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři MeSH
- trombektomie škodlivé účinky přístrojové vybavení metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIMS: Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in patients with STEMI based on the data from contemporary European ACS registries. METHODS AND RESULTS: Twelve registries provided data in a systematic manner on outcomes in STEMI patients overall, and seven of these also provided data for P2Y12 receptor inhibitor-based dual antiplatelet therapy. The registries were heterogeneous in terms of site, patient, and treatment selection, as well as in definition of endpoints (e.g. bleeding events). All-cause death rates based on the data from 84 299 patients (9612 patients on prasugrel, 11 492 on ticagrelor, and 27 824 on clopidogrel) ranged between 0.49 and 6.68% in-hospital, between 3.07 and 7.95% at 30 days (reported in 6 registries), between 8.15 and 9.13% at 180 days, and between 2.41 and 9.58% at 1 year (5 registries). Major bleeding rates were 0.09-3.55% in-hospital (8 registries), 0.09-1.65% at 30 days, and 1.96% at 1 year (only 1 registry). Fatal/life-threatening bleeding was rare occurring between 0.08 and 0.13% in-hospital (4 registries) and 1.96% at 1 year (1 registry). CONCLUSIONS: Real-world evidence from European contemporary registries shows that death, ischaemic events, and bleeding rates are lower than those reported in Phase III studies of P2Y12 inhibitors. Regarding individual P2Y12 inhibitors, patients on prasugrel, and, to a lesser degree, ticagrelor, had fewer ischaemic and bleeding events at all time points than clopidogrel-treated patients. These findings are partly related to the fact that the newer agents are used in younger and less ill patients.
- MeSH
- antagonisté purinergních receptorů P2Y škodlivé účinky terapeutické užití MeSH
- dospělí MeSH
- infarkt myokardu s elevacemi ST úseků komplikace farmakoterapie mortalita MeSH
- ischemie mortalita prevence a kontrola MeSH
- krvácení chemicky indukované epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- purinergní receptory P2Y12 účinky léků MeSH
- registrace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stanovení cílového parametru MeSH
- výběr pacientů MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
- Klíčová slova
- Apo-Simva,
- MeSH
- ateroskleróza farmakoterapie komplikace metabolismus MeSH
- časná diagnóza MeSH
- dolní končetina patofyziologie patologie MeSH
- farmakoterapie metody trendy MeSH
- hodnocení rizik MeSH
- ischemie farmakoterapie komplikace mortalita MeSH
- kardiovaskulární nemoci farmakoterapie prevence a kontrola terapie MeSH
- lidé MeSH
- morbidita MeSH
- mortalita MeSH
- rodinní lékaři využití MeSH
- vládní programy metody zákonodárství a právo MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
- MeSH
- analýza přežití MeSH
- ateroskleróza diagnóza komplikace mortalita MeSH
- dolní končetina patofyziologie patologie MeSH
- ischemie diagnóza etiologie mortalita MeSH
- lidé MeSH
- měření krevního tlaku metody využití MeSH
- plošný screening metody MeSH
- prognóza MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- metaanalýza MeSH
OBJECTIVE: Our results of extraanatomic bypass surgery in the last 5 years should be analysed in a retrospective study. PATIENTS AND METHODS: 66 extraanatomic reconstructions were performed in 65 patients (52 male, 13 female). Femoro-femoral bypasses (78.8 %) were mainly included in this study, followed by axillo-femoral (bifemoral) and obturator bypasses. The procedures could be divided in 45 (68.2 %) primary and 21 (31.8 %) recurrent operations. 57.6 % of the patients revealed a critical lower limb ischemia. RESULTS: The bypass patency rates were 97 % after one year and 81.1 % after 3 years. 24.2 % of the patients showed immediate postoperative complications, 12.1 % of them major complications (surgical and nonsurgical). No patient died postoperatively or in the first year after operation. The 3-year mortality rate ranged to 10.8 %. Major amputations had to be carried out in 4 patients (6.1 %) during the first year and in one patient later on, so that the total amputation rate amounted to 7.6 %. CONCLUSIONS: Our results prove extraanatomic reconstructions to be a valuable surgical tool in lower limb ischemia with good long-term success. Extraanatomic bypasses are technically simple procedures in the majority of cases and take good care of the patient with low morbidity and mortality.
- MeSH
- amputace MeSH
- arteria axillaris chirurgie MeSH
- arteria femoralis chirurgie MeSH
- arteriální okluzní nemoci chirurgie mortalita MeSH
- bérec krevní zásobení MeSH
- cévy - implantace protéz * MeSH
- dospělí MeSH
- ischemie chirurgie mortalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- následné studie MeSH
- pooperační komplikace chirurgie mortalita MeSH
- reoperace mortalita MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- ischemie etiologie mortalita MeSH
- krysa rodu rattus MeSH
- ledviny patologie MeSH
- modely nemocí na zvířatech etiologie metabolismus mortalita MeSH
- nisoldipin aplikace a dávkování MeSH
- transplantace ledvin MeSH
- vápník antagonisté a inhibitory MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- srovnávací studie MeSH
- MeSH
- ischemie farmakoterapie mortalita MeSH
- krevní tlak genetika účinky záření MeSH
- krysa rodu rattus MeSH
- ledviny krevní zásobení účinky léků MeSH
- míra přežití MeSH
- stárnutí MeSH
- výsledek terapie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- srovnávací studie MeSH
